It is best for the truth to come out
Special report: the future of the NHS

Leader
Guardian

Thursday November 16, 2000

The trio of reports documenting serious failings in the health service yesterday is not entirely bad news. It signals more openness in what has too long been a stealth service. Each report is alarming reading: a Carlisle hospital for elderly mentally-ill patients with "a shocking culture of cruelty"; a Welsh hospital where a man died after his one healthy kidney was removed; a heart unit in one of Britain's most famous hospitals, Oxford's John Radcliffe, "on its knees and riven by internal conflict". Even the BMA did not try to gloss over their seriousness. "Today's reports paint a picture of an NHS in trouble and under pressure," it said. "It could leave the public seriously concerned about the ability of the health service to deliver quality patient care, to learn from mistakes and to act swiftly when problems and concerns have been identified."

Perverse though it may seem, yesterday's reports are an advance. Four years ago, five student nurses blew the whistle on Carlisle's unacceptable procedures including tying patients to commodes. There was an inquiry, but nothing happened. The students' complaints were "lost". Nothing emerged publicly. All that has changed. Even before yesterday's report, the trust chairman had been dismissed, the chief executive suspended pending disciplinary hearings, senior managers warned. Similarly, Oxford's warring heart surgeons only came to light because a senior clinical nurse complained. She suffered severe harassment and an unacceptable two-year wait, but she finally succeeded.

What does emerge is that whistleblowers still need more protection; that hospital authorities need to move more quickly (10 months on in Wales the action plan is still not in place); and less obviously, that care needs to be taken in deploying the new health watchdog, the commission for health improvement. Using it in Wales made sense. It looked at wider issues than a single death. It might have made sense to use it in Oxford too, but that did not happen. But the CHI should not have been sent to Carlisle, where there had already been an external review. This was a diversion to deflect any political heat from ministers. The CHI is not a hit squad. It is a crucial monitoring unit, with a remit to visit every hospital and GP practice within the next four years. To raise standards, it needs their trust. Set up a separate hit squad if necessary, but the CHI's prime purpose must be protected.