Doctors were to blame, if not wholly to blame

EDITOR—Although I am sympathetic to much of the argument in Smith's editorial, I must challenge the use of the word scapegoats.1 The key individuals in Bristol declined to face up to growing evidence and growing anxiety among their colleagues about their own standards of work. There are other examples, in pathology to name one, where subsequent review of failures in standards and governance could be attributed in part or in full to the unwillingness of senior doctors to consider that they might in some way be wrong. This is linked to training and management of doctors, which continues to encourage a strong degree of individual rather than team working.

I have visited regional specialist units where senior clinicians have not spoken with or met each other for 10 years. They seemed proud of this, management felt powerless, and so a situation that was inevitably damaging to the services given to patients was allowed to continue. It is taking the point about wider difficulties in the health service too far to say those involved in Bristol were scapegoats. Nor is it fair on the many in the NHS who have not allowed similar lapses in standards to occur. Those at the centre of the problems in Bristol were indeed to blame even if they were not wholly to blame.

Excellence may not be immediately achievable

EDITOR—With reference to Smith's editorial, the Bristol affair has added more support to the system of clinical governance that drives our new culture of delivering only excellence.1 …