Newdick and Danbury1 rightly point to the depressing fact that not much seems to have changed since the Kennedy report2 following the Bristol scandal. The Bristol inquiry concerned the standards of care applied in the treatment of a relatively small group of patients, namely babies with serious heart problems, devastating and tragic though the consequences of failure were in those cases. The exposures at Stafford showed that many of the issues seen in Bristol persisted and affected many more patients. Doctors in Stafford showed themselves as reluctant to engage in clinical governance as their Bristol colleagues had been. Arguably ‘club culture’ existed in the managerial sector as well as the medical profession.

Newdick and Danbury's argument that the deficiencies exposed in Stafford were not unique to that trust has been strengthened since by the Secretary of State's expressed concern that standards at some other hospitals are ‘mediocre’,3 and the strong echoes of Stafford discovered at a number of other hospitals by among others, the Keogh Review.4

A number of professional staff at Stafford must not only have realised what was happening to patients, but have dissociated themselves from any personal responsibility. Why did the duties imposed on healthcare professionals have so …