where are they now?

When I was a student many moons ago, the head of education at our school of nursing announced that when she was working at the hospital she'd declined a donation for a new type of scanner on the grounds that the funds would have stretched to the scanner alone and wouldn't have paid for people to use it. There was much murmuring about this, and I have to admit that I was among the ranks of the disaffected. Now, in the light of the shoping-list of preventable disasters in Stafford General Hospital which includes staff switching off equipment because they didn't know how to use it, I give thanks for that particular manager.

Rebecca Smith, the Telegraph's medical editor, reports on a litany of failures so distressing that it's difficult reading. For example, some patients had to clean bathrooms themselves, other complained of being left in their own excrement for hours, and one woman, admitted for treatment for bone cancer, caught both MRSA and Clostridium Difficile (C. diff), and had been so ravaged by the latter at her death that her body had to be placed in the coffin in a sealed bag.

In the same paper, Ms Smith has alleged that NHS executives put NHS targets and cost-cutting "ahead of patients", to the extent that between 27% and 45% (between 400 and 1,200)of deaths in emergency care were higher than one would expect - leading to the accusation that "Not since Harold Shipman was still in general practice have NHS patients been so dreadfully betrayed" - Harold Shipman being the GP from the north of England who is reckoned to have murdered over 200 of his patients.

I don't think the statement is hyperbole: for the hospital's board of directors to have carried on regardless in ignorance of the attrition being suffered by the people they were supposed to serve - an allegation made by a local journalist on Jeremy Vine's talk-show this afternoon - is corporate manslaughter at the very least.

Julie Bailey, founder of the pressure group Cure the NHS, also appeared on the show: Ms Bailey's mother Bella died at the hospital in November 2007 aged 86, and helped her daughter keep a diary of the abuses happening on the ward. The campaign's website, which contains a page linking to harrowing letters of complaint, is dedicated to her memory.

Bailey made a surprising allegation on Vine's show, that people who came forward to make complaints were being "paid off", but I wasn't able to make out if this was by the hospital or by the Healthcare Commission, which is currently investigating abuses.

But where are the people who allowed the abuses to happen now? Well, the Healthcare Commission is soon going to be wound up and replaced by the Care Quality Commission, which will be headed by Cynthia Bower, former chief executive of the West Midlands Strategic Health Authority - which had the responsibility of checking the performance of hospitals, including Stafford General. I imagine that the Government couldn't give the post directly to Harold Shipman because, having committed suicide in prison, he's otherwise engaged. (Ms Bower was also named one of the Health Service Journal's 50 most powerful people in health service management policy, along with Alan Johnstone, Secretary of State for Health, who was forced to apologise to Parliament for the fiasco.)

Julie Bailey also pointed to Stafford MP David Kidney, who did a summer's work experience at Stafford General Hospital and said it was ok, although he now says that the Healthcare Commission report is damning.

It all comes back to targets. Targets and tickboxes are part and parcel of games theory as applied to politics and service delivery, and essentially says that if you give people targets and leave it up to them as to how to achieve them, they will excell themselves because they want to be rewarded for good performance. But if all managers and their masters see are ticked boxes without getting onto the floor and working with their employees, this debâcle is entirely unsurprising. Managers are allowed to get away with it all because they are insulated from workers on the ground by byzantine ranks of administrative staff.

Targets don't just infest the healthcare industry - the vice-chairman of the Police Federation has complained of frustration that crimes are being downgraded by the Crown Prosecution service "to hit Whitehall targets for reducing the number of unsuccessful trials".

David Kidney goes to pains to emphasize that "although there are some criticisms of individual staff actions in the report, the criticism is mostly about the systems". Fair point, but the systems are not sentient: they were put in place by managers and management consultants. A whitewash whereby a couple of senior figures are sent on gardening leave and the rest of the blame is forced down to nurses and receptionists (who had to assess emergency patients because of staff shortages) will not be acceptable, nor an attempt by powerful people to claim the Gordon Brown prize for getting out the lifeboats for the ship you've just scuttled.

And neither will be a situation where the Stafford General Hospital is investigated by the woman who failed in her duty of ensuring standards were upheld the first time - even if Harold Shipman wasn't available.