Speaking shortly after the publication on his Inquiry report Robert Francis QC reflected on his experience of the complaints system at Stafford Hospital saying:
“Complaints were made but depressingly there was a pattern. There would be a complaint, there would be a formal response and an apology plus an action plan that would not be put into force. The same thing would happen again, the same apology would be issued and pretty much the same action plan, and people carried on not being cared for properly.”
On the 31st January 2013, Sir David Nicholson, Chief Executive of the NHS and the newly formed NHS Commissioning Board issued an apology to the people of Stafford on behalf of the NHS saying that it had “let people down in the most devastating way”.
Furthermore, he made it clear that “apologies are not enough”. Those with an understanding of the art and science of apology would probably beg to differ.
The “Nicholson Apology” (is it part of a trilogy I wonder – the challenge, the apology and the resignation? ) was offered as part of a speech to the National Voices conference and as a report on the NHS Commissioning Board website.
But is this the way to make such an important apology?
At the time my colleague Dr Suzanne Shale, an ethicist specialising in healthcare, expressed her dismay.
“Please tell us this is just the trailer for the proper apology” she wrote on the NHS Commissioning Board website comments section.
Suzanne points us toward social philosopher Nick Smith’s book “I was wrong – the meanings of apologies” as an excellent discussion of the art and science of apology. In it Smith argues that a “Categorical Apology” has eleven vital elements.
Here is Suzanne’s analysis of how the Nicholson’s apology (as reported) measures up.
1) Corroborated factual record – Yes
2) Acceptance of blame – Not really
3) Identification of harm – This apology omits that the harm to patients was confounded by the harm of denying that anything was wrong
4) Identification of the moral principles underlying each harm – No
5) Endorsing the moral principles underlying each harm – No
6) Recognition of the victim as a moral interlocutor – Halfway there perhaps
7) Categorical regret – Yes, but one has to wonder about the motivation
8) Performance of the apology – No, emphatically not in this form
9) Reform and redress – Getting there but quite a long way to go
10) Intentions for apologising – Difficult to convey sincerity in these circumstances, but not bad.
11) Emotions – We’re half way there with the term “harrowing” but it would be nice to get a scent of shame or remorse for his own part
For Suzanne, the Nicholson apology gains just 5/10. She suggests that he needs to have another go.
Having subsequently watched the poorly produced video which serves as the NHS CB comment on the Francis Inquiry report, I think Suzanne is being generous with her marking.
Judge for yourself here and let us know what you think.