“What follows makes for hard reading,” Sir Brian Langstaff remarks at the start of his magisterial Report on the Infected Blood Inquiry, and so it does.
He describes great suffering prolonged for half a century by the refusal to admit error.
The Government yesterday sought to atone for five decades of failure by announcing an enormous compensation scheme. This comes too late for the more than 3,000 people who have died as a result of being given infected blood, and cannot restore lost health and opportunities to 30,000 more.
However anxious we are belatedly to make amends, we must not collude in the pretence that whenever the Government blunders over an extended period, it can make up for its mistakes by handing out taxpayers’ money.
The right response to this scandal is to reduce the risk of such a thing happening again, by increasing our ability to have the necessary argument as soon as a problem arises. Sir Brian points to “the dangers of clinical freedom”:
“Clinical freedom is the idea that doctors should be free to do what they believe to be right for an individual patient. But the danger of clinical freedom in the context of infected blood and blood products is that it allowed doctors to follow unsafe treatment policies and practices (such as administering commercial factor concentrates to young children, or giving unnecessary transfusions to postpartum women), and it meant that others (in particular the health departments and Chief Medical Officers) held back from providing advice, guidance or information in the misguided belief that this would interfere with clinical freedom.”
Clinical freedom can easily degenerate into clinical immunity from criticism, with NHS patients and their families reduced to the status of mere supplicants who have to be grateful for what they are given, which may be world-class or may, as in this case, be disgraceful.
Our medical tradition includes, or at least ought to include, the recognition that in difficult cases it is right and proper to ask for a second opinion.
Doctors can, indeed sometimes must, disagree with each other. We have somehow lost sight of this, and have come to suppose that disagreement, far from being a sign of honesty and vitality, is an indication of failure, for it betrays a shameful uncertainty.
In the identification and treatment of HIV, one of the diseases which many people caught through blood transfusions, everything was at first uncertain.
Sir Brian observes that one reason why the infected blood scandal went on for so long was
“institutional defensiveness, from the NHS and in particular from government, compounded by groupthink amongst civil servants and ministers, and a lack of transparency and candour. These factors drove the response of government over the decades.”
Ministers and officials believed their duty was to stick to the agreed line, regardless of the many horrific cases which demonstrated the wrongness of that line.
This doctrine of bureaucratic infallibility meant victims were treated, as Sir Brian recounts, with grotesque insensitivity:
“The harms already done to them were compounded by the refusal to accept responsibility and offer accountability, the refusal to give the answers that people fervently sought, the refusal to provide compensation, leaving people struggling and in desperate circumstances, the thoughtless repetition of unjustified and misleading lines to take, and the lack of any real recognition and of any meaningful apology.”
When the British Constitution works as it should, it encourages necessary argument. Parliament and the law courts are set up so both sides of the argument can be heard, and appeal can be made against unjust verdicts.
Every few years we have the chance, after the stunts and slogans of a general election campaign, to chuck out one lot of rogues and see whether the other lot can do any better.
A free press contributes to this argumentative atmosphere, and is another means by which injustices can be exposed. Nobody is considered above criticism, and by a rough and ready process of trial and error, blunders and abuses are exposed and corrected.
There is a kind of mind to which this way of conducting our affairs is anathema. The Commons is ignorant and unmannerly, the tabloid press an abomination, and the courts should be inquisatorial rather than adversarial, run so as to arrive at irrefutable truth rather than hear specious argument.
What could be more virtuous than to arrive at and defend the truth? And what could be more natural than to defend the institution within which one is making one’s career?
So the institution adopts a mask of virtue, and those who work for it bend their minds to the rejection of all attacks on it as wrong-headed and unworthy of notice.
Defenders of the NHS are inclined to dismiss all criticisms of it as malevolent. The concept of loyal opposition is not allowed, and critics are accused of wanting to flog the health service to American health care companies.
Institutions which render themselves impervious to criticism, and which also turn out to have no real love of virtue, can end up behaving in quite monstrous ways.
The Post Office offers a recent horrendous example. Its resources were devoted not to correcting the faults in its computer system, but to sending innocent sub-postmasters to prison.
One of the strengths of Sir Brian is his palpable independence of mind. He speaks as a judge should speak, without fear or favour.
But he was called in because for many years the politicians and officials charged with running the NHS, and the doctors working within it, failed most lamentably to respond or even listen to the evidence that something had gone disastrously wrong.
