Category Archives: Gagging

The reaality of cultural dissonance.. A GP Trainee recalls her hospital experience of discipline..

A letter in the Times from Dr Katie Musgrave 20th January informs readers of the reality of being a junior doctor in todays overmanaged health services. Read it at the end of this post.

The Bury St Edmonds terrorising of staff, threatening them with fingerprinting, and generally demoralising them further, is indicative of the whole of the 4 health services. 

The idea that managers can treat doctors as staff on a factory production line has led to this situation. Changing a culture is very difficult... especially for a state monopoly which most people still love the idea of… especially when the trust are all bust. No single person I have asked seems to realise that with the Brexit devaluation of the pound all costs have risen by 18%…

Add to this the overhead inherent in Wales (As opposed to Scotland and N Ireland) because of the Welsh Government..

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Bury St Edmunds Hospital in the dock. Cultures rarely change themselves. Reform is needed. Britain needs a truly independent body to which NHS staff can turn,

Missed appointments dont cost except in a factory model of General Practice. 20,000 missed appointments is actually welcome to most GPs. Now if there was a disincentive to make a claim….

Kent NHS ‘to send surgery patients to France’ – setting a precedent? Can the fragmented UK health services recover without some form of zero-budgeting and revolutionary reconfiguration based on overt rationing?”

NHS WHISTLEBLOWERS
Sir, Your report on West Suffolk Hospital (“Anger over ‘witch hunt’ in hospital”, Jan 17) will be shocking to many but did not surprise me. My husband (a GP) and I have just exchanged memories of times when, as junior doctors, we were both brought before committees accused of minor misdemeanours. He had logged into a results system online and forgotten to log out. Someone had subsequently used his account to look at a consultant’s personal medical results. He was made to “confess” and sign a document admitting his negligent behaviour. I was once accused of dropping a blood bottle into a regular bin rather than a clinical bin. The bottle had been traced to me and a committee put together to sanction me for this crime. At another hospital I was called to answer for having examined a child in the wrong clinical room. Apparently I had been anonymously reported. Such bullying tactics are widespread in the NHS and do indeed keep doctors from raising genuine concerns about patient safety. If, from your early years of training, you have been consistently threatened and undermined, it can be very difficult to maintain the resilience to speak up. We need independent advocates for NHS whistleblowers.
Dr Katie Musgrave, GP trainee
Loddiswell, Devon

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Bury St Edmunds Hospital in the dock. Cultures rarely change themselves. Reform is needed. Britain needs a truly independent body to which NHS staff can turn,

It is going to be impossible to rescue the gagging cultural demise of the health service without a form of “zero budgeting”. This was used by accountants to help turnaround a business financially, but now we need consultant teams to take over hospitals, change the rules so that everything is no longer free, and take the best out of various overseas systems.

Not only devolution has failed, but also the Four Health Services. Covert rationing is no longer acceptable.

Chris Smyth reports in the Times 17th Jan 2020: Anger over ‘witch hunt’ for whistleblower after death at West Suffolk Hospital – Managers demanded fingerprints from doctors

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Downing Street today warned the NHS to protect whistleblowers better after hospital bosses carried out a “witch hunt” against doctors in an attempt to identify which one had raised concerns about a woman’s death.

Inspectors are due to report within weeks on an incident in which staff were asked to provide fingerprints and examples of their handwriting to try to establish whether they had written an anonymous letter to a widower informing him about failures in his late wife’s care….

..Jeremy Hunt, the former health secretary, said yesterday that a punitive approach to staff who owned up to problems was a key reason why the NHS operated on the wrong part of someone’s body four times a day…

Eastern Daily Press: It was soul destroying – man criticises hospital for lack of basic care 

Matthew Weaver and Dennis Campbell report: Staff say hospital bosses misled them in hunt for whistleblower – Doctors told a patient’s widower about the failings in an operation that led to her death

The Times view on efforts to expose a whistleblower at an NHS hospital: Healthy Disclosure – Shameful efforts to expose a whistleblower at Matthew Hancock’s local hospital raise worrying questions about NHS culture

ealth secretaries speak warmly of whistleblowers, as they should. After scandals that centred on NHS cover-ups, Matt Hancock, said that he wanted “more people to feel they can put their head above the parapet”. His predecessors in the post, Jeremy Hunt and Andrew Lansley, also talked of ending a culture of fear and installing a culture of learning. Yet now Mr Hancock’s own local hospital has become the latest in a long line of NHS institutions to be mired in a scandal over its treatment of staff — and all because they tried to call attention to serious clinical mistakes. The case raises worrying questions about the culture of the NHS.

This latest scandal follows the death of Susan Warby after a bowel operation at West Suffolk Hospital in August 2018. Her widower was sent an anonymous letter which claimed that there had been errors in her procedure. The letter was made public in an inquest that began yesterday. It claimed that Mrs Warby had been given an intravenous glucose rather than saline drip and that a “tricky”procedure in which she suffered a punctured lung had been carried out by a junior member of staff.

Rather than come clean about the mistakes, the trust had instead instigated a hunt for the whistleblower. In the process it employed “bullying” tactics, including coercing staff into taking handwriting and fingerprint tests, according to doctors who passed concerns to the Care Quality Commission. At a meeting last month, senior doctors further accused the trust of misrepresenting its demands as “voluntary” in a statement it made to a newspaper in December. The trust has now apologised to staff for “stress and upset caused”. It has said that by the time the letter was sent to Mrs Warby’s widow an investigation into her death had already begun. Meanwhile it maintains that it was simply looking into a data breach.

Not everyone claiming to be a whistleblower has a valid complaint. Yet the health service’s long history of cover-ups is an argument for reforming the way that staff concerns are handled. Among scandals that have come to light is one dating back to the 1970s and 1980s, when the health service allowed some 4,800 haemophiliacs to be infected with blood contaminated with HIV or hepatitis C. In the cover-up that followed, diseases were allowed to progress and victims unwittingly infected others. Medical records went missing and when patients transferred from one doctor to another, doctors wrote notes to make sure patients were not accidentally told of their condition.

Other scandals have followed the same pattern of mistakes and neglect followed by cover-up. Between 1989 and 2000 at least 456 elderly patients died at Gosport War Memorial Hospital in Hampshire as a result of being given powerful painkillers. Likewise between 2004 and 2013 neglect at Morecambe Bay NHS Trust led to the deaths of at least 11 babies and one mother. In the Mid Staffs scandal, hundreds of people were feared to have died as a result of abuse and carelessness at Stafford Hospital between 2005 and 2009. In each case, whistleblowers were fired, gagged or blacklisted.

It is clear that warm words will not be enough to steer the NHS on to a better course. Cultures rarely change themselves. Reform is needed. Britain needs a truly independent body to which NHS staff can turn, along the lines of the Office of Special Counsel in the US which has the power to protect whistleblowers and hold institutions to account. Laws should also be strengthened to help whistleblowers contest the loss of jobs or promotions. Those found to victimise them should face penalties. NHS whistleblowers provide a vital public service. Quite apart from the lives they can save, they can help their institutions avoid far bigger scandals down the line.

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A toxic amalgam of 4 “health and social care” services

It seems that all the 4 health services are too toxic for any party to make a meaningful statement of how they, or social care, should be changed. The BMJ in a comparison of bribes describes the differences between the parties on Health and Social Care. Not one of them is suggesting that even with money, plant, people and cultural improvement, the system itself needs to change. It is not founded on a financial rock, and the result is a perverse incentive to deny or ration care covertly if possible, but overtly if the management cannot get away with it.

The ingredients for toxicity have been building up for years. Management, consultants, bullying, and culture etc.

Avoiding the issues Nowhere to go – The BMJ

2013 BBC News: Bullying ‘creates toxic NHS culture’ – BBC News

2013 The Independent: Watchdog warns of ‘toxic cocktail’ within the NHS

2013 Health Service Journal: NHS in-fighting is creating a toxic culture | Comment | Health …

2015 National Health Executive: ‘toxic’ bullying culture – National Health Executive

2019 HSJ: Surveillance of managers is ‘toxic’ says Don Berwick | News …

2019 The Guardian: Latest NHS maternity scandal is product of toxic ‘can’t happen …

2019 The NHS crisis of caring for staff | The King’s Fund

Miles Sibley in the BMJ: Changing the culture of learning from deaths

With the revelation that a “toxic culture” led to the deaths of mothers and babies at the Shrewsbury and Telford Hospital NHS Trust, patient safety in maternity services is once again in the spotlight…..

Was there ever a better opportunity to promote Proportional Representation?

 

 

 

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

GPs told to stop closing for half-days . Corporate bullying and breaking contracts unilaterally will not “gag” self employed GPs.

The contract between an independent GP as a self employed practitioner, and the state is a written one negotiated by the BMA. Some practices are large enough for there to be no half day closures, but some are not. This “instruction” is illegal, and should be ignored and challenged in court. (By the BMA). However, there is a problem with single handed practices, usually either in distant rural locations, or in city centres. GPs, mainly female appointments since 2000, are NOT an emergency service any longer, and their contract states this. Many GPs work part time to accommodate family commitments. The idea of the instruction is to free up appointments; I know of no GP who is not exceeding his contractual commitment, but it is very possible that corporate bullying of this nature will mean they start working to rule. It is not the professions fault that there are too few bodies at the coal face. Even today, when Medical Schools are trying to train more, there are 10 applicants for every place. Why not appoint on criteria rather than competitively…. Overcapacity might result in rather more appointments but it will take a decade. It is the perverse incentive to save money and plan for only the next four years, rather than empower good manpower planning, which has led to this situation. Government has been in denial of it’s own part in the mess that is General Practice today for at least 6 years… The corporate culture of Hospital bullying will not work in General Practice.

Exclusive: Doctors are ordered to stop halfday closing at surgeries …
Daily Mail19 Aug 2019

Anviksha Patel reports in Pulse 0n 19th August: GPs told to stop closing for half-days or risk losing £40k in funding

GP practices have been warned to stop closing for half-days or risk losing £40,000 in funding, according to new plans by NHS England.

The plans to withhold funding come as figures show over 700 practices in England regularly close for part of the working week, according to findings from the Daily Mail…..

….Figures show in 2018/19, 722 practices were shut for part of the week, 197 of which initially did not declare they were closed for a half-day. Additionally, 38 practices reported their total opening hours amounted to fewer than 45 hours per week, lower than the contracted 52.5 hours per week.

The BMA has said instead for ‘threatening’ GPs by reducing their funding, NHS England must address the GP recruitment and retention crisis as a solution to ‘lasting improvement to patient care.’

BMA GP committee chair Dr Richard Vautrey said: ‘It is disingenuous for NHS England to be so categorical in claiming they know exactly how many more appointments would be available if practices changed their opening arrangements….

Richard Ault in Stoke on Trent live 23rd August reports “North \Staffordshire GPs ordered to end half-day closing.

Orders issued to GPs to end the practice of half-day closing have been slammed as ‘political nit-picking’ by a leading North Staffordshire doctor.

NHS England says more than a quarter of a million GP appointments will be available when surgeries end the practice of shutting midway through the day…

In future, as part of the NHS Long Term plan, practices will have to seek permission from local health authorities to shut during working hours or risk losing funding worth more than £40,000 per business……

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Pulse 29th September 2017: Extended GP opening has ‘no immediate correlation’ to A&E … –

Sofia Lind in Pulse 27th October 2013: Longer opening hours needed

 

 

Whistleblowing Champions – in Scotland only (for now). Apply through NHSreality, or Holyrood.

With permission (I assume) from Peter Gregson in Scotland, I can publicise the new Whistleblowing Champion, in Scotland only for now, then apply for the job through the link below. The other 3 UK dispensations may follow suit, but you never know: after all there is no National Health Service any more, except for emergencies. Congratulations to Pete for getting this success… Now we need to measure outcomes, especially longevity in post and unemployment rates..

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This is Pete’s e-mail to me:

Here is the video of the event at Holyrood  –  www.tinyurl.com/blastvid

It lasts 90 minutes, but I think it’s good stuff.

The PA to the Health minister Jeane Freeman has asked for the link and says he’ll send it onto Jeane. I’d be impressed if she watches it.

I will send the link to the members of the Health Committee.

One of them, Alex Cole-Hamilton (LibDem) has asked to meet Rab and I. That should happen before the end of July.

Would any of you be interested in a new job? These are paid Whistleblower Champion posts.

https://applications.appointed-for-scotland.org/pages/job_search_view.aspx?jobId=1674&JobIndex=1&categoryList=&minsal=0&maxsal=150000&workingPatternList=&keywords=&PageIndex=1&Number=4

Finally, if you know of anybody who wants to log a whistleblowing concern with us, give them this link www.tinyurl.com/scottishNHSwhistleblowers  We’ll make sure the new Independent National Whistleblowing Officer, Rosemary Agnew, takes note.

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NHS Scotland must tackle bullying problems ‘head-on’ – Dr Lewis Morrison for the BBC News 25th June

Third high-level resignation from NHS Highland board in as many .. NHSH vice-chairwoman Melanie Newdick .Press and Journal 16th July

Surge in calls to Scotland’s NHS whistleblowing hotline – 19th April

Holyrood: NHS Whistleblowing champions ‘can come straight to me’, says Jean Freeman October 2018

Non-executive Whistleblowing Champions – NHSScotland – Apply here

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Tere is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

GP list sizes in England can be found here. 

Standards are falling in most areas because of the pressure of work both in Hospital and General Practice. Occasional well respected and popular training practices are the least under pressure. In social care standards are also falling, and one inspector (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission. He should be listened to, as there is a toxic culture, and disengagement everywhere in Health and Social Care. Of course there will always be examples of individuals who break the mould, but in general NHSreality says it as it is. The Times report is below..

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Mary MacCarthy in Pulse December 2018: Cappling GP lists would make GPs and patients safer: 

Nick Bostock in GPonline 12th December 2018 reports that since 2004, there has been a 50% increase in GP list sizes.

and earlier that year, he reported with Teni Oluwunmi  that the number of GP practices had declined by 263!!

and last year, according to the Mail by 138

Emma Bower for GPonline 5th June 2019 also suggests that Scotland needs a new target for the GP workforce. With increasingly elderly population with multiple pathologies and complexity, 15 minute appointments are also needed. (BBC News)

Anal Carcinoma needs prevention with HPV vaccine? A nurse comments on her own illness…in Healthonline

Research in the US has discovered what the drug manufacturers should have found: drugs for shrinking enlarged prostates cause delay in the diagnosis if the prostate goes malignant. Another case of Big Pharma and overtreatment.

Barry Stanley-Wilkinson gives his exit interview from the CQC. (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission.

Waiting lists are getting longer, even for cancer diagnosis and treatment. Nick MacDermott in the Sun12th June 2019 so keep up the private insurance payments as long as you can, especially if you live in Wales.

An inspector whose report highlighting failings at a scandal-hit hospital was never published resigned from the regulator, protesting that some of its staff were too close to the private company that ran the hospital.

Barry Stanley-Wilkinson also complained of a “toxic” culture at the Care Quality Commission and said many of its inspectors felt that they worked in a “bullying, hostile environment”.

Mr Stanley-Wilkinson resigned six months after he led an inspection in 2015 of Whorlton Hall, a private hospital in Co Durham for adults with learning disabilities or autism. Police arrested ten carers at the hospital last month after Panorama on the BBC broadcast footage of staff appearing to mock and intimidate patients.

The inspector reported in 2015 that some patients had accused staff of bullying and inappropriate behaviour. He said patients did not know how to protect themselves from abuse and recommended that the hospital should be given a rating of “requires improvement”.

His report was never published and a new CQC team that inspected Whorlton Hall in 2016 gave it a “good” rating. Mr Stanley-Wilkinson’s resignation email, sent to the CQC in January 2016, was published yesterday by parliament’s joint committee on human rights, which took evidence from two CQC executives. He expressed frustration that his report on Whorlton Hall had not been published “despite significant findings that compromised the safety, care and welfare of patients”.

He referred to a complaint about his report by the hospital, which was then run by the healthcare company Danshell, and pointed out that it had previously been run by Castlebeck, which ran Winterbourne View, a care home where there had been an abuse scandal in 2011. Whorlton Hall was taken over by Cygnet Health Care this year.

“I am concerned about the relationship managers have had with the service,” Mr Stanley-Wilkinson wrote. “Discussions had taken place without my involvement despite me being the inspector.”

Paul Lelliott, deputy chief executive of the CQC, said the 2015 report had had inconsistencies and lacked evidence. Ian Trenholm, its chief executive, said the CQC planned to develop a new way to monitor institutions.

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