Institutionalized Blindness

Amid the understandable uproar about standards of care at Stafford Hospital - where abuse and neglect contributed to hundreds of deaths between 2005 and 2008 - there was, at least, a genuine expression of regret from on high.

Too often, when an institution fails, its leaders bury their heads in the sand, but not Mike Farrar, the CEO of the NHS Confederation. Speaking on Newsnight earlier this week, a haggard-looking Farrar seemed to speak from the heart when he said: "As someone who came into the health service to do good, today is a day I genuinely feel shame."

Appalling Conduct

The harrowing catalogue of failings at Stafford Hospital is presently the subject of a fifth public inquiry. Like the fourth inquiry, this one was chaired by Robert Francis QC. More than 160 witnesses appeared at the hearings, and one million pages of evidence have been sifted through. The findings of the inquiry are due imminently. Tragically, it is a fair bet to conclude that even though this time the focus is on the commissioning, supervision and regulation of the trust from 2005 to 2009, "appalling" conduct will once again be found.

In the face of this, Farrar did not hide. He told Newsnight that "The culture of [Stafford Hospital] was not geared up to put patients' needs right at the heart of it; there was almost an institutionalised blindness to what mattered."

He added: "The risk, I think, today, is that we look to external things like better regulation or more inspection, to try to solve what effectively is a problem that can really be only solved by having a culture in every hospital where every member of staff is geared up to try and provide the best possible care for patients."

Mea Culpa

Farrar's mea culpa may not cut much ice with Stafford Hospital's mistreated patients and their families, but it is nevertheless to be applauded. Here, in marked contrast to the behaviour of politicians, senior journalists and bankers embroiled in recent scandals, is a man prepared to say sorry. And in his use of the phrase "institutionalized blindness", Farrar also sheds light on a phenomenon which regrettably spans many areas of modern life.

Take, for example, the problem of asbestos in schools. This seems to be routinely ignored, despite well-publicised instances of teachers contracting cancer and the simple fact that, of all places, schools are not predictable environments. When applied to a school, where children run, skip, shout and jostle as only children do (rightly so), the Control of Asbestos Regulations are surely negligent to state, as they do, that "asbestos is only dangerous when disturbed. If it is safely managed and contained, it doesn't present a health hazard."

The Corporate Line

But if this is a potentially terrifying example of institutionalized blindness, it extends to the corporate arena, too. As alleged this week, Marks & Spencer knew full well of asbestos risks 10 years before the company was fined £1m for breaches to guidelines for asbestos removal in its Reading branch.

William Wallace, who was at that time working as a health and safety manager, told the BBC that he wrote to the then chairman of the company, Sir Richard Greenbury, highlighting a series of breaches at M&S's Marble Arch store, recorded in logs between shifts. "You could not have guaranteed the safety of anybody, the workers, the staff, the customers: you could not have given a 100% guarantee that those people were safe", said Wallace.

M&S's response to these allegations is dismaying. Steve Rowe, an M&S board member, said: "On the face of it these allegations sound worrying, but our team at the time 15 years ago thoroughly investigated them on the day." He added that M&S was unable to find any "case whatsoever to say any member of staff or any member of the public was put at risk."

Turning a Blind Eye

This declaration is at odds with the findings of the court in the Reading case. In September 2011, M&S was convicted of two charges under the Health and Safety at Work Act 1974 in relation to the work at the Reading store. Fining the company a total of £1m, Judge Christopher Harvey Clark QC criticised M&S for the "systemic" failure of its management. In response to asbestos safety complaints, said the judge, M&S chose to "turn a blind eye" to what was happening because the asbestos work was "already costing the company too much".

In other words, profit came before staff welfare - but not according to Rowe, who told the BBC: "Marks & Spencer never, ever puts profit before safety. There wasn't a blind eye. Our investigations were full and thorough ... Implementation of the policy wasn't good at Reading. We are very sorry about that. We regret it. So we are disappointed by the judge's comments."

At the time of the Reading judgment, M&S stated it was "disappointed" by the ruling. Now, a year and a half later and in the face of further serious allegations, M&S seems once again to be "disappointed".

It would doubtless reassure M&S's staff, contractors and customers to learn that the company could find it in its corporate heart to open its eyes - and feel more than mere disappointment.

Being cool shouldn’t come at the expense of being safe

A few weeks ago I wrote a piece in which I wondered whether cyclists ought to be compelled by law to wear helmets. Its prompt was a conversation with Peter McCabe, the CEO of the brain injury association and charity Headway, whose aim is to increase awareness of brain injury and its consequences. Peter made a strong case for legislation to make cyclists have to wear helmets, something that the Post Office made compulsory for its 37,000 cycling postmen in 2003.

By the time I’d written my piece, I was erring strongly on Peter’s side. However, I recently attended a presentation by Martin Potter QC to the Association of Personal Injury Lawyers Transport Group, and found  the biblical proverb true: ‘The first to present his case seems right, until another comes forward and questions him’.

No legal duty to wear a helmet

Martin is a barrister at 2 Temple Gardens. He specialises in personal injury and clinical negligence cases, and has amassed plenty of experience in sports-related litigation, especially involving cycling. His presentation was entitled ‘Cycle Helmets: A Duty to Wear?’ and it ably set out both the law and the arguments for and against wearing helmets.

At present, of course, there is no legal duty for a cyclist to wear a helmet. There may be circumstances when not wearing a helmet could produce a finding of contributory negligence, but they are surprisingly rare. Moreover, Martin’s presentation revealed that only last February a parliamentary debate suggested that change was not in the offing, with MPs apparently convinced that there should be virtually no barriers to cycling, precisely because it is perceived as ‘a good thing’.

Cycling increases levels of fitness and longevity

As Martin put it: “The public policy interest in encouraging and promoting cycling is widely recognised and the subject of much public expenditure. Cycling increases levels of fitness and longevity and decreases obesity, healthcare costs, traffic congestion, pollution and the burning of fossil fuels.”

Thereafter, Martin skilfully examined the evidence as to the efficacy of cycle helmets in reducing brain injuries (inconclusive), assessed the risks in cycling per se (greater in terms of perception than fact), and adduced research which suggested that promoting the use of helmets actually reduced the levels of cycling – something we don’t want, given all the perceived benefits of cycling. In summary, Martin suggested that “it is neither right nor wrong for a cyclist to wear or not wear a helmet. It should be a matter of personal choice leaving the blame to lie with the person or persons responsible for the collision.”

I am not so sure, but, in truth, I can see both sides of the argument. Both Peter McCabe and Martin Potter QC are persuasive, articulate and convincing men. Martin posited the contrary case extremely well, but is it really the case that if we insist that all cyclists wear a helmet, we drive down the numbers of people riding bikes? By extension, if we legislate to compel a cyclist to do the opposite of David Cameron and Boris Johnson – both of whom seem to frequently  eschew a helmet even on the busy streets of London – can we really be said to be encouraging sloth?

Of course not. And yet ... Martin put his case so well that I have paused for further thought and reflection. What is certain is that this issue requires research, analysis and debate. Meanwhile, I’d favour  erring on the side of caution, particularly when it comes to children. The prospect of even one child needlessly suffering brain injury is too horrific to contemplate. Cycle helmets may not be the last word in fashion but they might just make a difference when it’s needed. Better to wear one than worry about being cool.