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Private Eye

September 29, 2010

Dr Phil’s Private Eye Column, Issue 1272 September 29
Filed under: Private Eye — Tags: — Dr. Phil @ 3:58 pm

The European Working Time Directive again.

Is it possible to train doctors properly in a 48-hour working week? The European Working Time Directive (EWTD), which enforced its final hours’ restriction last year, was agreed in 1999, giving the NHS ten years to prepare. The rationale was sound – there is overwhelming evidence that sleep deprivation and unnatural sleep cycles contribute to thought and movement impairments, injuries and error – but there were obvious dangers too. Halving the working hours of junior doctors could – unless cleverly executed – have a disastrous effect on both training and patient care.

The widespread training failures and alarming drop-out rates publicised in The Times suggests that the NHS, and the Labour government, buried its collective head in the sand over the EWTD. This was hardly new to Eye readers. Back in 2002, MD argued that specialties such as heart surgery needed to merge into fewer units, with a minimum of 4 surgeons, to allow proper training and supervision of those whose hours were restricted. Labour was ‘not persuaded’ by centralisation and we ended up with Oxford heart scandal, where an inexperienced consultant had no senior support or supervision in the hospital when

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September 20, 2010

Dr Phil’s Private Eye Column, Issue 1271 September 15

PFI at all costs….

In 2003 Dr Peter Brambleby, then director of public health for Norwich Primary Care Trust (PCT), received requests from senior clinicians at the PFI flagship Norfolk and Norwich Hospital hospital (Eyes passim) to look into their concerns about changes to the design and build that they believed put patients at risk. The ventilation system and isolation facilities were top of their list, but so were a lack of management response and a culture of secrecy.

When his preliminary inquiries confirmed cause for concern, evidence of covering up and a lack of proper supervision by Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (SHA), Brambleby put the matter in the hands of the National Audit Office (NAO) on 31 March 2004. The NAO, led by Sir John Bourn [Eyes passim], referred it straight back to the SHA and hospital to investigate.

External scrutiny did at least prompt some remedial building work (at the NHS’s expense), a belated clinical risk assessment (from which Dr Brambleby was barred), an internal inquiry (which omitted key witness testimony and declined to track down critical records on changes to design specification), and a flurry of press interest. Much was at stake.

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September 1, 2010

Dr Phil’s Private Eye Column, Issue 1270 September 1

A solicitor writes…

MD has received a disturbing e mail Huw Morgan, a Medical Protection Society solicitor representing a pathologist who has given evidence to the University Hospitals Bristol (UHB) Pathology Inquiry: ‘It has been alleged that it was he who provided you and/or Private Eye with the information regarding such services which appeared in the 2009 issue(s) of that magazine, shortly before the Inquiry was set up. This is not the case; however he is concerned that such any such mistaken belief on the part of Panel members might be an adverse factor in their assessment of the evidence which he has given to them.’

MD has never had any contact with the pathologist, and the public money used to fund the Inquiry (£464,000 to the end of June 2010) would be better spent focusing on the specific allegations of misdiagnosis in specialist adult and paediatric pathology. Equally important is to ascertain whether appropriate action was taken to investigate the allegations. Concerns about the lack of specialist paediatric pathologists date back to 2001: ‘Over the next 2 years paediatric work was done by adult pathologists with disastrous results, particularly in the fields of childrens’ cancers and Hirschsprung disease.’ An

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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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