What the Francis Enquiry will almost certainly reveal is a combination of the ravening ambition of bureaucratic mediocrities, institutionally perverted incentives that reward those who do worst, the creation of a nomenklatura class at the head of an apparat staffed by bullied, intimidated, fearful but also unscrupulous apparatchiks, intellectual dishonesty with compulsory lying on a vast scale, the proliferation of procedural objectives and bureaucratic tasks completely unrelated either to reality or to the welfare of patients, all combined with a revolting tendency to Pecksniffian self-congratulation and righteousness and an inability or unwillingness to speak or write in plain English.

Not long ago I was asked [to] conduct an inquiry into a spate of fatal events among the patients of an NHS Trust, and to determine whether there was a single factor that explained them. There was not; but when I reported to the Medical Director of the trust that while there was no such factor, it was clear to me that his staff were incompetent, unmotivated and completely unaware of what the purpose of their work was other than the filling in of forms (thousands of them, often with contradictory answers to the same questions in them), he replied with an almost Buddhist calm, ‘But that is the standard expected these days.’ He reminded me of a collaborator in an occupied country explaining that there was nothing he could do in the face of overwhelming military force.