Jumping the Gun

This week sees the much-delayed publication of the public inquiry report into disastrous care at Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009. The Eye will consider the findings in the next issue, but whatever Robert Francis QC recommends, it’s 3 years too late. The lessons from Mid Staffs were needed to inform Andrew Lansley before he launched into his vast, untested reforms in 2010. Reorganizations on this scale are invariably dangerous for patients, as was Labour’s desire to make every hospital a self-governing Foundation Trust. Mid Staffs should never have been forced down that route. It was too small and simply not up to the task, just as child heart surgery in Bristol was not fit for purpose twenty years ago. Both sacrificed lives to balance the books.

Bristol happened on the Tory watch but, as with Mid Staffs, it took a change of government to order a public inquiry. This took so long, it post-dated Labour’s NHS Plan and so none of its 198 recommendations were included. The chance to rebuild the NHS around transparency, humanity and safety was lost, despite all the extra funding.  It’ll be depressing to see

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‘We believe that the clinical evidence underlying last week’s decision is deeply flawed, and therefore call on you to reconsider urgently your advice to the Secretary of State.’

LETTER TO SIR BRUCE KEOGH, CLINICAL DIRECTOR OF THE NHS

04 February 2013

Professor Sir Bruce Keogh

NHS Medical Director

Dear Professor Sir Bruce Keogh,

We noted with great interest your letter to the Secretary of State for Health dated 30th January 2013i following his request for an independent clinical view on the recommendations by the Trust Special Administrator (TSA) for South London Healthcare NHS Trust (SLHT). The Secretary of State for Health’s decisions were influenced by your advice, including the amendments made to the TSA’s recommendations regarding Lewisham Healthcare NHS Trust.

We write with particular reference to the Secretary of State’s decision to recommend the downgrading of University Hospital Lewisham’s (UHL) emergency admissions and maternity services. We consider it a matter of public interest that you make available the evidence on which you have based your advice to the Secretary of State. This advice may ultimately have proved pivotal, since it has underpinned the assertions he made during the announcement to parliament on 31 January and has therefore provided clinical justification

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Robbie’s Law – Telling the truth about medical harm

In 2001, the Bristol Inquiry concluded that ‘when things go wrong, hospitals and healthcare professionals have a duty of candour: to be open and honest.’ The culture of blame and bullying in the NHS prevented this from taking root so in 2009,  the Health Select Committee proposed a statutory duty of candour, following a long-standing campaign by Action Against Medical Accidents and the relatives of Robbie Powell. Labour resisted legislation, as have the coalition, opting instead for a weak contractual obligation for providers to publish a ‘declaration of a commitment to openness’ on their website, or face a fine. The ‘principle of openness’ has also been enshrined in the toothless NHS Constitution. This is particularly insulting to the bereaved relatives at Mid Staffs, who are hoping Robert Francis QC, himself a negligence lawyer, may force the NHS to finally be honest about the harm and distress it causes, often lasting decades.

In 1990, 10 year old Robbie Powell died in Morriston Hospital, Swansea after many doctors failed to diagnose his Addison’s disease. Just 22 years later, the Welsh Government published a report into his avoidable death and the lessons

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I have been both a general practitioner and journalist for twenty years, breaking the story of the Bristol Heart Scandal in Private Eye in 1992 and giving evidence to the eventual Public Inquiry seven years later. Much of my journalistic work involves supporting and protecting NHS whistleblowers, while allowing their concerns to be made public in a way that could help protect patients from avoidable harm. One of the saddest elements about the high rates of death and brain damage for babies undergoing complex heart surgery in Bristol was that the problems were well known within the heart surgery community and regulatory authorities, and yet no-one – save for whistleblower Stephen Bolsin – saw fit to act.

Despite legislation to protect those who blow the whistle in good faith, I am not convinced that the lot of the NHS whistleblower has improved much over 20 years, nor that we have got any better at stepping in to protect patients from harm when concerns are raised. This is well documented in the recent Private Eye supplement, Shoot the Messenger. The Francis Inquiry may well find that NHS staff are now even less likely to blow the whistle, rather than more.

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Promises, promises

The most any government can hope for when it comes to the NHS is that it leaves it in better shape than it found it.  The hugely disruptive structural changes of the Health and Social Care Act are unlikely to amount to much more than jumping up and down on the spot come 2015, and funding will have flat-lined or dipped.  But the Government has made a number of  bold  half-promises that could make a big difference to patients. Will they keep any of them?

Routine services should be available 7 days a week.  This is currently ‘under investigation’ by  NHS Clinical Director (and former heart surgeon) Bruce Keogh. There seems little point in lighting and heating hospitals all weekend but only offering emergency services, and it’s outrageous that your chance of surviving hospital depends on whether you get sick ‘in hours’ or ‘out of hours.’ According to a Health Service Journal survey, NHS chief execs rate the ‘out of hours’ safety of their hospitals as only 5.9/10. The theory goes that if routine GP and hospital services were available throughout weekends, there would be fewer unnecessary emergency admissions. But Keogh’s plan requires investment, resources and union backing.

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