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Archive - Year: 2010

May 11, 2010

Dr Phil’s Private Eye Column Issue 1263, May 12, 2010
Filed under: Private Eye — Tags: , , , — Dr. Phil @ 10:07 am

Bully balls

Whatever happens to the NHS post-election, it desperately needs to be freed from its bullying culture. ‘New’ Labour talked a lot of tosh about devolution and empowerment  but controlled mercilessly from the centre and swept dissenters aside, as illustrated by the shockingly unfair dismissal of the chief executive of Royal Cornwall Hospitals Trust (RCHT) John Watkinson.

Watkinson took up his post in January 2007 and proved to be a popular and effective leader until he had the temerity to challenge Sir Ian Carruthers, the chief executive of the South West Strategic Health Authority (and a former acting Chief Executive of the NHS). In 2008,  Carruthers decided to centralise upper gastrointestinal’ cancer cervices to a single site in Plymouth rather than spread them out over the three existing sites in Plymouth, Exeter and Cornwall.

The need for reconfiguration was not disputed by Watkinson – complex treatment needs a concentration of expertise and resources – but he wanted more debate about whether Plymouth was the best choice and was wary of the fact that the then health minister Ben Bradshaw had lent support to his own unit in Exeter, which would have left Cornish patients with a two-hour trip to Plymouth without much benefit. But most importantly, he wanted to ensure that his hospital’s legal duty to proper public consultation was enforced.

Carruthers was less keen on public consultation. In a meeting in May 2008, he tetchily announced that the entire population of Cornwall could sign a petition opposing his plans and it wouldn’t matter, because this was government policy. Watkinson’s legal advice was that this hospital would be breaking the law if it avoided public consultation  and informed the RCHT board of this.

Watkinson and his chairman Peter Davies were then summoned to a deeply unpleasant meeting with Carruthers and told to toe the line. Instead Davies resigned his post and later, Watkinson was invited to take a ‘special leave of absence’ in September 2008 and subsequently sacked, and medical director Dominic Byrne resigned in protest at the treatment of Watkinson. So despite having the overwhelming support of the staff and patients, Watkinson found himself on the dole, and Carruther’s reconfiguration – without proper public consultation – came into force in January 2010. The local Overview and Scrutiny Committee referred the move to the Health Secretary and it s now the subject of an independent review due to report later this year.

However, the judgment from Watkinson’s employment tribunal appeared on May 6. The unanimous verdict of the panel was he was unfairly dismissed, that the dismissal was both procedurally and substantively unfair, and that he was dismissed simply for advising the hospital of its duty to undertake public consultation before reconfiguring services. The evidence put forward by RCHT was ‘in many respects unsatisfactory’ and Carruther’s behaviour ‘a matter for adverse comment’. He  refused to give evidence even though his office is was across the road from the tribunal in Taunton.

Carruther’s is unlikely to fall on his sword but his bullying has destroyed the career of a gifted and popular NHS chief executive, created a vast amount of resentment in Cornwall and left the NHS with a hefty bill for the cost of the tribunal and Watkinson’s likely compensation package. He has also threatened the viability of the reconfiguration he forced through, a tragedy given that it is probably best for the NHS, and most staff and patients could have been won over with proper consultation. This bullying bodes poorly for other reconfigurations in the south-west, particularly of pathology services in Bristol which are currently subject to an independent inquiry triggered by the Eye and provided by two hospitals neither of which has a permanent chief executive. I wonder why they left?

The Watkinson tribunal report is available in full here.

(more…)




May 2, 2010

Dr Phil’s Private Eye Column, Issue 1263, April 28, 2010
Filed under: Private Eye — Tags: , , — Dr. Phil @ 5:49 pm

Junior Doctors under Labour

Has the care provided by junior doctors got better under Labour? Certainly the hours worked have come down, with a limit of 48 hours a week imposed by European law last August, but there’s mounting evidence that this has not been done in a way that has improved medical training or made hospitals safer for patients, especially at night. A snapshot review by the Royal College of Physicians of the care provided by 887 clinical teams found that only 6% of teams included a consultant on duty at night, and that a single junior doctor could be responsible for as many as 400 patients (average 61).

When MD started this column eighteen years ago, one of the first stories was of a junior doctor covering 360 geriatric in-outpatients at night, some of whom were very ill and sprawled over eighteen wards (14/2/1992). By this measure, the hospital at night is no safer than it was then and many would argue it is much less safe. Eighteen years ago doctors worked ludicrous hours but were part of teams, had far more help at hand, got more on the job training, followed patients through and had rooms to sleep in when they were desperate.

The switch to shift systems to reduce hours need not have decimated medical training if it had allowed a truly consultant led service with protected time for training. But the NHS always does things on the cheap, so the vast majority of junior staff are left unsupported, with no consultant leadership. Typically, a junior doctor is only attached to a particular consultant for four weeks or less, so no chance to form any sort of working relationship. And with fewer doctors at night covering more patients, there simply isn’t time for supervised training.

There’s mounting evidence that shift systems are bad for your health and the Danish government has paid out to intensive care nurses who developed cancer after years of shift work. In the NHS, shifts are inevitable but only safe if staff have somewhere to nap when they are exhausted. Airline pilots and air traffic controllers have naps (although they don’t advertise the fact) and there’s good evidence that they improve concentration and reduce error afterwards. But the removal of on-call rooms from across the NHS has meant that a junior doctor looking after, say, 400 patients at night may well not have anywhere to put her feet up when it all gets too much. Just as galling is to be kicked out of the hospital at 16.59 even if you’re half way through treating a patient or desperate to stay on and learn a new skill. Why? Because managers are petrified of any breach of the 48 hour Europe-wide legal limit.

The morale of junior doctors relies on a sense of connection both to a clinical team and to patients you know and care about. Labour may have reduced hours but it’s also reduced clinical medicine to the level of unsafe and ineffective factory farming, which is another reason why NHS productivity has failed to improve despite massive injections of cash.

Secret Scandal

The Sunday Telegraph picked up the Eye’s coverage of alleged errors in the pathology department at Bristol Royal Infirmary (BRI) and interviewed the family of Jane Hopes, Director of Critical Care at North Bristol NHS trust, until she died from breast cancer at 55. It is alleged that pathologists at the BRI missed the cancer at a stage when it could have been treated but what is equally shocking is that her family had not been told about the allegation, nor that it has formed part of a large independent inquiry that they knew nothing about and so couldn’t volunteer to give evidence. When the family of a senior NHS manager are shown such disrespect, it shows how far we still have to go for openness and accountability in the NHS.

Meanwhile the inquiry team has assured MD that, although evidence in confidential and hearings are held in secret, any current risk to patient safety that emerges will be fed back to the BRI. Strange then that evidence of a further serious error and allegations that both the histopathology service and one of the pathologists is unsafe have not, according to the hospital, been passed on to them by the inquiry. MD gives evidence on May 6.




April 7, 2010

Dr Phil’s Private Eye Column, Issue 1259, March 31, 2010
Filed under: Private Eye — Tags: , , , — Dr. Phil @ 5:38 pm

Whistleblowing under Labour

It’s now over a decade since the Public Interest Disclosure Act was introduced to protect whistleblowers but the bullying of and discrimination against those who raise concerns in the NHS is still rife. Consultant paediatrician Dr Kim Holt used to work in the Haringey clinic, run by Great Ormond Street Hospital, where the imminent danger to Baby Peter was not spotted. In April 2006 – a year before Baby Peter was seen –Dr Holt was removed from her post after she and three other doctors wrote to management warning of tragedy due to failings including staff shortages, dangerous over-working and poor record-keeping. When Baby P was found dead, the hospital allegedly offered Dr Holt money to remain silent about her complaints.

Dr Holt claimed the hospital managers panicked after Baby Peter’s death: ‘They said I had to withdraw my allegation or the money was off the table. They were trying to buy my silence.’ Dr Holt refused to sign a statement saying all her concerns had been addressed. ‘I was not going to be gagged. I must speak about this because it is so wrong. If our concerns had been taken seriously at the time we raised them, then we could have prevented the death of Baby Peter. The children had no one else to speak up for them and we felt passionately that we were letting them down. The response of management was hostile and bullying.’
So what has happened to Dr Holt since she was sent on ‘special leave’ three years ago? Surprise! She’s still on special leave. In December 2009, Great Ormond Street promised to reach a ‘swift and amicable solution’ with Dr Holt after a damning NHS London report largely vindicated her criticisms of the Haringey clinic and recommended her reinstatement. However, Dr Holt has yet to be offerd her job back. NHS management remains notoriously intolerant of dissent, and yet Dr Holt is just the kind of brave clinician needed to speak up when patients are put at unacceptable risk. To support her reinstatement, sign here 1

Sir Ian Carruthers, the chief executive of the South West Regional Health Authority and a former acting Chief Executive of the NHS, is not a man to get on the wrong side of. Former Cornwall hospital boss John Watkinson quotes him as saying: ‘To teach chief executives to listen, I only have to put one head on a pole and put it outside the strategic health authority.’ Graham Rich, the chief exec of University Hospitals Bristol, offered his head on a pole in January, after the hospital failed to hit targets set for it by Monitor and became the subject of an inquiry into its pathology services. But – as with the heart scandal previously – the pathological allegations were long-standing and well-known not just to the hospital management but the PCT, local cancer networks and Royal College of Pathologists. Carruthers should have known about them too, but the culture in the South West is still to suppress bad news rather than encourage open debate.

The inquiry triggered by the Eye in June 2009 is being held in private and may not report until summer 2010. So is there a current threat to patients? UHB’s website would suggest not. The information for patients, last updated on 25/1/10, says: ‘University Hospitals Bristol NHS Foundation Trust and North Bristol Trust have been working jointly for some years to minimise any procedural obstacles to effective diagnosis. Both Trusts agree that no new concerns have been raised since 2008.’ 2 And yet MD has discovered that new concerns were made in November 2009, and that the Inquiry Panel, both hospitals, the GMC, the CQC and the NHS Medical Director are aware of them. Just don’t tell the patients….

1 gopetition.co.uk/online/34319.html

2 uhbristol.nhs.uk/histopathology-review-june-2009

Note: UHB have now updated their website in response to this article




March 22, 2010

Dr Phil’s Private Eye Column, Issue 1258, March 17, 2010
Filed under: Private Eye — Tags: , , — Dr. Phil @ 10:02 am

 Labour’s dead babies

‘The death of a child is an unbearable sorrow that no parent should have to endure’ said Gordon Brown a year ago. And yet Labour’s record in providing safe services to critically ill babies is lamentable. Whatever cause the current inquiry finds for the deaths of four babies following heart surgery in Oxford, it’s patently clear that the unit simply isn’t fit for purpose. With just one dedicated paediatric cardiac surgeon (now departed) and one surgeon mixing adult and paediatric work, it beggars belief that – after the Bristol scandal – Labour could have allowed such a small unit to carry on performing such complex surgery.

This is not a new argument. Since exposing the Bristol scandal just 18 years ago, MD has argued ad nauseum that highly specialised healthcare must be concentrated in fewer units that are safely staffed and equipped. Hardly rocket science. The Kennedy Inquiry reached the same conclusion in 2001 and triggered an expert review, chaired by cardiac surgeon James Munro, which recommended that the number of child heart surgery centres be reduced to six. Labour ignored the recommendations. NHS Medical Director and cardiac surgeon Bruce Keogh realised that another disaster was imminent, and instigated a second service review last year, saying that ‘Failure to reconfigure child heart surgery will be a stain on the soul of the specialty and will compromise the treatment of the most vulnerable members of the next generation.’ (Eye 20.1.10).

This review will shortly recommend that each unit must have a minimum of four surgeons and perform at least 400 procedures a year. Oxford did less than a hundred, but at least surgeon Caner Salih realised he worked in an unsafe environment and reported the run of deaths himself before leaving for another job. Labour should have decommissioned the Oxford unit back in 2003, along with several others with only two surgeons. But that would have been politically awkward. As MD predicted in January 2004,  ‘All the units will continue to provide a miraculously safe service with inadequate staffing until one cracks under the pressure… The seeds have already been sown for another Bristol, and the blame lies firmly with this cowardly government.’

Eye reader Joanne Ferguson is equally unimpressed with Labour’s failure to adequately fund neonatal care. The NHS Neonatal Taskforce was set up in February 2008, prompted by a National Audit Office report criticizing the organisation of neonatal services and staff shortages. Last November, the taskforce launched a Toolkit for High Quality Neonatal Services, describing it as ‘the best opportunity in 30 years to raise special care baby services up to the standard that babies and their families deserve.’ Alas, there is a shortfall of over 2,700 nurses and 300 supporting therapists that are needed to give premature babies one on one care. Labour has done very little to reverse this shortfall in paediatric intensive care, and labour wards are also perilously understaffed with 500 potentially preventable deaths a year still occurring in childbirth (see Eye November 2009).

Mrs Ferguson has set up a website1 linking expert recommendations that Labour hasn’t funded with harrowing stories of unsafe care. Brown may claim he wants no parents to endure what he has, but plenty still are thanks to a lack of courage from his government. And if he bumps into Mrs Ferguson on the stump, he’ll get some tough questions. Such as why, if £105 billion goes into the NHS, is she reporting the story of a premature baby lying all day in shit?

 1 www.signitgordon.org/

2 www.signitgordon.org/pages/stories_emma.html




March 4, 2010

Dr Phil’s Private Eye Column, Issue 1257, March 3, 2010
Filed under: Private Eye — Tags: , — Dr. Phil @ 8:56 am

Medicine Balls: A Tale of Two Scandals

What goes around, comes around. The Bristol heart scandal of 1984-1995 occurred under the Tories’ watch but it was the incoming Labour government that ordered a Public Inquiry and used the results to impose sweeping, centrist health reforms. Now the Mid Staffs scandal – which in many ways is worse than Bristol – has occurred under Labour’s watch and it’s the Tories lobbying hard for a Public Inquiry, the results of which – if they get in – will doubtless be used to force their own ideology on the NHS.

The Bristol heart surgeons at least cared deeply about their work and were trying their best, even when their results for complex heart surgery were demonstrably poor. The Francis Inquiry into Mid Staffs, held behind closed doors but published last week, is more troubling: “It was striking how many accounts related to basic nursing care as opposed to clinical errors leading to injury or death”.

The Kennedy Inquiry found that from 1991 to 1995, between 30 and 35 more children under one died after open heart surgery in Bristol compared to a typical NHS child heart surgery centre at that time. 198 recommendations were made to prevent avoidable deaths happening on such a scale again.  The largest ever increase in NHS funding was coupled with the largest and most complex regime of targets and scrutiny. But in March 2009, the Healthcare Commission uncovered ‘appalling standards of care’ at Mid Staffs, and estimated that from 2005 to 2008, between 400 and 1,200 excess deaths occurred compared to comparable NHS trusts. And in these years, the Commission itself had judged the hospital to be performing well and Monitor awarded it Foundation status for its managerial excellence.

Labour’s centralised monitoring of quality and safety just doesn’t protect patients.  It’s expensive, retrospective data collection is slow, insensitive, inaccurate and misleading. Hospitals can game their mortality rates by fiddling with the coding system and unsurprisingly, the crude results and rating scores aren’t believed by NHS staff, politicians or the public. Health secretary Andy Burnham caused insult of Hewitt proportions, describing Mid Staffs as ‘ultimately a local failure’ and claiming the NHS has had its ‘best year ever’. Five separate panic reviews have been ordered that are unlikely to see the light of day this side of an election, if ever.

The take home message at Bristol came from Steve Bolsin, the anaesthetist who first raised concerns and paid for them with his NHS career. ‘If you want to avoid another Bristol, never lose sight of the patient.’ This is strikingly similar to the conclusion of Robert Francis QC in the Mid Staffs report: “If there is one lesson to be learnt, I suggest it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented”.

The difference now is that we have the technology for patients and relatives  to provide valid and timely feedback on their care that will spot problems in the NHS years ahead of any quango. What’s needed is a cultural change that invites constructive scrutiny and has zero tolerance of avoidable harm to patients. Most NHS staff would love to work in such an environment, free from the tosh of political control and focusing entirely on the needs of the patients in front of them. That ‘new’ Labour could contrive a culture where £105 billion goes into the NHS and it’s still no safer then bungee jumping, with widespread staff shortages, over-crowded emergency departments, disillusionment and patient harm, suggests that much of our increased funding hasn’t gone where it’s needed. Oh, and we’re desperately short of inspirational managers who’ll stick two fingers up to Whitehall (when necessary) and focus on helping their staff to serve their patients.




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