Thursday, 7 February 2013

Institutionalized Blindness

Amid the understandable uproar about standards of care at Stafford Hospital - where abuse and neglect contributed to hundreds of deaths between 2005 and 2008 - there was, at least, a genuine expression of regret from on high.

Too often, when an institution fails, its leaders bury their heads in the sand, but not Mike Farrar, the CEO of the NHS Confederation. Speaking on Newsnight earlier this week, a haggard-looking Farrar seemed to speak from the heart when he said: "As someone who came into the health service to do good, today is a day I genuinely feel shame."

Appalling Conduct
The harrowing catalogue of failings at Stafford Hospital is presently the subject of a fifth public inquiry. Like the fourth inquiry, this one was chaired by Robert Francis QC. More than 160 witnesses appeared at the hearings, and one million pages of evidence have been sifted through. The findings of the inquiry are due imminently. Tragically, it is a fair bet to conclude that even though this time the focus is on the commissioning, supervision and regulation of the trust from 2005 to 2009, "appalling" conduct will once again be found.

In the face of this, Farrar did not hide. He told Newsnight that "The culture of [Stafford Hospital] was not geared up to put patients' needs right at the heart of it; there was almost an institutionalised blindness to what mattered."

He added: "The risk, I think, today, is that we look to external things like better regulation or more inspection, to try to solve what effectively is a problem that can really be only solved by having a culture in every hospital where every member of staff is geared up to try and provide the best possible care for patients."

Mea Culpa
Farrar's mea culpa may not cut much ice with Stafford Hospital's mistreated patients and their families, but it is nevertheless to be applauded. Here, in marked contrast to the behaviour of politicians, senior journalists and bankers embroiled in recent scandals, is a man prepared to say sorry. And in his use of the phrase "institutionalized blindness", Farrar also sheds light on a phenomenon which regrettably spans many areas of modern life.

Take, for example, the problem of asbestos in schools. This seems to be routinely ignored, despite well-publicised instances of teachers contracting cancer and the simple fact that, of all places, schools are not predictable environments. When applied to a school, where children run, skip, shout and jostle as only children do (rightly so), the Control of Asbestos Regulations are surely negligent to state, as they do, that "asbestos is only dangerous when disturbed. If it is safely managed and contained, it doesn't present a health hazard."

The Corporate Line
But if this is a potentially terrifying example of institutionalized blindness, it extends to the corporate arena, too. As alleged this week, Marks & Spencer knew full well of asbestos risks 10 years before the company was fined £1m for breaches to guidelines for asbestos removal in its Reading branch.

William Wallace, who was at that time working as a health and safety manager, told the BBC that he wrote to the then chairman of the company, Sir Richard Greenbury, highlighting a series of breaches at M&S's Marble Arch store, recorded in logs between shifts. "You could not have guaranteed the safety of anybody, the workers, the staff, the customers: you could not have given a 100% guarantee that those people were safe", said Wallace.

M&S's response to these allegations is dismaying. Steve Rowe, an M&S board member, said: "On the face of it these allegations sound worrying, but our team at the time 15 years ago thoroughly investigated them on the day." He added that M&S was unable to find any "case whatsoever to say any member of staff or any member of the public was put at risk."

Turning a Blind Eye
This declaration is at odds with the findings of the court in the Reading case. In September 2011, M&S was convicted of two charges under the Health and Safety at Work Act 1974 in relation to the work at the Reading store. Fining the company a total of £1m, Judge Christopher Harvey Clark QC criticised M&S for the "systemic" failure of its management. In response to asbestos safety complaints, said the judge, M&S chose to "turn a blind eye" to what was happening because the asbestos work was "already costing the company too much".

In other words, profit came before staff welfare - but not according to Rowe, who told the BBC: "Marks & Spencer never, ever puts profit before safety. There wasn't a blind eye. Our investigations were full and thorough ... Implementation of the policy wasn't good at Reading. We are very sorry about that. We regret it. So we are disappointed by the judge's comments."

At the time of the Reading judgment, M&S stated it was "disappointed" by the ruling. Now, a year and a half later and in the face of further serious allegations, M&S seems once again to be "disappointed".

It would doubtless reassure M&S's staff, contractors and customers to learn that the company could find it in its corporate heart to open its eyes - and feel more than mere disappointment.