These are the words that feature prominently in a long-awaited report on the scandalous lack of professional behaviour in the five hospitals under the authority of Mid-Staffordshire N.H.S.Trust. It is estimated that between 400-700 patients (why such a imprecise number?) died needlessly over a period of several years when under their care. ‘Cure the N.H.S.’ , a group of bereaved people committed to reform, campaigned for the matter to be looked into, and a Q.C., namely Robert Francis, has now presented his 2,000 page report. It was acknowledged in Parliament yesterday by the Prime Minister. Both he and the Leader of the Opposition apologised for the deficiencies revealed by the report, though both had still to fully digest its suggestions.

In his report, Robert Francis QC makes 290 recommendations. They include:

Openness, transparency and candour throughout the healthcare system, underpinned by statute. Improved support for compassionate, caring and committed nursing, including better standards, a stronger voice for nursing in organisational leadership and at ward level, and the regulation of healthcare assistants.

There should be stronger healthcare leadership – including the establishment of a NHS Leadership college, a code of ethics and the disqualification of those found guilty of serious breaches of the code and a registration scheme for those eligible to be directors of NHS organisations. Francis is against ‘scapegoating’, which means he doesn’t recommend any of the resignations demanded by the Cure the N.H.S. group and others.

This massive critique of a service which unifies the country in a remarkable and unique way – someone has called the N.H.S ‘almost a state religion’- and does so at a moment when it is enduring a massive restructuring, less for the people than for the profit of companies competing to take over its services, couldn’t have come at a worse time.

From my own observation I know that hospital care is fallible and variable. There are all the imperfections associated with any system (I worked for one for 50 years!) where it feels to outsiders that the organisation is secretive and self-perpetuating. As a patient and as a visitor I have sometimes felt I was facing an impenetrable wall, grim and forbidding.

But the temptation to ride on a bandwagon of shaming should be resisted. 90% of people leaving hospital approve of the care they have been given. To put it mildly, medical staff have a very testing job. Patients can be difficult, and the pressure of work remorseless. Better training and supervision, pay differentials, management more in touch with the reality of a ward may all be part of the way to improvement.

But care and compassion, treating patients as people under stress, ill but anxious too, matters most.

Bryan