Great is the rejoicing among the managerialists this week. Now they can get on with producing charts and implementation plans and meetings about Mr Francis’s five tasks, which recommend “transparency, candour… compassionate nursing… patient-centred health care leadership… accurate, regularly available information” and all the other things to which the NHS is always formally committed but never actually achieves.  How happily they have taken up Mr Francis’s insistence that there should be no “scapegoats”. But a scapegoat, remember, is a person made to bear the blame for others. It is clear from Mr Francis’s findings that the blame rested on many people, unnamed, at every level. How great does a crime or cruelty in the NHS have to be before the public can be allowed to know who committed it?  In his radio interview, Sir David Nicholson used a formula which, I have noticed, is popular with people wishing to acknowledge criticism without accepting blame. Speaking of what went wrong at Stafford Hospital, he said: “It is hard for me to imagine those patients’ experiences.” When you think about it, why? He was there for part of the time when these horrible things were happening. Did he not look in on A&E one dismal night, or visit Ward 11, where old people, seemingly every day, were being subjected to indignities which Mr Francis called “barely credible”?  The Francis Report this week is a great disappointment. It is woolly and over-long, full of jargon and euphemisms and forgettable recommendations. It is a waste of two years. But if you go back to Mr Francis’s first report, in 2010, you are sharply reminded of exactly what all this is about. It has 13 pages on “continence and bladder and bowel care” alone. These include stories about an old man forced to stay on a commode for 55 minutes wearing only a pyjama top, about a woman whose legs were “red raw” because of the effect of her uncleaned faeces, about piles of soiled sheets left at the end of beds, and of bowls full of vomit ditto. A woman arrived at 10am to find her 96-year-old mother-in-law “completely naked… and covered with faeces… It was in her hair, her nails, her hands and on all the cot sides… it was literally everywhere and it was dried.” One nice bureaucratic touch: another woman who found her mother with faeces under her nails asked for them to be cut, but was told that it was “not in the nurses’ remit to cut patients’ nails”.  So Sir David does not need to “imagine” any of this. He could have witnessed it, if he had understood what leadership involves. In many cases, I am afraid, he could have smelt it.  In his oral statement launching his report, Mr Francis began by saying: “Many will find it difficult to believe that all this could occur in an NHS hospital.” I am sure he is right. We have been taught with pseudo-religious fervour that the NHS is collective virtue personified.  But it should not be so hard to believe. The creation of the NHS in 1948 was not a scheme for making medicine better for patients. It was a way of taking charge of its delivery by centralised bureaucratic diktat, something which happens in no other country today except Cuba, North Korea and (oddly) Canada. It was therefore designed for the people who produced the service rather than for those who received it. Each extra patient was, from the producer’s point of view, a nuisance rather than a benefit. The NHS’s proud boast is that it is free at the point of use, but this is delivered in a variety of much more responsive ways in, for example, Australia, France, the Netherlands, Germany and Spain. Only in this country is the punishment of those whose actions or neglect have killed hundreds of people seen as “scapegoating”.  Many reading this will respond angrily, relating what wonderful care they have had at the hands of the NHS. Of course, they will be right (although they may be unaware of how much better the same treatment often is in comparably wealthy countries). It would be truly incredible if an organisation employing 1.4 million people did not contain many who did their best. But my point is that the goodness exists despite the NHS, not because of it. It often derives from the Christian inspiration to care for the sick which has existed for 2,000 years and is now under attack. In Stafford Hospital, Mr Francis records, one patient was mocked by nurses because he had a palm cross and a Bible.  The truth is the exact opposite of what we keep telling ourselves. The NHS is the least caring and most selfishly run important institution in this country. Until we recognise this, there will be plenty more Staffords.
We don&rsquo;t want any Mid Staffs 'scapegoats&rsquo; &ndash; just the people who   are actually to blame