Hot topic: Why do medical scandals remain hidden for years?

Next Monday (July 28) is World Hepatitis Day, which recognises the huge global impact of this disease of the liver, which causes some 1.3 million deaths a year.

Most of those result from infection with the Hepatitis B virus, which is commonly transmitted from mother to child during delivery, as well as through contact with bodily fluids and unsafe injections. Like many infectious diseases, the burden of hepatitis is greatest in lower and middle-income countries.

For those working in healthcare in Britain, hepatitis has a very particular resonance.

That isn’t because hepatitis is particularly common in the UK – it isn’t – but because it has become synonymous with the worst medical disgrace in the 77-year-old history of the National Health Service (NHS), the so-called ‘Tainted Blood’ scandal.

Between 1970 and 1991 some 30,000 people, mainly haemophiliacs, were infected with hepatitis and HIV after receiving contaminated blood products on the NHS. Some of the tainted blood came from US prisoners – a high-risk group for bloodborne infections – who were paid to donate.

What’s worse, highly suspect blood products continued to be given to patients even after the risks of infection became known.

An official enquiry published last year, chaired by Sir Brian Langstaff, found prominent doctors, health officials and politicians had failed to “put patient safety first”, while the NHS itself was accused of failing to investigate, instead opting for a “defensive closing of ranks”. There were “missed opportunities” to heed warnings over contamination risk and this was “compounded” by a long-standing refusal to admit mistakes were made.

“To save face and expense”, successive governments had “refused to admit responsibility, showing little interest in finding the truth, listening to those infected, or taking action”.

Of those affected, more than 3,000 people are thought to have died as a result of infection, including 380 children.

The scandal has cost the country dearly, both in terms of lives and money: after the report was published, the government set up a compensation scheme for victims expected to cost £11.8 billion.

Sadly, the Tainted Blood affair is not unique. It’s just the worst in a series of medical scandals. Others include “Mid Staffs” – named after the NHS hospital in the Midlands where hundreds of patients may have died between 2005 and 2009  as a result of appallingly substandard care – and numerous maternity scandals at hospitals across the country (Morecambe Bay, Shrewsbury & Telford, East Kent, Nottingham … the list seems to keep on growing every year).

All share common themes: a fog of numbers, making it hard to tease out a genuine problem from statistical noise; the reluctance to share information or be investigated by external authorities; discrediting of whistleblowers; an obstinate refusal to entertain the possibility that things might have gone wrong that amounts to sticking one’s fingers in one’s ears and whistling very loudly; and a more purposeful closing of ranks.

While all these examples are from the UK, it is highly unlikely that this is a uniquely British problem. The drivers that keep medical scandals hidden are likely to exist elsewhere too. It might even be argued that the fact so many scandals have (eventually) become public knowledge in Britain is a positive thing – a testament to the strength of its institutions and its inquisitive press.

But more can undoubtedly be done to ensure scandals are spotted sooner rather than left to fester unseen.

Last month (June), the UK government’s top health minister, Wes Streeting, announced that the NHS was to become the first health system in the world to use AI to analyse hospital data to identify potential safety scandals.  The idea is to scan for statistical outliers in things like stillbirth rates, sepsis deaths, mortality rates, and so on. It’s a great plan – but expect bosses of hospital that are “fingered” to squeal that the AI radar has got it wrong.

It’s a good start. However, technology alone is never enough. For real improvement, culture has to change. Healthcare systems – everywhere – need to be more open to external scrutiny, and the mainly good people who run them need to be more willing to admit that, sometimes, bad things do happen.