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Editor's blog Tuesday 9 November 2010: What is Francis II going to do?

Yesterday was the opening day of “>the promised Francis Inquiry Two: This Time, It’s Public. As with all sequel or remake, the inevitable first question is, will it be any better than the original?

The significant difference between Francis I and Francis II is of course that the former was a private inquiry, whereas the latter is a public inquiry. As well as representing a possible first for Health Secretary Andrew Lansley in preferring the public option to the private one, the public inquiry allows the compulsion of witnesses to give evidence.

Or does it? Mid-Staffs CE Martin Yeates, the most prominent absentee from the original inquiry, may apparently not give evidence this time because  he doesn’t feel well. Perhaps he has been reading the original Francs Report about what went on in his hospital - you know, the one for which he was the accountable officer. It’s certainly enough to make a person feel sick.

Francis is reported elsewhere as saying of his new inquiry, “We are all here because of the terrible standard of service inflicted on so many of the patients who went to Stafford Hospital and their families.

“Last year, in my first inquiry, I sat and listened to many stories of appalling care. As I did so, the questions that went constantly through my mind were ‘Why did none of the many organisations charged with the supervision and regulation of our hospitals detect that something so serious was going on, and why was nothing done about it?”

Nothing new under the sun
Back to my point: what will we learn?

I suspect that, unfortunately, the answer may well be ‘not much’.

Dismally, when Private Eye’s ‘MD’ Phil Hammond asked for a show of hands at the recent Tory Party conference health session including Liberatin’ Lansley and various Great’N’Good types of who could be confident that another Mid-Staffs were not in progress now, not a hand was raised in the room.

The NHS has a big secrecy problem. Thus far, thus unsurprising in a over-centralised and politicised system.

Secrecy is great if you want to keep your job and maintain the status quo.

It’s just a bit crap if you want to make an accurate diagnosis of the problem.

Time and again for over a decade, I have met apparently (and probably) good people who wrestle with a perceived conflict between being candid about real problems that affect patient care and a perceived risk of undermining public confidence in the NHS. They always seem unaware of the irony that efforts to maintain faith in the NHS by hiding errors or failures in the NHS may not actually in the longer term be very good for the NHS or the people whom it exists to serve.

We will learn what has been discussed here before. We will rediscover the fact that the locality had not long since merged five commissioning PCTs, who should have noticed poor acute care, into one.

Clearly, neither arrangement worked to expose bad care.

Nor did regulation work.

We will surely be reminded that the SHA CE of the time, Cynthia Bower, became the current CE of the Care Quality Commission. And that her predecessor as responsible SHA CE, David Nicholson, became chief executive of the NHS.

And we will be struck that for all the claims made that this or that organisation noticed the problem, the local paper – the Staffordshire Newsletter and Julie Bailey of Cure The NHS were far more reliable guides to what was going on than officialdom.

And systems have not got significantly better since then.

Which should worry us.

But ultimately, it was hundreds upon hundreds of individual decisions - made by staff at the trust, at all levels, day after day and week after week, for years - which created a culture that allowed the kinds of bad care none of us would think okay to be perpetuated.

The failure was distributed, and it was widespread. And it weas both managerial and clinical.

People noticed, and complained.

And the system did as close to nothing as makes no difference.