What the Francis Enquiry will almost certainly reveal is a combination of the ravening ambition of bureaucratic mediocrities, institutionally perverted incentives that reward those who do worst, the creation of a nomenklatura class at the head of an apparat staffed by bullied, intimidated, fearful but also unscrupulous apparatchiks, intellectual dishonesty with compulsory lying on a vast scale, the proliferation of procedural objectives and bureaucratic tasks completely unrelated either to reality or to the welfare of patients, all combined with a revolting tendency to Pecksniffian self-congratulation and righteousness and an inability or unwillingness to speak or write in plain English.

 

The fact that those at the top of the local bureaucratic hierarchy, having decimated the immediately surrounding countryside, moved on to higher or at least even better-paid things (such as private consultancy with the NHS) will not surprise observers of the NHS, because they have long known that no senior manager is ever truly sacked from that vast charitable organisation for the outdoor relief of second-rate bureaucrats. We should abandon the expression "turning up again like a bad penny" for "turning up again like a sacked NHS manager".

 

The Francis Report will almost certainly say that while it is the worst case that has so far come to light, the Mid-Staffordshire case is far from unique: and indeed, why should it be unique, when the principles upon which its management acted were those that pervaded, and continue to pervade, the NHS? It is a long time since I first asked the question of an NHS manager, "What is the government order you would refuse to obey?" and received no reply, because (I suspect) there is no such order. I remember a manager in the hospital in which I worked before my retirement, with no medical or even nursing qualifications, prowling the wards to look for patients who could be hurried home so that beds would become available for patients who would otherwise break the government's four-hour rule, that is to say the rule that no patient should wait more than four hours after the decision to admit him had been taken. The concern that patients should not have to wait for more than four hours was not for their sake, of course, but merely so that the central government could claim that it was improving services, and so that the hospital could claim to have met its target. In the event the target was met by the simple expedient of redesignating hospital corridors as wards, satisfactory all round - except for the patients, of course.