On Trust

Last week’s blog centred on Scottish Health Minister Shona Robison’s speech on day 1 (October 1st) of the Royal College of General Practitioners’ annual conference held in Glasgow.  Fast forward to the morning of October 3rd.  One of the presentations was given by Nick Ross, erstwhile BBC TV Crimewatch presenter talking, not surprisingly about crime.  GPs are interested in crime because crime and pathology are inextricably linked.  Mr Ross’s talk followed that of Shami Chakrabarti who was an extraordinarily charismatic and inspirational speaker whose talk “On Liberty” received a standing ovation.  The chairperson said “Follow that, Nick!”  Well, he did, with his own style and aplomb.

Mr Ross’s thesis was that crime prevention could learn a lot from preventative medicine.  He thought that crime, like disease, has a propensity to be endemic.  Society, he said, is not made up of crims and non-crims.  We are all potential criminals.  He challenged the audience. “If you have never committed a crime, raise your hand.”  I didn’t look round, but I gather there was no show of hands.  The Left, said Mr Ross, thinks that crime is caused by poverty; the Right thinks that crime is caused by individuals who choose to commit it.  Neither side is right, claims Mr Ross.  Crime is a product of temptation, and opportunity.  Remove the opportunity, and hence remove the crime.  If your car is burglar proof, it will not be stolen.  Society needs to take steps to vaccinate itself against crime, by removing temptation and opportunity.

To be honest, I found the notion rather dispiriting.  But I can see it has a certain validity.  Injury prevention has proceeded along similar lines.   I was reminded of the work of William Haddon, the father of injury prevention in the United States.  He would say, “There is no such thing as an accident”; he would fine his colleagues whenever they used the “A-word”, and thus he applied epidemiological principles to the disease of trauma. He devised a system known as “The Haddon Matrix”, which examines any traumatic incident in terms of the incident’s host, vehicle, and environment, along a time line of pre-event, event, and post-event.  So, with respect to a road crash, pre-event you get the driver to wear a seat belt, you give him a car with a good set of brakes, and you put a speed limit on the road.  During the event, the airbag deploys, the car doesn’t disintegrate, and the crash barrier withstands the impact.  Post event, the fuel tank doesn’t explode, the driver receives excellent Advanced Trauma Life Support, and the scene is investigated in order to learn lessons to improve outcomes in subsequent incidents.

Yet even Prof Haddon didn’t neglect the need “to fix the nut behind the wheel.”  He didn’t try to exonerate bad drivers.  Mr Ross seemed to imply that dishonesty, the propensity to commit crime, is inevitable.  I don’t believe this is so.  I know plenty of people who choose not to commit crime, all the way from breaking the speed limit to grand larceny, not because they are frightened of getting caught, but because they know it is wrong.  My father, who happened to have been a policeman, used to say, “There are two kinds of criminals.” (I think possibly he was referring specifically to the crime of theft.)  “There are the needy; and there are the greedy.”  It might be a stretch to say that that is the difference between blue collar crime, and white collar crime, but greed does seem more obviously to be a propensity of the wealthy.  The more you have, the more you want; the more you consider yourself “entitled to”.

Mr Ross’s pragmatic approach, to remove the moral dimension from the debate, is certainly the modern way.  If a group of senior executives are found to have rigged the bank rate, or to have diesel emission software rigged on their watch, they will put their hand up to own up, not because of a crisis of conscience, but because they have been found out.  They certainly won’t admit that they did wrong, rather they will say that they “fouled up”.  They “let people down”.  It was “an error of judgment.”  And so on.  This is of course all bullshit and I use that technical term specifically, in the sense of Harry G. Frankfurt, the Professor of Philosophy Emeritus at Princeton University, whose two tracts, On Bullshit, and On Truth, are surely the definitive treatises on present day moral philosophy.

The trouble with removing the moral dimension from crime prevention is that all you are left with, all you can do in response to criminality of any kind, is put systems in place designed to prevent a recurrence of malpractice, by manipulating the environment to make it impossible for people to transgress.  It’s the only thing you can do if you start with the presumption that “everyone’s a dodger”.  This is what happens when inquiries are conducted into institutions such as hospitals or care homes placed into “special measures” because of a scandal, usually involving cruelty, bullying, neglect, perhaps even wrongful death.  The inquiry takes a very long time and then comes out with a fantastic number of recommendations – maybe hundreds of them.  These are designed in part to placate the desire of deeply wounded relatives who understandably wish that “nothing like this must ever be allowed to happen to anyone else”.   The Mid-Staffs Inquiry into the failings at Stafford Hospital, published on 6th February 2013, had 290 recommendations.   Individuals implicated in such inquiries may or may not be held accountable, but either way the entire institution will in effect be punished and diminished – rather than helped – because it will be made impossible for the workforce to live and work normally.  The larger the number of recommendations, the less likely it is that the persons conducting the inquiry have reached some sort of diagnosis and formulation as to what has really taken place at the institute.  If they had, they could probably have put it all into an executive summary on one side of A4.  Critical to such recommendations would be the one that is paramount:  a small group of people in charge of the institution must be honest, trustworthy, kind, and competent.  That’s all.  Rather than trying to micromanage the institution, the inquiry should make it possible to empower a trustworthy leadership, and then say, “We trust you to fix this.”  An inquiry with 290 recommendations cannot see the wood for the trees.  Such inquiries are the product of communities whose members no longer trust one another.  I return to the Duke in Shakespeare’s Measure for Measure:

There is scarce truth enough alive to make societies secure, but security enough to make fellowships accursed.

If an entire society loses belief in the trustworthiness of its members, it can only be sustained through the application of totalitarianism.  We come to inhabit a monochrome moral universe in which, as Prof Frankfurt has said, we lose even the sense of where our own individual identify stops and another’s begins.

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