Category Archives: Gagging

A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear

Honesty and Candour are at risk. In a post truth world we need to control the damage being done to the medical profession. Without a no-fault compensation scheme this situation will get worse. Already precedent has been set by demanding access to Trainee doctors “educational portfolio”, and these two cases together are worrying. A sinister development in the role of the GMC the position of a trainee, and the risk of a worsening, defensive culture of fear. Gagging with such behaviour is really another form of bullying.

In Letters in the Times 5th December a team of 760 professionals at the top of their game question the GMC and it’s approach to candour. Medicine on trial:

MEDICINE ON TRIAL
Sir, We are concerned that the General Medical Council (GMC) is putting the culture of candour in medicine at risk and perpetuating an injustice by seeking the permanent erasure from the medical register of Dr Hadiza Bawa-Garba. Dr Bawa-Garba, a trainee paediatrician, was convicted in 2015 of negligent manslaughter after the tragic death of Jack Adcock in 2011.

The Medical Practitioners Tribunal Service (MPTS) then had to decide if she was fit to continue to practise. It heard that her clinical practice was generally regarded as excellent, with no other concerns flagged against her. It recommended she could apply to return to service as a doctor after 12 months’ suspension. The MPTS identified “multiple systemic failures” within the service. The evidence for these failures was not fully examined at the criminal trial; had they been, this would almost certainly have reduced her purported culpability.

The GMC is now appealing, via the High Court, seeking to have her struck off. We know of no evidence that terminating Dr Bawa-Garba’s medical career will make any patient safer. On the contrary it promotes a climate of defensiveness. In 2001, the joint declaration by the government and the GMC recognised that “honest failure should not be responded to primarily by blame and retribution, but by learning and by a drive to reduce risk”.

We urge the GMC to recognise that many within and outside medicine are already losing confidence in it and that this case could define its future.

Dr David Nicholl, consultant neurologist, Birmingham; Sir Peter Bottomley, MP; Nick Ross, journalist; Captain Niall Downey, doctor, pilot & patient safety trainer; David Field, professor of neonatal medicine, University of Leicester; Professor Sir Iain Chalmers, James Lind Initiative, Oxford. Plus a further 769 names at manslaughterandhealthcare.org.uk/letter

Trainee’s portfolio ‘used as evidence against them’ in legal case

The real man smiles in trouble, gathers strength from distress, and grows brave by reflection. Thomas Paine Article from Pulse magazine once again the opportunity to learn from mistakes will be lost in order to satisfy the thirst for cash for claims bonanza that is going on in the UK. Good luck retaining doctors with […]

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Whistleblowing law is expanded.. but hardly applies to GPs

The Times Law Report on 26th June: More than one employer can be liable to ‘whistleblower’

The trouble is that GPs are self employed and have no whistleblowing liable employer. However, GPs are more and more “portfolio” a career doctors with some time as partner or salaried partner, some time as educator, some time as referral centre letter reader, sometimes as Out Of Hours doctor or A&E assistant.

Image result for whistleblowing doctor cartoon

Court of Appeal

Published: June 26, 2017

Day v Lewisham and Greenwich NHS Trust and Another

Before Lady Justice Gloster, Lord Justice Elias and Mr Justice Moylan

[2017] EWCA Civ 329

Judgment: May 7, 2017
For the purposes of the protection for “whistleblowers” in the workplace, a person in training might be employed by both the employer with whom he had been placed and the training body that had made the placement, if the training body had substantially determined the terms under which he worked.
The Court of Appeal so stated when allowing the appeal of the claimant, Dr C Day, against the dismissal by the Employment Appeal Tribunal (Mr Justice Langstaff) ([2016] ICR 878) of his appeal against a decision by an employment tribunal to strike out his claim against the second defendant, Health Education England, that it had subjected him to a detriment for making a protected disclosure or “whistleblowing”. The first defendant was Lewisham and Greenwich NHS Trust. Public Concern at Work intervened in the proceedings.

Part IVA of the Employment Rights Act 1996 (as inserted by section 1 of the Public Interest Disclosure Act 1998) provides, so far as relevant:
“43K(1) For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) but who (a) works or worked for a person in circumstances in which (i) he is or was introduced or supplied to do that work by a third person, and (ii) the terms on which he is or was engaged to do the work are or were in practice substantially determined not by him but by the person for whom he works or worked, by the third person or by both of them . . . and any reference to a worker’s contract, to employment or to a worker being employed shall be construed accordingly.
“(2)(a) For the purposes of this Part ‘employer’ includes (a) in relation to a worker falling within paragraph (a) of subsection (1), the person who substantially determines or determined the terms on which he is or was engaged . . .”

Mr James Laddie, QC and Mr Christopher Milsom for the claimant; Mr David Reade, QC and Mr Nicholas Siddall for the second defendant; Mr Thomas Linden, QC, for the intervener.

Lord Justice Elias said that Part IVA of the 1996 act, read together with sections 47B and 103A (as inserted by sections 2 and 5 of the 1998 act), protected workers who disclosed information about certain alleged wrongdoing to their employers (colloquially known as “whistleblowers”) from being subjected to victimisation or dismissal as a consequence.

The appeal concerned the proper construction of section 43K and the application of that section to a certain category of doctors operating in the health service.

The claimant was a doctor who wanted to specialise and was accepted by the body then responsible for training doctors in London to take up a post from August 2011. He entered into a training contract that the parties agreed was not a contract of employment. He was allocated to the first defendant NHS Trust. Subsequently, the training body was taken over by a training board that was part of the second defendant, Health Education England.

Trainee doctors were allocated for relatively short fixed periods to NHS trusts. They entered into contracts of employment with each trust. The claimant worked, inter alia, at the Queen Elizabeth Hospital. While there, he raised a number of concerns with both the trust and with the South London Health Education Board about what he considered to be serious staffing problems affecting the safety of patients.

He alleged that those were protected disclosures within the meaning of the legislation on whistleblowers and he asserted that he was subject to various significant detriments by the second defendant as a consequence. He took proceedings before the employment tribunal against both the trust and the second defendant, as the body responsible for the actions of the South London Board.

The second defendant denied any wrongdoing, but took a preliminary point. To bring a whistleblowing claim the claimant had to fall within the statutory definition of worker and the defendant had to be his employer. The second defendant contended that that was not the position and, accordingly, that even if the facts alleged by the claimant were true, the second defendant could not be liable in law for any acts causing him detriment.

The only question was whether the claimant was a worker within the extended definition in section 43K and the second defendant was his employer as defined in that section.

His Lordship would refer to the person for whom the individual worked as the end-user and the party introducing or supplying that worker as the introducer. It was envisaged in section 43K(1)(a)(ii) that the terms on which an individual worked might be substantially determined by both the end-user (the heath trust) and the introducer (the training body). That might be either because the introducer and the end-user determined the terms jointly, or because each determined different terms but each to a substantial extent.

The extended definition of “employer” in section 43K(2)(a) was not limited to the person who played the greater role in determining the terms of engagement. Since both introducer and end-user could in principle substantially determine the terms of engagement for the purposes of the definition of worker, there was no basis for concluding that they could not do so when it came to applying the extended definition of employer.

That would in some cases have the effect that both introducer and end- user were employers and each would then be subject to the whistleblowing provisions. Indeed, that would seem to be an inevitable conclusion if the terms were determined by the end-user and introducer acting jointly. If only one party could be the employer, it was difficult to see by what principle it would be possible to determine who that should be.

The Employment Appeal Tribunal had been wrong to find that the fact that the health trust was a section 230(3) employer precluded the training body from also having that status.

There had to be some limitation on the words of section 43K, which began by providing: “For the purposes of this Part ‘worker’ includes an individual who is not a worker as defined by section 230(3) . . .” The insertion of some such phrase as “as against a given defendant” after “includes an individual who” would allow the section to operate against one of those parties even if there was a section 230(3) relationship with the other.

Accordingly the training body could in principle fall within the scope of section 43K(2)(a), notwithstanding that the claimant had a contract with the hospital trust.

The employment tribunal had not engaged directly with the question whether the training body itself “substantially determined” the terms on which the claimant was engaged. A tribunal should not limit itself to focusing solely on the contractual terms, although no doubt the terms would be overwhelmingly contractual. The section required the tribunal to focus on what happened in practice.

When determining who substantially determined the terms of engagement, a tribunal should make the assessment on a relatively broad brush basis having regard to all the factors bearing upon the terms on which the worker was engaged to do the work.

The case would be remitted to a fresh tribunal for determination of the preliminary issue whether the training body substantially determined the terms of engagement of the claimant.

Lady Justice Gloster and Mr Justice Moylan agreed.

Solicitors: Tim Johnson Law; Hill Dickinson, Manchester; Solicitor, Public Concern at Work.

Whistleblowing in the NHS – how safe are you? (Sharmila Chowdhury 4 August 2014)

Image result for whistleblowing doctor cartoon
[PDF] Wales’ GP Heroine Whistleblower…. The Spectator reveals “How the …

NHS reality. An NHS soapbox. Speakers’ corner for the NHS …400 × 305Search by image

The Spectator reveals “How the NHS silenced a whistleblowing doctor” – No cultural change yet… | NHS reality. An NHS soapbox. Speakers’ corner for the NHS.

The inconvenient truth: NHS faces £20bn funding hole whoever wins

Whilst the media discusses terrorism without any evidence of what might be successful, the health service is ignored, despite evidence that refinancing is urgently needed, and in the long term the ideology is unsustainable. A letter from the three leading health think tanks in the Times fails to mention the need to ration health care overtly, but rationing is the unspoken thought behind all three… (CALL TO STRENGTHEN NHS FINANCES). Could it be that Mssrs Dixon, Edwards and Ham are effectively gagged from using the “R” word by threats to their funding? And they seem to include all the different health jurisdictions, and ignore that, as far as patients in Wales are concerned, there is no NHS any longer.

The Times’ Chris Smyth reports 6th June 201,7: NHS faces £20bn funding hole whoever wins

The NHS faces a £20 billion hole whoever wins the election, according to three leading think tanks.
They warn that services will worsen and patients will wait longer and be denied new drugs because no political party is offering enough for the NHS to cope with an ageing Britain. The main parties’ plans will give the NHS less than half the money it needs to avoid getting worse over the next parliament.
The King’s Fund, Nuffield Trust and Health Foundation say that politicians must come up with a long-term answer to rising health spending or be forced into wasteful emergency bailouts.

The Conservatives, Labour and the Liberal Democrats have all promised to increase the NHS England budget, which is currently £124 billion. Analysis of manifesto pledges suggests that by 2022 spending will increase to £132 billion in real terms under Tory plans and £135 billion under Labour.
However, projections by the Office for Budget Responsibility (OBR) suggest that the ageing population, rising cost of new drugs and other pressures mean the NHS will need £155 billion a year by then to maintain services.

“A real-terms funding increase of about £30 billion a year is needed in five years’ time to enable the NHS to deal with these pressures,” Chris Ham, Nigel Edwards and Jennifer Dixon, heads of the King’s Fund, the Nuffield Trust and the Health Foundation respectively, write in a letter to The Times.

“Our analysis shows that none of the main political parties has pledged enough in their manifestos to cover even half of that, while the share of our national wealth spent on healthcare would fall under all of their plans.

“Failure to provide sufficient funding and improve efficiency will result in longer waiting times for patients, poorer access to cost effective treatments and a decline in NHS and social care.”

Siva Anandaciva, chief analyst of the King’s Fund, said the OBR figures assumed the NHS would make further savings of the sort they had managed in the past, with bigger ones unlikely.

“You can certainly have that aspiration. But what the OBR does is take historical productivity that the NHS has achieved and bake that in,” he said.

By 2022 the population is expected to rise by 3.7 per cent, over-65s by 9.2 per cent and over-85s by 14.5 per cent.

CALL TO STRENGTHEN NHS FINANCES)

Sir, A strong NHS is vital for a thriving population, workforce and economy. Public spending on healthcare accounts for just over 7 per cent of our national wealth. That is not enough to cope with the ageing population and other cost pressures.

Projections by the independent Office for Budget Responsibility suggest that a real-terms funding increase of about £30 billion a year is needed in five years’ time to enable the NHS to deal with these pressures. None of the main political parties has pledged enough to cover even half of that, while the share of our national wealth spent on healthcare would fall under all of their plans.

The next government must act quickly to strengthen the health service’s finances in the short term, as well as developing a sustainable, long-term approach to funding the NHS, to put an end to the cycle of feast and famine. This should include establishing an independent body to assess and advise on health and social care funding needs.

The NHS must also focus on improving efficiency and use additional funding to reform care to meet changing population needs. Failure to provide sufficient funding and improve efficiency will result in longer waiting times for patients, poorer access to cost-effective drugs and treatments and a decline in NHS and social care.
Jennifer Dixon, CEO, the Health Foundation; Nigel Edwards, CEO, Nuffield Trust; Chris Ham, CEO, the King’s Fund

Scotland and Whistleblowing

NHSreality takes the view that since morale is so low, no internal assessment of a whistleblower is possible. Cultural change needs to come quickly, and the start of this is meaningful “exit interviews” by an independent HR company. This company should report in general publically, for a Region, but specifically, in private to Health Boards. Copies of reports should go to the Minister concerned, and should be released once they are not embarrassing to individuals concerned. Incognito exit interviews could then be possible, and done for all staff moving or leaving posts; in particular juniors. I have delayed this post for 3 months hoping there would be some good news follow up… Post will be updated if there is. Some “good news” – Hywel Dda Trust in West Wales have told the consultants that they will initiate exit interviews. At least they are recognising their importance – now they need to recognise the barriers to speaking honestly to their own HR, especially for those moving post within the Trust, but even for those at retirement. The Health Services are on fire… Interesting that the problem has been deferred to the Health and Sports committee… reminds me of “turfing”, or passing the buck in the House of God. (Sam Shemm 1978)

Update 15th March 2017 from 17th Feb 2017:

Hello, If you want to read the transcript of the Petitions Committee meeting where MSP’s quiz Edinburgh Council, Public Concern at Work (PCAW) and Unison on whistleblowing read it here and you can see the video here which last 45 minutes. The Council scheme comes over as having overcome the culture of fear around when I worked there and contrasts hugely with NHS arrangements. The Council reps pointed out that they’d had 53 reports in the 3 years since it was introduced compared to only 3 disclosures over 8 years prior. PCAW said NHS Scotland needed better arrangements but disappointingly said nothing  about the shortcomings of Scotland’s Board Champions, who can’t take or deal with reports (even though I’ve heard they think this is a problem). Unison didn’t really say anything. The next landmark will be on 2nd March when the NHS Scotland Chief Executive, Paul Gray, is called to account.

Important news – the Scotsman reported that “the Parliamentary Health Committee has commenced an enquiry to investigate how the NHS deals with whistleblowers amid concerns there is a culture of fear which discourages staff from raising patient safety issues. NHS staff are to be asked for their views as part of the inquiry launched by MSPs on Holyrood’s health and sport committee.”
More details can be found on the Parliament website “Call for written views on Inquiry into NHS Governance – Creating a culture of improvement” at http://www.parliament.scot/parliamentarybusiness/CurrentCommittees/103512.aspx The Committee is considering whether staff are managed in a fair and effective way.

 And on 5th March 2017:

Hello, The evidence submitted by the NHS Chief Executive, Paul Gray, to Petitions Committee on the 2nd March was underwhelming. The MSPs gave him an easy ride. You can view the 45 minute video here: http://www.scottishparliament.tv/20170302_public_pets?in=00:00:17&out=00:45:04 The transcription is here: http://www.parliament.scot/parliamentarybusiness/report.aspx?r=10824

I was surprised that the Chair brought up grievances at the beginning, ignoring the fact that staff only bring grievances after they feel they have been unfairly treated. Why did she not ask not ask directly for views on the petition? Indeed, it felt as if they’d rehearsed the whole discussion beforehand. There were no questions as to the efficacy of the whistleblowing champions – in having no staff-facing role, with no means to knowing how many (and when) concerns were raised.  At no point did the well-known victimised whistleblowers at Aberdeen, Forth Valley, Ayrshire & Arran and Lothian get a mention, and how they could have been better protected- and no mention of Robert Francis’s recommendations. The only point at which any MSP acknowledged they’d read any of the submissions was when Paul Gray was quizzed about the falling number of helpline calls – to which the Chief Exec answered that the “bottled-up” frustrations in 2013 had created a “spike” – and also, due to ongoing improvements, staff had less need – so there was little, on an ongoing basis, to worry about. There were no references by the MSPs to the staff survey showing fear at speaking up and no calls for it to be run again. Whilst it was acknowledged that an independent whistleblowing officer would be good, it sounded like another consultation was  likely in August – (although they already consulted on this a couple of years ago, so maybe this would be the precursor to a Parliamentary Bill).

Interestingly, the Scotsman managed to make the evidence look newsworthy- see “Health staff fear consequences of whistle-blowing, NHS Scotland chief tells MSPs” here.

Anyway, the Petitions Committee concluded that they would now refer the petition onto the Health & Sports Committee for consideration. We can only hope that they seriously consider what the petition proposes. At no stage did the Petitions Committee express a view on the petition. Sigh.

Thus my petition has followed its course. If it is to go anywhere now, that will depend if the Health Committee. Let’s hope they’ll really discuss the subject properly.

They are currently conducting an inquiry into NHS Governance – Creating a culture of improvement. Whistleblowing fits well. The call for evidence has another 9 days to go – please send something in if you can; I know a few of you have– you can do it confidentially, if you wish.

So I won’t be sending you any more “Update” emails, unless you want updates on the Health Committee’s conclusions. If you would like that, please let me know.

You can submit your evidence openly, anonymously or confidentially. But you only have until the 15th March, just four weeks, to do so. I’ll be writing in – hope any of you at the NHS (either past or present) with views will do too. This represents a real opportunity to call for change.

 

Peter Gregson wrote 4th December 2016:

The Petitions Committee considered the petition again on 24th Nov. The official (verbatim) report is here: https://shar.es/18jO8j

You can view their 6-minute deliberation on the webcast at http://www.scottishparliament.tv/Search/Index/1548bdac-8fee-42b8-8e00-d890656e9e1a – it starts 52mins 34 seconds in and runs onto 58.05. In a nutshell, the Committee now wants to hear from the Chief Exec of NHS Scotland and “representatives of whistleblower organisations”. They suggested the unions, especially Unison. The minute  of the meeting states “The Committee agreed to invite the Chief Executive of NHS Scotland and other relevant stakeholders including the City of Edinburgh Council, Public Concern at Work and trade unions, to provide oral evidence at a future meeting.”

I immediately wrote to the Chair of the Committee and the other four MSPs, suggesting that I could assist with whistleblowing organisations, individual whistleblowers (Rab Wilson, ex-nurse, of Ayrshire & Arran has offered) and asking they try again to contact the English Health trusts (there are 3 in all). No response yet.

I subsequently did some searching and found Whistleblowers UK who assist whistleblowers and give support at tribunals. They have been around a bit more than a year and their website is at http://www.wbuk.org/. They have a helpline for whistleblowers (and no – it isn’t like PCAW at all!). I spoke with their chief exec and she may be able to come up from London to the Scottish Parliament, or send in a submission.

A Scottish whistleblower has been in touch with me saying that if evidence could be taken with the webcam switched off, then they would like to attend to speak to Committee. If any of you feel the same way, please let me know and I will relay this to Johann Lamont.

If you have time, you might like to read the 10 submissions that have come in from Scottish NHS chief execs on the Parliament website here. Only one institution has been positive- the City of Edinburgh Council – and there is a negative one from Unison. A reversal of fortunes from three years ago, when each of these body’s positions were the opposite of what they are now, when I last petitioned for a hotline for local authority staff.

I urge you to read the Edinburgh Council submission that shows how their hotline actually works and the difference it makes- the link is here (I had also petitioned them too, back in 2013). I was also pleased Dr Peter Gordon wrote in – the support of clinicians is key to securing change. Finally, my comment on all the submissions was published as well (Petitioner letter of 9th Nov).

I think the Petitions Committee will revisit the petition with the NHS Chief Exec, probably in late January. I think that will be a very telling meeting – I’ll keep you posted.

 Other news- my FOI to Grampian Health Board on the costs of Professor Krukowski’s treatment has been refused again (see their response here ) so I have now submitted an appeal to the Information Commissioner.

Other news is that on 22nd Oct at their conference, the Scottish Green party adopted this motion, thanks to one of our campaigners:

The Trade Union Group conference identified that existing policy is not clear about the role of trade union representatives on boards. Experience has shown that partnership working between trade unions and management, for example on Health Boards, can be used to incorporate unions into the agenda of management. This motion is supported by SGP TUG.

 …For publicly funded bodies (such as the NHS, local authorities, education institutions, etc.), which have a distinct and particular responsibility to protect employees and those using the services they provide, such measures should include the establishment of a whistleblowing hotline, independently managed by an organisation invested with powers of investigation and disciplinary powers will provide an additional mechanism to ensure good practice is adhered to and wrongdoing is addressed.” 

Best wishes

Pete Gregson

www.kidsnotsuits.com/nhs-staff-whistleblower-hotline-parliamentary-petition/

Speaking up – Whistleblowing in the NHS – file on four. The profession needs a scapegoat – Mr Hunt.

Nothing has substantially changed since the Francis report – indeed the leadership of politicians was not referred to in the debate, making out that the lack of a proper lead in cultural change was needed from Management, when actually it is needed from Politicians. The only way to find out if Jamie Grierson is correct is to do exit interviews on all staff (like those in file on four), and have these done by an independent Human Recourses body. SOSR means “some other serious reason” and all whistle-blowers need to consider whether this might be attached to their file after spilling the beans. The admirable ideology of whistle-blowers contrasts strongly with the ideology of HR departments described in File on Four today. If 66% of doctors are under “serious stress” then the profession, and the public, need a scapegoat….. Mr Hunt will do as a sub for all the successive ministers of health. Civil unrest is likely without honesty. The current winter “murmurings” of starlings will become a riot of protest and discontent. One of the major reasons for a state to exist ;”keeping it’s citizens safe”, is failing…

Speaking up – Whistleblowing in th NHS – file on four and part of the report is from BBC Liverpool (Staffing ‘inadequate’ at Chester baby death hospital)

Dave Simonds 12/02/2017

This is reinforced by Jamie Grierson in the Guardian: NHS hasn’t improved enough since Mid Staffs, says inquiry lawyer

Robert Francis, whose report uncovered poor care in hospital trust, says pressures on health service generally are ‘pretty bad’

Current conditions in the NHS ”sound familiar” to those that existed during the Mid Staffordshire scandal, according to the lawyer who chaired the inquiry into the hospital trust.

Sir Robert Francis QC said the health service was being hit by a combination of financial pressures and high demand.

The barrister whose 2013 report uncovered poor care in Mid Staffordshire said the pressures the health service was under were “pretty bad”.

His remarks came after a week of scrutiny of the NHS, with performance figures showing a raft of missed targets and record waiting times, leading health secretary Jeremy Hunt to say conditions were “completely unacceptable”.

Francis told the BBC’s The Andrew Marr Show on Sunday: “I think they are pretty bad. We’ve got a virtual storm of financial pressures, increased demand, difficulties finding staffing, and pressure on the service to continue delivering. And some of that sounds quite familiar, as it was those were the conditions pertaining at the time of Mid Staffordshire.

“Things have changed since then, so the very fact that we’re talking about this today the way that we are, the very fact that the secretary of state says things are unacceptable, shows that there’s a greater level of transparency.

“So people are talking about the problems in a way that they weren’t before. But the system is running extremely hot at the moment and it’s only working at all because of the almost superhuman efforts of the staff of the NHS, and it can’t carry on like that indefinitely without something badly going, or risking going badly wrong.”….

NHS Surgeons kicking their heels as thousands of operations delayed.

Michele Hanson opines: We are a rich country that can afford to pay for proper care – so why don’t we?  and Why are GPs having to beg for appointments to get their patients treated in hospitals?

Matthew Weaver reports: A&E in England had worst delays ever in January, leak suggests – Provisional data shows an unprecedented number of patients spending longer than four hours waiting to be seen

Dennis Cambell reports: Two-thirds of young hospital doctors (Anaesthetists) under serious stress, survey reveals -Trainee anaesthetists complain of fatigue, disillusionment, ‘burnout’ and fears for patients’ safety as pressure mounts on NHS

Undercapacity leads to undersupply. When skills are valuable and in short supply they demand high payment, especially if working “overtime”. Which party believes in market forces? All parties have failed to control the supply in a market it commands completely?

NHS ‘pays £7.5m a year for 20 most expensive agency doctors’ – Watchdog says health service could save £300m a year if locums charged within set price cap, after data found some are paid £375,000 a year

Jeremy Hunt: NHS problems completely unacceptable – Health secretary says there is no excuse for some of health service’s shortcomings after figures show record delays for patients

One in six A&E departments at risk of closure or downgrade- As many as 33 casualty departments across the UK could be lost by 2021 in an attempt to save £22bn from the NHS’s budget

Alexandra Topping reports: Woman, 89, trapped in hospital for six months despite being fit to leave – University Hospitals Bristol NHS trust launches inquiry after lack of social care led to stay that cost health service £80,000

BBC News: 2000 NHS doctors call on prime minister to increase spending

Robert Pigott for BBC news reports: NHS Health Check: ‘Most staff have been attacked’, doctor says

Nick Triggle reports for BBC News: 10 charts that show why the NHS is in trouble

An “existential crisis”? – as civil unrest gets closer… 

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An “existential crisis”? – as civil unrest gets closer…

The meaning of peoples lives is important and includes a trustworthy health safety net…If NHSreality was able to speak sensibly and get an honest response from our political representatives we would ask for an open discussion on health to include three main requests aimed at addressing the disengaged culture, honesty, and standards. Commissioners cannot be blamed for the “rules of the game”, and it is natural for perverse incentives to occur in all systems, but they should be overt, and post code differences in safety net standards are not acceptable.

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  1. That the language of health be honest and include overt rationing. By this I mean that citizens are made aware, in advance, of what will not covered by their health service.
  2. That confidential exit interviews are offered to all Health Service staff by an independent outside body – reporting publicly in the general, and locally in the specific.
  3. That management powers be given to doctors to implement change, including the timing of meetings organised well in advance so that they can attend. This might well include the re-introduction of “firms” or “teams” when staffing levels allow (years ahead) (Hunt calls for NHS to be run by doctors and not managers – Fariha Karim December 1st). Doctors are avoiding managerial roles (BMJ 2017;356:j529) because they don’t believe they can follow the rules and win within this system.
    An “existential crisis”? – as civil unrest gets closer…
    6b792-stahlersafetynetChris Smyth reports 10th Feb 2017 in The Times: New NHS scandal is inevitable, Mid Staffs inquiry chief warns

The NHS faces an “existential crisis” and a repeat of the Mid Staffordshire hospital scandal is inevitable, the man who led the public inquiry into the trust’s failings has warned.

(.. existential crisis, is also a reference to Existentialism, but it is often used in a humorous or sarcastic way, to suggest that the person or people being described spend too much thinking about themselves and the meaning of their lives. )

Sir Robert Francis, QC, said the government could no longer pretend that the health service was coping. Pressure to cut costs would again lead to the neglect of patients, he added, and public confidence was at risk of collapse.

The warning comes in the midst of a winter crisis that has exposed a rift between NHS leaders and the government. Figures showed yesterday that waiting times in A&E units were at their worst for more than a decade and revealed missed targets on surgery, ambulance responses and cancer care.

Jeremy Hunt, the health secretary, described waits of up to 13 hours seen in parts of the country as “totally unacceptable” but said that the government’s plan would “take time to deliver”. He added that there were “no excuses” for cases where lack of social care places left elderly patients stuck in hospital for months.

Sir Robert said that the NHS was manifestly failing and dismissed savings plans as unrealistic.

His inquiry into the suffering of hundreds of patients at Stafford Hospital, published four years ago, concluded that bosses became obsessed with cutting costs and government targets at the expense of care. Frail elderly patients were left without food or water. It was one of the biggest scandals in the history of the NHS. Sir Robert told the Health Service Journal that ministers were again trying to ignore warnings.

“Politically, with a small ‘p’, the message is put out we are putting more money in the service than we ever did and it is the best health service around, but against that there is a frontline feeling that things have never been as bad as they are now and we can’t deal with the pressures,” he said.

Last month 60,000 people arriving at A&E had to wait four to 12 hours for a bed and a record 780 waited longer, according to data leaked to the BBC. Of 1.4 million A&E visits last month, 82 per cent were dealt with in four hours, below the target of 95 per cent, which has not been met nationally since summer 2015. Official figures on hospital performance in December also painted a bleak picture. By the end of last year, 376,877 patients had been waiting more than 18 weeks for surgery, 100,000 more than in 2015.

Theresa May responded by pointing to “record funding” and higher numbers of doctors and nurses. Sir Robert said: “We are told, ‘Oh, well we have got more nurses’ — no nursing director I have come across seems to agree with that and they can’t find them.”

In the interview, to be published today, he said: “Let’s make no bones about it, the NHS is facing an existential crisis . . . The service is running faster and faster to try and keep up and is failing, manifestly failing. The danger is that we reach a tipping point, we haven’t reached it yet, but there will come a point where public confidence in the service dissipates.”

Asked if the same mistakes that led to the Stafford hospital scandal could happen again, Sir Robert said: “I think it is inevitable.”

Last night Lord Carter of Coles, a government adviser on the NHS, admitted that hospitals were operating in a state of “war”. In a speech to the Royal College of Anaesthetists in London, he said that the health service was facing “a very, very difficult” time until 2020, adding: “Our hospitals are running so hot, and yet they haven’t broken. This is like being [in] a war actually and we should be extraordinarily proud of it. But you can’t continue on a war basis for ever, as we know.”

The Department of Health acknowledged that NHS staff were under pressure but said that, after the Stafford report, a record number of people were receiving harm-free care and that there would be “no return to the days of problems being swept under the carpet”.

In an interview with the BBC, Mr Hunt was challenged over conditions at Royal Blackburn Hospital, where some patients have been forced to wait up to 13 hours in A&E. He said: “It is incredibly frustrating for me. I am doing this job because I want NHS care to be the safest and best in the world. That kind of care is completely unacceptable. No one would want it for members of their own family.”

Presented with the case of Iris Sibley, 89, who has spent more than six months at Bristol Royal Infirmary waiting for a bed in a nursing home, he said it was “terrible for Mrs Sibley but it’s also very bad for the NHS”.

Mr Hunt said that other developed countries were struggling to care for an ageing population, adding: “It’s wrong to suggest to people that these profound challenges . . . are ones where there’s a silver bullet.

“We have a very good plan, it has the support of the NHS, [but] it will take time to deliver. In terms of immediate support, we’re doing what we can with extra financial support to the NHS this year.”

● Patients could be made to wait up to two years longer for new drugs after Britain’s expected departure from the EU’s pharmaceutical regulator, the government has been warned. Sir Alasdair Breckenridge, former chairman of the Medicines and Healthcare products Regulatory Agencies (MHRA), said companies would prioritise getting their drugs into the larger European and US markets and could be put off by Britain’s separate regulatory regime.

Jeremy Hunt, the health secretary, has said that Britain is expected to leave the European Medicines Agency. Departure is likely to mean that the regulator leaves its headquarters in London, where it employs about 800 people.

David Jeffreys, of the Association of the British Pharmaceutical Industry, said that British patients “may be getting medicines, 12, 18, 24 months later than they would if we remained in the European system”.

Doctors are avoiding management roles, says Hunt – BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j529 (Published 30 January 2017) Cite this as: BMJ 2017;356:j529

Whistleblowing and gagging update

If Scotland accept the proposals there will be another area of Post Code differential. Peter Gregson in Scotland posts as a guest, and NHSreality hopes that other Regional Health Services will follow (but it will take more than this to change the culture):

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I wanted to let you know that the Scottish Parliamentary Petitions Committee will be discussing petition PE1605 this Thursday the 9th February at 9.15am. It will  take evidence from:

·         Laura Callender, Governance and Compliance Manager and Kirsty-Louise Campbell, Head of Strategy (interim), City of Edinburgh Council;

·         Cathy James, Chief Executive and Andrew Pepper-Parsons, Head of Policy, Public Concern at Work;

·         Tam Hiddleston, Secretary, Scottish Healthcare Branch, UNISON Scotland

 The agenda can be downloaded at http://www.parliament.scot/S5_PublicPetitionsCommittee/Meeting%20Papers/Public_Briefing_Pack_09.02.17.pdf

I’ll be there, but I won’t get to speak. If you want to attend, book your ticket at https://www.parliament.scot/visitandlearn/28754.aspx

You will also be able to watch it live on Parliament TV here

I’ll circulate the official report and link to the video in about 10 days’ time. (NHSreality will give a link in an update to this page)

 Here’s hoping for a revealing discussion. I think the Petition will be continued after Thursday – the clerk tells me that the Chief Exec of NHS Scotland is due to attend to discuss this but was not free on Thursday – he thinks Paul Gray will likely attend on the 2nd March.

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File on 4: Speaking Up – Whistleblowing in the NHS (BBC iPlayer 7th Feb 2017)

…Two years ago the first independent report into the treatment of whistle…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by the government amid concerns not enough progress had been made to create a more…