Hunt hunts Burnham

‘Shocking revelations on @andyburnhammps attempts to cover-up failing hospitals. We’re making sure this can never happen again.’ So tweeted health secretary Jeremy Hunt about his Labour predecessor on October 4^th, prompting a vociferous rebuttal and threat of legal action from Burnham. Hunt’s ‘apology’ was thus: ‘My tweet referred to revelations about political pressure on the CQC over the publication process for reports in failures of hospital care, and was not a suggestion that you personally covered up evidence of poor care.’ His tweet has remained up, despite Burnham’s insistence it be removed, and the ‘suing for defamation’ threat remains.

The Tories have targeted Burnham for a while. He’s been effective in exposing the organizational chaos that the entirely unnecessary Health and Social Act has visited on the NHS. Sir David Nicholson, chief executive of the NHS since 2006, was the one person who could have spoken up and derailed the reforms, but chose to remain silent as the bill passed and only now has declared that hospitals and GPs are being ‘held back from making changes that made perfect sense from the point of view of patients because they did not meet new rules on competition between healthcare providers’. Sadly, two years too late.

Burnham may not have personally covered up poor care but very poor care occurred on his watch as health secretary, and there were plenty of missed warning signs. However they were  also ignored or went unnoticed for a very long time by clinical staff, hospital managers, trust boards, commissioners, strategic health authorities, regulators, civil servants and Sir David Nicholson and his top team. Were it not for vociferous and persistent patients and relatives, such poor care as happened in Mid Staffs, Maidstone and Basildon would still be happening (and probably is).

Burnham may shy away from having all this dredged up in court, but Hunt’s bigger gamble is his promise to end cover ups in the NHS, simply by giving the CQC legislative independence from the Department of Health. A previously incompetent regulator doesn’t miraculously become competent by being free from political interference. Indeed Andrew Lansley’s biggest selling point for the Health and Social Care Act was that the entire NHS would be free from political interference. Yet Hunt has become the most interfering health secretary of all.

Cover ups occur all the time in the NHS. Most NHS staff and politicians are in denial about the harm that healthcare does but even a well-resourced, properly-staffed service would cause harm because of the speed and complexity of modern healthcare. The NHS is understaffed and in many places frankly dangerous. Yet in such a fevered, blame-dominated political climate, the gut reaction to serious error or terrible care is to cover it up and silence anyone who tries to speak the truth.

In promising to end NHS cover ups, Hunt has bravely set himself up for an extraordinary election run in. Whistleblowers and aggrieved patients and relatives will besiege him, many of whom have already been fobbed off by the local complaints’ procedures, CQC, professional regulators and ombudsman. Parents like Steve and Yolanda Turner, who have already written to Hunt, and to the NHS Clinical Director Sir Bruce Keogh on January 5^th about cover ups surrounding the death of their son Sean after heart surgery in Bristol. On March 13, Keogh responded with a promise of a formal review of Sean’s care and that of another child, Luke Jenkins. To date, this review hasn’t happened. When does a delay become a cover up? Sean died in March 2012, Luke in April 2012.

Whistleblowing surgeon Ed Jesudason has written directly to Hunt and the Public Accounts Committee about the cover up of poor care, the abuse of public money, the bullying culture and the victimization of whistleblowers in Alder Hey hospital’s general surgery and urology service (Eyes passim). The CQC have failed to get to the bottom of this so Hunt has suggested trying Monitor. Regulation has never been shown to protect patients from harm or prevent cover ups in the NHS. Hunt is naive to believe it will, but his desire to get Burnham may be overriding rational thought. If Hunt is serious about safety, he must ensure the NHS frontline is properly trained and staffed. If he wants transparency, a legal duty of candour and publication of the ‘covered up’ Risk Register for the Health and Social Care Bill is essential.

Justice for Robert Henderson

By far the greatest harm caused by the NHS is not the mistakes that it makes, but the fact that they are so often denied, dismissed, improperly investigated or covered up so that patients, or more often relatives, spend decades seeking the truth, accountability and apology.

The never-ending nightmare of Will Powell, father of Robbie, is a good example (Eyes passim) He’s spent 23 years, and all his savings, trying to get the truth about how and why Robbie died. He was promised a public inquiry, which never materialised, although he did make it to the European Court of Human Rights in 2000, which judged that ‘doctors have no (legal) duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even to refrain from deliberately falsifying records.’

More recently, James Titcombe has spent 5 years trying to get to the truth about the death of his son Joshua at Morecombe Bay hospital in November 2008. The coroner in Newcastle refused to open an inquest because he said Joshua died of ‘natural causes’, the trust did an investigation without interviewing the staff, the critical records of Joshua’s care ‘disappeared’ and the testimony of both parents was ignored. The Local Supervisory Authority (LSA) eventually investigated but admitted two years later that their investigation was flawed. The Health and Safety Executive refused to investigate because they don’t apply HSE legislation to clinical situations. Monitor didn’t investigate because clinical issues were the job of the CQC. The Ombudsman took a year to  ‘consider’ investigating but then refused to on the basis that it was the CQCs job.  The CQC didn’t investigate on the basis that they misunderstood the Ombudsman’s decision not to investigate as a signal that they didn’t need to.

The Coroner was eventually pursued to open an inquest which was held in 2011 and exposed a cover up at the Trust. Monitor eventually investigated the Trust in 2011. The CQC eventually investigated the Trust in 2012. Grant Thornton was commissioned to investigate the CQC in 2013 and delivered a scathing verdict of another cover up. The Ombudsman is currently formally investigating the LSA and the Trust. The Police are formally investigating the Trust. The DoH have commissioned an independent inquiry led by Bill Kirkup to investigate the Trust, the LSA, the CQC and the Ombudsman. Still James waits to find out how and why his son died.

John Henderson, Emeritus physician at the Ottawa Hospital has been trying to get an independent investigation into his cousin’s death at Treliske Hospital in Cornwall for 14 years. Robert Henderson died on October 7, 1999. John  has meticulously reviewed and analysed Robert’s medical records, which were then thoroughly reviewed by a panel of medico-legal experts (3 university professors and a coroner). Their conclusion may be summarized in two words: grave negligence. Henderson died shortly after perforating a duodenal ulcer, which may have been caused by his medication and certainly should have been investigated, diagnosed and operated on a lot sooner, given the amount of pain he was in, extreme tenderness on examination and the documented suspicions of a referring GP.

Despite the overwhelming evidence of avoidable harm, the Trust steadfastly refused to hold an independent inquiry, and appeals of the family to the Healthcare Commission and to the Parliamentary Ombudsman were dismissed on the grounds that local investigation had not been done. John Henderson’s last contact from the trust was from former medical director Dr Robert Pitcher,  who on 13 March 2008, stated he had asked one of his colleagues to look into the matter with the involved clinicians, and he would “make sure that  the outcome is sent to you.” It never was.  Henderson won’t give up and will write to Ms Lezli Boswell, current Chief Executive of Royal Cornwall Hospital on the fourteenth anniversary of robert’s death, to ask for a proper investigation that will give Robert’s wife Marjorie, the justice and closure she deserves. The response will be a test of the new duty of candour that is sweeping the NHS after the Francis Inquiry. Or not. Either way, the Eye will print it. MD