A LOT of angry words have been expended on the Mid Staffordshire scandal; there will be many more to come.
The report by Robert Francis QC has uncovered every variety of catastrophic failure, whether institutional, political, personal or professional.
In England and Wales, rightly or not, the entire NHS is under scrutiny. For all that, you could summarise the affair easily enough. Those paid to care, in both senses of the word, did nothing of the kind.
The story of Mid Staffs is a story of the callousness that accepted 1200 needless deaths for the sake of incentives, money and spurious "targets". It is a tale of compassion lost amid a self-serving refusal to take responsibility, of staffing and care degraded in the name of "achieving financial balance, and seeking foundation trust status".
No-one has been arrested because of Mid Staffs. The senior professionals who have found employment elsewhere are still in their posts. Between the lines of the QC's vast report, meanwhile, there is the familiar echo of an ugly modern attitude. If no-one else gives a damn, it whispers, you'd be a fool to worry. And where's the law that says you have to care?
Francis makes 290 recommendations. The very number illustrates the scale of the outrage. Time after time, these prescriptions return you to a fundamental issue. The QC says care standards "should be defined by what patients and the public want and are entitled to". He argues that if an organisation cannot meet these standards it "should be prevented from continuing".
Francis further recommends that it should be a criminal offence to cause death or serious harm by "non-compliance" with basic standards. He insists there must be a "duty of candour", backed by the law, to ensure that hospitals inform patients when things go wrong. He wants an end to the gagging clauses that cause staff to choose between keeping their jobs and speaking out.
You couldn't, I think, argue seriously with any of that. You could ask a question, though. Who takes work with the NHS and has to have basic ethics rammed into their skulls?
After Mid Staffs, the London Government will no doubt embark on another round of reforms in England. It will probably seek to enforce the bulk of the Francis recommendations. But how do you reform people who thought that 1200 deaths were a fair exchange for trust status?
Francis says nurses should be selected and trained "to deliver compassionate care". So how do you teach compassion, exactly? We give children lessons in empathy to aid their moral growth. Adults who have failed to understand, despite all experience, are lost causes.
You might be able to school them into treating NHS patients as "customers" who must be kept satisfied. The Coalition Government favours that view.
But as Dr Maria Flynn and Dr Dave Mercer of Liverpool University's School of Health Sciences remarked last week: "Compassion is not a recognised feature of competition, market forces or privatised service cultures."
Compassion seeks no reward. You cannot be compassionate on demand, or because you have done a course, or because a high-minded ideal is enshrined in the latest code of conduct. Compassion is not supposed to be selective, either, though you wouldn't know it from public life in modern Britain.
Speaking in the Commons last week, David Cameron was suitably aghast over what had been going on within an NHS trust. His compassion was there for all to see. Only a few hours before, however, he had been attacking Ed Miliband for opposing a benefits cut for those in social housing who happen to have a spare bedroom.
It didn't matter that the disabled will be affected. It didn't trouble Cameron if family homes will be forfeited. He has promised to protect wealthy homeowners from any "mansion tax" and inveighed against the idea that rich elderly people should mortgage their properties to pay for care. But that isn't "welfare", of course.
One defined purpose of social housing is to protect the vulnerable. Cameron's answer was this: "Why should we be doing more for people in social housing on housing benefit than people in private housing on housing benefit?"
He forgot to mention that those renting privately have had their benefit capped, that private rentals are scarce, that rents are rising inexorably, and that homelessness is increasing.
Come the third Friday in March, heartstrings will be tugged when Comic Relief delivers its annual reports on the plight of infants in the developing world. The money raised will, as always, show the British public in the best possible light. Should those infants turn up here as illegal immigrants, however, the owners of the heartstrings will be less well disposed towards poor little mites.
Last September, the British Social Attitudes survey found that only 28% of those asked – from a sample of 3000 – wanted to see more welfare spending. This was at a time when the Coalition was boasting of cuts and casting the usual slurs on claimants.
The figure had fallen from 35% in 2008 and 58% in 1991. Compassion had diminished drastically.
Penny Young, one of the authors of the survey report, said at the time: "Even where groups are seen as perhaps more deserving – retired people, disabled people – again for the first time since 2008 we've seen that the number of people who are prepared to see more money go on disability benefits has actually fallen."
You could argue over the politics, recall that the Tories are back in government, or remember what Thatcher had to say in 1987. The claim she was misquoted is false. She said: "And, you know, there is no such thing as society. There are individual men and women, and there are families. And no government can do anything except through people, and people must look to themselves first."
If the attitudes survey is right, Thatcher's view has prevailed. You needn't employ sociological language to make the point: Britain has become hard-hearted. People do "look to themselves first". Compassion is no longer regarded as a duty if it impedes institutional efficiency, self-interest, or a career. And lest it seem we are picking on her ladyship, remember Mid Staffs was allowed to happen when New Labour was in government.
The compassion Cameron displays extends only to those he deems worthy. He is a prime minister for our times. He can empathise with his own kind and with no-one else. It explains a lot.
This is not a matter of party, certainly not of nationality. Last August, this newspaper reported claims by the Labour MSP Duncan McNeil that a "culture" of failing to care for the elderly had become embedded in Scottish hospitals. Assessments and plans were not in place, or not being monitored. Some of the failures involved sophisticated treatments; some hinged on food, water and simple respect.
No doubt we are, none of us, the people we should be. It is a very long time since I worked as a hospital porter among children and the elderly. These days, I probably wouldn't last a shift. It is one thing to worry over the loss of compassion, in any case, but there's a harder question. How do we get it back?
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