Dr Kieran Mullan works in health policy. He contested Wolverhampton South East in 2017 and Birmingham Hodge Hill in 2015.
Sometimes the media can be accused of sensationalism, of crying scandal at the first opportunity. But the Gosport story deserves the headlines it is generating. What went on at that hospital is a scandal in every sense of the word. None the less, we must be cautious in what we do in response.
Whilst choosing his words carefully so as not to prejudice any future civil or criminal cases, James Jones has uncovered a culture of practicing what even the most forgiving interpretation can represent as involuntary euthanasia. Future criminal investigations may find it was even more sinister than that. So we are all asking: how this was happening for such a long period of time, and at such scale?
The first thing to understand is that there is a very reasonable and compassionate practice of prescribing strong drugs such as morphine to ease symptoms like pain for those nearing the end of their lives – knowing at the time that this might also shorten their lives. This is only allowed when the clear aim is to ease symptoms that are otherwise not going to be controlled. The aim must not be to end life prematurely.
But in Gosport – in a perfect example of why people oppose assisted suicide because of the dangers of it weakening boundaries – this practice grew into a culture that first blurred those lines and then outright crossed them. The end result was a devaluing of the lives of older patients completely and utterly.
Second, there was a strong culture of deference to doctors by nursing staff. This issue was specifically raised at the time when nurses first raised concerns about Dr Jane Barton, who oversaw the practice of prescribing on the wards. They were told that their nursing managers couldn’t question a doctors practice.
Fortunately, this deference has decreased hugely over the past decade. I know first-hand that doctors see themselves increasingly as part of a team of equals with a culture of mutual respect. There is room for more progress, but I expect this to happen as, across society, we continue to learning the dangers of an undue culture of deference – not just to doctors but to politicians, religious and community leaders and celebrities, partly as a result of the historic child abuse investigations and the Weinstein scandal.
Third, there is a mix of a fear of raising concerns, and a desire amongst the organisational leadership that hears them to avoid accepting that there are problems when this is the case. This is not unique to healthcare. Just think about you and your workplace. How readily would you complain about the conduct of a colleague, let alone a more senior member of staff? When the accusation you are making suggests that people have suffered harm or even died as a result, it takes even stronger personal courage to speak up, even though the need is even greater. You are potentially accusing someone of something much more serious than, say, using the work printer for personal use.
This mix of factors and others combined at Gosport with terrible consequences. I have been genuinely disturbed reading some of the cases included in the report. The example of one nurse joking to another about putting a patient they saw as troublesome on these strong drugs, and then that happening closely followed by the patient’s death, is horrifying.
My respect and admiration for the persistent and unwavering relatives could not be higher. During my time leading campaigns at the Patients Association, we released anthologies of individuals telling the stories of the cruel neglect of their relatives from across the NHS (see here & here). They suffered the same guilt, and the loss of the normal right to mourn and come to terms with their loved ones’ death, that those from Gosport have so eloquently described in the media. Imagine having a loving marriage of many decades, only for it to end with your partner asking you to help get them out of hospital to save them, and then seeing them die just as they feared. How would this not taint the legacy of your entire shared life together? Truly heart-breaking.
The Patients Association reports led to a series of a hundred inspections of hospitals by an independent regulator that didn’t even exist in its current form during the time of the Gosport deaths. And this brings me on to my request for caution – despite my recognition that what happened in Gosport as a shameful bookmark in NHS history. Along with the Patients Association reports, there have been a number of other scandals since Gosport that were uncovered sooner, and that have already led to detailed inquiries and recommendations for reforms.
The two most high-profile examples are Harold Shipman and Mid Staffordshire. Harold Shipman murdered his trusting patients in the hundreds. At Mid Staffordshire, a culture of neglect, ignoring complaints and the bullying of whistle-blowers led potentially to the unnecessary deaths of hundreds of patients. The resultant public inquiries were conducted over many years, and examined the circumstances that allowed these things to happen. Gosport seems to have been a mixture of the circumstances of Shipman and Mid Staffordshire. So there should already have been study of many of the same contributory factors, and the changes needed.
This is not to say that we might not find any further areas of reform, but we must avoid another wholesale exhaustive inquiry that takes many years to reach conclusions that will be by then more than twenty years out of date. We must limit our focus to specific issues identified that were not identified by the Shipman or Mid Staffordshire inquiries.
It would be also be more helpful to spend our time and effort carefully examining the speed of progress on recommendations already delivered by these two inquiries rather than starting from scratch. For example, more than ten years after they were recommended the Medical Examiners system which asks independent doctors to review death certificates must be introduced as planned in April next year. It may be debates about their independence when part of the NHS and not local authorities will need to be reopened.
This is not to say that exhaustive efforts shouldn’t be made to hold individuals involved in what happened in Gosport to account. This is a matter of natural justice, not future reform. It is the least we owe the relatives and patients. But when thinking about the NHS as a whole, we should be precise and forensic in determining what positive changes have already been made that would have helped to prevent what happened in Gosport. This will allow us to focus on those areas where further reform can make the most impact.