One baffling aspect of the Mid Staffs scandal is that the terrible conditions at the hospital were clearly visible to everyone, patients and staff, and likely also to regulatory bodies if they had cared to watch. We are not talking about counterintuitive problems that would have been difficult to spot, such as the adverse effects of a drug given to seriously ill patients, which may be recognized only after many years and from a thorough study of a large number of cases. On the contrary, the evidence in the first and second reports on Mid Staffs points to clearly visible breaches of standards of care that could be recognized as such by non-professionals.
Yet, it went on for years before being investigated seriously, just like with phone hacking or the widespread abuse exposed by the Saville scandal. Mid Staffs reveals an incapacity to identify and solve problems before they take plainly catastrophic proportions. This is all the more incredible considering that a hospital after all is not a closed environment where a rule of silence can be imposed easily. People come and go. And that bears the question of the lack of responsiveness from individuals witnessing alarming conditions.
We know from the Francis report that there have been complaints put to the Mid Staffs Trust by patients and their relatives. Those who could have acted upon these complaints did not know or did not want to know, or they did nothing significant to address them. Complainants were discouraged and sometimes bullied. Whistleblowers, of which there were a few, were victimised. The report asks why those professionals who raised complaints with the ward did not, in the face of obvious indifference or negative reactions, raise their claims to regulatory bodies externally. Why, considering the obvious failure from internal complaint management systems, did not many more individuals contest the authority of the institution and search for help elsewhere?
To explain this pattern of silence and cover up, the Francis report mentions ‘culture’. Even though there has been legislation on whistleblowing in the UK since 1998 (the Public Information Disclosure Act), the Francis report emphasizes that this legislation has been powerless without the culture to support it.
There is evidence for this ‘cultural’ explanation of the problem elsewhere than at Mid Staffs. In the onshore oil and chemical industry, one can also hear that blowing the whistle on incidents to regulators is rare. Indeed, in my talks with various stakeholders in the industry, almost no one could recollect any case of incidents that had been reported externally by employees since the Public Information Disclosure Act 1998 was passed. For some people who might consider one day taking advantage of that legislation, they appeared to feel it would not protect them from being victimised, just like at Mid Staffs.
This appears even more striking if one looks abroad for comparisons. In France, where the industry does not seem to be doing much worse than in the UK in terms of safety, there have been multiple cases where employees in the chemical and oil industry have blown the whistle on incidents that were not being disclosed to regulators. In my interviews with the same kind of stakeholders, who work for the same multinational firms than their British counterparts, there was evidence that many such reports have been made to regulators in the last decade. Some of the regulators informed appear to have done little or nothing as a result. But others have responded and put pressure on the industry to improve its performance, protecting the anonymity of their informers in the process. And there is not even any legislation in France to protect whistleblowers.
That may well be further evidence of the unwritten attitudes that the Francis report calls 'culture': a reluctance to report a range of harmful acts, especially if that would imply defying the authority of the institution responsible for the harm and for its mitigation. In sum, in spite of frequent references to accountability in the British public discourse, sometimes followed by actions at certain levels or towards certain populations, the dominant attitudes on the ground are often about getting away with things, abiding institutions even when they are failing, and cutting one’s losses: a mindset of which Mid Staffs is only the ugliest reflection.