The Sunday Times April 3, 2022 23COMMENT
Matthew Syed
We must challenge our leaders
when they lazily deify the NHS
Inquiries
have been
designed not
to unearth
the truth but
to cover it upShrewsbury is merely another example of shocking practice — when will we break the cycle?
K
ate Stanton-Davies should
have turned 13 this month.
Instead, she died after six
hours of life at a hospital
where an obsession with
“normal” vaginal birth
merged with a lethal mix of
failings. “Apparently I was
screaming,” Rhiannon Davies, Kate’s
mother, said yesterday about the
moment when she realised her beautiful
girl had passed away. “I grabbed her and
didn’t let her go.”
These and other tragedies provide the
backdrop for the report by Donna
Ockenden into the Shrewsbury and
Telford Hospital NHS Trust, where 201
babies and nine mothers avoidably died
over two decades. One anonymous
mother, who worried that a natural birth
might cause a scar from a previous
operation to tear, was talked out of a
C-section and died on the operating
table. Another contacted the hospital
frantically after she lost fluids and the
movements of her baby reduced and
was told that she had “wet herself ”. Her
son was stillborn in November 2018.
But even as we absorb the harrowing
texture of this report, we should also be
brutally honest. Ockenden’s
recommendations, however well-
intended, will do little to reduce risks in
the NHS, or mitigate the dangers to
mothers and unborn children. One can
say this with conviction because her
findings are a carbon copy of previous
investigations into the very same area of
patient care. The Morecambe Bay
report, written in 2015, chronicled
precisely the same litany of failures:
defective treatment, evasive responses,
the closing of ranks and national
oversight that failed.
This is not a watershed for the NHS; it
is institutional déjà vu.Indeed, the deeper story here is not
the deaths of innocents but the fact that
we might never have found out about
them. In the case of Morecambe Bay,
dozens of tragedies were hidden in plain
sight for years before James Titcombe,
whose son Joshua passed away on his
ninth day of life, battled to uncover the
truth. When he pushed for an
investigation, he was demonised as
“angry” and “unreliable”. Every time he
took a step forward, Kafkaesque forces
pushed back. In the end, it took more
than 400 letters to kickstart an
investigation, a process that added
incalculable pain to agonising grief.
Precisely the same story emerges
from Shrewsbury, a trust that would still
have its reputation intact (its maternity
unit was rated as “good” in 2015) were it
not for Davies and Kayleigh Griffiths,
bereaved mothers who convinced
Jeremy Hunt, then the health secretary,
to bring in an independent reviewer.
“It’s difficult enough to grieve for a
child but to have to fight on top, it’s been
so hard to keep strong and not let it
consume you mentally as well,” Griffiths
said last week. “We didn’t see Pippa this
morning but we told her this was for her
and we fought for her.”
For years, I have taken an interest in
patient safety. In 2015, I wrote a book on
the subject and in 2017 worked with
Hunt to bring in a series of reforms
modelled on aviation, a system where
every near miss is reported and every
accident investigated.
Through this culture of continuous
improvement, the accident rate has
dropped to one crash for each 11 million
take-offs — a hugely impressive
achievement. On this basis, the Health
Safety Investigation Branch (modelled
on the aviation equivalent) was brought
into law along with other changesdesigned to undercut the “blame
culture” in the NHS and make it easier to
be honest about mistakes. The basic
point is that it is necessary to identify
failings before they can be addressed.
But I realise now that these reforms
have not had the intended effect for a
simple but devastating reason: the
problem within the NHS is not
institutional but theological. In short, we
have deified this organisation for so long
that it is no longer amenable to rational
reform. Think of the language: nurses
are “angels”, doctors are “heroes”, the
NHS is “world beating”. Our politicians
compete to eulogise the NHS as if by
emphasising its brilliance it will thereby
become so. During the pandemic, we
were told to “protect the NHS” rather
than the other way around.
This, I believe, has had terrible
consequences, turning the NHS into a
quasi-religion. It means that internal
investigations are Potemkin exercises
designed not to unearth the truth but to
cover it up. After all, if an institution is
sacred, defending its reputation
becomes more morally important than
helping its patients.
Consider the words of Ockenden,
mirroring almost identical phrases from
Mid Staffs, Morecambe Bay, Ely and
beyond: “It failed to investigate, failed to
learn and failed to improve, and
therefore often failed to safeguard
mothers and their babies.”
The same applies to the treatment of
patients, who are routinely castigated
for questioning the quality of care, a
point that leaps out from the
experiences of Titcombe, Davies and
dozens of others. Again, read the words
of Ockenden: “There was a tendency of
the trust to blame mothers for their poor
outcomes, in some cases even for their
own deaths.” The problem, I’d suggest,is not that nurses are uncaring; it is that
they have so thoroughly absorbed the
ideology of the NHS that they have come
to regard criticism as sacrilegious — not
unlike devout priests defending the
excesses of the medieval church. This is
how compassion morphs into
callousness, humility into arrogance.
Think, too, of the treatment of
whistleblowers where 66 per cent of
NHS staff who speak up report that they
were dismissed or victimised as a direct
result, according to Protect, a whistle-
blowing charity. At one trust, fingerprint
experts were hired at public expense to
hunt down doctors who had written
anonymously about failings. I suspect
that the trust’s chief executive, even
now, believes he was doing God’s work
in defending his “church”.
The particular tragedy of maternity
care is that it was hamstrung by multiple
theologies. In addition to the deification
of the NHS, there was the deification of
natural birth. Women were made to feel
guilty for raising alternatives in a
hospital that fetishised low caesarean
rates. The silent accusation was that far
from seeking the wellbeing of
themselves and their children, they were
“too posh to push”, a horrific slur that —
incredibly — continues to stalk this
branch of healthcare.
This is why I warn that the NHS
cannot be meaningfully reformed until
we first target its theology. It is why we
must push back when politicians
mindlessly claim it is “world beating”;
push back against the fantasy that health
workers are morally superior to other
public servants; push back when the
institution is elevated above those it
serves. Until this ideology is surgically
removed, the NHS will remain trapped
in a vicious circle of institutional déjà vu.
In short, it is time to secularise the NHS.W
hen a female activist in
Lviv contacted me a
couple of weeks ago to say
Russian soldiers were
raping Ukrainian women
and posting videos on
porn sites, my heart sank,
but sadly I wasn’t
surprised. As a woman reporting on
conflict, I have always focused on what
happens to women in war, seeing them
as the real heroes for somehow feeding,
educating and sheltering their children
as all hell breaks loose around them. Yet
there is also a dark side: over the past
few years I have seen more sexual
violence inflicted on women by soldiers
and militias than at any time in my three-
decade career.
It was on the tiny Greek island of
Leros in 2015, during Europe’s last
refugee crisis, that I became fully aware
of the extent of the abuse. In the ruins of
a mental asylum I spoke to Yazidi
refugees who told me about being taken
from their villages in Iraq by Isis fighters
and sold into sex slavery, often over and
over again.
Not long before that I had been in
Nigeria after the Chibok abduction — 276
schoolgirls snatched from their
dormitory by Boko Haram fighters. This,
it turned out, was the tip of the iceberg:
thousands more women and girls there
had been abducted unreported.
In 2017 I was in Bangladesh when the
Rohingya fled over the border from
Myanmar — 700,000 people in a few
months, mostly women and children,
driven out by Burmese soldiers or
Buddhist militias. Woman after woman
told of being dragged from a burning
hut, tied to a banana tree and gang-
raped in front of her children.
I couldn’t believe this was happening
on such a scale and no one was doing
anything. It wasn’t as if we didn’t know —
the women were coming forward and
bravely telling their stories.
There has always been rape in
conflict, from the ancient Greeks to the
“comfort women” of the imperial
Japanese army in the Second World War.
Indeed the reports from Ukraine bear
horrific echoes of the liberation of Berlin
in 1945. As many as two million German
women are believed to have been rapedAfter the
atrocities in
Bosnia in the
1990s, Europe’s
leaders vowed,
‘Never again’by Red Army soldiers — so many that the
Soviet memorial in Berlin is known as
the “Tomb of the Unknown Rapist”.
The fact is, it’s hard to find a conflict
in which it hasn’t happened. In recent
years ethnic and sectarian groups have
used rape as a weapon, not just to
humiliate and terrorise but to wipe out
what they see as rival groups.
When it happened in Bosnia in the
1990s, political leaders were so horrified
by the idea of rape camps in Europe,
they vowed, “Never again.” Yet here we
are in 2022, and not only is it still
happening, but it’s on the rise. It’s too
early to say if what is happening in
Ukraine is men being “caught up” in the
adrenaline of war and taking advantage
of the chaos, or something systematic. A
Ukrainian who is setting up a treatment
centre described it to me as “a wave”,
saying Russian soldiers were taking out
their anger over the war not going well.
One woman in Mariupol was apparently
gang-raped so violently that she died.
The problem is, no one pays a price.
After 20 years of operation the
International Criminal Court has
secured only one conviction for war
rape. In 2000 every member country of
the UN, including Russia, voted to pass
Resolution 1325, which calls on them to
protect women and girls from sexual
violence in conflict. Since then the
problem has only grown. I can’t help
thinking it would be different if men
were being sexually assaulted by women
on a mass scale.
Ukraine is a chance to change this. We
are all watching the war in real time, and
already one woman has come forward to
tell Catherine Philp of The Times of
being raped as her four-year-old son
sobbed in the next room and her
husband’s body lay outside.
The foreign secretary, Liz Truss, has
described war rape as a red line akin to
chemical weapons, and the Foreign
Office will host a global summit in
November. It’s time to do more than talk
and to stop treating this as a side issue.
Christina Lamb is the author of Our
Bodies Their Battlefield: What War Does
to Women (HarperCollins)Christina
Lamb
Rape is the
weapon of
war we don’t
want to
talk about
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