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Editorial: Good Report, Bad Spin

The Chief Medical Officer has just published An Organisation with a Memory 1 which deserves to be read by all of those with an interest in standards, governance, audit and litigation involving both NHS and private medical care. The report brings together a number of acknowledged experts in the relevant disciplines, including aviation safety which has a considerable amount to teach us about medical accidents, involving both human and technical failings. The report contains sobering statistics about the magnitude of the problem within the National Health Service together with a detailed and thoughtful biography for those who wish to explore the subject in more detail. In general terms it is well written and readable and the level of jargon is unobtrusive and fairly acceptable. The accompanying foreword by the Secretary of State for Health deserves to be read if only for its unexpected irony given the circumstances in which the report was released. The report points out that medical disasters can result from rogue doctors or system failures but is rather circumspect in concluding that the latter are quantitatively far more important. A standardised and centralised mechanism for identifying, reporting and analysing adverse incidents is required. This could usefully be based on the immense experience already held by the Medical Defence Organisations and the NHS Litigation Authority. It is unclear whether such information relating to serious and ongoing problems would be used by government agencies such as NICE and CHI to identify problems which require urgent investigation. Members of the Society will recall that Professor Donaldson prefaced his recent presentation (see pages 89–100) with the disclaimer that resources were not to be the issue under discussion and the political reasons for this are fairly clear. Editorial comment in the BMJ on the report 2 is generally enthusiastic, although tempered by a