Why didn't the GMC prosecute Mid Staffs directors?

Tom Kark QC said 'the overwhelming preponderance of the evidence is favourable to the defendant doctors' at Mid Staffs. Photograph: Christopher Furlong/Getty Images

The GMC, on legal advice, has decided not to prosecute four medical directors, who were in place during the Mid Staffs trauma years, because of lack of evidence. The mind boggles as it has never boggled before: hundreds of needless deaths and wards full of patients afloat in their own excrement. And yet there is "insufficient evidence". The law is indeed an ass. And the GMC is toothless, impotent and living in another universe.

I have some questions for the GMC and for Tom Kark, the QC who gave the legal judgment.

• Apparently, 26 witnesses were questioned and it was their replies that offered insufficient evidence to prosecute. Who were these witnesses: clinical colleagues, hospital managers, junior doctors, or perhaps (God forbid) a few patients or relatives of the dead? Tom Kark says that "the overwhelming preponderance of the evidence is favourable to the defendant doctors". They were "well-intentioned individuals doing their best in difficult circumstances to improve poor standards". To me this smells like the cosy evidence from professional colleagues, not from traumatised patients.

• Why were there only 26 witnesses? Why not 200 or 2,000? I am sure Julie Bailey, the relatives' spokeswoman, could summon up an army of witnesses, patients and relatives, who suffered over the long years of the Mid Staffs trauma. Or maybe, their evidence, confused and emotional as it would be, would be dismissed as anecdotal" by the fine legal and medical minds of the GMC.

• Why does the GMC not punish managerial incompetence? Tom Kark claims that "all of the relevant doctors have been described as good or excellent clinicians in their own fields and there is no evidence whatever that they personally delivered poor care". But surely, their clinical competence is not at issue here. They were medical managers, and it is their lack of managerial skill and downright negligence that should be investigated. Even if you can't find sins of commission, they have clearly committed sins of omission.

• Tom Kark, in his judgment on the insufficiency of evidence says that "the case would have to be based on evidence of very poor management". There was plenty of evidence for that, I would, as a layman, have thought. I suppose it is the wrong kind of evidence, unfamiliar to the GMC in its day-to-day work of striking off individual doctors for fraud or whatever. Apparently in 2012, the GMC did review the duties of doctors in management positions. Not, apparently, enough of a review to cover the Mid Staffs case. Will the GMC launch another review to cover Mid Staffs-type scandals, and make its procedures fit for purpose?

• Does the GMC ignore past wrongdoing by doctors? Kark says "it is not impairment at the time of misconduct which the panel is looking for, it is impairment of the doctor's fitness to practice at the time of the hearing." Does that mean that the GMC cannot strike a doctor off if they keep their nose clean and if the hearing is delayed for long enough?

• Do Tom Kark and the GMC consider the hospital board's "systemic management problems" to be the sole cause of Mid Staffs, and all the doctors to be whiter than white? If so, they have lost all sense of reality.

It is not only the GMC that has shot itself in the foot with this crazy judgment. It is the whole NHS.

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