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Archive - Month: June 2013

June 22, 2013

A few Morecambe parents would help sort out the CQC
Filed under: Private Eye — Dr. Phil @ 10:59 pm

Times Thunderer Column, 21.6.13

‘Those currently in power in the NHS don’t listen to the truth’

David Cameron and Jeremy Hunt profess to be “shocked” by the latest appalling NHS scandal, this time in Morecambe Bay, but they shouldn’t be. A regulator that failed so miserably in one hospital, Mid Staffs, is likely to have failed in others, along with the managers, clinical staff and commissioners who either failed to spot the scandal or colluded in the cover-up. What is shocking is that the Government decided to stick with the same leader of the NHS, Sir David Nicholson.

When the fish is rotting from the head, you need to remove it. Instead Mr Cameron and Mr Hunt fully support him as the only man to lead the NHS into this new era of openness and transparency, where we no longer cover up our mistakes. Sir David has finally agreed to retire next March, but his legacy is not just one of fear and bullying in the NHS, where too many in the chain of command kiss up, denying appalling care beneath them and delivering only good news to Downing Street. He has also ensured that many in key positions of power in the NHS are “David’s people”. As such, it is difficult for them to speak truth to power, as Cynthia Bower, the former chief executive of the Care Quality Commission, found to her cost.

It seems inconceivable that high- level CQC discussions about serious failings at Morecambe Bay would not reach the ears of Sir David and others in the Department of Health. But as Robert Francis found in his report into Mid Staffs, it’s fiendishly difficult to pin down the evidence linking scandal to the centre. Sir David may also outlast Mr Hunt, who is playing a very dangerous game of pass the buck. Many senior doctors and nurses warned of the dangers of rushing in to the new 111 out-of-hours service, but the Government went ahead anyway, and three fatalities at least are alleged to have occurred. Mr Hunt’s response has been to blame a nine-year-old GP contract. It shows that those currently in power in the NHS still don’t listen to truth, even if you dare speak it to them.

It might be more prudent for Mr Hunt to have one large truth and reconciliation hearing, rather than a series of public inquiries. Above all, we need people like the Morecambe Bay parent James Titcombe, who are unafraid to speak the truth. Mr Titcombe is modest but unrelenting. He works in the nuclear industry and has been staggered by the slack, defensive safety culture in the NHS. I would trust the CQC far more if people like him were on its board. Give the power to those who’ve earned it.

Phil Hammond is a GP turned hospital doctor and Private Eye’s medical correspondent





June 19, 2013

Private Eye Issue 1341
Filed under: Private Eye — Dr. Phil @ 3:11 pm

CQC in the Dock

NHS England has confirmed there will an ‘inquiry in public’ into the serious systemic failures at University Hospitals of Morecambe Bay Foundation Trust (UHMBFT). But will it have the balls to expose yet more failings in the regulation and leadership of the NHS? The inquiry was sparked by the avoidable death of baby Joshua Titcombe at Furness General Hospital in November 2008.  Joshua had a low temperature due to lung infection that would have been easily treatable had it been diagnosed. Sadly, it wasn’t. Joshua’s crucial observation chart disappeared soon after his death, despite ‘extensive’ searches, leading the coroner to deduce,  32 months later, it may have been ‘deliberately destroyed.’ He concluded there was a ‘very worrying mark of suspicion hanging over the maternity unit at Furness General Hospital (part of UHMBFT)’ and identified ten serious failures. A previous review into the service had also found serious failings. So why did the Care Quality Commission not investigate?

Whistleblowing CQC board member Kay Sheldon recently accused the CQC of registering failing hospitals as safe to avoid another public scandal such as Mid Staffordshire.  ‘It seems to me that CQC gave assurance about the Trust that wasn’t actually accurate…It was a very shocking thing to find, thinking that an organisation that’s there to protect patients had effectively given what amounted to false assurance and that meant that problems in the Trust carried on unacknowledged and unaddressed.’

James Titcombe, Joshua’s father, works in the nuclear industry and knows a thing or two about safety: ‘The idea that any regulator could deliberately give false reassurances about the safety of vulnerable people is deeply shocking. Could you imagine the Civil Aviation Authority knowing about significant safety issues in a type of passenger jet, but then deliberately suppressing the concerns?  What would happen in these circumstances if a plane subsequently crashed and hundreds of people died as a consequence?’

At Morecambe Bay, following the ‘all clear’ registration of the Trust by the CQC’, the Dr Foster unit at Imperial College London calculates that 415 excess deaths may have occurred (up to and including 2012). In 2011, the statistical estimate was more than 257 excess deaths (the highest mortality rate of any Trust in the country).

Titcombe has meticulously and courageously unearthed documents which unequivocally show the serious concerns CQC had about Morecambe Bay as far back as September 2009. At this time, the Health Service Ombudsman was considering undertaking her own investigation into concerns regarding the Trust’s maternity services, including the death of Joshua. During this process, a discussion took place between the deputy Ombudsman (Kathryn Hudson) and the regional director of the CQC (Alan Jefferson). Ms Hudson recorded details of the conversation which she forwarded to the Ombudsman, Ann Abraham. It revealed clear evidence of systematic failure in maternity services across the Trust, and serious concerns about how the entire Trust operated1. And yet in February 2010, Abraham refused to investigate, saying it was the CQC’s job to address failures,  and  two months later, CQC registered Morecambe Bay ‘without conditions and with no planned investigations’.

The scandal also implicates Mike Farrar, who was CEO of the North West Strategic Health Authority between July 2006 to October 2011, and is in the running to succeed Sir David ‘No Accountability’ Nicholson as chief exec of  NHS England. Farrar’s partner, Rosamond Roughton, is the Director of Commissioning Development at NHS England. That shouldn’t obstruct a thorough ‘inquiry in public’.

1 www.morecombebayinquiry.co.uk





June 4, 2013

Private Eye Issue 1341
Filed under: Private Eye — Dr. Phil @ 6:26 pm

A Law Unto Themselves

The success of Robert Francis QC in stopping the NHS from covering up the harm it causes is crucially dependent on the behaviour of his own profession. At the time of the Mid Staffordshire scandal, there was unequivocal guidance for NHS trusts, managers and clinical staff to be open and transparent when patients may have been harmed by their care, but lawyers tend to focus their attention on the law, and who’s paying their fees. Hence the solicitors’ code of conduct – to act in the best interests of the client – invariably trumps any wider ethical guidance to the NHS, particularly when it comes to admitting anything that might expose a hospital to bad press, litigation and financial loss. Francis’ solution – to make non-disclosure of harm a criminal offence –is as big a shift in the culture of medical law as it is to the NHS.

Eye readers will be well aware of the extent the NHS uses publically-funded lawyers to suppress whistleblowers. The case of John Moore-Robinson at Mid Staffs illustrates how such a defensive – but entirely legal –  culture obstructs parents from understanding how their son died. Moore-Robinson, a previously fit young man, was examined in A&E at the Trust on 1 April 2006 following an accident on his mountain bike. He was examined by a junior doctor and, in spite of the protests of friends who were with him, discharged – in a wheelchair as he could not walk – with advice to take an analgesic. He was still being sick as he left A&E. He died the following day at another hospital. It was later found he was suffering from a ruptured spleen, a lethal injury unless diagnosed and treated promptly. He was showing signs and symptoms which were indicative of this as a possible diagnosis and he should not have been discharged. It is likely that his life could have been saved had he been kept in hospital for a thorough investigation and treatment.

The Trust received a request from the Coroner for information in relation to the death. The junior doctor had left the Trust, so Mr Ivan Phair, the senior A&E Consultant, was asked by the Trust’s legal team  for a “report addressed to the Coroner for use in the inquest.” Phair concluded that the junior doctor should have interpreted that Mr Moore-Robinson could have been suffering from some form of bleeding. ‘I cannot find enough evidence which would lead me to conclude that a thorough abdominal examination was carried out… I would therefore raise the possibility that his unfortunate, untimely death may have been avoided, had he been more properly assessed on his initial attendance to the A&E department.’

 

On May 25, 2006, Kate Levy, the Trust’s in house solicitor, wrote to Mr Phair saying his report had not been forwarded to the coroner. ‘Whilst it would be entirely appropriate as a report in respect of a clinical negligence claim it goes beyond the issues which concern the Coroner. The Coroner is undertaking a fact finding exercise and does not concern himself with matters of blame or potential negligence. I would therefore like to suggest that the section of your report headed “Conclusion” with the exception of the final para be removed’

 

When Mr Phair refused, she wrote: ‘As reports are generally read out in full at the Inquest and the press and family will be present, with a view to avoiding further distress to the family and adverse publicity, I would wish to avoid stressing possible failures on the part of the Trust.’ She suggested removing the two paragraphs of the conclusion. ‘I feel such a concluding statement may add to the family’s distress and is not one which I would wish to see quoted in the press.’

 

Mr Phair amended his report but it still contained his grave concern, his opinion about the ‘brief an incomplete’ abdominal examination and the possible cause of death. Levy decided not disclose either version to the coroner or Moore-Robinson’s parents, and neither did fellow solicitor Stuart Knowles. When the failure to disclose Phair’s report was discovered by the Francis Inquiry, Levy was dismissed from the Trust in 2010 but won her case for unfair dismissal and was awarded £103,000 in damages. Capsticks solicitors advised the Trust that it was normal to exclude issues of blame and potential negligence from a coroner’s inquest. The Solicitors Regulatory Authority and the Bar Standards Board agreed Levy had acted entirely professionally in line with her employment contract and solicitors’ code of conduct, and there was no case to answer.

 

Meanwhile, Knowles – who was also the deputy coroner – privately advised the NHS Litigation Authority that ‘it would not be unreasonable to view the matter as indefensible’. In October 2007, the claim was settled for £15,000, a step Mr Knowles said was “eminently sensible” but “slightly overpriced”. The Trust stressed in a press statement that ‘liability was not admitted.’ Chief executive Martin Yeates wrote to John’s parents in an attempt to apologise. ‘While I understand that nothing can compensate for the loss of a loved one I hope that the fact that matters have been resolved speedily will go some way to enable you to put this matter behind you and move on.’

 

Knowles was flummoxed at the family’s anger and wrote: ‘The apology was the standard NHSLA affair and it was approved by someone … This family have been going on about this and they appeared on telly recently … we settled very quickly even though there might have been issues that could merit further investigation. I take the view that we treated the family very well … Who is causing a problem and what are they trying to achieve? … Anyway hopefully we can sort this out soon but I suspect the family are having issues (quite understandably) with grief etc… it is indeed unfortunate that what appears to have been a rapid and well-handled [settlement] by the NHS does not appear to have been appreciated by the family and that they have taken this unfortunate line.’ Seven years later, John’s parents are still campaigning for an independent inquiry into his death. If lawyers can’t be trusted to give patients and relatives the truth, there needs to be a law against it.





June 3, 2013

Why is patient funding the lowest in the North West?
Filed under: Private Eye — Dr. Phil @ 12:42 pm

Interesting letter from GPs at Holmes Chapel Health Centre in Cheshire saying that some other  CCGs receive approximately 50% more money per capita than Eastern Cheshire CCG. Is this true? If so, how can it be justified?

CCG unfair funding

 





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