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Archive - Month: September 2010

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 four babies died (Eyes passim)

In July 2003, the Eye reported a survey of 211 hospitals which found that 166 ‘do not have sufficient numbers of specialist registrars to give continuous cover of acute medical admissions. These hospitals have less than 10 specialist registrars in medicine, with 44 having fewer than five and, at present, completely unable to cope with the EWTD. The drastic reduction in hours in the current system will also have a dire effect on surgical training, with many new consultants already unsafe to independently cover all of the operations in their job description.’

The EWTD could only ever have been safely implemented with a redesign of the service, working across teams and merging units to concentrate manpower. Homerton hospital started planning for the EWTD give years ago and have implemented it successfully by separating emergency and elective patients, extending consultants’ hours and designing a well-staffed acute care unit to ensure patient get properly treated while doctors get properly trained. It’s required a cultural shift that’s beyond the ingrained rivalries in many hospitals and gave consultant Dr Croakley ‘many sleepless nights’. But it works because all the staff – junior and senior – had input into the changes and agreed them. In most of the NHS, change is enforced at the last minute with no discussion, and whistle-blowers are shot.

NHS hospitals that didn’t plan for the EWTD are in chaos, made far worse by Labour’s imbecilic decision to send home the thousands of excellent and experienced doctors from India, Pakistan, Egypt and elsewhere who have kept the NHS afloat. These doctors provided both excellent care and training, and the theory that newly qualified British graduates or an influx of European graduates could fill such a gap has proved disastrously optimistic. The result is that there aren’t enough experienced doctors, and novice juniors are marooned on night shifts, covering dozens of patients across multiple wards with little or no supervision. No wonder they’re throwing in the towel.

As one junior put it: ‘Our rotas in most acute specialties are 30% down, so the NHS is having to pay us to do the shifts. Some places are exploiting juniors by getting them to sign EWTD forms that lie about their hours, but most places are just accepting it. The problem is that if you do, say, an extra night you then miss two days of training during the day time. We need to go back to a firm based structure, working in a team, and with more junior doctors. But the juniors we have either aren’t experienced enough or just can’t get on to specialist training.’ Over to you Andrew Lansley.

September 22, 2010

How many PCT Chief Execs. does it take to answer a few simple questions?
Filed under: FOI Balls — Dr. Phil @ 9:32 pm

Three apparently.

On 30th August 2010, the following FOI request was made via the website

Dear North Somerset Primary Care Trust (PCT),

Please answer the following questions:

1. When was your Chief Executive, Mr Chris Born, first made aware of serious allegations of histopathology misdiagnosis made against University Hospitals Bristol NHS Foundation Trust (UHB)?
2. By what means was Mr Born first made aware of the allegations?
3. When did Mr Born inform his Board about the allegations?
4. When Mr Born found out about the allegations, what actions did he take to protect the safety of the patients on whose behalf his PCT commissions services from UHB.
5. There have been at least three further allegations of misdiagnosis raised since the UHB commissioned inquiry started.
6. When and by what means was Mr Born made aware of them?
7. What action has Mr Born taken to protect the safety of patients on whose behalf his PCT commissions services from UHB, given the the ongoing issue of lack of implementation of common standards of
quality and safety in labs in the locality that has led to the recent allegations.

The existence of the UHB commissioned histopathology inquiry will not be accepted as a reason to claim exemption under FOIA as the actions of NHS North Somerset are not within the published terms of
reference of the Inquiry.

Yours faithfully,

Mrs D Havercroft

The same request was made of NHS South Gloucestershire, whose Chief Executive is Mrs Penny Harris.

On 20th September, it seems that Chris Born had a stab at this response, which somehow found its way onto the internet, even though it’s obviously work in progress:

Sent: 20 September 2010 10:32
To: [FOI #45966 email]
Subject: FW: Freedom of Information request – Bristol Histopathology –
allegations of misdiagnosis 2010-228

Thank you for your email of 30^th August 2010 regarding a freedom of
information request on Bristol Histopathology.

Please find below my response to your questions:

1. 14^th June 2009

2. Bristol, North Somerset and South Gloucestershire PCT Chief
Executive’s meeting

3. Awaiting results of investigation

4. Agreed that NHS Bristol would continue as lead commissioner to assure patients were protected.

6. Specific clinical incidents are dealt with through a trust’s normal incident procedure and are normally not reported to PCT Chief Executives.

7. Included requirements for quality and safety in contracts for
services from acute trusts. This includes………………….

Many thanks

Chris Born

Chief Executive
NHS North Somerset
Tel: 01275 546681
Fax: 01275 546767

`Making it right for you’


On 22nd September, Deborah Evans, Chief Executive of NHS Bristol commented on Chris Born’s draft. This found its way onto the internet as well:

Evans Deborah

22 September 2010

Link: [1]themeData
Link: [2]colorSchemeMapping

Dear Chris and Penny,

Our advice would be to stick with the answers to 1 and 2 as you have
written them.

Question 6 I would just leave it at the words “specific clinical incidents are dealt with through a Trusts normal incident procedure.”

Question 7 I would say “we do not accept the premise on which this statement it based” – otherwise you are accepting the generality that there is a lack of implementation of common standards etc and this could
be twisted in a subsequent request or statement.

I hope this is helpful
Mrs Havercroft finds it very helpful indeed.

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. Not just safety of patients and staff using the hospital, but the reputation and value of this scheme to its financial backers and the credibility of the whole multi-billion pound NHS PFI programme to follow.

On 4 May 2004, the PCT asked Dr Brambleby to give a statement to the media but to check with the SHA press officer, who was briefed and ready for the call. He said he had read all the “libellous” correspondence, had briefed the Secretary of State (John Reid), and warned Dr Brambleby that unless he dropped the whole matter he would end up “like Dr David Kelly who was found dead in the woods with his wrist slashed.” Complaints about that threat to NAO and SHA fell on deaf ears.

Documents recently released on the instruction of the Information Commissioner’s Office show that Norwich PCT chief executive Dr Chris Price took up the complaint in a letter to SHA chief executive Peter Houghton on 11 June 2004: “… the unacceptable behaviour of Mr Davies … was an orchestrated and deliberate attempt to bring pressure to bear … to intimidate me into making public statements which would discredit Dr Brambleby … (the press officer) made wholly inappropriate referral to the death of the late David Kelly as an illustration of what happens to whistleblowers … I know he said these things because he had a very similar conversation with me … I would hate to think that he might subject some other less robust individual to the same sort of treatment in the future and I guess that is the real reason I feel compelled to make this complaint.”

And the response? Nothing. It was months before the SHA looked into it, and years before the findings were released, albeit in redacted form, and through the intervention of North Norfolk MP Norman Lamb. In it, the press officer claimed his advice was: “… wholly appropriate given the circumstances … talked through the advice with colleagues … the recent case of David Kelly was a perfect illustration of someone who ended up caught in the crossfire between politics and the media … Peter Brambleby, as a public servant, had no democratic legitimacy … it was advice I would give to others in similar situations.”

This latest example of top-down bullying of those who raise legitimate concerns in the NHS reveals Labour’s desperation to make PFI work at all costs. While safety concerns were suppressed, former health secretary Alan Milburn was paid handsomely to speak at a ‘strategy seminar’ in the south of France, as guest of Financial Securities Assurance, the bankers who remortgaged the Norfolk and Norwich PFI.

September 16, 2010

University Hospitals Bristol Paediatric Pathology Concerns’ Timeline
Filed under: Bristol Pathology Inquiry — Tags: — Dr. Phil @ 11:49 pm

Richard Spicer, a recently retired consultant surgeon at University Hospitals Bristol NHS Foundation Trust (UHB) has compiled a timeline of the concerns raised about paediatric pathology during his time working there. The documentary evidence supporting this timeline has been submitted to the current pathology inquiry, which is due to report soon; but there are concerns that long-standing problems in paediatric pathology may be sidelined. What saddens me most is that the Bristol Heart Inquiry found that children’s services often play second fiddle to adult services, and the recommendations to prevent this happening don’t seem to have been implemented.

As Mr Spicer observes:
‘Services for children provided by the Bristol Royal Hospital for Children are uniformly excellent but Paediatric and Perinatal Pathology have been subsumed within the Department of Ault Histopathology. Managers of adult services in the BRI have controlled the destiny of the paediatric department over the last 10 years and managers within the Children’s (now Women and Children’s) Directorate have had little or no influence over the events described below even though they have ultimate responsibility for the children treated within the Children’s and St Michael’s Hospitals.

Paediatric Pathology Timeline

The Cast

GB Dr Graham Bayley, Clinical Director, Laboratory Medicine

NB Dr Nick Bishop, Medical Director

MM Dr Morgan Moorghen, Lead Clinician,Histopathology

GN Mr Graham Nix, Acting Chief Executive (afterHR)

MP Prof. Massimo Pignatelli, Head of Department of Histopathology

HR Mr Hugh Ross, Chief Executive

PR Mr Peter Richardson, General Manager, Laboratory Medicine

JS Dr Jonathan Sheffield, Medical Director (after NB)

LS Ms Lesley Salmon, General Manager , St. Michaels Hospital

The Narrative

10/7/01 Letter from Paediatric Surgeon to HR and NB warning them that actions taken by adult histopathologists and managers (notably PR) threatened to destroy the department of Paediatric Pathology.

16/7/01 Letter from Prof. of Paediatrics to HR and NB supporting above letter.

29/8/01 Letter from 8 senior clinicians in the Children’s Hospital to HR expressing concern that the lack of expert paediatric pathology was threatening the standard of care for children.

8/10/02 Letter from Lead Clinician for Children’s Surgery and Chairman of Division of Children’s Services to GN and NB expressing extreme concern that decisions taken by adult managers had resulted in the collapse of Paediatric Pathology with potential severe adverse effects on patients.

8/1/02 Letter from paediatric surgeon to MP reiterating concerns about standards of care (particularly for children with tumours and Hirschsprung disease) since adult rather than specialist paediatric pathologists were providing histopathology services for children and also concerns that no moves were being made to rebuild the department and specialist paediatric technicians were being diverted to adult histopathology.

14/11/02 Letter from Clinical Director of Obstetrics and Gynaecology to NB ,GN,LS and MM expressing concern at the loss of paediatric pathology and the severe effects of this on neonatal, fetal medicine and genetics services. He lays the blame for the loss of service at the door of UBHT managers.

1/10/03 Letter from Professor of Paediatric Oncology to various managers , including GB expressing concern that there was no management support for paediatric pathology and that a detailed report of the Paediatric and Perinatal Pathology Working Group (which he chaired) had been ignored by the Medical Director and Executive Director.

24/2/04 Letter from Prof. of Paediatric Oncology to GB, MM, MP and PR reiterating above concerns.

19/5/04 Letter from recently appointed Paediatric Pathologist complaining about lack of support from adult pathologists and managers and the difficulty of having to work within an adult department rather than having a separate dedicated paediatric department , as previously existed. This individual subsequently moved to another centre.

29/9/04 Letter from Consultant in Paediatric Intensive Care to MM highlighting the poor quality of Post Mortem services for children. This was particularly based on cases of children dying of cardiac disease and a decision was subsequently taken to send all such cases to London to a paediatric pathologist previously working in Bristol who had been forced to leave Bristol due to decisions taken by adult managers which adversely affected his working environment.

14/2/08 Letter from Prof of Paediatric Oncology to MP and JS highlighting the incompetence of adult managers in attempts to recruit paediatric pathologists. I quote “many of us have been disappointed to see how, over several years, the need for adult pathology development is seen as a competitive and (I regret to say) obstructive element in addressing paediatric pathology. In today’s NHS no one should feel the need to extinguish another person’s light just to help theirs shine brighter”.

September 12, 2010

Carterballs 2
Filed under: FOI Balls — Dr. Phil @ 12:06 pm

According to Dr Ian Barnes’ 3rd June 2010 letter to SHA QIPP Leads (see Carterballs 1), SHAs should have commented on the national workstream plan for pathology.

NHS South West did, but claims it didn’t keep a copy of what it said to the Department of Health. A Freedom of Information Request is now with the DoH. Presumably they did keep a copy of NHS South West’s comments.

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