Culture of institutional defensiveness must end at organisations like the NHS and the Post Office - David Behrens

And that isn’t even the worst of it – because for years afterwards these people and their families were denied the dignity of an apology or admission that anything had gone wrong. Instead, the NHS closed ranks to protect its officials, lying to ministers and making a mockery of the regulatory framework that was supposed to hold it to account.

But let’s not get bogged down in the bureaucracy of it, for this is a story of desperate personal tragedy – as Colin and Jan Smith will testify. Their little son, also called Colin, was just seven and weighed only 28lbs when he died in his mother’s arms after being infected with HIV from products used to treat his haemophilia. His parents believed he’d been used as a guinea pig and died from needless treatment. Perhaps you saw them on Channel 5 on Monday, kissing their son’s photo and putting flowers on his grave.

For years they campaigned for accountability; all they got was a brick wall. And that is the real scandal here: not that mistakes were made but that no-one had the courage to own up to them.

It’s why the NHS can’t go on as it is, empowered by a culture at odds with its mission, which puts self-interest above patient care and exists for the benefit of managers not medics. It’s also why Sir Brian Langstaff, in his report on the infected blood scandal, insisted that culture change must happen within the service.

For although no-one emerges with any credit, this is an outrage that can’t be laid purely at the feet of politicians. Ministers can act only on information they are given; they rely on those who are supposed to brief them not to look them in the face and lie through their teeth.

As Lord Lansley, health secretary under David Cameron put it, ministers were “repeatedly advised that something was true which was not true”. It’s this institutional defensiveness that must end, and while there is already a “duty of candour” on health workers to be honest with patients about mistakes, no such requirement applies to mandarins in the Department of Health who, in the words of another ex-minister, kept their grubby secrets to themselves and treated the casualties as an inconvenience to be managed.

That era is clearly coming to an end. Ministers don’t like being made fools of – they’re good enough at doing that themselves – and will likely take their revenge by placing a legally enforceable onus of honesty on every civil servant.

It’s a necessarily wide-ranging sanction, for this is not an NHS issue alone. We are seeing the same lack of transparency from the Transport Department as it seeks to defend its flawed decision to do away with the hard shoulder on ‘smart’ motorways in spite of safety advice. Some 22 people died on such carriageways in 2022 alone.

And of course our Post Office leads the world in the abuse of power by managers who believed they were indestructible. Its former boss, Paula Vennells, appeared delusional at the Horizon inquiry this week as she boo-hooed her way through her multiple failings. “How could you not know?” she was asked repeatedly of the campaign of lies that saw hundreds of subpostmasters falsely prosecuted because of a broken IT system.

Vennells had no answer. She didn’t even seem to understand the question. She is a living example of corporate mediocrity; of puppet managers put in place because they pose no threat to the hierarchy above them.

Hers is an organisation beyond redemption for it doesn’t really matter if the nation distrusts the post office. It always did. But the NHS is an instrument of life and death; it will have to find a way to regain our faith.

And though it has a mountain to climb, the answers are in plain sight. We will judge it, as we always have, on how quickly we can see a doctor when we need one, on the length of hospital waiting lists and the availability of services close to where we live.

These can be addressed not just by pouring ever more money into a bottomless pit but by proper management of the people and resources the service already has.

It will be the job of whoever is health secretary after July 4 to hold managers’ feet to the fire to make that happen – so that when next they tell us things have improved, we might begin to believe them.