Author Archives: dianasmith

Is Hack an irregular verb?

I suspect that “Hack” is an irregular verb.
·         I investigate,
·         You hire private eyes (in the public interest of course),
·         He hacks.
Journalists are very keen to say – We abide by the code – We do not hack – We do not do this sort of thing.
I like most of the journalists that I know. They are people who find the world deeply interesting. They try to make sense of it and they try to convey what they see to other people.  All of these things are admirable.
I deeply dislike anything in the way of a witch hunt, and I do not like that at present many journalists will feel threatened by the crisis that is hitting their profession. It is of course nothing like as bad for the majority of them as it was for the MPs when their turn of being in an unwelcome spotlight came two years ago. The journalists have the advantage that they can tell things their way, and a pretty good chance of making themselves heard, a privilege that was completely unavailable to the MPs who were attacked without mercy by the press.
However I do not accept the comfortable view held by many journalists, that the state of journalism is fine, there are just a few bad apples, criminals who should bear the full penalty of the law.
If we look at what the some elements of the press produces, sensationalism, speculation, exaggeration, celebrity focused gossip, the prejudging of people accused of a crime, the details of murders, tragedies, scandals, the demonization of individuals and of different sectors of the community,  then we are forced to see that all is not well.
If we look at the many burning issues that the papers raise but do not really help us to grasp: the future of pensions, jobs for young people, the state of our care services, tax avoidance,  fuel poverty  to name a few, it is right to expect that the press could do so much more.
If we look at the way in which papers drive a wedge between people who we elect to try and solve these problems for us then we could wish for a different and more productive ways for the press to promote better communication.
It is not all well. The press needs to see this. It needs to accept that this is a moment where a change is both possible and necessary.
The press would be happier if the focus remains on the extreme horror of the Milly Dowler case. This would be a wasted opportunity.
I have spent much of the last 6 months sitting listening to hearings of the Stafford Hospital inquiry. The common perception , which has been fostered by some rather seriously flawed reporting, is that Stafford is unique, and that therefore other hospitals do not have much to learn from the matter. This is a shame. Most of what we are finding by close scrutiny of the Stafford Hospital case actually shows that the problems that did exist here were not spotted because they are not in any way as extreme as they have been portrayed. There were a series of individual problems which are on the spectrum which takes in the whole of the NHS. The NHS has a lot to learn, but because the press has not yet been able to see this clearly the NHS does not yet recognise this.
There is an analogy with the News of the world and the press. There are aspects of what was happening with the NOTW and NI which are pretty unusual, and perhaps unique, in particular the behaviours for which Vince Cable has just coined the phrase “heavy lobbying”, and the uncomfortably close relationship with the MET, but there are other aspects of questionable ways of getting a story, or failures to check accuracy which we can find throughout the press.  The behaviour is not an aberration, but something on the edge of a broad spectrum of behaviour which is common to many other papers and journalists too.
So what is to be done about it?
If we stay with the perception of isolated extreme behaviour the temptation is to go after the individual journalists that went too far, and throw the book at them, sackings, trials, prison sentences.  But if it is part of a spectrum, part of a culture in which bad practice thrives and the best practice struggles, then a different approach is needed.  The curing of this widespread insidious infection has to come from within the body of the journalistic profession. Journalists have to play an active part in the healing process.
A number of people are suggesting some form of amnesty for journalists; a window of opportunity for them to come forward and declare the things that they feel have been wrong, an opportunity to openly analyse and to assist with the process of devising good rules, good monitoring processes and imagining a better press.
The urging for this amnesty is coming from a range of different people, who may have different, and perhaps conflicting reasons for suggesting it. I suggest it because I value openness and I hate witch hunts, it is possible that other people are suggesting it to deflect attention from the Murdoch press and to spread blame more widely.  I am not sure if an amnesty is something that journalists would welcome, or if it should be done. I would like to hear other people’s views on this.  
The ground rules that have governed the press are the “editor’s code” this is what it says. It is a code that is devised by editors, and it is there to help protect editors. If their journalists infringe the code then that is cause for dismissal. If they remain within the code then this is protection from being sued by people who object to their coverage. This is all good for the interests of the editors and proprietors.
Does this code serve the public well? Does it serve the interests of principled good journalists who want to follow the highest standards of the profession?  How could or should it be improved?
All of this will come under close scrutiny as the Leverson inquiry takes shape. I want to see journalists working with the public to devise rules that are for the good of the public as a whole.
Going after the journalists who can be seen to have done wrong is something that will appeal to the “sleuth” in many journalists, and it could run and run. Personally I do not see this as a productive process. A great deal of real harm has been done to many people by the press over many years. Maybe now what we need is not so much retribution as a truth and reconciliation process.
What do other people think about an amnesty where journalists can own up to bad practice, followed by a period of generous and prominent apologies to those have been harmed over the years?  This should be coupled by the full co-operation of the journalists in the devising of a code where the primary purpose is to protect the public, to foster the public good, and to protect journalists from undue pressure.
Let me know what you think about this. Does there need to be a wider survey to canvass opinion?

Cops, Robbers and Scoop.

I’ve  found myself thinking back to childhood, the games that were played in the playground, and some of the board games we used to play in the family.
The boys lived in a vivid imaginative world, cops, robbers, Indians, sleuths.  When it rained and we played indoors, there were a handful of board games, Monopoly, cheat, and we also had scoop, a competitive game about journalists getting their story.
The people who are the top of the journalistic profession now were brought up with the same influences. I have been thinking to about some of the impulses that have driven the creation the kind of press we have now.
The industry is driven by powerful individuals – and their character is reflected in the papers they produce.
Amongst the snippets of information about Rupert Murdoch that have emerged there are a few inconsequential matters that stood out for me.  There was the tree house, which is where his father apparently insisted he should sleep during part of his childhood, to “toughen him up”.
We have had the fascinating glimpse back 40 years to one of Murdochs early stories covering the fugitive Ronnie Biggs in Australia, where Murdoch, who had obviously developed his links with the police very early in his career persuaded the police to verify the finger print on documents sent to him by Ronnie Biggs. This was of great help to Murdoch in publishing a verified story, and apparently of help in funding Biggs to remain on the run, but apparently of no great help to the police in catching their man!
One of Murdoch’s contacts testifies to his genuine interest in his papers, and the detailed questions he would ask people about how they got their stories. He apparently took real pleasure in the process of journalism. – did he enjoy the games and stratagems used to “land” a story?
There is also a moment during Murdoch’s evidence to the select committee, when he talked about his father. A lot of people wondered why on earth he was doing this, a plea for sympathy, the ramblings of an old man- but to my mind it was central. I believe that this is a man who is still at the age of 80 trying to live up to his father’s expectations, and who had been confronted with the very uncomfortable realisation that after having “succeeded” in building an empire which met his father’s expectations, that the quality of what he had done had been weighed and found wanting.
It is of course ridiculous to suppose that Rupert Murdoch could or would have had any idea of the criminal activities being carried out in his name, but he does have a responsibility for the culture of the titles that he owns, the culture that produced this behaviour,  and for the apparently ramshackle nature of corporate governance within these organisations.
I think it is also ridiculous to suppose that phone hacking occurred only within the News of the World, or that phone hacking is necessarily the most serious abuse that exists within the press.
What I am pretty certain that we do have, and here I am back to the excitable boys in the playground, is a culture that puts far too strong an emphasis on “sleuthing”, and finding out what is hidden. Journalism – is perhaps seen by many as fairly dull stuff, involving a lot of very boring and hard work, but “investigative journalism” is all together much more exciting.
Operation Motorman shows us that there were many papers involved in the use of private investigators . The BBC Radio 4 programme “the report” indicates that if papers are outsourcing fact finding to people who are not under the direct control of the paper, then you can quite quickly get to a point where just about anything goes.
More recently we have had all the interest in MPs expenses, where it was the idea that things were being hidden that kept the interest of the press alive in the very dull details of what all bit a handful of MPs were actually being paid. That all began with stolen information being shared with a newspaper. All justified in the name of public interest of course. It is certainly not a bad idea to challenge the key institutions of our country, but I think that most people would now say that the press did in many cases get this entirely out of proportion, and that they certainly did so to political effect.
 There has been Wikileaks with all the excitement that that entailed.
There was the huge fuss surrounding the “climategate emails”, which we now hear may have involved Neil Wallis, Andy Coulson’s deputy editor at News of the World. This was important. The leaking of hidden emails gave an interest and odd credibility to the idea of a conspiracy to exaggerate the threat of global warming, and it did so at the crucial moment to destabilise the Copenhagen conference.  So this had the ingredients of hidden information, being using in a misleading way, which confused people, and this had a political effect.
In the case that I am close to, I have a ring side seat to watch the process of journalists “getting” a story.   The Stafford Hospital story is interesting in that it does involve two completely separate elements that became merged through the press.
The press chose to champion the campaign of a small group of people who had found themselves deeply frustrated by the complaints process at the hospital and throughout the NHS. They had every right to do this. They then got caught up in the distinctly messy business of a set of mortality figures which were leaked to the press because they had been deliberately excluded from the Health care commission report on the hospital.  Like anything that is “hidden” this immediately excited undue attention.

If the press had chosen to print this leaked information with clear acknowledgements that it was leaked and clear explanations of why it was hidden, this would have treated readers with respect, and allowed them to make their own judgement. No paper has adequately done this.  The nationals for the most part do not even know the doubtful source of the material. All the press throughout the country has simply accepted this seriously flawed and misleading information at face value, and it has been used for political purposes.  The widely criticised “reforms” to the NHS have been “sold” with reference to the public perception of Stafford created by the press coverage.

The Inquiry was convened  to try and deal with the inconsistency, to explore how it could be possible for very large numbers of people to have died in the way these figures indicated, whilst no one saw anything out of the ordinary. What we have seen is that there are many indications that Stafford suffered problems that are real but widespread.  We have also seen quite a few indications that the boring nuts and bolts of corporate governance is not fine tuned enough to pick up some of the basic problems of patient care, and needs to be strengthened in Stafford and throughout the NHS.       
Occasionally there has been a little glimmer of excitement for the press. There was for instance the evidence of Professor Jarman, which showed his anger at what he perceived to be the “gaming” of his system by the West midlands hospitals. I watched with interest the excitement of the press pack picking up this story. It was the evening headlines on the BBC and next day in the press. Unfortunately no one was in the press gallery the following day when the Counsel put a rather different interpretation and infinitely more plausible explanation of events, and when the Chairman of the Inquiry indicated his serious displeasure that the press continued to trot out the misleading mortality figures.
After so many months of an inquiry there is very little that is “hidden” about Stafford, apart from the fact that the story is still not being told in a well rounded way by the press.  The real story that we can now see if we choose to look has I am afraid very little of the excitement of the story that the press and media believed existed. The decision of the press not to openly tell the full story is or course a very interesting “hidden” story in its own right!
The press interest is still focused on one witness that they want to see produced, A witness who is unlikely ever to appear.
With the Phone hacking and Murdoch story – there is so much that remains hidden that people will remain deeply interested. There are bin bags full of unread notes, potentially thousands of victims, and the archive of “smoking gun” emails at the wonderfully named Harbottle and Lewis lawyers.  There is all the jigsaw of who knew what and when and who can be blamed, alongside a fair bit of understandable political anger about decades of dirty tricks. There is the human story of people who want to settle scores.
This is what will hold peoples interest, but the really important matters here are what happens as a result of all of this. We will get to see what went wrong with corporate governance? What needs to be done to ensure that individual newspaper proprietors do not exert too much influence? What needs to be done to ensure the ethics and quality of reporting? How do you ensure that the links between politicians and the press is not a malign influence on both?
Of course journalists will always get caught up in the excitement of the stories they tell, this is in the nature of the profession, and papers are in part entertainment, but it would be really good if in the wake of the Hacking scandal that papers begin to redefine their role.  Will papers continue to focus on what is good for their proprietors and the proprietor’s friends, or will some papers see it as their job to look at the interests of the community as a whole? Could papers act to allow a wide range of voices to be effectively heard, or will the proprietors still wish to be selective? Will there be papers in ten years time, and if so what will they look like?
Leverson will I hope require the press to do the boring stuff of looking at their own corporate governance and their own standards.
We are entering into a world where there will be many shadowy companies delivering many of the services which used once upon a time to be public. There is a major job here for good journalists all over the country to be the eyes and ears of the public and tell us more about what is happening within these companies. Some of it might even involve a bit of sleuthing!   

The Anatomy of the press scandal

As the days turn to weeks many people write many words in an attempt to understand just what this press scandal is and what it means.
Is hacking just a storm in a teacup?
There are some who would like the matter to be contained, for it to be a narrowly focused question of why an individual newspaper hired an individual man to hack into the phones of celebrities, politicians and ordinary people who just happened to find themselves in the news.
There are many who hope that this is all a storm in a teacup, that of the thousands of potential victims in the Mulcaire notebooks only a handful will have suffered anything more than a theoretical intrusion into their privacy.
There are also many who fervently hope that there is nothing within these notebooks to link what is being found to other newspapers, but the opinion from people who have watched these matters closely throughout the years is that hacking and other forms of intrusion is an infection that is widespread throughout the media. It probably began when Mobile phones first began to be widely used.
Intrusion is not new. The media hunger for salacious stories has been satisfied by many different means. Hacking was simply an invisible way of doing it with no chance of being discovered elbow deep in someone’s rubbish bins.
Mobile phones and the media became the story many years ago now, with the interception of mobile phone conversations by members of the royal family.  Hacking into messages is simply a natural development from that, and the fact that it was illegal does not seem to have been much of a restraint to people involved in such a potentially lucrative practice.
The problem that underlies all of this is the routine blurring of the line between what is of interest to the public, and will therefore sell a lot of newspapers, and what is in the public interest.  This is one of the questions that we must hope Lord Leverson will attempt to clarify in his Inquiry.
People who found themselves too much of “interest to the public” especially the bereaved have had some defence against the excess of press intrusion when they knew it was happening, but they had no effective defence against this invisible and completely illegal theft of their feelings.
Who was part of the trade in information?
Hacking is the starting point of this scandal, but the problem is so much wider than this.
What is still to emerge is how did this industrial scale theft of phone numbers and pin numbers come about.  Who encouraged it? Did they understand what was being done? How many people throughout the country are implicated in this illegal trade in personal information?
How are stories verified?
With the question of who knew about the trade I think that the starting point should be what action did the papers take to ensure themselves that the stories they were printing were true?  
We heard in the Select Committee on hacking in 2009 that the news of the world employed a legal advisor, who was there in part to ensure that the paper did not leave itself open to the possibility of expensive liable suits. This was especially necessary for a paper that prided itself on exposing uncomfortable truths.  My assumption is  (and I may be completely wrong about this) that it would be simple good practices for any editor to a story was true, and would not harm the reputation or pockets of the paper.
The stories being captured by phone hacking had the huge advantage that they were certainly essentially true, and they were certainly exclusive.
We need to understand the verification process that operated within the papers. How do they know if a story is accurate, How do they know what sources of information were being used? Would there be people within the paper who will actually have listened to the messages?
As the suspicions of phone hacking has grown over the years more and more of the victims have challenged the News of the World  about the source of the “exclusives”. They have done so with considerable success at the cost of millions in out of court settlements.
Who authorised out of court settlements?
This raises big questions. Someone in a position of some authority had to sign off these cheques, and it is reasonable to assume that they would have wanted to know why they were doing so.
The storm clouds have been gathering for a long while now. I did not really become aware of it all until 2009 but many people have been tracking this story now for years before that, and it is these people who have insistently raised the uncomfortable questions about David Cameron’s former head of communications, Andy Coulson.
Was there a cover up?
These questions are big and deeply worrying. If people knew that phone hacking had been an issue for almost a decade then why despite internal investigations, a police investigation and a review of the investigation, why despite bin bags full of evidence would no one publically recognise the scale of the problem.  
Were News of the world and by extension News International hiding things from the police?
Were the police sweeping things under the carpet and if so why?
Why didn’t more politicians speak out?
A small number of politicians knew of the allegations and were demanding action, what are the different reasons why politicians from different parties were not giving them their unequivocal support in this?
Where politicians simply accepting the assurances of the police that there was not a significant problem?
Where politicians hesitant to pick a fight with News of the World and the Murdoch empire because in the shadow of the MPs expenses scandal which had indiscriminately smeared  so many MPs, they understood and feared the consequences for themselves as individuals, and for their chances of electoral success?
Was it because for some MPs and politicians it actively suited them for the sun and the news of the world to have a free hand to do as they pleased?
Was it because being and remaining on the right side of Rupert Murdoch mattered?
Why didn’t the Press complaints commission deal with the concerns?
There is a regulatory body for the press, but it is a body run by editors for editors. It has insufficient powers to investigate, it takes people at their word.
David Cameron and Murdoch
There is the invidious position of David Cameron.
David Cameron is a man who places a great reliance on friends, and Rupert Murdoch is a man who lives to exert influence.  We have seen through the friendships forged within the chipping Norton triangle the way in which the interests of David Cameron may have become merged with the interests of Rupert Murdoch in a way that may now be deeply harmful to both.
We have seen through accounts of the networking conducted by the Murdoch empire, how controlling access to power, the circles within the glamorous settings of the summer parties may involve many people in subtle forms of corruption.
David Cameron and Andy Coulson
The friendships at the heart of these circles we now hear brought Andy Coulson into the employment of David Cameron at the suggestion of Rebekah Brooks.  This is something extraordinary. We have a highly skilled media manipulator, someone who understands exactly what sparks the public interest, and what sells papers, able to act as Murdoch’s man in number 10 and as Cameron’s man in the media.
Just think of the opportunities that this creates.  
What is the impact on the way in which political communications were carried out?
We have not yet even begun to analyse the way in which the communications operation worked, at the Conservative headquarters, and later at number 10, but we know we have at the heart of it a man with the skills to package stories, a particular view of the world that is in tune with the views of the Murdoch empire, and he now has access to the Conservative party machine, a machine which would be primed to pass good stories through so that they could achieve maximum impact.
We saw the way in which Cameron in opposition used Prime Ministers questions to inflate what he described as “Daily Mail Specials” into stories with national mainstream media significance.  We have seen how many of these stories were based on “individuals” in true tabloid style, and that many were also based on misleading information.
In my own town I have seen a story which encompassed both these elements used to devastating political effect.  I believe when we begin to look more closely at the way in which communications was conducted in the years from 2007 that we will find much more that will concern us.
Putting public interest at the heart of the relationship with the press.
All of this raises many big questions. We have lifted the lid on a press as the plaything of powerful men, operating in the interests of the few, and contemptuous of the needs or rights of those people who become the focus of interest.
When we look we will find out much that relates  to the specifics of phone hacking and the individuals at the centre of this particular story, but I believe that we will also find the failings of the press regulatory system that permits many misleading stories to be told, and does not enforce proportionate apologies.
The current PCC has at its heart the Editors code committee, made up of editors. This must change.
Reimagining the press.
The press has been, for as long as we can remember the means by which rich and powerful individuals can promote their view of the world. If this is fundamentally changed by the changes in regulation that will come, then where does this leave us?
There is a real need for a different kind of press. Something that really does address the communication of the problems that confront us all, something that brings people together to find solutions.  This is completely at variance with the interests of powerful press proprietors, who actively seek to create division, to be on the winning side and to control.
If we change the ground rules, if we create a press that is in the interests of the many, will the proprietors simply close up shop, or will they adjust themselves to the needs of a changed world?

The Exploitation of grief.

It already seems a long time ago since we first heard about the hacking of Milly Dowler’s phone. What has brought down the Murdoch empire is that we finally saw clearly that we were dealing with people who simply do not abide by any normal rules, who saw it as their right to satisfy the interest of the public at any cost.
I would like to suggest that what we saw here is the extreme edge of a spectrum of intrusion and exploitation. Maybe we need to think a little about the way we have become desensitised to the public “ownership” if grief.
Most journalists learn their trade in the local press. What they are trained to look for is something unusual happening to the ordinary people that make up their small world.
Accidents, crime, what the coroner said, and the occasional murder are all occasions when ordinary people become of fleeting interest to the press.
Sometimes it goes further, sometimes there will be an individual prepared to answer the question “how does it feel”, opening up a window into the mind of an ordinary person coping with some big emotion.
When it comes to murder our interest and the interest of the press become much stronger.   The families of a high profile murder victim become for a time at least public property. 
This is nothing new. The penny dreadful of the Victorian period relied on murders as their stock in trade, but now the reporting of high profile murders, especially of young women or children has acquired its own predictable ritual.
The bereaved know the rules of this. They play their part.
There are the press conferences, with the fraught and tearful appeals to the public for information on missing persons. Here the police and the relatives genuinely need to attract the maximum press interest. It has a purpose.
There is the finding of the body, with helicopter views of the tented area, and statements from representatives of the bereaved family.
There are appeals for information, police press conferences on the progress of the murder hunt, the announcement of the interviews with suspects, arrests, charges. There are opportunities at every turn for the reactions of the bereaved.  Often the press are warned off from overt unwanted attention.  The editors code gives clear guidelines to protect the bereaved. This is why the hacking of mobile phones was such a powerful tool for the press. At the time when the public were  hooked by a story and wanted to know everything then hacking  provided a window into the hearts of the bereaved without their knowledge or consent.
And then there are the funerals, with photographers with long lenses, there to capture the mourners and the coffins, interviews with family, friends and anyone else with a story to tell.
Then we have the trial. Different families behave differently. For some they need to be there, to have the opportunity to look at the face of the accused, to understand this person who has impacted upon their lives so cruelly.  Others keep a distance, remain away.
The trial is the show piece for the press. This is the opportunity to report some of the worst aspects of human behaviour. It is nothing new. This is the foundation of the tabloid press.
The verdict, is the time when families are expected to give a reaction, to show their response to the “justice” delivered in their case.
 For most families, this can if they choose be the end of the ordeal by the press. They are then free to grieve quietly in their own way. How much of all this process is in the “public interest” is difficult to judge, but we do know that it is something that the public will find of consuming interest. It all sells many newspapers.
For some of the bereaved there are special reasons why this is just a beginning of a new phase.
It is a completely natural instinct to feel that if you have suffered something so terrible, especially if it was in some way avoidable, that it is a duty to use the experience, and to try to ensure that no one else has to suffer in the same way. In high profile cases, the bereaved will already have built a close relationship with the press. Often this is a perfectly genuine warm indentification between someone who has suffered something extraordinary and someone who has tried their best to tell the story in the most truthful way. The bereaved will often develop the feeling that the press are the only people who really understand what they have suffered.  Prolonging the story, may be something that both the press and the victim actively want.  It is a way of converting grief into action, and it is a way of giving the public something they find interesting.  In the occasions where there is a campaign which comes out of a tragedy, the families need and actively seek the public response, and the strong outpouring of sympathy will ensure that politicians may well be forced to bow to this emotion.
We have seem Sarah’s Law, which was so strongly advocated by Rebekah Brooks, (but is criticised by many community organisations). We have seen the vetting laws brought in for all people in regular contact with children, following the murders of the two girls in Soham. (but this law is criticised by many people for stifling community involvement and volunteering). We are seeing on the front page of the Sunday Mail today an appeal for Claires law.  There must be many more examples.
We saw the Dowler family raising vocal concerns about their exposure to prurient interest by the court and the press, and now we have the extraordinary spectacle of the Dowler family, fighting the shocking exploitation of their grief, becoming the symbolic face of the hacking crisis and the worst possible form of press intrusion. In the process they are accidentally bringing down an empire, that exercised power by corrupt practice, prurient intrusion and fear.
The major changes to the regulation of the press that will follow the hacking scandal would never have happened without the Dowler murder.  This is now a once in a lifetime opportunity to understand and rebalance the relationship between the press and the people. It is an opportunity we must take.  Finding the right code to protect those in grief from exploitation must form a part of this exercise.

The Murdoch summer parties.

Max Hastings on Andrew Marr Sunday 17th July painted a fascinating picture of the Murdoch summer party of 2010.
On the terrace, supping the Murdoch champagne the invited guests mingled.  In this sunny privileged world introductions were made, alliances confirmed, opportunities were opened.
Twenty yards away in the centre of the lawn Rupert Murdoch stands with David Cameron, and one at a time selected guests are summoned into the presence and introduced by Rupert Murdoch to David Cameron.
We have a world where dancing to the tune of the wishes of Rupert Murdoch could open doors, and where he controlled access to those who are nominally in power.
There was an inner golden circle, and there was a wider circle of those who are allowed to bask in the rays of the sun.
Who was it that attended these famous parties, the rich, the famous, the expensively educated, the well connected, the beautiful, the ambitious?  
Who were specifically excluded from this privilege, and how did this affect them?
What did this mean to the many millions of us who have no place here.  We, if considered at all were there to buy the papers, to buy the products they promote, to buy opinions shaped in the way the proprietor chooses and to buy  a government  when required to do so.
I have found myself writing this in the past tense.  This particular golden world is already a piece of history. People are already writing the screen plays for the films that will capture these past moments,   but the desire that produced these sparkling parties and that kept people dancing willingly to these tunes is still with us.
The anger that many people feel now comes from knowing that the press which many believed to be “of the people”  had its interests elsewhere. This was a corrupted press that had abandoned an honest commitment to tell the truth, to show us what is there, to challenge the powerful. This was a  press that aimed to be at the very heart of power.
The challenge for the future is to build a press that does not seek to divide us, but can genuinely serve the needs of the many, not of the few.

Images from the press scandal.

Scandals are landmarks on our political landscape. We are used to the way that the press and the media can build a furious row on a range of matters for a day or two, and then it subsides.
This scandal – which hasn’t yet even got a convincing name – is different.
It is different because it is the press itself which is now finally and inescapably at the centre of our vision.  It is different because the scale of public outrage, and way in which the prime minister is so closely bound into the heart of the problem means that he has had to take far stronger action than anyone else could or would have dared, and he has had to set up a full Public Inquiry.
We can have no idea at this moment just what this Inquiry will find, what it will tell us about our society, but the expectation is that it is going to be a deeply uncomfortable process for many people. The hope is that it will show us clearly what it is that went so badly wrong in the relationship between the press, the politicians, and the people, and what steps need to be taken to put this right.
The name most commonly used for the scandal is “hackgate”. I am not sure that this is right. It captures the moment when the floodgates burst, when the universal horror over the most extreme action of a single private investigator hacking into Milly Dowler’s phone, in order to access sensational material to sell newspapers, brought home to the country as a whole that something toxic was happening to the press. 
The danger of this name is that it offers comfort to far too many people.  The quality press and the BBC would not dream of “hacking” though they have never been shy of parasitically reporting the stories.  The other tabloids if they were doing it at all would have drawn the line somewhere. This is about unspeakable crimes, crimes that could only be committed by “other people”.
It is good that Lord Leverson sees a wider picture. He will look beyond the criminal failures in News international and the police to the wider issues of corporate governance and a media culture that allowed this extreme amoral example of bad press practice to exist.  He is approaching this from the point of “who guards the guardians”.
What will we see when we do begin to look wider?
If we are looking for monsters my guess is that we will not find them.
In the tsunami of stories that have swept over us in the last 10 days there are images that float to the surface.

I see the image of Rupert Murdoch with his arm around Rebekah Brooks, offering her protection against the clamour from the mob.  Is this an image of a company where things that we normally see as good, family and friendship, was allowed to matter too much, at the expense of the public and of the people who work within their organisation.   
I hear the protestations of Rebekah Brooks, that she did not know, and I find this believable. I find it completely believable that there are many things that people would have chosen not to tell her, because these are things she would not have wished to hear.
I hear the accounts of journalists of the pressures they experienced within the company, the relentless pressure to deliver the right story, and I see that this pressure, something that exists well beyond the confines of the News of the World, could drive many individuals to deliver stories got by many dubious means, stories that may have a tenuous connection with the truth and stories that may be in the interests of the proprietor, but not in the broader public interest.
I see images of Rupert Murdoch, this energetic bright old man, now out from behind the curtain and exposed, and I think of the ways in which we have all, all of us allowed him to fill us with fear over the last 30 years.  If there is a monster it is a monster we have built in our imaginations.
I am sure that when he does speak, he will convince us that there are things he did not know.  He will not have been told, but people will have striven to deliver stories that they believed he will have wanted to see.
I saw the image of David Cameron, staying away from the House of Commons to announce another variation of the Big Society. Here the TV images played surreal tricks. The signal was corrupted. His smooth concerned face continually distorted and peeled away.
When I listen to David Cameron on the big society I hear many things that resonate. He is right that there is a limit to what the state can do, and that there is a need for us to take far greater control over our world. I see that he means this. What he does not and perhaps cannot see, what he is still hiding from himself is that this “big society” cannot have a firm foundation on the tangled mass of vested big money interests that is symbolised by his oh so close links with the Murdoch Family.
I hear David Cameron’s statements about the things he did not know, and again I find these completely believable. I think we have often seen with him the capacity to not look too closely, to block out inconvenient truths, to believe that all is well within his simple and sunny vision of the world,  and we are back to the problem that people will have told him only those things that he wanted to hear.
There are people who we now know have told him strongly that there were real issues with the hiring of Andy Coulson, but for the most part he will have seen them as his political enemies, and the relationship between the parties has been so toxic, in part because of the press, that he will have chosen not to believe what he was told.
We have seen Andy Coulson, again at the centre of the story, battling his way through the crowd of cameras. As always when I see this man I do not see a monster, but a servant seeking to do the bidding of those who employed him; an intermediary between the unspoken desires of his masters and the hidden means of delivering them.
I do not see, because they are not yet visible, the other interests that lie behind all of this; those people and big business interests that supported Murdoch’s view of the world, and wanted his influence over the voting public to continue. Is Murdoch the puppet master himself a useful puppet, a servant of other masters.
I see the big set piece debates and PMQs, where we are seeing a combination of a desire to move on, clear up the intolerable mess, build a better future, with the raw and painful explosion of  anger and the moment of freedom to speak out and expose some of what has been so badly wrong.
I see the committees becoming compulsive viewing. I welcome to the desire to understand what it was that happened, why problems went unchecked, and I worry about our need to put a face on what has happened and create scapegoats for all of this.  
Beyond all of this we are beginning to see the jostling for position. The desire to own and claim credit for the better future.
As the tsunami recedes and we see the wreckage left behind the task is to imagine what this future looks like.  We will get this right if we see the future in terms of the interests of the many, not of the few.
   

First thoughts on Dilnot.

First thoughts on Dilnot.
The Dilnot report on social care funding comes out today. This is an essential part of the complex changes needed to make Hospital care and End of life care work, and of removing a great deal of the fear from old age . Here is Dilnot on BBC Radio 4 Today.
Everyone knows that we need Dilnot. That is why there is agreement to work across parties to make this work.
This is an interesting challenge to the press. – Where is the conflict? What can be said to make this an “interesting” story from the media point of view.
I would suggest that what the press can and should be doing is taking up the challenge of showing people clearly why something that many members of the public will not instinctively take to is in fact in their very best interests.
The press need to help with the process of driving whatever modifications are needed, but also they need to help us to “love Dilnot”.
My own journey towards “the Dilnot solution” began around 12 years ago, when I began to be a full time carer for my mother. A very respectable conservative voting friend took me on one side and advised me to “lose” her limited assets, so that they would not be swallowed up in care costs if mum eventually went into care.
His position showed me that the manifest unfairness of the means tested system we still have are so great that the “respectable” and “prudent” line of action is to take steps to evade payment.
When I looked at this more closely I could see that he was the tip of a very big iceberg of overpriced rented properties for the elderly, and clever financial advisers that are all based on the premise of getting rid of your money before you have to pay care costs.
The cost of all this activity becomes apparent when you see what it is like within a cash starved care industry, where the quality of care is often very far from being what anyone wants. We are also seeing (if we look carefully enough) the cost of this evasion in the quality of life being lived by that elderly lady living out the end of her life in a house several doors down the road from you.
Dilnot is not perfect, any more than its predecessor, the White Paper on Social care produced by Labour in 2010 is perfect. It is the product of the government that we as voters have empowered. It is something that may change a little over time, but if it does not, then I think that we can live with it.
I have not yet read the report, but from hearing Dilnot’s very clear interview on Radio 4 Today  I would suggest a number of key things that Dilnot is getting right.
Raising the Means tested threshold.
 Raising this from the ridiculous £23,000 to £100,000, is something that the Joseph Rowntree Foundation has been campaigning for, over many years.  This is a realistic aspiration for people to have this level of “wealth” to pass on to their children. Some people will fall below this, but it will no longer be “respectable” to try and fall below this more generous figure.  (questions- how does this work with couples?)
Capping the contribution
I was pleased to hear Dilnot say this should be at £35,000 . (We have been hearing a lot about £50,000 – not sure where the pressure for this figure is coming from).
Capping the contribution from the individual does two things. It immediately takes away the fear of unlimited costs, and it makes it possible for the insurance industry to offer some kind of sensible packages to cover this known risk.
This is actually very similar to the proposals I put forward about 7 years ago now.
Recognising costs at home and in care
An anomaly in the existing system is that you can do what I in fact did with mum. You can spend years caring at home. Reach the point where it is no longer possible to buy in enough help to make that viable, and then end up spending £100,000 on residential care costs.  Dilnot’s cap applies to Care in the home and care in a residential home. 
(questions – how do we set the minimum needs thresholds for care provision, – how does this work with the localism agenda)
Hotel Costs.
With all the talk of Care costs, it is important to know what is covered and what is not. The fear is that you get a shift to disguised care costs, being called hotel costs, as has happened in Scotland.  Dilnot addresses this by setting a cap on Hotel costs, at £7,000 which is the minimum income anyone would get from the state.
(questions – is this going to satisfy care providers – what about people who want “a luxury care home” – Will some homes be able to opt out, and will that then put pressure on families to pay “top ups”)
Is it fair to pay out for people who do not need help
Dilnot does mean that rich people will get state help with their care costs. Some will see that us unfair. Dilnot was quick to point out that this works on the same basis as the NHS.  If we are worried about fairness then that is what the tax system is there to do.
Today is only the start of discussion. It is also perhaps the start of a better way of doing politics, and a better way of making our society work for us.
Will it make care any better?
The first tweet I saw on Dilnot is the question will Dilnot make the quality of care better. My answer is yes it can. At present the care funding system is so problematic that most of us just simply avoid thinking about a problem that we cannot deal with and will not go away. The Dilnot framework gives us something we can work with to create a care system that we all “own”. We will all have a vested interest in  making the whole system work better for us. 
Lets do it.  
Let’s use the opportunity.

Insulin, badly drafted law, & the threat of No win No Fee claims.

An increasing amount of time at the Stafford Hospital inquiry is being spent on looking into the circumstances surrounding one individual case.
A press report of the inquest of this case is here.
Last week we heard from the Health and Safety executive who unexpectedly found himself at the centre of the Stafford Hospital mess. He came under astonishing pressures from a number of different directions to use a legislative loophole and open up a legal case.
The HSE took the best advice it could get and backed away from this action, for reasons that were very thoroughly explored in the evidence.  The HSE may have had a theoretical power to act, due to a very loose piece of legislative drafting on an old bill, but taking action in this particular case would set precedents that would have had major implications for all of us. 
The main function of the HSE is to protect the health and safety of people at work. Their 500 inspectors cover the entire working environment for the entire country. They have to prioritise their work. Within hospitals they are often concerned with matters like safe lifting, techniques, they also have some requirement to look at the safety of the premises and equipment.  Here are examples of work that they have done in a hospital setting. The delivery of treatment is not normally considered to be within the remit of the HSE. This is covered by other regulators, and therefore the HSE is instructed to avoid duplication of effort.
The arguments for using this legislation to take this particular case are highly unusual. The case might potentially be winnable, but the effects of this would potentially to a huge increase in the numbers of health and safety claims in all manner of working environments. It would require a massive increase in the numbers of HSE inspectors, and it would mean taxpayers and insurance payers channelling a lot of public money through No Win No Fee lawyers.      
We frequently hear from the press about the unintended consequences of over use of Health and Safety legislation. Here is the most recent example.

This quote is in relation to school trips but does flag up the worrying impact of a claims culture

The people behind unreasonable rulings were often “well-meaning but misguided jobsworths” who go too far, said Hackitt, adding that many organisations imposed restrictions not out of concern for people’s safety but due to fears of no-win no-fee lawsuits for personal injury. Other bodies used the guidance as a cynical excuse to cut services, she added.

This government is keen to reduce red tape and the number of burdensome insurance claims.

The particular case at Stafford is about the failure to give insulin at the right time. This is clearly wrong, The Coroner is clear that it did contribute to the death of a very sick lady, and the family have every reason to be hurt and angry.  

I was certain that I had heard that this is in fact an extreme example of what is a very common occurrence.

I found this study from the US.

The Patient Safety Alert follows a review of 16,600 patient safety incidents involving insulin, reported to the National Reporting and Learning System (NRLS) over a six year period between 1 November 2003 and 1 November 2009. Six deaths and 12 incidents resulting in severe harm were reported. Of the 16,600 incidents, 26 per cent were due to the wrong insulin dose, strength or frequency and 20 per cent were due to omitted medicine. Patients being prescribed or dispensed the wrong insulin product accounted for 14 per cent of incidents.
The NPSA analysis shows the main categories of failings.
administration of a wrong dose,
● administration to the wrong patient,
● use of the wrong insulin type,
● administration via the wrong route,
● wrong timing of doses,
● omission of doses,
● failure to properly adjust insulin therapy, and
● improper monitoring, timing, and assessment
of blood glucose (BG) results.
One of the main things that many families want when their family member has been involved in a tragedy of this nature is to ensure that lessons are learned and that other families should not suffer in the same way. They often have a very generous wish that other people should benefit from the mishap that they have suffered. If we look at the actions being taken by NPSA we can see there is now a detailed programme to improve the care of patients with diabetes in hospital. This will involve a widespread training programme for staff and new safety protocols.
I have no way of knowing if all this was triggered by this individual case, but if it was then it is a major achievement for the family. If this has the effect of reducing the very substantial numbers of insulin related incidents that take place in our hospitals all the time, then they can have the satisfaction of knowing that they will have made a substantial difference to health care.  
It would be good the think that this knowledge, in addition to the great many apologies the family have received may go some way to healing the hurt.
As to taking the case through the courts, maybe for some families there does need to be a way to do this.  It is clear that there was at the time of this incident a real gap in the powers of the Health Care commission. The Inquiry evidence shows us that the clear focus of the HCC was to learn from things that went wrong, and work to improve matters. It was not their remit to focus on individual cases.  That goes a long way to explaining the very real frustration suffered by the families. I am sure that Robert Francis will be ensuring that in the future there are simpler and more effective ways of a addressing the needs of families who feel that the problems they have suffered crosses the line into injustice.
The HSE would certainly see it as preferable that this should not be done through the legislation that they have to operate. They do not believe it would be in the public interest, and I think the figures I have quoted on insulin related cases above indicate that they may well be right.  Cases related to insulin would just a tiny proportion of the potential cases that no win no fee lawyers could seek to bring if this particular legislation was to be used.
The local and national press have been campaigning for justice for the individual family. I am sure that Robert Francis will be taking a great deal of trouble to find a solution that is good for this family and good for the wider public interest.
When we do campaign for a particular course of action it is I would suggest always worth listening very carefully to those individuals who have detailed knowledge of what this would imply; People who can show us the unintended consequences of the actions we take. We need to be careful what we wish for.

What the Ombudsman said.

When I first heard about what would become Cure the NHS, right at the end of 2007 it became immediately apparent to me that there had been a failure of the complaints system at Stafford Hospital.  This raised big questions for me then, and it continues to do so now.
The ombudsman matters.  This is the end of the road for complaints. It is our guarantee that if someone has suffered injustice or hardship as a result of failure of the service, or failure to provide a service or, maladministration, that their case can be examined.  You will find more about the service here
Ann Abrahams is clear that the ombudsman is very much a last resort. People only come to her when they have exhausted other possibilities. For some people this works, and for other people and Julie Baileys evidence shows that this includes her, the process is frustrating.
The ombudsman has to work within the clear confines of a act.
what the ombudsman is empowered to investigate is a complaint that a person has sustained injustice or hardship in consequence of service failure or maladministration.
The case has to satisfy both of these requirements.
Often the cases are not cut and dried. Here is an example that Ann Abrahams used to illustrate the problem
So it may be that somebody comes to us and says: there was a delay in diagnosis and as a consequence, my loved one is no longer with us, and if that diagnosis had been done when it should have been done, because, you know, the referral time for — for tests had been adhered to, then my husband wouldn’t have died. And — and we can look at that and we can, with the benefit of expert advice from our clinicians, we may well be able to say that: yes, there should have been a referral and there should have been a diagnosis, you know, six months previously; but we may also be advised by our professional advisers that it would have made no difference; and therefore that the consequence in terms of injustice as the complainant, you know, quite reasonably believes it to be the case, actually isn’t sustained as a result of one of our investigations. So, you know, the — the two legal concepts of service failure and injustice have to be both present and the injustice has to be as a consequence. That’s what the law gives me to work with.

THE CHAIRMAN: But presumably in a case such as the one you mention, an injustice might be identified in terms of the distress caused by the late diagnosis, even if it has no physical causative effect. 

A. Absolutely, chairman, and I can think of a number of cases in — in which what we’ve concluded is that the – the outcome in terms of the person’s death may not have been any different, but that doesn’t mean there has been no injustice.

There was a discussion on the concept of “worthwhile outcome”.  This is something which is not defined in law, but has been used by the ombudsman’s office as an internal measure to test if anything meaningful can be achieved by pursuing a complaint. There is a clear meaning for this within the office, but this can be less clear to other people.
Ann Abraham says that this has been flagged up by the parliamentary select committee as a concept that can cause offence to some complainants, and they are going to review the use of the language.
For Ann Abrahams what she is trying to identify is if the ombudsman’s action can achieve what the complainant wants. If it can’t do that then is it in the wider public interest? If the complaint has specific wishes like seeking the disciplining of an individual doctor then this is best pursued by other means.
 if somebody is really concerned about the professional conduct of an individual clinician, and that’s what’s eating away at them, then there really isn’t any point in the ombudsman taking that case on for investigation, because at the end of that, we might, if we felt there was sufficient concern about the professional conduct of an individual, make our concerns known to the relevant professional regulator, but it would be a very indirect way of supporting the outcome the complainant was looking for.
There may be cases where there is no point in trying to do more than has already been done in other ways.
And in a case where something may well have been seriously substandard, but the NHS body has acknowledged that and accepted that and apologised for that, and there has been an appropriate remedy for the individual, and there has been an appropriate systemic remedy put in train, and there’s been learning, and the regulator is on the case in terms of follow-up action, then I would say, and I think my staff would say: what is to be gained by an ombudsman investigation for this individual and for the wider public interest in these circumstances?
Ann Abrahams feels strongly that the right way is to aim for local and immediate response to complaints. This shows some of the work being done to establish better complaint handling. They have been supporting the process of improving the complaints process at a local level by visits and training sessions with the 50 trusts with the highest complaints level. With the first of these there has already been a major drop in complaints to the ombudsman.
( I will add my own suggestion here, It may be that the process they are trying to bring about here needs to mirror that of the NSPA, where the aim is to increase the level of low level reporting – which could here be comments or concerns – with the aim of raising issues before they ever reach the stage of being complaints )
She Reacts to Health Select Committee’s report
I suppose I’m always concerned with recommendations which seek a change in the law, when actually what people want is a change in behaviour and it may well be that my office needs to behave differently and we needto use some different language, but I don’t think there’s anything in the legislation which stops us doing that.
She is keen that there should be no major structural changes. It has taken from 2002 to 2009 to get the system to current 2 stage process and she is certain this is the right solution
Previously there was a three stage process, starting local – then going through Health Care commission and then ending up with ombudsman.  The fatigue of dealing with this cumbersome system could well have deterred people from complaining.
The new system is working faster. Ann Abrahams sees complaints coming through now within 6-12 months. Previously it was much longer.
The Inquiry wanted to know why are there so many more complaints?
in 2010 to 2011 you received 13,625 enquiries.
The Healthcare Commission during its time as the second stage received roughly 8,000 referrals  a year.
Ann Abrahams did not have an answer to this.  (I would personally suggest that this may be to do with greater prominence of these issues in the press we have seen that the patients association had to increase its staffing levels from 2 to 6 following the publication of the HCC report, and that there have been a stream of high profile reports, which will all have had the effect of increasing the likelihood of people complaining.
Ann Abrahams was asked if this might reflect worse handling of complaints at a local level. She does not think this is the case. Her caution is that we should try to understand the story, rather than try and deduce the story from the numbers.
The inquiry looks at numbers of contacts, and the numbers that were pursued to investigation . in 2009-2010 there were 15,579 contacts, and only 219 interventions and 349 accepted for full investigation. Ann Abrahams was at pains to say that the presentation of the is data may be a little misleading, and there may be an element of double counting, but she agreed with Robert Francis that investigations were a tiny proportion of total complaints.  This is useful to know as it puts Julie Baileys disappointment that her case did not proceed to investigation into a wider context. The most likely reason why her case did not proceed was that by the time a decision was made she had already been very heavily involved in the healthcare commission report. and the David Colin Thome report and Alberti Report had already taken place. The steps to learn from and remedy the issues her case raised had already been taken and it was unclear that any further benefit could be gained from pursuing an ombudsman’s investigation.
There was some discussion about if it is right that the numbers should be so small? Ann Abrahams thinks that it is. The priority should be to improve the quality of local complaints handling, so that complainants are not subjected unnecessarily to long, drawn out processes.  She feels that the NHS has a long way to go before it can be said to be offering a good complaints service.  In the 2010-2011 year only 2 trusts did not have a complaint to the ombudsman.  
if the NHS is doing the sort of job it should be doing, in resolving complaints locally, and the ombudsman is the last resort in that; well, what size should the ombudsman’s office be? What sort of numbers of complaints should it review and should it investigate? And how much public money, you know, should go into that part of the system? So they’re all, you know, perfectly proper questions. And it has always been my overriding objective to work in a way that drives improvements in the way the NHS handles complaints and delivers healthcare, rather than to suck huge volumes of complaints into a — a national ombudsman’s office.
Ann Abrahams was at pains to add
I’m not for a moment suggesting that everything’s okay out there, because we all know it’s not.
She was asked to look at the reasons why some people will remain  dissatisfied with the system? What are the causes for dissatisfaction
·         outcome of their complaint,
·         no one to help them make their complaint, so the advocacy services were poor.
·         People may be unhappy with how long it took.
·         Is it about the culture in the NHS which provides defensive responses?
She told us that  I can’t shed much light, if any, on the events at  Mid Staffordshire NHS Foundation Trust between  January 2005 and — and March 2009. the pattern of complaints that we received  didn’t provide any information to distinguish  Mid Staffordshire from any other NHS trust, and we had  no other information that would have led us to do so.
With regard to the Health select committee she strongly argues that there should be no major changes to the service. It needs time to settle into the new structures set up in 2009
I spent the five years in this job arguing for reform, and then I spent the following two years working to implement reform, and to achieve a smooth transition and we did that. And what I said in my evidence to the Health Select Committee earlier this year was that the two-stage NHS complaints system introduced in April 2009 is quicker, simpler and more effective than the previous system. And that the new system is already demonstrating its potential and needs to be given time to prove its worth. So the design is good.
But that doesn’t mean that everything is working as well as it should be, and it doesn’t mean everything is working as well as it could be. It doesn’t mean the NHS is performing as well as it should be, it doesn’t mean that there’s no scope for my office to improve the service it provides. But it does mean that we don’t  need to redesign the system.
Her recipe for a  better complaints system  includes
·         Advocacy
·         Information
·         Leadership
·         Time.
Both Robert Francis and Ann Abrahams were concerned about the effect that the complaints process can have on the complainant.  This exchange shows a little of this.
 THE CHAIRMAN: What is the answer to the problem of the complainant who makes a complaint in which they believe and have very strong feelings, which can then, of course, be exacerbated by the system that they have to go through, but you find, as perhaps others in the organisation have found, that there is no actual justification for the particular subject matter of the complaint, but the individual remains firmly of the belief that there is some substance to it?
I mean, in a sense, by definition that’s an impossible problem, but it seems to me from my previous inquiry, and generally my experience, that there is a diaspora of complainants who are damaged by a process, whether or not their original complaint had any foundation to it?
A. Well, I think, you know, your experience and mine is the same. And I think what my office tries to do is ensure that — that we give proper consideration to — to complaints, that we make a decision which is fair to both sides in this dispute and that’s our job, and that we explain the reasons for our decision, if it’s a decision that the complainant’s not going to be happy with, we do this for everybody, but if — if somebody’s not going to be happy with our decision, then our challenge is to explain that with the proper combination of analysis and empathy for what’s happened to them. And we have in place a review process which is my safety net, so that if people think we have — have got it wrong, that somebody who has not had any previous involvement can have a look at it, and — and if we still think that there’s nothing more that we can do or, you know, our analysis of these events is very different, then we will write a final letter and we will usually say that we will look at anything else that the person sends us, but we may only acknowledge any further correspondence, because we have to draw a line. And we try and do that as sensitively as we can.
Here is some more information from the Ombudsman website.

End of life care: some straws in the wind.

It is clear that we are not doing end of life care well.
We have powerful medicines and wonderful delicate surgery which can do things that would have been seen as impossible even 10 years ago. These mean that the conditions which people were dying of just a few years back are treatable. People survive, and that often means surviving in a very frail and dependant state for many years.
During John Major’s government we saw a big shift. We had already begun to see the extending of the “twilight years” and at that point many people were ending up in Geriatric wards in hospitals. It was seen as a problem then, and the cost was crippling the NHS.  The solution put forward by John Major’s government was the community care act which encouraged the creation of private nursing homes, and meant that the burden of costs passed to the individual, with the safety net of means tested payments from Social Care once a life time of savings had gone.
The fact that many people were likely to lose their life savings to pay for care was quickly recognised by the Labour Party and it was one of the issues on which they stood in 1997.
Resolving the question of how we pay for care has proved very difficult. A series of commissions and reports all recommended that we needed major surgery, but offered sticking plaster options. In the face of resistance to anything that looked as if we needed to spend more on the issue we got the sticking plaster. My family was one of the many casualties of this period, with care costs for my mother close to the £100,000 mark.
I recognised that this was not acceptable and spent five years working quietly with my MP to find a fairer solution. I think it is partly because of his quietly insistent work on this that we got the major rolling consultation led by Caring Choices, followed by a well publicised green paper.  We also held a seminal conference here at Stafford University which the MP organised to answer some of my questions. This brought together all the key players from Whitehall, the insurance industry, Health and social care, the voluntary sector and many representatives from our community.
It was not until the white paper of 2010 that we finally had a brave solution offered. For a brief period there was real hope offered on this, with the health spokesmen from the three main parties working secretly together to talk about the solutions. Then the lure of electoral advantage was seized by the Conservative party who broke away from the talks and got the tabloid press into a frenzy with the now infamous “death tax” posters.
My husband’s humorous suggestion that it is all my fault, that I brought down the Labour Government, is I think going a little too far, but I accept that it has at least a few grains of truth in it! Sorry!   
So where are we now?
The Stafford Hospital inquiry has show us that a hospital, especially a busy hospital with chronic staffing shortages and the wrong kind of ward layout, may not be the most restful or dignified place for people to come to the end of their life. The very effective media management methods used by the Stafford pressure group have been successful in forcing many people who would rather not have seen, to face the uncomfortable fact that some of what is on offer as elderly care is simply not good enough.  The media and the press are also completely tied in to this issue. People throughout the country are now being vocal about failures of care in a way that would never have happened before Stafford. The extent to which the Conservative party have aligned themselves with this sentiment means that failures in care under their leadership will not be tolerated. It is now a political imperative to find good solutions.
From the point of view of my interest in the press and elderly care, I am wondering about the press and media stories that will affect the difficult decisions ahead, and wondering if the media can this time play a positive role in allowing all the arguments to be clearly heard.
So how can we do elderly care better at a time of austerity?   Here are a few of the straws in the wind.
The Alzheimer’s society recommendations.
There will be a lot of anxiety that the decisions taken by this government about end of life care . Many people will believe – fairly or unfairly – that cost will be the deciding factor.
It is worth putting a counter argument. The Alzheimers society report “Counting the Cost” showed clearly that people are ending up in hospitals because of failures of primary care, and they are staying too long because good social care options for re-enabling after a period of acute illness do not really exist.
The prolonged hospital stays are a huge and potentially avoidable expense for the NHS. Confused but mobile patients can completely wreck the running of otherwise viable wards as we have seen at the Stafford Inquiry, so the cost and efficiency arguments matter, but long hospital stays for confused elderly patients is something that can be distressing, undignified, at times life threatening, and can destroy future quality of life.
It is a priority to get people out of hospitals if they do not need to be there. We need to recognise that. We need to create the right pathways.
Making the NHS cost effective  
Cost cutting in the NHS and the move towards the GP commissioning is aimed to concentrate minds and stop people passing the problem from one budget to another. It will be in the financial interests of commissioners to ensure that no one ends up in hospital because of lack of support from primary care, and that people do not stay in hospital too long because of lack of good options for helping people return home or to more appropriate care settings.  These priorities fit with the Alzheimers report and also with the Alberti report on Stafford Hospital.
The increased focus on quality.
The NHS has been talking about quality and the ways to improve it and measure it for at least the last decade. Many improvements have been made. The Stafford Inquiry has spent a lot of time looking at this issue, and has ensured that quality will remain high up on everyone’s agenda. This will happen not least because the Stafford Hospital case, coupled with the ubiquitous presence of mobile phones has now made speaking up against poor care fashionable. The media now notices these issues in ways which it never did in the past.  
We need to start asking the deeper questions. What do we actually mean by quality for end of life care. What is a good death and how can we create the conditions for more people to experience this.
Dilnot
Dilnot comes at the end of a decade of commissions and reports on the vexed question of how to pay for Care costs. It will have taken as a starting point the Labour White Paper on social care from 2010. Dilnot will report very soon.  All the indications are that this is going to be very stormy 
It sounds as if there is a preference from some parts of the cabinet for an insurance based care funding solution. This is bad news. It is what John Major tried. It did not work, and that is why by 2009 people were being offered an insurance package by only one remaining insurance company that still thought there was any point in this at a cost of £80,000.
For those who are very rich, too rich to worry about care costs, there is clearly an interest in voluntary insurance packages to fund care risk. For everyone else the best option is for universal risk sharing.  The “Death tax” is only one way of doing this – there are many possibilities.  We need to understand the options better. The media have a major part to play in this.
Southern Cross
The problems with Southern Cross have helped focus our minds. This is the kind of company set up in response to John Major’s Community Care legislation, and fostered under New Labour. Many people feel a great distaste at the idea that this business which is now in real financial trouble, and threatens the security of many very frail elderly people, has been the source of major profits to big business through maximising the profits from property speculation.
There is a need to do things differently. People do not like the sense that their misfortune is the source of profit for other individuals. We should remember Southern Cross and start thinking seriously about community ownership of the care of our elderly.  
The media and local press could be playing an important part in helping promote discussion on these issues.
Steve Field Future Forum.
Steve field has completed his listening exercise for the NHS “pause”.  One of the roles for competition, choice, and other providers that he identified is for better options for end of life care.
Communities have a clear interest in understanding this. If we come together there is an option for community led and community owned solutions. If we do not there will be plenty of big businesses willing to come in and give us “choice” of Southern Cross mark 2!
NICE
It is the Job of NICE to lay out guidelines for Cost effective options for the NHS and care systems. They will research and issue guidelines on ways of delivering the best quality we can achieve at the price we are willing or able to pay. They are now beginning a consultation on end of life care which will end in November.  It would be very useful of the Media can share with us the opinions that are feeding into this consultation. The results of it may be rather important.
Terry Pratchett
Terry Pratchett matters. He is doing a wonderful job of presenting the dilemmas that face Alzheimer’s sufferers. He wants us to talk about the right to die. He has made this an issue that far more people have thought about.
A conversation about better ways to die
There are many taboos in this country. One of them is about dying. We have shied away from this. When I was a child many people died at home. They died quietly and peacefully with their family around them and a little reassurance from visiting doctors and nurses.  Perhaps we were less afraid of it. Now for all sorts of reasons death has become a “medical issue”. The incredibly frail elderly people that we are now seeing often need experts working in pairs to move them, and we are frequently looking at families where the person dying is in their 90s and the person caring is in their 70s.
Many people believe that they need the full range of feeding tubes, drips, help with breathing, and pain relief in order to die a good death. This need not be the case. In the case of my own mother, after having seen three distressing deaths with a lot of medical intervention, and after having read up on some of the more modern approaches to death, I chose minimal intervention. In her case at least it was a very peaceful and positive way to die.
We have lost the art of the good death. Maybe it is now time for the media can tackle this taboo and help us to understand the options more fully.
Over the next few weeks I predict an outbreak of discussion on Death Taxes. Death and Taxes are the two certainties in life. Let us hope that we use this opportunity to ensure we all have the comfort of knowing we are creating the conditions for ourselves and all the people we care for to die well.