Alternative title, not to be used publicly: how to protect your reputation at all costs

When a patient dies 

1. Don’t bother apologising or the family might get the wrong idea and try to sue us.
2. Assign as much as possible to ‘natural causes’, especially if they’re using mental health services, have a physical disability or are learning disabled. Science has come on leaps and bounds but ‘these people’ still die prematurely. If the family challenge you blame a degenerative condition (it doesn’t matter if they have one or not), say it’s what she would have wanted/they had a good innings/they’ll not suffer any longer.
3. Impress upon the family the need to ‘accept that they’re gone’, advise them to ‘move on’ and offer to help them to do so, don’t actually offer any bereavement support or real help though, we don’t have the budget for that, but we can offer as much pop psychology advice as we can muster (your local comms team can advise).
4. Remember at the moment there is no statutory duty on doctors to report any death to the coroner (See page 29) so we should exploit this loophole while we can. Keep the local coroner on side, tell the family an inquest isn’t required if we know what their relative died of (see Point 2), and do what we can to close this down before it becomes anything substantial. There’s always more danger of the truth emerging if there’s an inquest.
5. If the family persist in being troublesome suggest that they come into the Trust head office to meet the CEO or a Director; never give medical records or information freely, always make them come to us to collect it – the more we force them to visit the Trust where their relative died the sooner they’ll break.
6. Try not to ‘invoke the Duty of Candour’ if at all possible. Don’t worry about those who suggest we should be open and honest in all cases, no-one is really clear on what the Duty of Candour actually means at the moment and we can claim we’re 100% candour compliant irrespective of our actual behaviour or performance.

Inquest preparation

1. Consult the in-house legal team and ensure that we book legal representation from someone who’s made their career out of squashing families and defending the indefensible. If you’re in doubt of who to go with then choose Capsticks because they’re solidly focused on our shared interest – reputation: ‘Capsticks’ inquest team can help protect your organisation’s reputation and give your staff the support they need in the lead-up to and during an inquest’. That’s always what matters the most, reputation.
2. Make sure staff know the drill. It’s sensible to give them some coaching so that they all stick to the same story, it probably doesn’t look good if that gets out though so in our internal policy we call it ‘inquest preparation and support’.
3. Tell staff to try and dig out something smart to wear. If they’re on maternity leave they can bring the baby to the court cafe, with a bit of luck the jury if there is one, or the Coroner either way, will see them as caring.
4. Make a judgement call but if it looks like the staff member might not stick to the same story as we want out there then cut them adrift a week or two before the inquest. Let the Coroner know so he can register them as an Interested Person.
5. Disclose information as slowly as possible. Make relatives jump through as many hoops as possible to access records. Always make bereaved relatives prove their relationship to their dead relative.
6. In an ideal world all information should be disclosed before the inquest starts, but get real, we don’t work in an ideal world. In the real world you can disclose as late as possible – the days or weeks before the inquest starts, indeed if you’re really clever you can disclose new information during the inquest. If the family challenge as to why the records are being drip fed to them blame: human error; Rio or the medical record software package; the difficulties in having paper and electronic records; the weather.

In court 

1. Make sure the family know how hard it is for staff, survey them before they give evidence and inform the family of any recent bereavements, health complications, stresses or strains. Make the staff look human.
2. Make the most out of the opportunity for a little get together. Remind staff they might like to bring a picnic lunch, hugs and back slaps of each other when they’ve had their time in the dock is ok (morale is desperately important) but try not to cheer until you’re out of court. Some families have complained before that staff are smirking and giggling during the inquest, don’t worry just because they’ve lost their sense of humour.
3. Say as little as possible. If you think you’re going to say something that might damage the trust’s reputation then say nothing, or ‘I don’t recall’, or ‘I’m sorry I don’t think I understand the question’.
4. If there’s a jury make sure that they see you apologise to the family, don’t worry about looking at them, just somewhere in the general direction will do. Phrases such as ‘I’m extremely sorry X died’ are ideal, that doesn’t take any responsibility for your role in the patient’s death. If in doubt refer to the patient’s death as a tragedy.
5. Try to elicit sympathy for staff; there are a number of strategies for this: paint a clear picture of how difficult the patient was – blame their mental health/physical health/disability or if all else fails their family; emphasise how saddened (deeply saddened if you’ve really cocked up) staff were at the patient’s death; talk about the government cuts and how no-one goes into medicine to harm anyone; if all else fails paint the family as having unreasonable expectations (indeed Jeremy witch Hunt has given us a useful steer on this).
6. Try to get the expert witness on side, if you’re unlucky they’ll apply a level of rigour and critique that may end up showing what actually happened, if you can’t get them onside then try to pull apart their qualifications and question their fitness to be an expert.
7. Never let a statement of poor care be left unchallenged, if in doubt counterbalance it with something good, for example if there is an independent review or an inspection report showing failings in all areas of care, make sure the jury hear that you’ve since been complimented on the choice of curtain fabric in the waiting room.
8. Don’t worry too much about time keeping, yes there’s a bereaved family involved but we need to make it clear to everyone else that we’re important and busy people. Don’t even worry if the outcome is due, your lunch is more important.

Most senior trust witness

1. Apologise to the family (see advice above) in front of the jury, or via a press release issued to the media. Never do it in private or without an audience, it’s just a waste.
2. Repeat back the questions you’re asked to try and appear knowledgeable.
3. Make full use of the bland platitude strategy. A golden favourite is ‘a tragedy such as X’s death can not be allowed to happen again’ don’t worry about the fact you say this twice a month, no-one will ever check or join the dots.
4. Always emphasise what has been done since, if in doubt ‘We have developed an action plan’ make sure it sounds like something is happening. If in doubt always state that ‘work has started’ that way you’ll not have to produce any evidence of anything actually happening.
5. Never miss an opportunity to trot out the ‘lessons have been learnt’ phrase, indeed you’ll not complete your Inquest Bingo card without it.

Once a decision is reached 

1. If it looks like we’re going to get away with it then don’t bother sending anyone to listen to the outcome, its taken enough time already and the family aren’t going to get what they want so we don’t have to worry about offending them any more
2. If it looks like we’re going to be slated then don’t bother sending anyone to listen to the outcome, its taken enough time already and the Coroner will send us a report in the post and we don’t want to be caught having to faux apologise to the family again (see Point 1)
3. Reassure the Coroner that everything is in hand, if they issue a Prevention of Future Death report treat it as the bureaucratic inconvenience it is and make sure you get on record in court that you’ve already got an action plan and have learned lesssons
4. Try to keep a straight face when the Coroner says he’ll investigate the delayed disclosure of documents. We all know that will amount to a line telling us off in a letter, he has no legal jurisdiction over us. Remember we don’t work in an ideal world (see Point 6)
5. If there is likely to be media interest make sure the Comms Team have put together a press release. In it say we apologise to the family, but don’t give a copy to them or say it face to face. If pushed you can always say you said it in court. This ‘apology’ is purely a reputation management stunt. Use the pick and mix template (action plan/lessons learned/tragedy/never happen again/staff were distraught/very busy/government cuts) and don’t worry too much about the fact it’s the same thing you said a fortnight previously, few of the local journalists make the connection (keep a watch on those that might and invite any you think you can get on side for a special day in the life with the CEO – it will make them both feel important and we can impress our perspective onto them).
6. Don’t forget to thank the Coroner for the opportunity to share with them the brilliant, award winning work you’ve done off the back of this patients tragic, untimely death.

This guide is obviously fictional, but it is based on family experiences shared on social media of engaging with the NHS around an inquest process. To quote Mark Twain ‘truth is stranger than fiction’, almost certainly so in this case.

I do not mean to diminish how daunting giving evidence in a coroner’s court must be for most #NHS staff, so much as to juxtapose that reality with the reality faced by a bereaved family whose lives have been turned irrecoverably upside down by their relatives death, and for whom this isn’t an unfortunate inconvenience to get through, so much as a defining and in some cases brutally destroying process.