Don’t blame me. I’m only the boss

The faces were not just sad. They were brow-beaten. They were defeated. The faces were those of the relatives of some of the hundreds of people who died, from systemic neglect or the callous indifference, in Stafford Hospital over a shocking four year period. They had just emerged from reading the findings of the Francis Inquiry into the biggest scandal in the recent history of the National Health Service.

Theirs is a world turned upside-down. They had entrusted those they loved to a hospital they assumed would help its patients to get better.  Instead, in a grotesque inversion, it killed them off. Between 400 and 1200 people died needlessly.

The detail defies belief. Patients were left lying in their own urine and excrement. Others were denied the medicines they had been prescribed, refused pain relief and left unfed by heartless and overworked nurses. Some were left so thirsty that, desperate with dehydration, they drank water from flower vases.

And yet Robert Francis QC at the end of his 139-day inquiry, with its 164 witnesses and its million pages of submitted evidence, did not name the succession of individuals responsible for this catalogue of coldness and cruelty. Instead he blamed a culture which put corporate interests and cost-control ahead of people’s suffering. Target-setting, box-ticking and performance management goals blinded hospital staff to the humanity of the weak and vulnerable individuals who had been placed in their care. Everyone was doing their job, and yet the job was not getting done.

One of the most bizarre examples of this is Kate Levy, the Stafford Hospital solicitor who asked a senior consultant to alter his report which found a junior doctor had been negligent in not spotting a ruptured spleen after a mountain-bike accident. He diagnosed bruising and sent the young biker home where he died hours later.

When health chiefs discovered this they sacked Ms Levy who promptly took them to an employment tribunal. She was awarded £103,000 compensation after arguing it was her job to suppress the evidence – to “avoid further stress” to the dead man’s family and prevent “adverse publicity” for the hospital. “My actions were entirely consistent with my duties as a lawyer,” she said. “My duty was to my client, not to the [dead man’s] family.” The topsy-turvy tribunal agreed. Clearly you can have dirty linen on the patients’ beds, but you must not wash it in public.

If it is the proper exercise of someone’s job to withhold information in that way then the lineaments of that job, and the way its duties are defined, have been poorly conceived by society. No wonder Mr Francis lamented the lack of “a duty of candour” in current NHS systems. Ms Levy was accountable, but to a set of standards which did not serve the common good.

The same can be said of the barrister in the Manchester choirmaster abuse case who set out to destroy the credibility of a child abuse victim – and did it so effectively that the victim went home and killed herself. “You did your job,” the judge told the prosecutor who had repeatedly called the victim a liar and a fantasist. But is this the kind of job a responsible society should want done?

It is a characteristic of the contemporary fad for accountability that it is fractured in this way. It institutionalises buck-passing. It means that everything can always be someone else’s fault, rather like Chris Huhne’s speeding points.

We see that again in the horsemeat lasagne scandal. “This is an appalling situation,” thundered Catherine Brown, chief executive of the Food Standards Agency, demanding supermarkets test all their processed beef products for equine DNA contaminants. It was more buck-passing from an organisation which failed to spot the problem in the first place (that was detected in Ireland, Germany, France, Poland – not the UK) and which has been snail-like in its communication of the breaches in the traceability systems constructed after the BSE crisis which is one of the key responsibilities of the FSA to monitor.

The same compartmentalisation is there in the banking industry. Sir Philip Hampton, the chairman of the taxpayer-owned Royal Bank of Scotland, announcing details of the bank’s £390m fine for fiddling the Libor rate, talked of bankers “losing touch with the basic principles of right and wrong”. He announced that John Hourican the head of the bank’s investment arm would be falling on his sword for the scandal, and said the £90m would not come from the public purse but from bankers bonuses – omitting to point out that Mr Hourican was set to leave the bank anyway with £4.77m cashed from his huge 2009 two-tranche bonus.

The trouble with accountability is that it is an external regulation which, in the end, encourages people to think “What can I get away with?” Old-fashioned responsibility, by contrast, internalised moral duty so no control was needed beyond the inner voice of conscience. But social and personal morality have drifted slowly apart like separating continents.

So, in Stafford, we end up with a hospital which is awarded foundation trust status, a supposed marker of NHS excellence, just three months before it is investigated for alarming death rates. We have a chief executive, Martin Yeates, who lays off too many people in a deep round of cost-cutting and then quits with a £400,000 pay-off just days before a Healthcare Commission report reveals how many have died.

We have Dr Helen Moss, the hospital’s director of nursing during the worst period of neglect who is found by the Nursing and Midwifery Council – behind closed doors – to have “no case to answer”.  Most bizarre of all Cynthia Bower, head of the West Midlands strategic health authority at the height of the debacle, has been promoted to chief executive of the Care Quality Commission. And Sir David Nicholson, the top health official in the region at the time, has been made chief executive of the entire National Health Service. But none of them are to blame. It is only the fault, concludes the Francis Inquiry, of “the culture”.

Culture, said another great moral exemplar, the former Barclay’s boss Bob Diamond, is “how people behave when no-one is watching”. It is also how they brazenly behave, it seems, even in the full glare of public scrutiny and scorn.

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