The papers were full of demands for sackings and retribution. In this climate it was impossible to ask the Hospital to re-examine cases, trust between patients and the hospital was so badly damaged that there had to be an outsider, and Dr Laker was brought into to run an independent analysis of the case notes.
His evidence to the Inquiry has been a quiet, thoughtful day He has tried to give answers about complex questions on hospital governance, and to look at the experience he had in trying to assist the bereaved families. The complete transcript can be found here
Initially there were about 20 families who came forward, but the press were very interested in promoting this process and continued to print prominent editorial stories to support it. This was in addition to the advertisements placed by the trust. It was also around that time that googling "Stafford" would always bring up adverts for lawyers offering their services.
As the press coverage continued day in and day out the numbers of families who felt that there may have been problems in their case grew too. The pressure group and their influential supporters made it clear that Dr Lakers process was not what they wanted. They wanted a public Inquiry. They did however advocate that as many families as possible should put their names forward for casenote review, in order to build up the pressure for an Inquiry.
In the end around 200 families signed up for this process and were seen by Dr Laker and his team. This large number put the process under real pressure. Additional staff had to be appointed for the task, and there was eventually re-organisation to have the project managed by the Primary care trust, Dr Laker felt the PCT did a very professional job.
The Inquiry made the point that this 200 were a self selected group, of those who felt that they had experienced a problem. By the end of the review process 60% of this self selected group felt that they were still in some measure dissatisfied and wanted to take matters further. Many of these were involved in the group legal claim that was "settled" by the hospital in 2010.
Dr Laker was asked about the expectations of the group, and whether he felt the process had been able to meet them. One of the expectations that he found was that some families wanted him to tell them if they were “one of the 400”, referring to the problematic number used repeatedly by the press of those who “may” have died as a result of poor care. (It is the use of this number and the misleading claim that this is stated by the Healthcare Commission, which is central to the report which is now finally being investigated by the Press Complaints Commission).
Dr Laker says that answering this question from the families was by no means straightforward. There were a small number of cases – a handful – where it was possible to identify with complete clarity that some form of medical mishap had taken place, but this was unusual. There were also cases where the case note process was able to give people closure. They could see by working through the case notes with an expert, and asking the questions that they needed to ask that there had been nothing untoward. They could let their worries go.
There were other people – the majority out of this group of 200- where issues were identified and were able to be fed into the independent inquiry process that began under Robert Francis in 2009. Dr Laker felt that for many of the people that he saw, this was important. They wanted to know that their experience counted for something, and that what they had seen would help other families in the future to a better experience.
This is not a clear matter of black and white - but hundreds of shades of grey.
One thing that Dr Laker talked about that made me feel very sad, was the way in which the media focus on the hospital stirred up unresolved issues for other people, theoretically outside the scope of the case note review. Some people came forward who had stories from 10 years ago or more. Some of these had been through every possible stage of the complaints procedure, the hospital, the healthcare Commission, even the ombudsman. Some of them had their complaints upheld by the ombudsman, but this had still not enabled them to let go of their grief or anger. They felt the need to come back and be part of the Case note review, even in cases where the notes had been long ago destroyed.
The Chairman Robert Francis wondered if in cases where people had held onto their grievance for so long, if that then made is much harder to find a way to let it go. Dr Laker said
Robert Francis asked a hard question. He wanted to know if Dr Laker felt that the process had in anyway helped those involved. He thought about this clearly. And the answer was that he does not know. He never had any feedback. He does not know if any of the families felt any better for this process. Here is his answer. :
I believe that is the case. The longer it goes on the more difficult -- the more protracted it becomes. The more difficult it becomes to deal with.
I think I've indicated earlier that I have difficulty knowing how effective this process has been, because for me the test would be whether at the end of the process it has allayed any of the issues raised by families or they're able to come to terms more with what happened. I simply don't know that. A number of comments were made to members of the teams that saw families initially, that suggested that some were deriving benefit from having the initial meeting.
Certainly the comment was made on more than one occasion that it was the first time that someone had listened sympathetically to the issues that the families were raising. But that's early on in the process, and I wouldn't form a judgment on that. I would want to know, after the process has been completed, whether families derived benefit from the independent clinicalnote review process, and I simply don't know whether they did or not.