When sorry seems to be the hardest word

In 2009 I attended an inquest into the death of a patient who had been discharged from hospital just a few days before. I heard a Consultant responsible for the deceased’s care, explain the sequence of events that had led to the patient being discharged from hospital without an accurate diagnosis or any treatment. The failings, such as they were, were failings of systems and processes. All of the clinicians involved in the patient’s care did what they had to do but no-one joined the dots. Tragically a man died.

After the inquest the Consultant approached me and asked if he could speak to the patient’s widow. We spent a few moments together with the Consultant and during that time he offered a full, genuine and very moving apology for the failings that had led to the death of her husband. This gesture of kindness and compassion brought some degree of comfort to a grieving family.

Tragic incidents of this sort are thankfully rare. Sadly, this type of honest, open apology is rarer still.

With just a few days to go until publication of the Mid Staffs report the subject of patient safety and care is very much a live issue for all those involved in working with and for individuals who have suffered harm as a result of medical treatment. According to an article in The Guardian on 29th January there is something of a consensus both inside and outside the medical profession that “we need to change the culture in the NHS”.

This is a feeling that is echoed by many of the clients who have approached us seeking help and advice after their own adverse experiences of healthcare. Each and every enquiry we receive is different and very individual. Some patients report stark and obvious failings in treatment. Others have been urged to seek advice by members of the medical profession. Still others simply have been left with the feeling that all is not as it should be. Some have no real complaint about the outcome of treatment but just feel that they were treated poorly with a lack of respect or dignity.

Most of the new clients who come to us are at pains to stress that they are not interested in compensation. Most have never made any sort of claim before. Most are motivated purely by the desire to prevent anyone else having to experience what they have been through. Very occasionally clients may be motivated by a desire to see a doctor or clinician called to account but this is quite rare.

Occasionally we are asked to help new clients prepare letters of complaint to an NHS Trust. We see the responses to those letters. They are tautly and carefully worded and put up a clinical defence wall to the patients concerned. They rarely go to the heart of the issue. Apologies are almost unheard of.

When, as is often the case, the formal response to the legal letter of claim is simply another bland denial of any failings, attitudes become entrenched. It is still possible that open, honest and genuine apologies at this stage may be enough to avert an expensive claim but those sorts of apologies are rarely if ever forthcoming.

NHS Trusts do occasionally offer full and unreserved apologies. Sadly they are often made after litigation, at the end of the claim when the matter has been compromised or settled. For those who are perhaps mourning a loss of a loved one, paper apologies made at that late stage, do little but add insult to injuries.

The reluctance on the part of the NHS to openly admit failings may well be a result of our adversarial system. In the eyes of many, apologies are tantamount to admissions and these lead to blame and financial liability.

The reality of course is that even those who have bad experiences at the hands of the NHS are likely to go on to need NHS care and support in subsequent years. If those who have suffered loss are to have confidence and faith in the NHS then the ability to admit errors and apologise for those errors is an essential first step.

If anything positive can come from the terrible events at Mid Staffs perhaps an acknowledgement of the power of apology would be a good place to start.