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Private Eye

August 22, 2010

Dr Phil’s Private Eye Column Issue 1269 20.8.10
Filed under: Private Eye — Tags: , , — Dr. Phil @ 1:01 pm

Rewarding Whistleblowers

Well done Channel 4 News and the Bureau of Investigative Journalism for their exposure of the widespread use of taxpayers’ money to silence NHS whistleblowers (Ch 4 news, 2.8.10). Many employment contracts still have gagging clauses and most doctors who invoke the Public Interest Disclosure Act (PIDA) to raise concerns about unsafe or fraudulent practice reach a settlement with their employer to prevent concerns being made public. Superficially, this smells of whistleblowers bottling it and taking the money, but when you look at the experience of those who refuse to be silenced, there’s no great incentive to do the right thing.

The NHS’s most famous whistleblower, Dr (now Professor) Stephen Bolsin, was praised in Parliament for raising concerns about standards of child heart surgery in Bristol nearly 20 years ago, and his actions were fully vindicated by a Public Inquiry. Yet he became unemployable in the NHS and relocated to Australia, where he continued his excellent work in monitoring clinical outcomes. Had Bolsin remained in the NHS, it is inconceivable that small units would have been allowed to continue operating and the Oxford heart scandal would have been avoided (Eye last).

If Andrew Lansley is genuine

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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

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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

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July 9, 2010

Dr Phil’s Private Eye Column Issue 1267, July 7, 2010
Filed under: Private Eye — Tags: , — Dr. Phil @ 2:39 pm

Tory Health Policy

 ‘Health secretary Andrew Lansley has just spoken to more NHS managers than he will ever do again’. So observed the Health Service Journal after he told the NHS Confederation conference that management costs (i.e. jobs) would be ‘shaved’ by a minimum of £220 million this year. Redundancy packages and Brazillians all round.

 According to Lansley, we’ll need fewer managers because targets will be abolished, GPs will be in charge of the money and an independent NHS board will ensure fair play. If only it was that simple. Targets per se are not a bad thing. If you can prove they improve outcomes for patients and the staff are given a degree of flexibility in implementing them intelligently, they work. If you enforce them with a rod of iron, irrespective of the clinical context – as Labour did too often – then they lead to bullying and disillusionment,  and harm as many patients as they help.

 Too many targets are inevitably counter-productive, like squeezing a tube of toothpaste in ten places at once. Labour’s failing was to believe that the NHS was a linear system, easily controlled by central levers. Doctors have never have been easy to control

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June 25, 2010

Dr Phil’s Private Eye Column Issue 1266, June 22, 2010
Filed under: Private Eye — Dr. Phil @ 8:41 am

Commissioning Balls

 Health secretary Andrew Lansley has a touching faith in GPs if he thinks we can spend a £60 billion NHS commissioning fund wisely. Clinical staff should have the power to purchase services for patients, but the commissioners need to include representatives from hospitals and primary care, across all specialties, and the care they purchase needs to be integrated to avoid duplication and make sure patients get treated in the right place at the right time.

 MD does however have several commissioning suggestions. Firstly, stop commissioning NHS inquiries in secret. If a scandal has reached the level of requiring an inquiry, you can be sure lots of people knew about it and failed to act, and there are lots of powerful vested interests trying to minimise the fall-out.  Being able to give evidence in secret in the knowledge that it will never be made public is a strong incentive to continue the deception. Clinical staff and NHS managers are public servants, and if they can’t tell the truth in public, they aren’t fit to serve.

 The fact that Lansley has ordered a public inquiry into the Mid Staffordshire scandal after several expensive private inquiries is a case in point.

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