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Archive - Month: July 2010

July 30, 2010

Dr Phil’s Private Eye Column Issue 1269, August 4, 2010
Filed under: Private Eye — Tags: — Dr. Phil @ 8:00 am

Oxford Heart Inquiry

Ever since exposing the Bristol heart scandal in 1992, the Eye has argued that complex child heart surgery should concentrated in fewer, more specialized centres. Now, thanks to the rank amateurishness exposed in the Oxford heart inquiry, small units may finally have to merge. The report has many echoes of Bristol, where between 30 and 35 children less than one year died than might have been expected at a typical unit at the time. In Oxford, the numbers were smaller, because surgeon Caner Salih blew the whistle himself after four deaths in fifteen operations between December 2009 and February 2010 (4.8 times the expected death rate). But between 2000 and 2008, 9 deaths occurred in children undergoing less common procedures, 5.29 times the expected death rate. In a nutshell, such a small unit should have ceased doing complex paediatric cardiac surgery after the Bristol report a decade ago, and must never be allowed to again.

Prior to the arrival of Mr Salih in December 2009, the Oxford Radcliffe Infirmary had a single paediatric heart surgeon, Professor Steven Westaby, dividing his time between adult and paediatric work. For over four years, Oxford had the equivalent of half a child heart surgeon, on call twenty four hours a day, every day of the year. When Mr Salih arrived from Melbourne, Professor Westaby took a deserved three week holiday. So a new, relatively inexperienced surgeon started on the unit with inadequate induction, no on-site mentoring and no senior operating help for the more complex cases.

Professor Westaby told the inquiry ‘that he did not expect Mr Salih to operate during his absence. On learning from the panel that Mr Salih had operated during that time, he said that he did not expect that the operations were complex.’ Unfortunately, they were. Mr Salih told the inquiry he did not regard Professor Westaby’s absence as ‘relevant to what operations he carried out’, and it was clear that the two had ‘not satisfactorily discussed the matter.’ By the time Westaby returned, Salih had announce his intention to leave his job. Westaby presence didn’t improve matters, because he had an ‘idiosyncratic’ approach to operating and so they worked in isolation, rather than as a team.

Having been promised two operating lists at interview, Mr Salih wasn’t given any to start with, having to cram operations in whenever a slot arose. He was finally given one on a Friday morning, not enough to improve his skill levels, and intensive care was often full and monitoring of sick babies over the weekend harder. There was no dedicated paediatric perfusionist able to offer the life support back-up he was used to, and neither was the surgical equipment he needed available from the start of his appointment. He did manage to find a mentor, over the phone in London, but this was hardly ideal given the complexity of the operations he was attempting. The review concluded that ‘all the cases were complex and surgery was high risk. We found no errors of judgement that directly lead to any of the deaths…. we found no evidence of poor surgical practice… it was an error of judgement for him (Mr Salih) to undertake the fourth case.’

The review found plenty of evidence of the dismal monitoring of safety by the Trust. In December 2009, Mr Salih expressed concerns about the support he was receiving, but by February 2010 he still hadn’t met the Paediatric Directorate manager. On February 19, he informed colleagues that he was ceasing to operate because of the string of deaths, but no formal action was taken to suspend services on that day. Surgery was not officially ‘paused’ until February 24, but no-one considered this warranted reporting a ‘Significant Untoward Incident’ or telling the SHA. Only when a journalist threatened to leak the story was an SUI declared on March 3. Once the story broke, an extraordinary mortality meeting was held to discuss the four deaths, 21 days after the last had occurred. Prof. Westaby didn’t attend and neither did one of the paediatric anaesthetists. Most damning of all is that parents don’t appear to have been told the true, surgeon or unit specific risks of the operations their babies were undergoing but rather national average risks. It’s as if Bristol never happened. Labour ducked the opportunity to safely sort out child heart surgery. The coalition mustn’t make the same mistake.

MD





July 25, 2010

Hello
Filed under: News — Tags: , , , , — Dr. Phil @ 2:00 pm

DR PHIL HAMMOND NEW TOUR DATES 2017-2018

Dr Phil’s Health Revolution  

UPCOMING TOUR DATES

2017

Stroud Subscription Rooms 08-Oct-17 Online / 01453 760900  

Stowe Roxborough Theatre 18-Oct-17 Online / 01280 825710

Taunton Tacchi-Morros Arts Centre 20-Oct-17 Online / 01823 414141

2018

Venue date box office website
Shoreham Ropetackle Arts 24-Feb 01273 464440 ropetacklecentre.co.uk
York Crescent Community Centre 27-Feb 0113 376 0318 wegottickets.com
Wakefield Unity Works 28-Feb 01924 831114 unityworks.co.uk
Exeter Phoenix 14-Mar 01392 667080 exeterphoenix.org.uk
Fareham Ashcroft Arts 23-Mar 01329 223100 hampshireculturaltrust.org.uk
Margate Theatre Royal 24-Mar 01843 292795 theatreroyalmargate.com
Halifax Square Chapel Arts 28-Mar 01422 349 422 squarechapel.co.uk
Loughborough Town Hall(studio) 29-Mar 01509 231914 loughboroughtownhall.co.uk
Cambridge Junction 30-Mar 01223 511511 junction.co.uk
Tunbridge Wells Trinity Theatre, 02-Jun 01892 678678 trinitytheatre.net
Happy Birthday NHS Shows
Frome Merlin Theatre 15-Apr 01373 465949 merlintheatre.co.uk
Bristol Tobacco Factory 29-Apr 0117 902 0344 thecomedybox.co.uk

Phil Hammond – NHS doctor, BBC broadcaster, Private Eye journalist and whistle-blowing comic –  combines both of his 2016 sell-out **** Edinburgh fringe shows in one unforgettable evening. Laugh, sort your life out, stay sane, plan your death and save the NHS – all in only 119 minutes. And a new show previews in Frome and Bristol in 2018 to celebrate 70 years of the NHS

“If Dr Phil were a medicine, you should swig him by the litre” The Times ****

“One of the most entertainingly subversive people on the planet.” The Guardian

“Hugely enjoyable, well crafted, poignant stand up” Broadway Baby 2016 ****

“Hammond is a passionate rabble rouser and impressively positive…. the perfect health secretary” Fest Magazine 2016 ****

“Very funny, honest, clever and moving. Passionate about the NHS” Dr Clive Peedell, founder National Health Action Party

Remaining dates are below. If you’d like to book the tour show, or half of it, please contact Warren Lakin at Lakin McCarthy Entertainment. warren@lakinmccarthy.com, 01359 230483

Reviews of the shows are here

For all other enquiries, please contact Shelley Devlin at the Richards Stone Partnership shelley@vivienneclore.com, 0207 497 0849

GET THE CLANGERS HABIT AND SAVE THE NHS

The daily habits of healthy, happy people are easy to say but harder to do. Try to do your daily CLANGERS, and help others to do theirs. Changes in lifestyle are far more powerful than any drug we have to offer.

My review in The Times of Dr Rachel Clarke’s riveting medico-political memoir ‘Your Life in My Hands’, which details the pressures felt by NHS junior doctors working in an unsafe system, and the desperation that lead them to strike.  Uncomfortable reading for Jeremy Hunt and the BMA

SUPPORTING JUNIOR DOCTORS

A SEVEN DAY NHS NEEDS MORE STAFF AND FUNDING TO BE SAFE AND HUMANE

Here’s my BBC NEWS interview about junior doctors. You can’t have a ‘truly 7 day NHS’ without truly 7 day funding and 7 day safe staffing levels. For junior doctors alone it would require another 4,000 to have the same high quality, safe care 7 days a week – you can’t just stretch 5 days’ staffing over 7. the same applies to all other groups of NHS staff. The 7 day NHS is an aspiration that will take time, training, inspiration and involvement to achieve.  It can’t be brutally imposed to a political deadline with no funding or staffing.

WHISTLEBLOWING IN THE NHS

Has anything really changed since 2011? Has any NHS whistle-blower been compensated or reinstated? Is it any safer to blow the whistle in the NHS?

‘Shoot the Messenger’ – a Private Eye special investigation by Phil Hammond and Andrew Bousfield into how NHS whistle-blowers are silenced and sacked was shortlisted for the Martha Gellhorn prize for journalism 2011. Available to download here

TO BOOK A SHOW FOR ANOTHER VENUE, AND FOR ALL OTHER INQUIRIES, PLEASE CONTACT SHELLEY DEVLIN OR VIVIENNE CLORE AT shelley@vivienneclore.com, vivienne@vivienneclore.com, 0207 497 0849

 

Phil bbc

Dr Phil Hammond

NEW BOOK

Staying Alive – How to get the best from the NHS – is full of inspirational stories from patients and carers and glued together with my own reflections of working in, thinking about and investigating the NHS over 30 years. You can read the reviews or add your own tips and tactics here

‘This is a fantastic book about how to live well. Phil Hammond’s goes beyond the usual tips about diet and exercise – we hear about the power of positive thinking, as well as how to get the best out of the health service. And this book is packed with real stories – from people who have become survival experts through their own experiences. Their stories are heartwarming, enlightening and useful.

Phil Hammond has a knack of being brutally honest and very funny at the same time. This is quite simply the most useful book about health and the health service that I’ve ever read.’

Professor Alice Roberts BSc MB BCh PhD Hon.FBAASc
Anatomist, author & broadcaster
Professor of Public Engagement in Science, University of Birmingham
www.alice-roberts.co.uk

NEW BOOK and EBOOK – WHAT DOCTORS REALLY THINK

AVAILABLE HERE

“This is a real find; funny, poignant, thoughtful, worrying, reassuring, and so good it should be on prescription.”
–Roy Lilley @RoyLilley

“Smart and funny, Phil Hammond is the perfect way to inoculate yourself against the nonsense which passes for most health commentary.”
–Alastair McLellan – Editor, Health Service Journal @HSJEditor

“A fascinating insider’s history of the past sixteen years of the NHS. This wise, witty and often moving diary reveals what really went on behind the political and managerial bluster. So well written it turned me into a compulsive page turner.”
–Dr Michael O’Donnell, author of The Barefaced Doctor, a Mischievous Medical Companion

With cartoons by Fran Orford

untitled23

‘GAMES TO PLAY WITH YOUR DOCTOR’  CLIP

 

Phil Hammond is an NHS doctor, campaigner, health writer, investigative journalist, broadcaster, speaker and comedian. He has done all these jobs imperfectly and part-time since 1987, and was also a lecturer in medical communication at the Universities of Birmingham and Bristol. As a doctor, Phil worked part time in general practice for over 20 years, and has also worked in sexual health. He currently works in a specialist NHS team for young people with chronic fatigue syndrome/ME.

Phil presented five series of Trust Me, I’m a Doctor on BBC2, and has been a presenter for BBC Radio Bristol since 2007. He is Private Eye’s medical correspondent, broke the story of the Bristol heart scandal in 1992 and gave evidence to the subsequent Public Inquiry. In 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Investigative Journalism for ‘Shoot the Messenger,’ a Private Eye investigation into the shocking treatment of NHS whistle-blowers. In 2014 and 2015, he was voted a Top 100 NHS Clinical Leader by the Health Service Journal. He has fiercely supported NHS junior doctors in their battle with the government against an imposed, untested and potentially unsafe new job contract.

As a comedian, Phil was half of the award winning double-act Struck Off and Die, with Tony Gardner. He has done three solo UK tours and is returning to the Edinburgh Fringe in 2016 with two shows – Life and Death (But Mainly Death) and Dr Phil’s NHS Revolution. Phil has appeared many times on Have I Got News for You and Countdown. His NHS comedy, Polyoaks, is written with David Spicer and has had three series on BBC Radio 4. He is a columnist for Telegraph Men and Reveal, and writes comment pieces for the Times. Phil is a Vice President of the Patients’ Association and a patron of Meningitis UK, the Doctors’ Support Network, the Herpes Viruses Association, Patients First, PoTS, the NET Patient Foundation and Kissing It Better. He is also a fundraiser and advisor for the Association of Young People with ME.

Phil has never belonged to any political party but was highly critical of the Health and Social Care Bill (now Act) in a BBC1 Question Time debate with then health secretary Andrew Lansley. He said the reforms were ‘wonk’, there was no convincing narrative explaining the reasons for the changes and that the focus on competition rather than the collaboration and co-operation needed for an integrated service.

question time

Phil has written  five books – Medicine Balls, Trust Me, I’m (Still) a Doctor and Sex, Sleep or Scrabble? ‘What do Doctors Really Think?’ and ‘Staying Alive – How to Get the Best from the NHS’.

Phil was revalidated by the GMC in September 2013. Below is the feedback from his colleagues and patients for my revalidation 360_feedback_Dr_Philip_Hammond[1]

Real time reviews of my consultations from patients and parents can be found here

My NHS work is as part of a specialist NHS team in Bath, treating young people with Chronic Fatigue Syndrome/ME, based at the Royal National Hospital for Rheumatic Diseases in Bath. Details of the service we offer are here Good advice on accessing specialist CFS/ME services and treatments available can be found via the AyME website (for people up the age of 25)  and the Action for ME website (for those over 25)

 I can’t give any personal medical advice via this site, and I don’t do any private practice.


Praise for Dr Phil’s comedy

                                  “One of the most entertainingly subversive people on the planet.” The Guardian

 “Tough on doctors, patients and politicians. And he’s funny.” The Telegraph

 

“Sceptical, irreverent, very funny and like a mighty gush of fresh air in a field that’s bedevilled with cover ups and cloaked in a vow of silence” Time Out

 

“Generates dozens of laughs and more ire than any amount of tentative taboo-breaching” The Financial Times

                                    ‘If Dr Phil were a medicine, you should swig him by the litre’ **** The Times

‘Consistently funny’ *****  The Sunday Telegraph

“You’ll never see a doctor in quite the same way again.” ***** The Scotsman

  Galaxy 749Born in the NHS

To read Phil’s Private Eye columns, written under the pseudonym MD, click on… er… Private Eye.

Dr Phil 2IMG

These action shots were taken in 1988, by photographer Homer Sykes, when glasses were riduclously big and babies were ridiculously slippery.

Dr Phil and Dr Tony, then and now

SOAD 8

 

Galaxy 375

Struck Off and Die’s first ever performance, Bristol, 1990

 

Dr Tony’s Braineater, Berkley Brasserie Bristol 1990

 

Dr Phil’s First Stand-Up, Berkley Brasserie, Bristol 1990





July 23, 2010

Dr Phil’s Private Eye Column Issue 1268, July 21, 2010
Filed under: Private Eye — Tags: , , — Dr. Phil @ 2:20 pm

OXFORD HEART INQUIRY LATEST

Just had a phone call from a very reliable source about the Oxford heart inquiry, due to report on Thursday, I believe. Apparently big failures in clinical governance and oversight at trust level, lessons not learned from Bristol etc but despite that, the Oxford unit has asked to be allowed to continue paediatric cardiac surgery. I strongly believe it should remain suspended pending the findings of the latest paediatric cardiac services review. Decision rests with the SHA. Who will take these decisions when there’s no SHA?

 Medicine Balls: The White Paper

How does Andrew Lansley’s Equity and Excellence: Liberating the NHS compare to White papers past? Frank Dobson’s  1998 bestseller, ‘A First Class Service – Quality in the new NHS’  gave us 191 mentions of ‘quality’ and promised to ‘publish outcomes to end unacceptable variations in health care.’ A decade later, Lord Darzi gave us ‘High Quality Care For All’ with 359 exhortations of ‘quality’ and a warning that the ‘unacceptable variations that have grown up in recent years must end.’ Lansley is also a firm believer that the way to achieve ‘quality’ (110) and to end ‘unacceptable services’ is to publish ‘outcomes’ (85). But after 13 years of Labour, we have precious little access to robust and valid comparisons of different clinical services. And without outcomes, offering patients ‘choice’ (Darzi 62, Lansley 84) is pointless, and you can’t ‘commission’ (Lansley 184) excellent services.

 There will always be variation in healthcare, and collecting and analyzing outcomes to try to understand which variations are due to chance and which to unacceptable practice is both complex and expensive. Labour made little headway and most commissioning was done on the basis of cost. So various PCTs gave Out of Hours Services to a company called Take Care Now because the price was right and they sounded as if they cared. Alas, they employed overseas doctors who didn’t know the patients, didn’t know how the NHS worked and didn’t understand how to use drugs like diamorphine. Dr Daniel Urbani killed David Gray by injecting him with ten times the safe dose because he was exhausted, had poor English and the drug was not routinely used in Germany. Prior to his death, two other German doctors had made similar errors (without causing death) but despite warnings from one of its own doctors that ‘it was only a matter of time before a patient is killed’, Take Care did not take note.

 One way to stop doctors giving ten times the dose of diamorphine is to not allow them to walk around with it in their bags. I’ve only ever carried one 5mg ampoule, so why Dr Urbani had 50mg or more on him is a mystery to most GPs. Lansley said before the election that he was going to put GPs back in charge of commissioning out of hours care, and it makes sense that clinicians should help commission and manage the services they know most about. Indeed Lansley is very big on services being ‘clinically commissioned, credible, approved, led and justified.’

 But just who are these clinicians? Midwives get 1 citation in Liberating the NHS, nurses 2, pharmacists 2, consultants 5 and GPs….. 75.  ‘Manage’ gets 43 citations but ‘manager’ only 3. GPs, apparently, can do it all by organizing themselves into ‘consortia’ (new entry, 64). Lansley has picked up the Tory baton from where it was discarded 13 years ago, just as fund-holding GPs were pooling themselves into multifunds, only to be scrapped by Labour and replaced by PCTs. In seven years as shadow health secretary, Lansley has had his ear bent incessantly by GPs complaining about the control-freakery and lack of clinical understanding of PCTs. So he’s calling their bluff, taking out the Strategic Health Authorities and the PCTs, and giving GPs the responsibility for commissioning nearly everything, while saving £20 billion and making sure the mighty Foundation Trusts don’t hoover up what’s left.

 GPs have always seen themselves as NHS gatekeepers, managing as much illness as possible in the community to present precious NHS resources being squandered in expensive hospitals. But emergency admissions to hospital are up by 12% and unless GPs can put a brake on this, they’ll be taking on an impossible job. It’s a bit like being handed the steering wheel just as the runaway coach approaches the cliff edge. And amidst all the financial pressure, it’s hard to see who will find the money to collect and analyze comparative outcomes in a meaningful way to guide commissioning and choice. Lansley’s catch phrase of ‘no decision about you without you’ sounds great for patients (217). But when they ask me which of my local hospitals is best for, say, hip replacements and which is ‘unacceptably poor’, I haven’t got a clue. And I’m supposed to be in charge. Now I must find out which consortium I belong to.

 MD





July 21, 2010

Pathology Audit Methodology
Filed under: Bristol Pathology Inquiry — Dr. Phil @ 9:59 pm

Pathology Methodology

This is the methodology, acquired under the Freedom of Information Act, that University Hospitals Bristol NHS Foundation Trust (UHB) used to select 3,500 cases/specimens (it’s never been made clear which), for one year only, 2007,  in response to an “allegation that there was a high error rate in the Bristol Royal Infirmary Histopathology Department”. Except nobody made that allegation. It was alleged that some serious errors have been made in the areas of respiratory, breast, gynaecological and skin histopathology, affecting patients of North Bristol NHS Trust (NBT) some of them going back to 2000.

The rule of selecting every fourth case was used until the methodology was found to have selected more specimens for one pathologist than the others. UHB then changed the rules so that each pathologist contributed approximately 550 things (cases or specimens?) to the audit. Whether these numbers reflect the relative caseloads of the pathologists is not known.

This methodology is likely to have delivered UHB’s desired audit result of an error rate of less than 2% for the 3,500, but it won’t answer the question of whether there have been serious, avoidable errors in the reporting of breast, respiratory, gynaecological and skin histopathology for both UHB and NBT patients from 2000 to the present.

Over a year after the 3,500 audit was announced we still don’t know whether it is 3,500 cases (an occurrence of disease or a disorder in a patient) or specimens (samples of tissue used for analysis and diagnosis).

As many cases will each have more than one specimen that has been considered in making a diagnosis, it would seem rather important to understand what exactly has been audited. Odd that Jane Mishcon’s Inquiry Panel hasn’t sought clarification for the public on this matter.





Taunton Specialist Centre for Gynaecological Cancer Surgery
Filed under: FOI Balls — Dr. Phil @ 8:30 pm

Patient and Public Campaigners who objected to NHS Bath & North East Somerset’s refusal, on the grounds that the RUH did not serve a large enough population, to consider keeping a joint Multidisciplinary Team for Bristol/Bath and surgery in both cities, were bemused to read this Freedom of Information Response from NHS South West in respect of Taunton:

“I refer to your Freedom of Information request of 22 June 2010.  In compliance with the Freedom of Information Act 2000, the South West Strategic Health Authority is able to respond to your request as follows.

1. Who made the decision that Taunton should become a Gynaecological Cancer Surgery Centre, despite not meeting Improving Outcomes Guidance recommendations in terms of population numbers?

The decision to designate Taunton as a gynaecological cancer surgery centre was made by the National Cancer Action Team in 2004, in response to an action plan signed by the Dorset and Somerset Strategic Health Authority and the Taunton Deane Primary Care Trust in June 2004. The proposal took into account the population size of 0.5 million and proposed that Taunton would be part of an Avon, Somerset and Wiltshire multi-disciplinary team with subspecialist support and continuing professional development provided by the Bristol specialist team.

The National Cancer Action Team provisionally agreed to Taunton as a centre subject to it performing well under external peer review in early 2006. The Peer Review Report for the Avon, Somerset and Wiltshire Cancer Network published in September 2006 indicated that the Taunton specialist gynaecology team scored 97% on 1* measures and 80% on level 1 and 2 measures. Against all measures the Taunton centre scored better than either UHBT or RUH Bath.

Therefore the decision to designate Taunton as a gynaecological cancer centre was made by the appropriate bodies and it does meet Improve Outcomes Guidance standards, as the Guidance allows for a centre serving a population of 0.5 million provided it is part of a multi-disciplinary team with a larger centre.

2. What were the reasons for making Taunton an exception?

It is not an exception.

3. Please describe what, if any, consultation took place with Somerset patients, the public and Health Scrutiny Committees to obtain their views about whether they supported the establishment of a non IOG compliant centre for their community.

No consultation took place with Somerset patients and the public and Health Scrutiny Committees about establishing a non IOG compliant centre as the centre was compliant with the IOG.

4. If patients, the public and Health Overview and Scrutiny Committees were not consulted under Section 11 Health and Social Care Act 2001/Section 242 Health & Social Care Act 2006, why was that?

Consultation with Somerset patients, public and health Scrutiny Committees was not necessary as this was the designation of a service as opposed to a substantial variation.

5. Please send me copies of all the documentation to show the audit trail for the decision to make Taunton an IOG exception for Gynae. Cancer Surgery.

Documentation on the 2004 designation process and the 2006 peer review is not held by the South West Strategic Health Authority. It is not an IOG exception for gynaecological cancer surgery”.

Note to NHS South West. The RUH serves a population of approximately 500,000. Taunton and Somerset NHS  Foundation Trust serves a population of approximately 340,000 (source NHS Education South West – Severn School of Medicine).

Despite what the SHA says, serving a population of only 340,000 certainly makes Taunton look very much like an IOG exception to patient & public campaigners – an exception that seems to be performing better than Bristol, the PCTs’ preferred site for a centralised Bristol/Bath Service.






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