A convenient scapegoat

Was the General Medical Council merely grossly incompetent in pursuing Dr Hadiza Bawa-Garba through the courts to strike her off following the death of six-year-old Jack Adcock on 18 February 2011? Or is it complicit in a wider cover-up of where accountability should lie? An internal investigation by Leicester Royal Infirmary admitted “79 domains of systemic failure” in Jack’s death, and made 23 recommendations, including that the consultant on call for emergencies should review all the new admissions in person (something that was already happening in units providing a decent standard of consultant-led care).

Dr Bawa-Garba made a serious error, which she openly admitted, in not recognising the significance of Jack’s very abnormal admission blood test results, which made a diagnosis of sepsis more likely. However, her consultant Stephen O’Riordan made an even more serious error – given his seniority, experience and responsibility – in failing to spot that same risk of sepsis. He was told the abnormal pH of 7.084 and the fact that the blood lactate concentration was high, and wrote them down in his notebook. At that moment, the overriding duty of care for Jack was passed from junior doctor to consultant, and O’Riordan became

[…..] Read More

Tiredness and Overwork can be Lethal

MD’s first ever Eye Column (Eye 785 17/1/92) featuredjunior doctor Chris Johnstone ‘who won the right to sue Bloomsbury health authority for subjecting him to a particularly onerous obstetrics job.  Johnstone had taken his decision after falling asleep at the wheel: he used a portable EEG to measure his cerebral activity during a 48 hour shift and found that he was registering sleep waves while sewing women up after labour. Despite his high court victory, the job remained the same and the doctor who followed him spent time in intensive care after a paracetamol overdose.’

Like many junior doctors at the time, MD made catastrophic errors while overworked and sleep deprived, and drove his car off the road after an 81 hour shift. Several colleagues committed suicide during or after such long shifts, and it became clear that poor judgement, exhaustion and mood disturbance caused by sleep deprivation and work related stress was contributing to the deaths of doctors and their patients. 30 years ago, junior doctors were paid just a third of the standard rate for overtime, so it was much cheaper to make one work 120 hours a week than to hire

[…..] Read More

Oh GOSH

In this new era of candour and transparency in the NHS, how hard is it for the media to expose poor practice? Very, if you’re taking on a national treasure. On April 18, 2018 tucked away at 10.40 pm, ITV Exposure screened ‘Great Ormond Street: the Child First and Always?’, a documentary collaboration with the Bureau for Investigative Journalism.  It revealed that consultants in GOSH’s Department of Gastroenterology had been misdiagnosing and overtreating young patients with Eosinophilic Gastrointestinal Disease (EGID). Children had been prescribed powerful immunosuppressant drugs and/or put on highly restrictive diets too quickly and left on them for too long. This was well known within ‘gastro circles’ for years and was documented in a Royal College of Paediatrics and Child Health (RCPCH) review in 2015. So why did it take nearly three years to surface?

When hospitals realise they have a problem, they can invite a Royal College in for ‘independent expert opinion’ safe in the knowledge that the Trust senior management ‘owns’ the report and can ether refuse to disclose it or heavily redact it. Reputation management still trumps transparency in the NHS. When the RCPCH returned to GOSH in 2017 to check for improvements,

[…..] Read More

Happy Birthday NHS?

 The NHS was 70 on July 5, with just five years to wait before all the introspection, celebration and politicisation is repeated for what remains of it at 75. The UK will forever be remembered as the first country to introduce universal healthcare and the last to fund it adequately. The NHS is constantly playing funding catch-up with Europe but nothing can reverse the damage done by decades of parsimony. If we had committed the same percentage of our GDP as Germany to health since 2000, we would have put £260 billion more into the NHS. Germany too sometimes struggles with demand, but not in crumbling estates using outdated equipment and technology, with queues extending down the corridors, patchy access to GPs and millions on the waiting list for hospital treatment. This isn’t about how we pay for healthcare, simply that we don’t pay enough.

Jeremy Hunt hopes that an NHS App will revolutionise the service and end the ‘8am phone scramble for GP appointments’ but it won’t end the desperate shortage of GPs, and the tech-savvy patients will simply jump the queue. In its 70 years, the average annual funding increase over that time has been

[…..] Read More

The Gosport Scandal – another cover-up, another failure of consultant-led care 

At Gosport hospital from 1989-2000, Dr Jane Barton was deviating so widely from the accepted clinical guidelines for prescribing opiate drugs via syringe drivers, that it could be spotted from space. The situation may not have been helped by the use of easily confused syringe drivers, one of which discharged its contents over an hour, the other over 24 hours. Many countries replaced such drivers long before the NHS, which still operates on the CATNAP principle (Cheapest Available Technology Narrowly Avoiding Prosecution). The Gosport inquiry found that hundreds of patients admitted for respite care and rehabilitation, who should never have come anywhere near a diamorphine driver, died shortly after this ‘treatment’ was commenced (often combined with the sedative midazolam). Some of the nurses charged with starting the drivers tried to speak up and were silenced, others accepted that was just how things were done in Gosport. As at Bristol, the institutional blindness to poor practice was known by many people over many years at many levels of the NHS, from the consultants who supervised Dr Barton and reviewed her drug charts, to the managers who failed to act on

[…..] Read More