A good part of my working week is spent in other people’s offices where I've noticed that there are little signs telling people how to use a microwave, what the fridge policy (a fridge policy!) is, reminders not to steal and that in the event of a fire they must leave the building to avoid being burned to death. In one office there were 14 full colour, laminated notices telling people to come to work on time, not to pour boiling water on toddlers, to avoid spreading infectious diseases, the sink policy – yes, really - that time in the kitchen was being monitored, and that staff attendance was under review.

This in an organisation that "doesn't have the money" for a box of tissues.

I'm a big fan of Health and Safety legislation, it really is necessary to tell people that hot water is hot, but Health and Safety is not the issue in an organisation that feels it necessary to watch how long individuals are spending in a kitchen.

The private sector doesn’t seem to have the same issues. People there somehow know how to use a fridge without needing a policy. It's not that people who work in the private sector are any brighter than people who serve the public, far from it. It’s more that initiative is more likely to be nurtured rather than treated with suspicion and organisational vision tends to be wider than what’s happening in a microwave.

Work in the public and voluntary sectors is too often reduced to a Kafkaesque model of not-work where flair and imagination are perceived as suspect and personally threatening. In the private sector innovation, ideas and positive critique are more likely to be welcomed.

I've worked in places where little children bellow and cry too much while stressed workers scream nursery rhymes at them. The staff have obviously gone through training and got appropriate qualifications. The staff ratios are legal and the toilet-cleaning rota is managed very well, everything is fine on paper and that's all that matters. Sickness rates and staff turnover are costing an arm and a leg but the funders are content with the reports sent to them. Funders tell organisations what they expect to hear and then organisations repeat it back to them including, incredibly, sending them ‘case studies’ instead of saying, “No, we will not send you a case study because that would be entirely inappropriate.” Instead, organisations make case studies up.

It's true that many people are put into positions of responsibility that they are not worthy of and they can have a profound effect on the people working under them. It's an irony that those people who don't feel anxious about being competent at their job, who believe they're indispensable to the organisation, are more likely to be so comfortable at work that they feel no need for personal development. Similar problems arise when a leader isn't confident enough to lead but just keeps doing what they're told rather than saying, "Why do we need to be told not to scald children? What's going on here?"

Writing a fridge policy is not a good use of anyone's time. Any organisation that needs a fridge policy has far, far greater problems than manky yoghurt.

The Mid-Staff Enquiry will create a great deal of media noise but I’m not sure it will make much of a difference on wards where health care workers feel justified in taping a dummy to a sick infants face. That speaks to me of becoming utterly shut down and divorced from reality.

I trained as a nurse back in the 80’s and frankly didn’t like my job very much until I got off the wards. Part of my discomfort was that there was always too much work to be done by too few nurses. Part of my despair was seeing patients treated as ‘The Chest by the window” “The Abdomen in bed 10.” But we were never allowed to speak about patients with contempt and leaving anyone lying in their own waste was genuinely unthinkable, a personal failure that would be punished. This was during the first rabid set of cutbacks, when one qualified nurse and two students routinely looked after 30 patients.

An elderly care ward I worked on as a student was run by a self-satisfied nurse who cared not a jot for the people under her care. The routine for meals was to place as many patients as possible on a commode and put their food in front of them to save time. We quickly got used to doing this, especially since she was a bully and doctors and other professionals who attended the ward made no comment on it. This was a culture of box ticking so that the smug nurse, who could barely drag herself round the ward, could pay for her holidays. And even so, we fed patients who couldn’t feed themselves.

Is it surprising that “Bullying is endemic in the NHS”?

Nurses now no longer curtsy and avert their eyes when a surgeon graces the ward but health care remains a rigid hierarchy, and as in any hierarchy the most vulnerable are at the bottom of the heap: in the NHS that’s patients. It used to be that a sense of vocation and a national culture of pride in and respect for nurses gave nurses satisfaction and self-respect which didn't make up for the lack of a decent wage but went some way towards making it more bearable. I remember hating the ‘Angels’ label, I wanted higher wages and reasonable working practices, but in the endless grasping for 'professionalism' we got the worst of all worlds: unrepresentative wages, a loss of status and clearly a loss of purpose.

What kind of dehumanizing process does someone have to go through to leave people to starve to actual death, to lie unwashed for a month, to withhold pain relief? Were they born a casual torturer? Do casual torturers make their way to hospitals to get their kicks? Or is it that culture can be so strong as to actively create and reward people who behave like this and scapegoat those who whistleblow? The answer from today’s Francis Report, and from the experience of anyone who’s ever studied any group is a resounding Yes.

Mid Staffs is by no means alone in allowing grotesque failures of care and I suspect yet more revelations about abuse in hospitals will quickly come to light. Where people are vulnerable other people become abusive. That's been the case throughout history and we just need to say that out loud and deal with it. One of the ways of dealing with it is looking at the causes and cultures of good practice wherever it occurs - in a ward, an office, a children's home, a business, a charity. Why do some wards retain their staff, have great results and no complaints? Why do elderly people in some homes live longer and experience less illness? Even more valuable would be to take notice of the huge numbers of such studies which already exist and actually implement their recommendations.

We all are part of the culture around us which at present is frankly pretty crap. We all value and devalue certain kinds of people so that we can feel better about ourselves. When we become too comfortable with that we risk becoming shut down, divorced from reality, capable of doing shameful things.