Mr Hunt won’t get involved in Mr Ahmed’s case, or indeed the case of any individual whistleblower whose career and livelihood has been destroyed for following their moral and professional duty to speak up and protect patients from avoidable harm. However, the Department of Health is considering how to ensure that whistleblowers are not just protected but praised, thanked, rewarded and kept in NHS employment wherever they speak up. We shall see. Mr Hunt’s response is below

Reply from Jeremy Hunt to Patients First

There’s a better way to good health than popping a statin

Should you take medical advice from a surgeon? Much as I admire Sir Magdi Yacoub for his services to heart surgery, I strongly disagree with his paternalistic prescription that everyone over 40 should take a statin to lower their cholesterol. To be fair, Yacoub was trying to rebalance the debate after the British Medical Journal seriously over-egged the side effects of statins, and if those who need to take them stop doing so as a result of this scare it could worsen their heart disease. But we shouldn’t all start blindly popping the pills when we hit 40. A far better approach is to encourage each of us to take responsibility both for our health, and our healthcare. 80% of what can be done to reduce the risk of heart disease, liver disease, kidney disease, strokes and diabetes is down to our behaviour. Health care adds a comparatively modest 20%. Walking wherever and whenever we can, and a modest reduction in portion size are each far more powerful and effective at preventing disease for most of us than statins or blood pressure pills.

If you have established disease or are at high risk, drugs can be life saving but too often we use them as an excuse not to change our behaviour. ‘I’m on a statin or a blood pressure pill so I can eat or drink or smoke what I want.’ A statin may be right for you, but you should be part of that decision and understand the balance of risks and benefits as best you can, and have the right to stop it if you don’t get on with it. For all the heated arguments about side effects in academic journals, you as an individual are the best person to judge if you’re getting any. Many people get none at all, but some get more side effects from blood pressure or statin medication than symptoms from high blood pressure or high cholesterol. It’s your choice if you want to put up with them to reduce the risk to your heart, brain and kidneys.

I in 3 children born today will live to 100, 1 in 3 will develop diabetes and 1 in 3 will develop cancer. The challenge ahead is clear but the evidence for the benefits of mass medicalisation of people with no symptoms and low risk is lacking, and it can make them unhappy, passive, disempowered and dependent. It’s time for patients to be active. When all is said and done, we are each responsible for taking care of our health. And the rewards are huge. Healthy living can give you 20 more years of a healthy life. And it might even save the NHS.

Dr Phil Hammond is a GP turned hospital doctor, and a Vice President of the Patients Association.

Raj Mattu and the death of whisteblowing

If ever a case demonstrated the futility and jeopardy of blowing the whistle in the NHS, it is that of Dr Raj Mattu. Eye readers will be well aware of the protracted and inhuman victimisation of Mattu (Eyes passim) which has destroyed his health and career, and robbed the NHS of a brilliant cardiologist who was brave enough to speak up about patient harm. University Hospitals of Coventry and Warwickshire (UHCW) has already wasted £6 million pursuing this vendetta, and may waste even more appealing against the employment tribunal judgement that he was unfairly dismissed and that his whistleblowing had been entirely justified. Mattu will never work as a consultant again, so the NHS has also wasted all the money it spent training him, patients have been deprived of his expertise and the compensation payment will be considerable. There has never been a proper inquiry into the alleged deaths and harm caused by the trust’s persistent cramming of five patients into four-bedded bays over a long period of time, relatives have been denied the truth and any chance of justice, and the NHS has not learned from its mistakes.

Perhaps most shocking about the treatment of Mattu, who had to endure absurd and invented allegations of sexual misconduct, fraud and over 200 spurious referrals to the GMC, is that it did not occur in secret. The serious problems in this hospital under the ‘leadership’ of chief executive David Loughton, who Labour handed a CBE to in 2010 for services to healthcare, were widely known to Parliament and at every level of the NHS. Mattu blew the whistle by the book. He filled in clinical incident forms from 1999, made protected disclosures and wrote meticulous, polite letters to Loughton in 2000 and 2001 about harm and possible deaths of patients. These were never answered. When it became clear that he had exhausted all the correct internal channels and the trust was not going to act appropriately to investigate or protect future patients from avoidable harm, he escalated his concerns in entirely the right manner to the media and local MPs, with the support of his consultant body. In the 15 years that he raised concerns about the appalling treatment of patients and then himself, he wrote to successive health secretaries, chief executives of the NHS and senior Department of Health officials. Nobody in authority in the NHS intervened on his or his patients’ behalf. For all the talk about the vital importance of whistleblowing and an end to cover-ups in the NHS, Mattu was simply hung out to dry in exactly the same manner as Steve Bolsin, the Bristol heart scandal whistleblower was 20 years ago, and Alder Hey whistleblowers Ed Jesudason and Shiban Ahmed are now (Eye last)

His local MPs at least took up the baton, and they had plenty to go on.  In 1999, the year Mattu started raising concerns, the trust suspended surgeon Alban Barros D’Sa after he blew the whistle on high deathrates after colorectal surgery.His suspension lasted 20 months and wasted around £500,000. A disciplinary panel said that dismissal would be “wholly unjustified” and recommended his reinstatement but when Loughton discovered Mr D’Sa had written to his MP, Jim Cunningham, about the “unacceptably high” death rates, he deemed this to be  a “breach of trust and confidence” and accused D’Sa of “serious professional misconduct”. After Mr Cunningham and his fellow Labour Coventry MP, Geoffrey Robinson, expressed outrage in the Commons that a constituent’s letter should be used against him, a High Court judge granted an injunction against the hospital. The Royal College of Surgeons recommended the cessation of colorectal surgery by a specific surgeon (a Clinical Director appointed by Loughton) but the Trust allowed him to continue performing these procedures for two and a half years after concerns were first raised.

In 2001, UHCW was found to have the highest death rates in the NHS for heart bypass surgery, more than double the national average. The consultants elected Mattu to lead them, but this was vetoed by the Loughton. Dr Mattu said that the hospital was obsessed with reaching targets rather than interested in quality care. ‘I believe there have been serious administrative deficiencies in supporting effective cardiac care. When these concerns were raised, management’s response was to victimise us.’ That year, the Commission for Health Improvement gave UHCW a damning ‘zero star’ inspection report, and was particularly critical of the practice of cramming 5 patients into four bedded bays, which had made it impossible for Mattu to resuscitate a patient. Six local MPs called for Loughton’s resignation and he went in 2002, only to re-emerge 2 years later as chief executive in Wolverhampton, supported by former NHS chief executive Sir David Nicholson. Nicholson also approved the appointment of Martin Yeates, the ill fated chief executive at Mid Staffordshire hospital, where hundreds of patients received degrading and substandard care. He and Loughton were Yeates ‘informal mentors’. Nicholson told the Francis Inquiry that Yeates never raised concerns about patient harm with his mentors (who would?), and neither did many clinical staff blow the whistle about the appalling care. Mattu tried his best at nearby UHCW – which had even higher death rates than Mid Staffs – and look what happened to him.

Here’s Dr Raj Mattu’s first disclosure on 1/7/2000 to chief executive David Loughton about the death of his patient on 21/12/1999 which he had raised concerns about but the Walsgrave board had ignored

Mattu 1

It got no response, despite its clear implication of patient harm and ongoing risk to patients. So he wrote again, on 27/4/2001. The letter makes extremely serious allegations requiring urgent investigation

Mattu 2

Again, Mattu gets no response. However, a cursory review is carried out two years later that doesn’t interview Dr Mattu or any of the staff. It is still damning of the trust.

Mattu 3

In 1999, whistleblowing surgeon Alban Barros D’Sa was suspended from the Walsgrave for raising concerns about high death rates for colorectal cancer surgery.

In 2001, the Walsgrave (now UHWC) was found to have the highest death rates in the NHS for heart bypass surgery, more than double the national average.

In 2001, the Walsgrave   received a damning ‘zero star’ inspection report from the Commission for Health Improvement, and was particularly critical of the practice of cramming 5 patients into 4- bedded bays.

Loughton resigned in 2002, was given a plumb job as CEO in Wolverhampton and a CBE for services to the NHS. Raj Mattu stayed in Coventry, tried to expose the cover up and patient harm, suffered appalling victimisation and will never work as a consultant again.

NHS cover-ups go right to the top

‘Patients’ lives are saved when courageous people speak up – openly and honestly – and when each of us takes personal accountability for putting things right.’ So said incoming chief of NHS England Simon Stevens on April 1^st. But the joke is that no one helps put things right for whistleblowers themselves, nor holds those to account who smear, ignore or black-ball them.

It is scandalous that whistleblowing Alder Hey surgeons Professor Ed Jesudason and Shiban Ahmed cannot operate in the NHS (Eyes passim) after making protected disclosures about patient safety. Ahmed also worked for the University Hospital of North Staffordshire (UHNS) and was suspended by them in 2009 on the grounds that he is as a mental health risk after a hotly disputed allegation by two Alder Hey surgeons – Matthew Jones and Colin Baillie – that he was suicidal, an allegation of which Ahmed was cleared by a subsequent investigation. Although Baillie and Jones accepted they were behind the suicide claim, this crucial evidence was withheld from Ahmed’s Employment Tribunal, and Alder Hey denied the claim had any role in his suspension. Ahmed’s insurers withdrew funding for his tribunal challenge due to the lack of evidence to support his case.

Jesudason discovered what Baillie and Jones had done to Ahmed, led the petition against Ahmed’s mistreatment and  unearthed material evidence of the unproven allegation and that Alder Hey withheld vital evidence from Ahmed’s ET. Alder Hey then wrote offering Jesudason a six figure pay off part of the deal being that he had to destroy this evidence.  He refused and was forced out after his High Court hearing collapsed (Eyes passim). During the hearing, the Eye was at one stage asked to destroy its damning evidence against Alder Hey because it was ‘the property of the court’, but this request was then rescinded. No attempt was made to examine the evidence, call witnesses or expose the mistreatment of Ahmed and the attempted silencing of Jesudason. MD has referred Simon Gorton QC – a barrister employed by Alder Hey and copiously funded by the public purse – to the Bar Standards Board, to investigate whether or not he played a role in misleading Ahmed’s ET, which  Gorton adamantly denies.. Ahmed and Jesudason’s patient safety concerns have never been properly investigated, but Alder Hey was recently classified as “potentially unsafe” after failing to meet four in five standards of quality and safety in an unannounced inspection by the Care Quality Commission (Eyes passim)

Equally shocking is the smearing of CQC board member Kay Sheldon. In 2012, Sheldon gave evidence to the Health Select Committee about her treatment after making very well founded and politically devastating accusations about incompetence and cover ups at the Care Quality Commission (Eyes passim). On November 28, 2011, Sheldon gave oral evidence to the Francis Inquiry which was publicly refuted through a message on the CQC website. Jo Williams, then CQC chair, wrote to Health Secretary Andrew Lansley the same day asking for her immediate suspension and replacement. Messages were also sent to CQC staff from chief executive Cynthia Bower and Williams undermining the evidence that whistle blowers gave to Francis.

Sheldon continued to attend board meetings but the atmosphere was so unpleasant it was hard for her to do her job properly and she experienced significant stress. She asked for an assessment with someone who understood her situation but was instead referred by Williams, without her knowledge or consent, to Medigold, a private occupational health company. On January 30, 2012, she spoke to the executive chair of Medigold, Dr. Mike Goldsmith, on the telephone for around 10 minutes saying there had been some crossed wires and that she didn’t need to see a doctor. They did not discuss any details about her health.  Following this conversation, and on the same day, Dr. Goldsmith wrote a three page letter to Williams. “My clinical view, based on a 20 minute telephone call, is that this lady is suffering from a mental health problem, which is likely to be one of the conditions that involve paranoia. The most common of which is paranoid schizophrenia and certainly some of the things that were said to me in a completely normal voice and without any emotion would fit with paranoid thinking” and “She may well be in denial, but I suspect she is actually suffering from significant paranoia at present”. He also suggested that her past history be obtained “in confidence” and that “if necessary, obtained a psychiatric opinion on her”. He said he would be happy to speak to the Chief Medical Officer about her. He also stated “I think it is really important that she is assessed or else removed from her position, because I think there are some serious issues here that need to be dealt with and not swept under the carpet”. Goldsmith also wrote a disturbing email stating he would be involved in her case “behind the scenes”.

Sheldon remains a vital member of the CQC board and has shown no signs of paranoid schizophrenia. Williams and Bowyer both resigned from the CQC when all of Sheldon’s allegations were proved correct. Dr Goldsmith was reported to the GMC and no action was taken, despite the inadvisability of suggesting a diagnosis of paranoid schizophrenia when you are not a psychiatrist, based on a short phone call that did not discuss health matters and did not gain patient consent.

The business of covert assessments, and other occupational health work, appears to very profitable.  Dr Goldsmith’s company – Medigold – paid him £256,676 in 2012 with much of the money paid as fees for the Medigold trademark meaning it may well be very tax efficient.  When asked about the tax efficiency, Dr Goldsmith’s son, a former City banker and now finance director of the company replied, “So what?”

But why did the CQC engage a private family occupational health company to do a secret psychiatric assessment? The answer was revealed as Sheldon gave evidence to the Public Accounts Committee last month. Medigold was recommended to the CQC by the Permanent Secretary of the Department of Health, Una O’Brien. So the DH was instrumental in organising the inappropriate, secret and erroneous psychiatric assessment of hugely embarrassing whistleblower by a private occupational health doctor based on a short phone call where health was not discussed.

Una O’Brien remains the most senior civil servant at the Department of Health and one wonders how many other secret mental health assessments have been conducted under her leadership. O’Brien refused to comment personally, but claimed, “The Department suggested Medigold, with which the Department holds a contract for the provision of occupational health services.” If Stevens really wants to support whistleblowers, and reverse the culture of his predecessor David Nicholson, he needs to shine the light at the top of the NHS