Patient Safety Congress (Part 2): Apologies and Forgiveness

At the Patient Safety Congress, I learned how an apology can bring about a minor miracle. James Titcombe related how he lost his baby boy due to serious failings in maternity care. Although these were later detailed in the Morecambe Bay report, James felt there was still a gap in his healing needs. He had never had the chance to speak to any of the people involved in his son’s death and he was left with a sense that nobody cared. Eight years later the Trust facilitated a meeting with one of the midwives they had suspended. During this, she burst into tears, said she blamed herself, and wanted James to know that she was deeply sorry. They ended up crying and having a hug. For James that was “the moment of profound healing”. 

Four months after my daughter died, I received an email from the Trust responsible for her care admitting that her death was “more likely than not to have resulted from problems in care delivery and service provision of the Trust.” 

I didn’t realise it at the time, but reading this was a turning point. I started to believe that rather than blaming the Trust, the best way forward was to work with them to try to prevent future avoidable deaths. I realised it would be futile and pointless, not to mention unpleasant, acrimonious and probably damaging to my health, to go down any legal route. Shortly after my daughter’s inquest, I met the Clinical Director for the Trust’s Children, Families and Young Person Service to talk about Tobi and what had happened to her. We spent a couple of hours together in which we both cried. Not long after, the Chair of the Trust sent me this email: “May I say how deeply sorry I am for the failings of the Trust and for the loss of your beautiful daughter. I am so desperately sorry that had we listened to her and treated her properly she would and should still be alive today.”

This is what I wanted to hear. Not only an acceptance of responsibility but also, more importantly, a display of emotion and compassion commensurate with the enormity of the tragedy of my daughter’s death. This is the effect openness and honesty can have on the relationship between the bereaved and a Trust. 

Marina Cantacuzino giving the James Reason Lecture, which closed the Patient Safety Congress on Day 1

Marina Cantacuzino, founder of the charity The Forgiveness Project, in her compelling James Reason lecture “Untangling the knot of apology and forgiveness”, the closing session of the first day of the Congress, maintained that a sincere apology “turns on the slider switches that make forgiveness happen in your head” and that “If you’re honest with people often you’re forgiven.”

Hearing her stories of people’s forgiveness made me confront the question of whether I have forgiven the individuals involved in my daughter’s death. I don’t think I have. I’ve been avoiding it. I think I’m probably too scared to meet them, as James did. I don’t know who they are and I think it’s impossible to forgive nameless and faceless people. The reason I have never tried to find out who they are is probably because I am unsure whether I could forgive them. They may be less than willing to meet me too. I hope they think about me, and more specifically about my daughter. I’d be depressed if they didn’t spare her a thought from time to time. It’s hard to forgive an organisation, whatever sympathetic face they may show the public, even when represented by an individual who shows the appropriate contrition. It’s part of a CEO’s job description to offer an apology for other people’s errors which, however uncomfortable, is easier to do than front up for what you yourself have done. It’s much harder for the person who’s made the fatal mistake to apologise. But it’s a thousand times more sincere, and powerful. As James can testify.

Marina’s thesis makes sense, but I have yet to unentangle her knot. Should I forgive? Can I forgive? In my view whether or not I can forgive should not matter. Learning from mistakes and changing behaviour can and should happen without waiting to be forgiven. Forgiveness is meaningless if the same mistakes continue to be made.

I don’t know if I will ever reach a place of forgiveness. Just because it worked for James does not mean it will work for me. I’m not as brave or generous as he is. An apology did work for me, but I am still on the path to forgiveness, and I don’t think I will arrive there on my own. I am not a good enough person to make my forgiveness unconditional. It needs to be contingent on learning. I don’t think I have it in me to forgive people who will not change their behaviour to keep patients safe.  

What did I learn from the Congress? Did I take away anything positive? Some of it was undoubtedly uplifting even though some of it was dispiriting. I did gain new perspectives, including insight into my responses to my daughter’s death, but they haven’t altered my goal – to save just one life. It made me think it might be harder to achieve than I believed but it hasn’t totally discouraged me. 

So that’s where I ended up after two days. Not at all optimistic about the prospect of organisational and cultural change, which I doubt I can influence anyway, but more so about the power of individuals to make a difference, by persuading, through their actions, other individuals. Which is what I’ll continue to try to do. It’s what feels right for me.

About Trevor Stevens

Trevor’s career has been spent teaching in schools and working as a publisher and trainer for educational publishers, and he is now self-employed. His daughter Tobi took her own life in December 2020 whilst in the care of the Norfolk and Suffolk NHS Foundation Trust. Trevor’s focus since Tobi’s death has been to tell her (and her parents’) story so that the importance of including families in the treatment of young people with mental health problems is recognised and valued as a potentially life-saving resource.

You can read Part 1 of his impressions of the 2023 Patient Safety Congress in Manchester here.

2 thoughts on “Patient Safety Congress (Part 2): Apologies and Forgiveness”

  1. Before I lost my daughter, I thought forgiveness was a simple thing. Sitting with my vicar a year after Bethy died, I explained to her that I was weighed down, because I was struggling to forgive the person responsible – especially as they weren’t at all sorry. My vicar told me I didn’t have to forgive them …indeed I shouldn’t – because to forgive that person would be to submit to his control, just like my daughter had. A very different scenario, but an illustration of how forgiveness is so complex. I have now forgiven, in my own time, because it releases me to focus on more positive things, but I will never forget, and certainly don’t choose to spend time with this person or listen to them. I have forgiven because I realise that it wasn’t just his fault and that my daughter, like Tobi was failed on so many levels by systems, processes, misdiagnosis, dismissive responses and general unkindness. We can in time forgive, but we will never forget.

  2. This is distressing enough just to read; I cannot imagine how painful and traumatic it must be to write it. However, it is really important that people like Trevor do this so that the rest of us can begin to understand the issues involved in these unbelievably awful events and situations. I detect some similarities between health and education authorities first on the not always positive approach to whistle blowing and gradually now on the approach to apologies. As a much less significant example than Trevor’s, when I was a Head, a member of staff came off her bicycle when going over a new, high — and disputed — speed bump in the school grounds. It was clear that she was at least moderately injured by a blow to her head [ despite wearing a helmet ]. I received an instruction from the School’s solicitors that I was on no account to apologise to her and preferably not to visit her at home to express sympathy. This was all to avoid the danger of litigation and claims for damages. I ignored the instruction; my apology was greatly appreciated; there was no claim against the School; and eventually the staff member recovered. I notice a report today that King Charles III expressed ‘ great regret ‘ in Kenya for wrongs committed in colonial times but ‘ stopped short of an apology ‘ presumably, it was alleged, under the influence of the British government. I believe this fear of apologising and tendency to shy away from it is an unwelcome, sad and dangerous development in our society. I sense that Trevor’s family and doubtless many others will have suffered from this negative practice and it would be so healthy and positive if society could move away from it.


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