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Archive - Month: November 2010

November 26, 2010

A Report on the Bristol Histopathology Inquiry
Filed under: Bristol Pathology Inquiry — Dr. Phil @ 7:43 pm

Inquiry Panel Chair, Jane Mishcon’s official report into the serious concerns about University Hospitals Bristol NHS Foundation Trust’s histopathology reporting in the specialisms of breast, lung, gynaecology, skin and paediatric pathology has not yet been published.

NHS organisations in Bristol have said that it will be published in December 2010.

Meanwhile, this report has been produced by Daphne Havercroft, a patient advocate who has used Bristol’s histopathology services and knows the NHS well, having been involved in local service reconfigurations.

Report on the Bristol Histopathology Inquiry Nov. 2010

Daphne’s report raises the questions that, as a user of the service, she thinks the Inquiry Panel must answer. She waits to see whether Jane Mishcon has answered them in her report.

The Royal College of Pathologists describes pathology as “the hidden science that saves lives”. Patients and the public have a part to play to flush it out of hiding. A good start is to read Daphne’s report, and then the Panel’s report when it is available, to see if Daphne’s questions have been satisfactorily answered.

November 25, 2010

Medicine Balls, Private Eye Issue 1276
Filed under: Private Eye — Dr. Phil @ 8:44 am

Buying Silence with Public Money

Should the concerns of whistle-blowing NHS staff who’ve signed silencing deals with their employers now be made public? In 2008, a staff survey by the Healthcare Commission found that Liverpool Women’s NHS Foundation Trust (LWNFT) had the second highest national rate for bullying of clinical staff by management, with a high percentage of staff wishing to leave their jobs. In 2009, after a long freedom of information battle, it was revealed that the Trust had signed twelve silencing deals (or ‘compromise agreements’) with staff over ten years, at a cost of £392,000. All contained gag clauses preventing the staff from going public with any concerns they may have had about medical care or mismanagement.

The agreements were drafted and negotiated by Liverpool solicitors, Mace & Jones. Since 2006, the Chairman of Mace & Jones has been Roy Morris, who has also been a non executive director of the Liverpool Women’s trust since 2005. He denies any conflict of interest. Mace & Jones were instructed by the Trust to ensure that any names of silenced employees are not revealed under information law, a view challenged in a recent Information Tribunal hearing1.

The trial heard evidence from Peter Bousfield, a consultant gynaecologist at LWNFT and a former medical director of Fazakerley hospitals. He had been concerned about staffing levels, lack of proper equipment and lack of ITU at LWNFT. After a bruising battle, he was paid £160,000 to retire and keep silent. He has since been threatened with an injunction by Mace & Jones if he raises his concerns with his local MP or anyone outside the NHS. In his witness evidence, he said he was truly horrified by this prospect and viewed it as a ‘disgraceful bully boy abuse of power’. He also revealed that the trust is now subject to a £20 million negligence action, despite the doctor in question raising concerns about his own practice.

Also in the witness box was David Ednay, a former superintendent sonographer, who had become concerned about nurses doing intrusive ‘HyCoSe’ scans to investigate infertility. When he raised his concerns, he was accused of bullying and suspended by the Trust. An independent assessor, Philip Orme, was brought in. The Trust initially refused to disclose the Orme report but Mr Ednay eventually obtained it under data protection law. It found that his suspension “could be regarded as wholly unwarranted even vindictive” and could “create the impression of a witch-hunt”. As a result, Mr Ednay was offered money with a gagging clause but refused, preferring to speak freely. In sympathy with Mr Ednay, seventeen sonographers resigned and moved on. In the witness box, Mr Ednay said he had formed the view that the Trust was essentially ‘corrupt.’

In court, the Trust claimed that only two of the compromise agreements referred to doctors. One was Mr Bousfield, and the Trust produced a letter from the other doctor refusing to give consent for his name to be made public, as he is still reliant on the Trust for references. Without knowing his identity, the Information Tribunal ruled that it could not be proved that this doctor was a whistleblower, and any concerns he may have had about standards of care remain a secret. So much or an open, transparent and safety-first NHS.

Bill Cash MP, who was instrumental in securing the Mid Staffs public inquiry, has argued for a new law to overturn all gagging clauses, allowing previously silenced doctors to voice their concerns about patient care. At the very least, Health Secretary Andrew Lansley should now insist all Trusts publish detailed information on all compromise agreements, including any patient safety concerns, to ensure taxpayers’ money is no longer used to buy the silence of whistle-blowers.


November 11, 2010

Medicine Balls, Private Eye Issue 1275
Filed under: Private Eye — Tags: — Dr. Phil @ 4:35 pm

Neutering NICE

The demotion of the National Institute for Health and Clinical Excellence (NICE) from NHS head-teacher to somewhere between a dinner lady and a classroom assistant caught the quango by surprise. An e mail sent by chief executive Sir Andrew Dillon to NICE committee members suggests he wasn’t in the loop: “I am sorry that speculation on the future of the appraisal programme has appeared without me being able to forewarn you. We were also taken by surprise.”1 But the neutering of NICE started with health secretary Andrew La-La Lansley’s pre-election pledge of a cancer drugs fund to pay for drugs that doctors and cancer patients wanted, but NICE didn’t think were cost effective for the NHS. If NICE’s judgements can so easily be bypassed by one politician, there is no point in making them mandatory for the rest of the NHS.

In 2006, as chair of the NICE conference, MD invited then shadow health secretary Lansley to say: ‘There is, and has to be, rationing in the NHS.’ (Eye 12.12.06 ). He duly obliged, and the NICE hierarchy relaxed, safe in the assumption that they had devised the fairest system for rationing the NHS had ever seen, and no health secretary of any party would be stupid enough to tear down their firewall between politicians and the press.

But Lansley has done just that. NICE will continue to produce reams of guidance, at least for now, but the NHS will no longer be obliged to follow it. Instead, decisions about what doctors can and can’t afford to prescribe will be made by, um, doctors – at least until the money runs out. From October 1, £50 million has been put aside in the cancer fund to take us through to March 2011, with £200 million a year available thereafter. But why just a cancer fund? Why not a fund for MS or rheumatoid arthritis? It makes no moral sense. And what happens when a single drug such as Avastin takes out the entire cancer fund and there’s no money left for Glivec? Or Mrs Black at number 32 gets her cancer drug, but Mrs White at 31 doesn’t because her cancer struck late in the financial year.

NICE is not perfect. Its measurements and benchmarks are limited and crude, but far better than anything else we’ve come up with. It had got a bit bloated and pleased with itself, and some staff found it a macho and unforgiving place to work. But at least it tried to make sense of the drugs’ budget and standing up to the might of the industry in a way not previously seen. NICE already recommends 75% cancer medications. Pausing for thought over the remaining 25% that offer a few months at a huge cost is not always a bad thing (unless you only have a few months to live)

Even big pharma isn’t celebrating. At least companies know the rules with NICE and roughly what they had to do to get approval. The thought of selling to 150 struggling GP consortia fills them with dread. Bring back the cheer leader reps, the branded pens and the educational curries. La La is married to a GP, and appears to have a touching faith in our abilities. As well as taking over from the doomed Strategic Health Authorities and Primary Care Trusts, GP consortia have to cut management costs by 45%, save £20 billion through something called QIPP, learn how to procure and commission £80 billion of services and get to grips with an incomprehensible new way of paying for drugs called Value Based Pricing. If you’re really lucky, we might even see some patients.


Ra Ra Rationing

NHS Warwickshire – a bust primary care trust – is racing ahead with rationing ahead of the financial squeeze. Some cataract removal and hip replacements are among the restricted treatments. For the full list of doom, go to

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