Four hundred and fifty-six people dead. That’s a large-scale tragedy. But that is the number of elderly people killed with opiate painkillers applied without medical need. It happened at the Gosport War Memorial Hospital over 12 years from the late 1980s. (The independent Gosport Report was published on June 20).

Apparently two nurses reported their concerns back in 1991. They were accused of “making waves” and the ranks closed. It wasn’t until 2014 that the initial Jones Inquiry into Gosport was held. It was described as comprehensive and devastating. The Observer commented on the “complete unwillingness of the NHS to listen to complaints and respond to them”.

In one respect I was not surprised. I have written before on the question of communication in hospitals. I referred, in this column, to the Clergy Review of July 1964 in which the late Professor Donald Nicholl, a great and holy man, used a revealing secular example. He reported on a study which a distinguished sociologist had carried out on hospitals. Professor Reg Revans had been asked to find out why certain hospitals had a particularly poor record in retaining junior nursing staff. Closer investigation revealed that a similarly high turnover was present at all levels, up to the most senior.

As a good scientist, Revans took a comparison group of hospitals which had low turnover of staff at all levels, and he examined a range of hypotheses which might throw up essential differences. The contrast turned out to be the quality of communication.

The poor hospitals were, of course, communicating, but the direction of communication was typically downwards. Each level treated the level below as idiots, and the final level of idiocy was the patient at the bottom of the heap. Virtually no communication travelled upwards, and, interestingly, there was very little lateral communication – that is, the different professional functions chose to insulate themselves from each other.

The good hospitals had an easy flow of communication upwards and downwards, and the professional groups worked comfortably together to maximise efficiency. In only one respect did the good hospitals have a higher turnover: the patients had shorter stays because they got better more quickly. It was as if the poor hospitals existed to maintain themselves, with the patients as no more than an unavoidable nuisance, while the good hospitals worked together, and with the patients, in the shared objective of healing. Could the former be a description of Gosport Hospital?

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