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Archive - Month: May 2010

May 28, 2010

The Bristol Pathology Inquiry, as seen by Private Eye
Filed under: Bristol Pathology Inquiry — Tags: — Dr. Phil @ 4:43 pm

The Bristol Pathology Inquiry was triggered by my Private Eye column in June 2009 detailing allegations of significant errors in histopathology reporting at the Bristol Royal Infirmary, part of University Hospitals Bristol (UHB). Initially, allegations of error were made by four senior sources working at nearby North Bristol Trust (NBT) and covered the areas of respiratory, gynaecology, breast and skin pathology. A further source from within UHB then made serious allegations about long-standing errors in paediatric pathology, a shortage of paediatric pathologists and specific allegations about a named paediatric pathologist who was eventually reported to the General Medical Council but removed his name from the Medical Register and so was not investigated.

Incompetence can be extremely hard to define in a doctor, particularly a pathologist, given the complexity of some cases and the subtleties in interpretation of tissue samples. It was, and remains, unclear as to whether these alleged errors are as a result of general incompetence, or whether otherwise competent pathologists were working at the margins of their competence in dealing with particularly hard to interpret samples. In a grown-up safety culture, pathologists in the two hospitals would readily share samples and combine expertise and resources to give patients the best chance of the right diagnosis and the most appropriate treatment. The fact that this doesn’t appear to have happened in Bristol and that these allegations have been grumbling on for years without resolution (and without patients knowing about them) is a damning indictment of both of the inept management and secretive medical culture, and suggests that the lessons of the heart scandal have not been widely applied.

The heart and pathology inquiries differ in so far as the heart inquiry was in public, was easy to find out about and many patients and relatives were able to give evidence to it, whereas the pathology inquiry is being held in secret, in London rather than Bristol, and very few patients or even doctors are aware that it is happening. The Inquiry is due to report later this year. If you want to find out more or give evidence, contact:

David Jones
Inquiry Manager

Verita

53 Frith Street

London W1D 4SN
Tel: 020 7494 5670
www.verita.net

DavidJones@Verita.net

In the meantime, here’s Private Eye’s telling of the story so far…..

Private Eye: June 10, 2009

Pathological Sickness

 

On June 1, 2007 a letter was sent to Dr Martin Morse, Medical Director of North Bristol Trust (NBT), detailing eleven alleged serious diagnostic errors made by histopathologists at the Bristol Royal Infirmary, resulting in significant patient harm. These cases  came to light when slides and samples were subsequently reviewed at NBT.

According to the allegations, one woman (now deceased) was told her breast biopsy was benign but later presented with metastatic cancer, and patients with malignant lymphoma, melanoma (twice) and vulval carcinoma were also initially told they did not have cancer. Conversely two other patients allegedly had treatment for cancer when review of their biopsies found no evidence of it.

Documented errors appeared most likely in patients with rare lung disease. Again, patients have allegedly been told they have cancer when they don’t, and vice versa. Another was allegedly told he had tuberculosis when subsequent review found that he didn’t.

Interpreting tissue slides is stressful and complex, and some mistakes inevitably happen. The Royal College of Pathologists (RCPath) clearly states that when discrepancies in reporting occur, prompt independent review is required but some of these errors date back to 2000, and when the college was invited to do such a review, it apparently declined as it did not want to get involved in an ‘internal matter.’

Bristol is blessed with some fine pathologists, including respiratory specialists based at NBT, and if they worked in teams, accepted the same quality control and shared difficult diagnoses, then doubtless some harm to patients could have been prevented or reduced.

Alas, the long-standing rivalry between Bristol hospitals has prevented this from happening. Until July 2008, NBT pathologists claim they were unable to access the slides for their patients who were treated at the BRI, though this has now been resolved. However, slides from other patients who might benefit from the specialist service at NBT are still not being shared. Dr Morse has raised concerns with the Medical Director of University Hospitals Bristol (UHB), Dr Jonathan Sheffield but – two years after the whistle was blown – an independent external review has not happened. Four additional cases of apparent lung misdiagnosis have now been documented, but Dr Sheffield has stated that there is ‘no evidence to confirm a significant error rate’  in the service.

As well as the RCPath, these concerns have been brought to the attention of the chief executives of both trusts, the medical director of the strategic health authority, the medical director of the Avon Somerset and Wiltshire Cancer Services and the National Clinical Assessment Authority, thus far without satisfactory investigation or resolution.

It seems extraordinary, given what happened previously in Bristol, that UHB staff would not accept they might have a problem in their pathology department and act quickly to get an outside assessment. An urgent external review and the assimilation of pathology services across Bristol into a network that encourages scrutiny and shared expertise is now vital for patient safety. Dr Sheffield and the RCPath have been sent a detailed summary of the alleged misdiagnoses and MD has asked Barbara Young at the Care Quality Commission to investigate.

Private Eye: June 20, 2009

Has Bristol learned from Bristol? 

 

How much has the safety culture at University Hospitals Bristol (UHB) changed since the public inquiry into cardiac surgery? On the plus side, when the Eye broke the heart scandal in 1992, it took seven years to announce an external inquiry. When allegations of serious histopathology errors were published last month (Eye 1238), it took seven days.  There’s even a web page dedicated to the histopathology review.

http://www.uhbristol.nhs.uk/histopathology-review-june-2009

But  there’s still plenty of ‘old’ Bristol. Too much power concentrated in too few hands, very serious allegations not shared with the trust board, arrogance and bullying, a shortage of specialist staff, an ineffectual royal college and a brave consultant who raised concerns but felt compelled to leave Bristol when they were not taken seriously. And once again, many doctors, managers and establishment figures have been well aware of the problems for some years, but virtually no patients.

The UHB website says the review was ordered after ‘15 potential cases of histopathology misdiagnosis’ were published in ‘the satirical magazine, Private Eye.’ But the trust knows that there are far more than 15 alleged errors dating back from 2000. These are a sample of the errors collated by a single consultant where significant harm to patients had occurred. There are other examples where harm was fortuitously averted. Other consultants have also raised concerns specifically in four areas (respiratory, breast, skin and gynaecology), some as far back as 2004.

Other allegations that have been explicitly made to the UHB medical director Dr Jonathan Sheffield or the chief executive Dr Graham Rich since 2007 include:

UHB pathologists not routinely sending difficult slides for an outside opinion

Diagnostic errors and omissions in gynaecology reporting picked up by a specialist pathologist over a 2 year period with ‘serious implications for patient safety.’ The more serious errors were confirmed by an external expert.

Attitudes of hostility and denial when the above concerns were raised, a smearing of the specialist and a consequent abandonment of the specialist scrutiny of gynaecology reporting

Formal and informal complaints against a lead UHB pathologist.

Coroners reports performed to a substandard level by UHB  pathologists but no action taken.

Deficiencies in UHB pathology audit

Dr Sheffield, himself a histopathologist, has frequently met and exchanged correspondence, with those raising concerns but to no satisfactory resolution In July 2008, the minutes  of the Medical Advisory Committee at North Bristol Trust (NBT), state that there ‘continued to be serious cases of respiratory misdiagnosis by UHB histopathologists of specimens from NBT patients, despite there having been assurances by UHB that the problems had been overcome’ and ‘UHB continued to refuse to allow slides to be looked at by NBT histopathologists.’ Dr Morse, then medical director, said that unless an external review was arranged, he would report the matter to the Healthcare Commission. In August 2008, Graham Rich gave a written assurance that an external review had been requested. It never happened. The Royal College of Pathologists was contacted but claim they never received the formal agreement of both trusts to do the review. And without an invitation, the royal college is powerless to intervene even if serious misdiagnosis is occurring.

Forced into action by the Eye, UHB has organised  its own external review using a private company called Medical Solutions, which already does the trust’s breast cancer receptor testing, and so has a financial stake in one of the four areas of concern. Hardly independent. 3,500 slides across the entire pathology service are going to be chosen at random for one year (2007) to see if there is a significant error rate. If UHB had proper prospective audit,  it would already know what it’s error rate is for subspecialties and pathologists. The random selection will not include any errors prior to 2007 and, according to one statistician, ‘is fraught with methodological problems and  extremely unlikely to get to the heart of the problem.’

Specialist pathology is not simply making a diagnosis of, say,  benign or malignant but recognising other features of the tissue that should guide very complex treatment in discussion with the entire team. There is a national shortage of specialist pathologists, and Bristol can only provide a safe service by merging the expertise of its two trusts. As one senior consultant at NHS Bristol put it: ‘We’ve been trying to do this ever since I arrived in Bristol 25 years ago.’ The external review is looking for the wrong problem in the wrong place.  It’s changing the culture and service afterwards that matters. Time to grow up and get on with it.

Private Eye: September 11, 2009

The histopathology review at University Hospitals Bristol prompted by the Eye’s exposure of allegations of serious errors in reporting of skin, breast, lung and gynaecology specimens between 2000 and 2008 (Eyes passim) may have to cast its net still wider. A senior specialist with many years experience working at UHB has now demanded that paediatric pathology be investigated too.

The paediatric pathology department was recognised as one of the best in the world prior to the Bristol heart inquiry in 2001, with three specialists including a professor and a senior lecturer. The samples they kept were instrumental in proving that the standard of complex paediatric heart surgery prior to 1995 had been so poor. When it emerged that most of the samples had been kept without parental consent, the pathologists were hung out to dry in the press and, unsupported by management, they left.

According to the allegations: ‘Over the next 2 years paediatric work was done by adult pathologists… from a highly dysfunctional department, some of whose competence in their own fields was in doubt. The results were disastrous, particularly in the fields of children’s cancers and Hirschsprung’s disease. In 2002-2003, the Trust appointed a non-UK trained paediatric pathologist, Dr S,  who had not been short-listed for posts elsewhere. He should never have been appointed and within a few months it was apparent that he was incompetent. Serious errors in children with cancer and Hirschsprung’s disease continued (one of the latter died as a direct result of this). His post-mortems were of a very poor standard. This caused particular problems in children dying of heart disease. After clinical staff reported numerous incidents to managers they were eventually forced to take action and he left to work in Europe.’

‘In 2004, two new paediatric pathologists (PP) were appointed but one found the environment so hostile that she left in 2005. Since 2005 a single-handed PP has soldiered on valiantly despite hostility from adult pathologists and little help from managers. The standards are very high when she is there but there are still major problems when she’s away. She does all the biopsy work but not post mortems. £450,000 comes to the Trust for regional perinatal work and the adult pathologists have tried to keep this for their own use. They have also used devious tactics to try to block appointments to the 2 vacant PP posts. It is hoped that one post will shortly be filled but meanwhile there are serious deficiencies affecting oncology, cardiac, genetic and surgical services.’

In response, UHB has referred all these new allegations to the pathology review team, to be chaired by Jane Mischon. In addition, ‘the incident alleged in the letter was fully investigated at the time.  As a result, the Trust reported an individual to the General Medical Council, whose name was removed from the medical register at the end of 2004.’ Meanwhile, in the draft minutes of a June 12 2009 meeting, UHB gynaecologist John Murdoch refers to the Eye’s reporting of Trust’s pathology problems as ‘sensationalist’ and referring to ‘a few lung cancer cases’.  In fact, many of the allegations are in his own area and the Trust has confirmed that ‘Mr Murdoch was aware of the serious allegations about gynaecology reporting in June 2008.’ Odd that he should not minute them a year later.

Private Eye  September 25, 2009

Irregulation

The GMC  has issued a puzzling statement about Dr S, a paediatric pathologist employed by United Hospitals Bristol (UHB).  According to the GMC: ‘We received information from UHB in 2004 regarding Dr S. It became clear that conducting our normal investigations was going to take longer than was in the public interest. We therefore decided to remove the doctor from the register with his agreement. The doctor was removed from the register in December 2004 and has not been registered with the GMC since that date. This means that he has not been able to practise as a doctor in the UK since 2004.” 

MD has asked the GMC to clarify how it can be in the public interest not to investigate serious concerns about patient safety, but without reply. One argument used locally to silence dissenters is ‘the last thing Bristol needs is another scandal.’ In fact, the last thing Bristol needs is another cover up. Jane Mishcon, chair of the UHB pathology review,  has a lot of digging to do. Meanwhile Dr S is now a Professor in Canada, citing ‘Clinical Reader at the Bristol University’ as one of his achievements.

Private Eye: January 20, 2010

 

Bristol Update

 

‘Failure to reconfigure child heart surgery will be a stain on the soul of the specialty and will compromise the treatment of the most vulnerable members of the next generation.’ So says NHS Medical Director and cardiac surgeon Sir Bruce Keogh, just 18 years after the Bristol heart scandal was exposed in Private Eye. The Public Inquiry a decade ago found that as many as 35 babies had died unnecessarily, and a review in 2003 recommended the concentration of scarce expertise and equipment in fewer centres. Alas, Labour ignored it for fear of the political ramifications.  Keogh admits there has ‘frankly been little progress’ since the inquiry and he can’t at present guarantee that ‘another Bristol’ won’t happen. 

The job of fixing it has now been handed to the National Specialised Commissioning Group (NSCG), which since 2007 has been responsible for making sure the treatment for all rare and complex conditions is ‘safe and sustainable.’ As Keogh puts it: ‘The NSCG has to flex its muscles. Politicians  have to accept their recommendations and clinicians have to put aside personal conflict and institutional self interest.’ And patients and parents have to accept they may have to travel further to get the best treatment. We shall see.

The battle to safely reconfigure specialist services is also at the heart of the current Bristol pathology inquiry, which MD is due to give evidence to next month. The Royal College of Pathologists (RCPath) describes pathology as ‘the hidden science at the heart of modern medicine’ but it’s high time it was flushed out into the open. As medicine becomes increasingly technical and individualised, there is an urgent demand for specialist pathologists with the experience to spot the complex nuances in tissue samples and advise on treatment. Alas, specialist pathologists are in short supply and the temptation, to save money and hold onto business, is to let those with insufficient expertise report on complex slides.

This is the allegation made against pathologists at University Hospitals Bristol, with evidence submitted of serious reporting errors for complex gynaecology, respiratory, dermatology, breast and paediatric tissue samples. There is also evidence that, as with the heart scandal, a lot of senior NHS managers, consultants and the royal college have known concerns about UHB’s pathology department for some time. So there are powerful vested interests in not having another scandal.

UHB ordered the external inquiry, chaired by Jane Mishcon, but only after the Eye went public with the allegations. The Trust was initially overseeing the inquiry, but this clearly lacked independence and it has now transferred to London under the management of Verita. However, the inquiry panel has no control over the analysis of samples. The alleged errors reported to MD have occurred between 2000 and 2009, and all in specialist areas. Whereas the inquiry is looking at a random sample of 3,500 adult slides taken across a single year and including all the ‘bread and butter’ reporting, so complex mistakes can be buried and the overall error rate will look small. This is precisely the tactic used in defence of the heart surgeons. The inquiry needs to focus its attention on specialist areas and specific cases.

Against this background, local cancer services are in the process of being reconfigured to make them ‘safe and sustainable’. All are highly dependent on co-operation between hospitals and developing specialist pathology services but whether Bristol’s clinicians and managers can work together and share expertise remains to be seen. Oh, and UHBs chief executive Graham Rich has just resigned.

Private Eye: January 26, 2010

Very human errors  

Last year, MD met an Australian surgeon who tells his junior staff: ‘Your job is to stop me killing anyone.’ Nurses, receptionists, patients and relatives are all encouraged to speak up if they think something isn’t right, and it’s looked into promptly without knee-jerk blame. As a result, his cock-ups and complaints are commendably sparse and he has no shortage of applicants for his training posts.

The NHS has been trying to develop a grown-up safety culture for over a decade, but there is still a huge reluctance for staff to comment on each other’s work. A senior nurse who helped developed the national guidelines for the safe and sterile insertion of central venous lines recently observed a junior doctor putting a central line with a clearly dirty technique. The drapes weren’t in place and there was a danger he would introduce infection directly into the patient’s blood stream. But because it wasn’t her patient and she didn’t know the doctor, she didn’t feel in a position to comment.

The reticence of some NHS staff to offer constructive criticism and the unwillingness of others to accept it is at the heart of many clinical errors. When serious errors are analysed in detail, staff have often spotted something wrong but not said anything, or tried to raise concerns and not been taken seriously. In the infamous ‘wrong kidney’ disaster, both the medical and nursing students tried to point out the surgeon was operating on the wrong side. And in the death of Elaine Bromiley (Eye 8.5.08 ), nurses recognised that she needed an emergency tracheotomy after a failed anaesthetic,  and even brought the kit into the operating theatre, but didn’t feel able to interrupt the consultants.

Elaine’s husband Martin, a pilot, founded the Clinical Human Factors Group (CHFG) to help the NHS learn that guidelines and checklists are pointless without behavioural and cultural change. Under pressure, even the most senior doctor can panic, develop tunnel vision and go badly off piste, and without a team ethos that allows someone more junior to point this out, a disaster inevitably happens. The CHFG has now joined forces with the Patient Safety First campaign for a series of webcasts on the importance of addressing human factors in preventing medical error. One relatively simple idea is to encourage anyone performing a procedure to say: ‘If you think I’m going to make a mistake, please tell me.’ This also applies to patients and relatives. A change of pill colour or site of infusion is always worth querying. And given that 1 in 10 patients are harmed by their treatment, even a modest reduction in medical error could pay huge dividends.

Picking up errors after the event is also important. Pathologists are particularly vulnerable because tissue patterns are complex and subtle, and samples reported under stress are then stored for others to analyse at leisure. Specialists are also in short supply and this makes it imperative that pathologists work in teams and networks across regions, double checking difficult samples and seeking expert opinions. In Bristol, where pathologists in one hospital have tried to raise concerns about errors at another, the culture appears to be stuck in ‘how dare you question my reporting?’, rather than ‘let’s work together to make sure this patient gets the correct diagnosis and best treatment.’ Whether the current inquiry sorts it remains to be seen, but the pathology departments of both hospitals could do worse than sitting down together for the Truth and reconciliation following serious harm webcast (Thu 4 Feb, 10.30-11.30)1

1www.patientsafetyfirst.nhs.uk/Content.aspx?path=/Campaign-support/humanfactorsweek/.





Dr Phil’s Private Eye Column Issue 1264, May 26, 2010

More Cornish Pastings….

Following the Eye’s coverage of the unfair dismissal of Cornish hospital boss John Watkinson (Eye last), health secretary Andrew Lansley has ordered NHS chief executive Sir David Nicholson to launch an inquiry.  Of particular interest is whether the South West strategic health authority, headed by Sir Ian Carruthers,  pressurised the Royal Cornwall Hospitals Trust (RCHT) into sacking Watkinson when he blew the whistle on their avoidance of proper public consultation  before moving a cancer service to Plymouth. Whether Sir David is the man to scrutinise Sir Ian is unclear. Sir Ian, himself a former acting NHS chief executive, has long been Sir David’s close friend and mentor.  And Sir Ian chaired the panel that recommended the knighthood for Sir David this year.

South West SHA has mounted a robust defence of Carruthers. In a letter to Health Policy Insight, regional director of public health Dr Gabriel Scally wrote: ‘ The claim for unfair dismissal was made not against Sir Ian Carruthers or the South West Strategic Health Authority but against RCHT, which made its own decisions acting on independent legal advice.‘ This is at odds with the recollection of John Mills, RCHT Chair at the time of Watkinson’s suspension:
‘The way they (the SHA) went about it was to put pressure on the board and I believe it is not unreasonable to view this pressure as tantamount to bullying. They said if you do not go along with the proposition that John Watkinson is suspended, then we, the non-executives, would be suspended under the powers to that end available to the Secretary of State. We were left in no doubt that it meant the removal of the non-execs and their replacement with a pliant group selected for the purpose by the SHA. By this time John Watkinson was seen as a trouble maker. They (the SHA) decided it was time to tackle him. The SHA had decided it wanted to get John out and I sensed didn’t much care how it was done. With the wisdom of hindsight I do regret not standing up to the pressure put on us by the SHA to do its bidding, and equally I regret not having voted against some of the conclusions, and perhaps therefore having resigned from the board there and then.’

RCHT may appeal against the findings of Watkinson’s tribunal, chaired by Judge John Hollow, but they were so unequivocally damning it’s hard to see how this would be anything more than a further waste of public funds:

“Our unanimous conclusion is that this appeal was a travesty of anything approaching basic fairness … the claimant’s dismissal flew in the face of any concept of fairness”.

“A fair-minded employer would have investigated the issues he (the claimant) raised and taken them into account, giving them careful consideration before reaching a decision. Patently that was not done … The speed and incompetent manner in which the claimant’s dismissal was handled sheds light in our judgment as to the respondent’s reason”.

“We have come to the unanimous conclusion that we can and do draw the inference that the reason for the claimant’s dismissal was due to pressure brought to bear on the RCHT by the SHA and the reason for that pressure was the claimant’s stance over the issue of consultation … the respondents had determined to dismiss the claimant as a result of pressure from the SHA”.

Lansley’s inquiry needs to broaden its remit beyond RCHT and consider other allegations across the region and the wider NHS where staff have been forced out or silenced for raising concerns or challenging the SHA, and where the public have not been properly consulted before changes have been forced through.  The NHS faces some tough spending decisions, and some services may need to be merged to make them safe and sustainable.  Labour’s preferred tactic was central control and bullying, and it filtered down into NHS management.  Lansley needs a more intelligent approach, based on public consultation, sound evidence and allowing anyone to speak up without fear of reprisal. After Watkinson’s ordeal (unemployed at 54 with house on the market), whistle-blowing seems as unattractive as ever.

 MD





May 16, 2010

Independent on Sunday: ‘Top-level review ordered into sacking of whistle-blower
Filed under: Private Eye — Tags: , , , — Dr. Phil @ 11:45 am

Top-level review ordered into sacking of whistle-blower
New Health Secretary promised before election to give better protection to concerned NHS staff ‘moles’

By Nina Lakhani
http://www.independent.co.uk/life-style/health-and-families/health-news/toplevel-review-ordered-into-sacking-of-whistleblower-1974694.html
Sunday, 16 May 2010

The new Secretary of State for Health, Andrew Lansley, has ordered an unprecedented high-level investigation into why a senior NHS manager was sacked for whistle-blowing.

John Watkinson was dismissed from his post as chief executive by the Royal Cornwall Hospital NHS Trust (RCHT) in 2009 following pressure from the Strategic Health Authority (SHA), which oversees the NHS in the South-west.
An employment tribunal ruled last week that the Mr Watkinson was clearly “to be got rid of” after he refused to close a local cancer service without proper public consultation. His resolve to fulfil the legal obligation to consult patient groups was seen as an “irritant” to SHA bosses, determined to move the upper gastro-intestinal cancer service to a larger centre in Devon.

The tribunal panel was highly critical of the fact the SHA chief executive, Sir Ian Carruthers, and chairman, Sir Michael Pitt, were not called by the Trust to give evidence. Several witnesses refused to answer straightforward questions and key documents were also withheld from the tribunal, says the judgment.

Mr Lansley has taken the rare step of asking the most senior figure in the NHS, its chief executive Sir David Nicholson, to investigate the activities of the SHA over the sacking. However, experts claim an independent inquiry is needed to guarantee fairness and transparency. Mr Lansley refused to be drawn on whether a pledge to improve legal protection for NHS whistle-blowers made while in opposition last month would be honoured.

Dr Peter Gooderham, a whistle-blowing expert from Manchester University’s Law School, said: “Following the Stafford scandal we were repeatedly told by ministers that whistle-blowers enjoy complete legal protection. This case is the latest which shows this to be untrue. It should be an inquiry headed by a demonstrably independent person given the seniority of Sir Ian.”

John Watkinson had dedicated his life to the NHS, joining it as a store man at 19 before working his way up to chief executive by the age of 35. He was headhunted for the Cornwall job while chief executive of the struggling Bromley NHS Trust in south London. When he moved his family to Cornwall in January 2007, the hospital had been rated the “worst performing trust” by the health watchdog after several management changes, spiralling debt and a failure to meet performance targets.

Mr Watkinson’s team made good progress within the first year. Morale improved, waiting time targets were met and financial woes began to ease. It was voted the “most improved trust” of 2008. So what went wrong?
In 2001, the Department of Health issued guidance for improving the survival rates for cancer patients. Upper GI cancer is rare and outcomes are better if specialists treat at least 50 patients a year. As a result, the SHA wanted to transfer the small Cornwall service to Devon.

But there is a legal obligation to consult local people before such changes are made. The tribunal ruled that Mr Watkinson was sacked by the Trust because he refused to bow down to SHA pressure on this issue. It rejected the assertion made by the Trust that he was dismissed because of reported failings at his previous job or a breakdown of trust and confidence in his leadership.

The tribunal judgment said “his dismissal flew in the face of any concept of fairness” and stated the “appeal was a travesty of anything approaching basic concepts of fairness.”

The SHA denies exerting pressure on the Trust board. A RCHT spokesperson said: “We contest the judgment of the Tribunal and are considering an appeal. We welcome the fact that the new Secretary of State for Health has asked the NHS chief executive to review these matters and we look forward to setting the record straight.”
Speaking exclusively to the IoS, Mr Watkinson has described his dismay at being forced out of the NHS after 34 years of continuous service. He gave a warning about a pervasive bullying culture faced by NHS staff which threatens patient care.

He said: “I’ve been booted out at a time when surely experienced people like me are most needed. That makes me very sad. I love the NHS and I’d like to go back, but you can’t meet tough financial targets and keep clinical standards up by bullying people.”

His legal fees thus far are about £200,000. Unemployed at the age of 54, his house is up for sale. “I would much rather be in work, but they have damaged my reputation so badly, that I’ve not been able to get another job. The public have a right to know how much money has been spent on kicking me out of the NHS unfairly,” he said.
“This wasn’t the way I should have gone out of the NHS. I wasn’t expecting a band, but I wasn’t going to accept being booted out like this, not after 34 years, with a good record in tough places. Yes I won, but it has cost me a lot of money and it’s a terrible way for it to end.”





May 15, 2010

Update on John Watkinson’s unfair dimissal from a source close to JW
Filed under: Private Eye — Dr. Phil @ 5:21 pm

The Independent on Sunday has got a bee in its bonnet on whistle-blowing and has run a number of stories on various individuals over recent months. They are running a piece tomorrow on JW. The reporter is Nina Lakhani, she’s done the other whistle-blowing stories and has told JW that having read his judgment it is the most clear cut finding on whistle-blowing that she has seen.

She approached Lansley for comment and got a statement saying he has ordered Nicholson to conduct an inquiry. (This is somewhat amusing when you think that Carruthers is Nicholson’s mentor – tho’ maybe Lansley is being really clever and passing the poisoned chalice to Nicholson: it’s said that Lansley wants rid of Nicholson and the culture he has engendered.)

She also approached both RCHT and the SHA with one question each. She asked the former for the real reason why JW was sacked (since the tribunal clearly didn’t believe what they had put forward during the 13 days of hearing) and asked the latter why, if RCHT was so capable of making its own decisions as the SHA continually asserts, the SHA had found it necessary to bully RCHT into suspending JW (as the tribunal concluded). Both responded by asking her to submit their question by e-mail so they could consider their answer





May 14, 2010

Lots of reaction from latest Private Eye column….
Filed under: Private Eye — Tags: , , , — Dr. Phil @ 12:44 pm

Here’s a post from Andy Cowper from Health Policy Insight (http://healthpolicyinsight.com/?q=node/502) in response to Private Eye, and responses from Dr Gabriel Scally, Regional Director of Public Health For The South West in defence of Carruthers, and a further response to that from a former NHS manager and colleague of John Watkinson. Any other responses from either side welcome. Please post below.

Editor’s blog Wednesday 12 May 2010: Employment Tribunal trashes Sir Ian Carruthers’ treatment of Royal Cornwall CE
Publish Date/Time:
05/12/2010 – 12:34

The excellent Dr Phil Hammond is well-known for his nom-de-plume as Private Eye’s MD.
His latest Eye column, reproduced here on his website, looks at the Employment Tribunal’s ruling over the suspension and subsequent dismissal of Royal Cornwall Hospitals Trust chief executive John Watkinson in 2008.
The RCHT disciplinary action followed Watkinson’s protesting against the SHA’s plans involving a lack of (legally-required) consultation over changes to gastro-intestinal services in the region.
Phil has kindly hosted the written verdicton his site.

It is comprehensive in its condemnation of RCHT’s actions towards Watkinson, and pins the blame for their proceedings against him firmly on Sir Ian Carruthers and the SHA, NHS South-West.
By any legal standards, the rebuke is complete (though it also reserves some criticism for Watkinson for reading from his correspondence during the hearing).

It states:
“Our unanimous conclusion is that this appeal was a travesty of anything approaching basic fairness … the claimant’s dismissal flew in the face of any concept of fairness”.
“A fair-minded employer would have investigated the issues he (the claimant) raised and taken them into account, giving them careful consideration before reaching a decision. Patently that was not done … The speed and incompetent manner in which the claimant’s dismissal was handled sheds light in our judgment as to the respondent’s reason”.
“We have come to the unanimous conclusion that we can and do draw the inference that the reason for the claimant’s dismissal was due to pressure brought to bear on the RCHT by the SHA and the reason for that pressure was the claimant’s stance over the issue of consultation … the respondents had determined to dismiss the claimant as a result of pressure from the SHA”.

Aspects of NHS management are not for the faint-hearted. Sometimes, difficult decisions have to be taken. A good balance of judgment is required.

Employment law is, ultimately, pretty simple: you have to follow proper procedure, and be reasonable and fair.
In NHS management and in employment law, the secret of success is knowing how not to go too far.
It is unfortunate to see clear evidence that Sir Ian, whose career has been a successful one (including his tenure as acting chief executive of the NHS post-Crisp and pre-Nicholson), has acted so foolishly and unreasonably in this case.
Dark rumours have been emerging from the patch about the driving of activity to be the SHA with the country’s shortest waits costing the health economy across the region serious good-will.

Dark rumours always emerge; this news makes them seem better-founded.
I don’t know John Watkinson. I do know that when a medical director resigns in protest at their chief executive’s defenestration (as Dominic Byrne did in this case), you can reasonably assume that something seriously wrong has taken place.

As Hammond points out, this also undermines NHS South West’s ability to make the case not only for this reconfiguration (which in a bitter irony, Hammond suggests is probably clinically appropriate), but for other service reconfigurations going forwards.

If SHAs survive the policy turbulence, the lack of faith in NHS South West’s processes that this will engender is bad news.
It may now be time for Sir Ian to consider spending more time with his beloved Southampton FC and Somerset CC. At 59, he is young enough to enjoy it. This is not the sort of thing for which he should be remembered.
In football terms, this verdict is akin to relegation from the premier league. In cricketing terms, it’s an innings defeat.

Editor’s blog Right Of Reply Thursday 13 May 2010: Health Policy Insight blog on Sir Ian Carruthers “inaccurate and offensive”Publish Date/Time:
05/13/2010 – 19:46
The Health Policy Insight Editor’s Blog condemning the treatment of Royal Cornwall Hospitals’ former chief executive John Watkinson is inaccurate and offensive.
The claim for unfair dismissal was made not against Sir Ian Carruthers or the South West Strategic Health Authority but against Royal Cornwall Hospitals NHS Trust, which made its own decisions acting on independent legal advice.
Your piece makes reference to Sir Ian’s distinguished, 41-year track record in the NHS but fails to mention that John Watkinson’s suspension from Royal Cornwall Hospitals Trust followed an independent review which concluded that the Trust was headed towards ‘corporate failure’.

This review was in itself triggered by a damning report by Michael Taylor into the financial management and governance at John Watkinson’s former Trust, Bromley Hospitals, which was shown to have accumulated debts of £87 million.
As for ‘dark rumours’ about the driving of activity to achieve the shortest waits, we are proud of our ambitions which have been set out and led by clinicians themselves as part of the High Quality Care For All agenda.

It was this same pursuit of clinical excellence that led the Strategic Health Authority to support the drive to reconfigure upper gastrointestinal cancer services in one specialist centre, in line with Improving Outcomes Guidance and with the endorsement of two independent expert clinical consultants who conducted a local review.
Saving lives, not reputations
The aim here is to save lives, not reputations.

A recent Strategic Health Authority Assurance Process, undertaken by the Department of Health, highlighted a culture in NHS South West that was fair and based on strong partnerships between NHS organisations and people.
The findings, published recently, said that our ‘top team is widely respected across the healthcare system.’ It also said that we had a ‘gold standard approach’ and ‘a highly effective approach to managing individual NHS organisations characterised by well-judged and appropriate interventions.’

You claim that ‘by any legal standards, the rebuke is complete.’ You should be aware that the legal process itself is not complete as Royal Cornwall Hospitals Trust is actively considering an appeal.
Since John Watkinson’s departure the new management team at Royal Cornwall Hospitals NHS Trust has turned the organisation around – they are now meeting national standards and are no longer considered a‘failing’ Trust for the first time in years.
This is hardly an innings defeat, least of all for Sir Ian.

Dr Gabriel Scally
Regional Director of Public Health For The South West

RESPONSE TO RIGHT OF REPLY FROM A FORMER NHS MANAGER AND COLLEAGUE OF JOHN WATKINSON

The response from NHS South West is laughable. It asserts error but fails to demonstrate it, and it’s also worth noting that the response conveniently ignores the point that the review showing RCHT heading to ‘corporate failure’ was thoroughly discredited by the employment tribunal.

I was also greatly amused to see a couple of ‘old stand-by’ PR tactics deployed by NHS South West in the response: if you know you are going to be criticised and have no real defence, get a third party report manufactured (the ‘SHA Assurance Process’ ) that gives you something to hide behind. Secondly, the ‘we’re considering an appeal and therefore can’t comment’ manoeuvre, which enables you to kick the issue into the long grass for a while, and hope that everyone forgets. (I say with confidence that these are tactics because they’re exactly what I would have done given the desperate circumstances facing Carruthers et al!)





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