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, 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.