Monthly Archives: June 2014

Savile and the abuse of absolute power

Janice Turner in The \times 28th \june 2014 opines: Savile and the abuse of absolute power

A freelance despot, Savile befriended both high and low in the NHS. In return, they helped him commit his crimes

Steve Bell 26.06.2014

In the whole 253-page report into Jimmy Savile’s activities at Leeds General Infirmary there is just one instance where he troubles hospital bosses. Doctors complain that, although only a volunteer porter, he is plonking his vast Rolls-Royce in the consultants’ car park, filling two bays.

Savile skulking the wards in the dead of night; his access to nurses’ quarters and mortuary alike; the near-universal disgust felt for him by female staff — and, of course, his copious crimes — were not under their purview.

For a study in absolute power — how to win and exercise it; how to create useful allies and deflect would-be enemies; how to indulge undetected your taste for violence, humiliation and sexual depravity; how to steal trophies from the dead and the innocence from children and yet be garlanded with honours — forget Machiavelli. Read the Leeds and Broadmoor hospital Savile reports. Not every despot needs a nation; some go freelance.

The first principle of Savile’s modus operandi was: sort out the top and the bottom, then the middle will neither care nor dare. So at Leeds he first befriends night porters, dropping in for late-night chats, buying TVs for their seedy hospital bolt holes where they drank, played cards and entertained women. All against the rules, but Savile wouldn’t tell if they kept his secrets, too.

We never learn the names of men who note that Jimmy, viewing the board where portering jobs were chalked up, always bagged patients from the women’s or children’s wards. Nor do we know his accomplices, who, after his victims had been assaulted in linen cupboards or side-rooms, suddenly appeared to lead them away. “No one knew” is the Savile refrain. But they saw, they heard, they knew.

Besides keeping sweet the lowliest men, Savile ingratiated himself with the most powerful. At Leeds he befriended the chief governor; in Broadmoor he actually chose him, after Edwina Currie bizarrely trusted his judgment in heading up a task force to change hospital culture. He promised the minister he’d win officers’ compliance by threatening to expose their overtime fiddling to The Sun. He never did; conscious, no doubt, of what they had on him.

In Broadmoor, he didn’t need the slapdash security guards to lend him keys, to slip him in without question as he had in Leeds. The governor gave him, along with an office and a house near the grounds, a whole set of his own. This not only afforded him a back route to the women’s wards, but guaranteed nurses never challenged what he was allowed to see. Some were uncomfortable as Savile watched the female patients bathe, commenting on their “nice Bristols”. But they knew he had the power to have them sacked.

Nurses mainly feared and loathed Savile: scuttling out of the canteen or into their station when he showed up. The senior ones knew “You don’t get too close”; that it was dangerous to leave him alone with a student, especially one who looked young for her years. They found him a hindrance on the wards, hated dodging his groping hands. They had an idea what he was doing to patients, since he relentlessly tried the same on them.

Moreover, as several in the Leeds report point out, this was the reign of the Yorkshire Ripper. If police could not keep women safe from a serial killer, why would they bother about Jimmy Savile? So the nurses mostly shut up and watched their backs.

But not all. The only heartening moments in the report are when Savile is challenged. A senior nurse turns on him and says she doesn’t want the self-styled “chief cheerer-upper” dropping in whenever he feels like it. A grandmother, seeing her granddaughter being felt up beneath blankets, screams. And instead of confrontation, Savile
melts away.

In Broadmoor, he avoided the wards run by the sternest custodians, those who wouldn’t bend rules because it’s “just Jimmy”, the governor’s best pal. Savile used his customary greeting — kissing the length of a woman’s arm — to “scope” for malleable staff: homing in on the gigglers, sidestepping those who recoiled in disgust.

These reports are a cure for nostalgia, especially about the NHS’s supposed golden age. It is hard to feel sentimental about porters and consultants alike being drunk, while a single student nurse is left in sole charge of a ward all night.

Savile could not operate with such impunity today.

And yet the female Broadmoor patient who is written off as troublesome after complaining about abuse reminds me of girls in the recent Oxford grooming case. When they complained to police and social workers about the men who raped, drugged and tortured them, they were dismissed as child prostitutes who had made a “lifestyle choice”.

Meanwhile on the very day of the Savile reports, Ofsted admitted that its inspections into Stanbridge Earls School had failed to pick up a culture that enabled the rape and sexual assault of pupils. Closed institutions are still problematic worlds.

But at least the Savile reports may quell your fury about the annoyances of modern life: swipe card security, CRB checks and the professionalisation of menial jobs such as portering. And you may conclude that we don’t live in a dirty-minded age that imagines paedophiles around every corner, but one that has learnt, over decades and after many grave mistakes to protect little girls on hospital trolleys from roaming eccentrics with squeaky clown noses.

The Guardian 26th June reports: Those who shielded Jimmy Savile are still silent

Given the evidence from dozens of witnesses, how did Savile, a child molester and sex pest,
escape attention?

Don’t tell me the mental health system isn’t in crisis – I’ve been in it

Johnny Benjamin in The Guardian writes 27th June 2014: Don’t tell me the mental health system isn’t in crisis – I’ve been in it

The most rationed part of the Regional Health Services is Mental \Health: and thats because we the public, and the professionals, and the media, let the politicians and administrators get away with it.

The mental health system is in crisis. It’s a car crash waiting to happen.

That’s according to Prof Sue Bailey, the outgoing president of the Royal College of Psychiatrists, in an interview earlier this week. Her comments came a day before the British Medical Association’s annual meeting, where delegates were told that cuts to mental health services are resulting in avoidable deaths and suicides. Sadly, neither of these stories told me anything I didn’t already know. I’ve seen at first-hand how the mental health system is failing vulnerable people. For many of us dealing with mental illness, the car crash has already happened.

In fact, my experiences of mental health care were so bad that a few years ago I completely gave up on trying to get support. I’d been going through a period of severe anxiety and had waited for months to see a therapist. But after a few sessions, she told me she was being transferred. I’d have to go back on the waiting list and start all over again.

The Observer: Crisis grows in mental health care
Services for the mentally ill are facing a growing crisis across Britain due to soaring staffing costs and accelerating numbers of young patients.

 

Jeremy Vine discuses saving the NHS on radio two, 26th June 2014

On Thursday 26th June Jeremy Vine asked GPs and Health professionals to ring him and give their views. Rationing was not discussed.. Too complex for Radio 2, or would Mr Vine be disciplined for raising the subject overtly?

Jeremy discussed Wonga chasing debts from its customers using made-up law firms, how new charities can undermine existing charities, saving the NHS money and drinking water.

 

 

GP A&E Triage – would be a good idea if we had planned for the numbers needed. We have not.. and GP partnership and continuity of care is in decline

Despite a lack of evidence, some CCGs are allocating scarce resources  to GP A&E Triage. Sofia Lind reports in GP Magazine 26th June 2014: CCG plows further half a million into PM’s seven-day opening model despite uncertainty over A&E impact

GP A&E Triage would be a good idea if we had planned for the numbers needed. We have not.. My old trainer used to say “every patient deserves and examination” as well as “if you do n’t put your finger in you put your foot in”. The risks of litigation increases by not examining the patient. Those doctors who are good at emergency medicine, as well as as triage, and GP primary care will be the “polished” and much desired doctors of the future… This does not necessarily mean they will be GP partners… and continuity of care will be in decline. This will mean more demand for private care in affluent areas, and more importance for working integrated IT systems (which don’t yet exist). The perverse incentive to reduce quality of continuing care is in conflict with the need to ration emergency care services within budget.

David Millett reports for GP Magazine 26th June 2014: GPs should not provide front-line A&E triage, says former GPC leader

In Cornwall, since 2012 GPs have been involved in A&E Triage. Observer article prompts big changes at Cornwall Regional, reported by DONNA HUSSEY-WHYTE Sunday Observer so there should be some evidence…. West Cornwall Hospital still has a skeleton GP manned service, but it seems to be adequate, with no increase in mortality or morbidity..

There is no plan. The lunatics are running the asylum – and we are condemned to a “managed decline”. (by our politicians)

NHS faces crisis in litigation as well as A&E. Introduce no fault compensation (NFC)?

 

‘Honest debate’ needed over NHS crisis, says Gerada

Alex Matthews-King reports in Pulse 27th June 2014: ‘Honest debate’ needed over NHS crisis, says Gerada

Just look at the demographics and the trends in the Guardian 26th June 2014…. No need to be more explicit on the need to ration overtly. The impact of the older generation on England’s healthcare system… It is cowardly politicians, trust and CCG Managers and Directors (and disengaged professionals) that are holding back this honest debate.

NHS chiefs have too much of an ‘emperor’s new clothes’ optimism and instead need to have an ‘honest debate’ about what is going wrong with the health service, former RCGP chair and NHS England advisor Professor Clare Gerada has said.

Professor Gerada who advises NHS England on its London primary care strategy said that although some CCGs are doing ‘really good stuff’, underneath the ‘optimistic talk’ was still a ‘demoralised workforce’, with general practice in crisis and hospitals failing to fill vacant posts.

And GPs could not be expected to ‘fund their own transformation’, she told Pulse, with her work with NHS England showing that the issue of GP premises and funding must be addressed if GPs are to cope with additional work being brought out of hospitals.

Speaking at the Commissioning Show in London on Thursday, Professor Gerada said that the Government needed to crack down on doctor-bashing stories in the press and policies designed to ‘name and shame’ such as NHS Choices, the Friends and Family test as well as the CQC inspection regime.

She also called for more investment in occupational health services, saying: ‘Our politicians have to be facing inwards to us, and supporting and protecting us.’

In response to an audience member who commented that they were ‘struggling to find the positivity in the changes that we’re going through at the moment’ Professor Gerada said: ‘It’s the emperor’s new clothes, these figures that I’ve quoted are all referenced: 25% of NHS staff feeling bullied, four times the rate in the normal state.’

‘And yet you’ve got people saying it’s all wonderful, it is not wonderful, the problem is we have to say it for the young [doctors] because we’re all used to holding ourselves up.’

‘We need to have an honest debate about what’s going wrong in the NHS today, for us, because all of you are feeling like naughty schoolchildren.’

‘You’re being told off daily about how bad you are. How can you get up in the morning, how can we get up? We get NHS Choices in our inbox and I delete it if it says negative because I cannot bear to see another negative comment.’

Professor Gerada explained to Pulse that the Government’s ambitions for the NHS could not be achieved without addressing the current ‘crisis’ in general practice.

She told Pulse: ‘With respect to the emperor’s new clothes and recent changes, I think some CCGs are doing really good stuff, but actually I think if you scratch away at a lot of the optimistic talk what you’re still seeing is a demoralised workforce – even hospitals are failing to fill their posts.’

‘So this is not just about general practice, but general practice is the crisis because it’s the front door of the NHS.’

She added: ‘We have to give GPs the headroom, my work in NHS London is saying that if we want GPs to change, we need to give them the physical space: premises, but also the head space to change. They should not be expected to fund their own transformation.’

In Graphics: “The impact of the older generation on England’s healthcare system”

George Arnett in The Guardian reports26th June on “The impact of the older generation on England’s healthcare system”

The government has produced a report looking at the impact people aged over 65 have on the NHS. We look at the figures ….Download the data • DATA SOURCE: HSCIC

look at the Guardian’s graphics. Can we really provide best possible care, everything for everyone for ever (until death) for all these people without rationing out the cheaper and less fearful services overtly? Even the ex chair of the RCGP sems to agree, but without using the R word. ‘Honest debate’ needed over NHS crisis, says Gerada

The proportion of England aged over 65 has increased dramatically over the past 50 years and looks set to grow even more in the coming decades

In 1951, 11% of people were aged 65 and less than 1% were over 85. In 2011, those proportions had increased to 16% and 2% respectively. Government projections suggest that by 2051, one in four will be over 65 while 7% of the population will be 85 and over.

An older England means that the way healthcare is delivered (and the cost) will change because of the different needs that age groups have. The Health and Social Care Information Centre (HSCIC) have released a report compiling many of the statistics around the subject. We run through some of the key figures below…..

Do Jeremy Hunt’s NHS safety league tables focus on the right issue?

Richard Vize in The Guardian opines 26th June 2014: Do Jeremy Hunt’s NHS safety league tables focus on the right issue?

An emphasis on reporting rather than learning makes it unclear what focus or benefit new safety measures will bring

The superficial appeal of health secretary Jeremy Hunt’s new safety league table obscures deeper questions about how to create a safety culture throughout the NHS.

As part of the government’s Sign Up to Safety campaign, the NHS Choices website now carries a measure of “open and honest reporting” of patient safety incidents. Open and honest reporting is of course essential to developing a safety culture, but it is questionable whether this particular measure is focusing on the right issue.

The indicator has five components, such as an organisation’s NHS staff survey rating on whether it has fair and effective incident reporting procedures, and potential underreporting of death and severe harm to the National Reporting and Learning System – the central database of patient safety incident reports, which has logged over four million cases since it was established in 2003.

The staff survey for 2013 reveals how far there is to go in embedding a safety culture; among almost 200,000 respondents, 85% agreed they were encouraged to report an incident, but only 62% agreed their organisation took action to ensure it wasn’t repeated. So almost a quarter of organisations encourage reporting but do little with the information.

But this new indicator is overwhelmingly focused on the recording rather than the doing – process rather than outcomes again. It becomes yet another league table which organisations have to climb, but it is far from certain that will translate into creating a culture which turns a safety incident into a driver of staff learning and real, meaningful change.

Being judged on reporting bad news is necessary, but odd. As always with a target, it is likely to create perverse behaviour. Will a ward that routinely reports fewer incidents than its neighbour be praised for the quality of its care or come under suspicion? Since it is the reporting, rather than the learning, that is primarily being measured, which will be the focus?

Yet again we have a government quality initiative that is useful and reasonable, yet somehow misses the point. It is another opportunity for managers to focus on measurement rather than leading change.

Alongside this came the announcement that Sir Robert Francis QC will be leading an inquiry into the culture of fear that surrounds whistleblowing in the NHS, and making recommendations on how to create an open culture. This is welcome and overdue. Despite government support for whistleblowing and the legal protection offered by the Public Interest Disclosure Act 1998, those who speak out currently still expect to suffer at the hands of their employers.

But unlike his Mid-Staffordshire report, this one needs to be short and punchy. It will only help change culture if everyone in the NHS can read and understand it; plain English, not lawyerly circumlocution, is required.

Boards – especially non-executive members – are central to championing a culture of openness and transparency. They must spell out to managers and the whole workforce that they regard trying to silence a whistleblower as a serious patient safety incident.

Hunt has skilfully positioned himself as the patient champion while avoiding more difficult questions about the future of the NHS. But the government is only able to make the running on safety because the NHS itself has failed to do so. Everyone, from the Royal colleges to the NHS Confederation, should be owning this issue. All of them have spoken on it with passion and commitment for many years, but the staff survey shows that so far their leadership has not delivered the required change.

Hunt vows to punish NHS bullies – an independent enquiry – is “face” too important?

‘Let’s add life to years, not just years to life’

Gill Hitchcock in the Guardian, 26th June gives voice to the opinion of Phsiotherapists:

Karen Middleton: ‘Let’s add life to years, not just years to life’

The new Chartered Society of Physiotherapists chief executive discusses patient-first care, technology and rehabilitation

Physiotherapy, despite being a core need for rehabilitation and education is being downgraded by deliberate covert rationing by undercapacity. Unemployed physios are legion….If you wish for physio speedily, which is where it is useful for musculoskeletal injuries in particular, you have about as much chance as finding an NHS dentist.. In some parts of the UK, the any qualified provider recommendation (AQP) has been used to commission private contracts with non NHS pension firms.. The chancellor is delighted… It makes sense for the budget, but not for quality of care and access to the service.

 Karen Middleton has left NHS England’s offices as chief allied health professions officer for what her colleagues call the “other side”. Having trained initially as a physiotherapist at St Mary’s hospital in Paddington, London, before practising in Essex and east London, she has headed home.

 

In February Middleton became chief executive of the Chartered Society of Physiotherapists (CSP) – a body that represents 52,000 physiotherapists in the UK. It’s not quite as old as its Georgian headquarters in London, but since 1894 the CSP has been the key association, and more recently trade union too, for physiotherapists.

Despite their vital care for patients with cancer, heart failure, chronic obstructive pulmonary disease, stroke and sports injuries, physiotherapists have a low profile compared with many other healthcare professionals. Perhaps this is why Middleton insists that her most significant achievement at NHS England was in getting greater recognition for physiotherapists and the other allied health professionals (AHPs), such as podiatrists, occupational therapists, radiographers and speech and language therapists. “While we’re nowhere near where I’d like to be in terms of visibility, now there’s much greater recognition of the role of AHPs in every care pathway,” she says, “and that’s been as a result of some key pieces of work.”……

Online doctor appointments ‘are insecure’

Chris Smyth in The Times reports 26th June on the BMA line: Online doctor appointments ‘are insecure’

Many doctors feel very insecure and unhappy with on-line consultations, and training will be needed. In addition, Insurance premiums (already high) might reflect the number of consultations a doctor makes without examining the patient…. Rationing by encouraging indirect encounters is risky..

Patients should not be pressured into seeing their GPs over the internet, doctors warned yesterday.

Virtual NHS consultations were insecure and risked wasting doctors’ time on the “IT savvy” rather than those who were actually sick, the British Medical Association said.

In a swipe at Jeremy Hunt, the health secretary, Chaand Nagpaul, chairman of the BMA GPs’ committee, said that it was “simplistic” to expect big savings through technology.

Mr Hunt has argued that the NHS needs a digital revolution to follow those in banking and budget airlines but Dr Nagpaul dismissed that comparison, saying that apps that let people talk to their GP would never be more than a niche product.

The doctors union said that more research was needed on e-consultations because of concerns over “ethics, confidentiality, clinical safety and standards”.

Dr Nagpaul said: “We’re not against the idea of technology but we need to make sure it does not become misinterpreted as a simplistic approach to managing the pressure on GPs . . . A mantra has developed that Skype consultations can somehow solve NHS pressures.”

He warned it would be a “disaster” if internet consultations could be hacked or eavesdropped

Top doctors urge Welsh Government to rethink plans to cut consultants’ pay

Mark Smith reports in Walesonline 26th June 2014: Top doctors urge Welsh Government to rethink plans to cut consultants’ pay 

As if there were not enough medical recruitment problems in Wales already….. This is short-termism and financial rationing of the worst sort. Trying to deal with the budget deficit in a knee-jerk reaction. I suppose the WG could close every hospital in Wales and purchase all care from England… It would probably save money..

Medical experts have called on the Welsh Government to rethink plans to cut pay for consultants or risk driving more doctors out of the country.

The Doctors and Dentists Review Body, an independent body which advises government on rates of pay, has determined that doctors should be given a 1% pay increase in line with their growing workloads after taking evidence from governments and trade unions.

But the British Medical Association Cymru claims the Welsh Government has not accepted the recommendation but has gone further, by proposing to cut the salaries of consultants and other healthcare staff.

This could mean that consultants will earn 5% less than their counterparts in other parts of the UK.

The BMA has warned the move will worsen the continuing recruitment crisis in Wales and deter consultants and other healthcare staff from coming to work in Wales.

In response, the Welsh Government say the BMA has got its figures wrong.

Chairman of the BMA Welsh Council Philip Banfield, speaking at the BMA conference in Harrogate yesterday, said Wales is facing a stark future which could scar the nation.

He compared the Welsh NHS to an oil tanker on a collision course with rocks.

He said: “Frontline clinical staff have morale at an all time low, stress at an all time high and this is when mistakes happen and patients die unnecessarily.”

The BMA says it has received more than 450 unsolicited e-mails and letters from consultants working in Wales expressing their dismay at this proposal.

Many expressed their intention to leave the country or retire and others warned that morale would sink even lower and recruitment made even more difficult.

Welsh Secretary of the BMA, Dr Richard Lewis, said: “This is not an acceptable way to treat hospital consultants when it is already difficult to recruit doctors to Wales.

“This will have a negative effect on the health service and on patients. Scotland has shown that they value their staff by implementing the DDRBs 1% increase.

“It is difficult to believe that Welsh Government values its staff and is seriously trying to solve the recruitment problems across the country.”

Dr Lewis says patient safety will be seriously compromised if Wales’ recruitment problems are not sorted out.

He added: “This is not about money. It is about making sure that we have enough doctors in Wales to treat patients.”

Kirsty Williams AM said she was hugely concerned by the news.

She said: “We already face a recruitment and retention crisis in our NHS and these proposals would only serve to exacerbate the problem.

“There is no denying that there is an acute shortage of doctors and consultants here in Wales. We need these vacancies to be filled as a matter of urgency as such issues can lead to temporary hospital closures, which then have a detrimental effect on patient safety and care.”

In response, a Welsh Government spokesman said: “We have received the pay review body’s recommendation and are working with representatives from professional bodies and trades unions about how an equivalent sum to that being made available in England can be distributed to NHS staff in Wales.

“There are no proposals to cut consultants’ pay. We share BMA Wales’ aim of continuing to improve healthcare, but regret it has been unable to come to the table to negotiate with NHS Employers in Wales about the reform of terms and conditions in the Welsh consultants’ contract.

“In the absence of Welsh discussions, which we would very much have preferred, we are now considering how we can ensure that comparable opportunities are available to consultants in Wales as to their colleagues in England.

“When it comes to spending on health the BMA has got its figures wrong. Wales actually spends £42 more per head of population on health than England.”