Richard Smith: Revisiting “Stalinism in the NHS”

The appalling story of some 600 patients in Gosport Hospital being casually killed and the failure of every authority to take action makes me remember something that I wrote in The BMJ in 1987 on “Stalinism in the NHS.” (The events in Gosport ran from 1989 to 2000.) The story makes me think as well of the marvellous quote from Liam Donaldson, chief medical officer in England from 1998 to 2010: “To err is human, to cover-up is unforgivable, to fail to learn is inexcusable.”

The 1987 article began: “Almost by definition it is difficult to obtain information on attempts by those in power to keep information secret and stop people talking publicly. Yet every day in our conversations with doctors, administrators, researchers, and others we hear stories of suppression of information about health and the health service.”

The article listed 20 examples of where important health information had been suppressed.

Seven years later we returned to the theme, and I wrote:

“Recently I sat at dinner between a senior nurse and a senior NHS manager, and much of the talk was of Stalinism in the NHS. These people were convinced that the NHS was becoming an organisation in which people were terrified to speak the truth. This opinion is heard time and time again, and everybody seems convinced that it is becoming worse. We thought that it would be useful to consider this issue, and the following three articles look at examples of the suppression of information within the NHS, the historical context of regional directors of public health being gagged, and the fact that Britain is an unfree society with an unfree press.

Censorship has a long tradition in Britain, and the ruling classes instinctively suppress information. The English poet John Milton knew strict censorship at the beginning and the end of his life, but free speech flowered briefly in the middle of the 17th century. At this time Milton published the “Areopagitica,” which perhaps better than any other document gives the arguments for free speech.

“Give me,” wrote Milton, “the liberty to know, to utter, and to argue freely according to conscience, above all liberties.” Truth, he argued, was never “put to the worse in a free and open encounter…. It is not impossible that she [truth] may have more shapes than one…. If it come to prohibiting, there is not ought more likely to be prohibited than truth itself, whose first appearance to our eyes bleared and dimmed with prejudice and custom is more unsightly and implausible than many errors.”

“We can never develop the NHS and the health of the British people without a lively debate, which will be debased if people cannot say what they truly believe. “Where there is much desire to learn,” wrote Milton, “there of necessity will be much arguing, much writing,  many opinions; for opinion in good men is but knowledge in the making.”

“Perhaps these truths should be quoted on the front page of all the many annual reports of the NHS.”

Naomi Craft listed 30 examples of suppression of information. You can read the articles at: Failure to learn is “inexcusable.” This is not much of a 70th birthday party for the NHS.