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Archive - Year: 2015

April 9, 2015

Private Eye Issue 1388
Filed under: Private Eye — Dr. Phil @ 9:46 pm

Dementia Time Bomb

David Cameron’s reluctance to contest a third term or talk about the NHS is entirely understandable given the state it’s likely to be in whenever he leaves office. Last week, the Kings Fund reported that performance has regressed to 1990’s levels. NHS funding needs to increase year on year not just because people are living longer, but because they are living longer with multiple diseases, and particularly dementia. When the NHS was founded in 1948, half the population didn’t make it to 65. Now one in three people in the UK are likely to live to a hundred, and the person who lives to 150 may already have been born.

Between 1948 and 2011, NHS annual funding growth averaged 4%. From 2011-2015 it was 0.9%, and the target growth 2015-2020 is 1.5%. If Cameron wins the election, and even if he loses, the NHS is likely to be stretched beyond repair in five years. NHS England gets very excited about the efficiency savings from new models of working (Vanguard locality commissioning has now replaced GP Pathfinder commissioning on the bullshit bingo cards), but the biggest challenges to the NHS remain inequality, poor self-care and frailty. The difference in disability-free life expectancy at birth between the richest and poorest parts of the UK is nearly 20 years. A quarter of the population (over 15 million people) have a long-term condition such as diabetes, depression or dementia– and they account for 50 percent of all GP appointments and 70 percent of days in a hospital bed.

The number of older people likely to require care is predicted to rise by over 60 percent by 2030. And yet local authority spending on social care for older people has fallen in real terms by 17 per cent during Cameron’s first term. In that time, the number of older people aged 85 and over rose by almost 9 per cent. The number of people able to get publicly funded social care has fallen by 25 per cent since 2009 (from 1.7 million to 1.3 million) and in 90 per cent of local authorities only those with ‘substantial’ or ‘critical’ needs get publicly funded services.

The buck at present stops with unpaid often elderly carers. 32 percent of carers aged 65 to 74 are providing 50 or more hours of unpaid care a week, and 55 percent of carers aged 85 and over – many of whom are in bad health themselves. The number of carers aged 65 and over has risen by 35 percent since 2001 to 1.2 million, and 90,000 are over 85. For dementia alone, there are currently 850,000 people in the UK who have been diagnosed, costing the UK £26 billion a year. Two-thirds (£17.4 billion) of the cost of dementia is paid by patients and their families, either in unpaid care (£11.6 billion) or in paying for private social care. This is in contrast to other conditions, such as heart disease and cancer, where the NHS provides care that is free at the point of use.

The King’s Fund predicts that the financial cost of dementia in England will rise from £14.8 billion in 2007 to £34.8 billion in 2026. Research suggests that this cost could be significantly reduced by improvements in diagnosis, treatment and support for people with dementia and their carers to help avoid future admissions and improve clinical management. However, that would require a substantial investment in services. Currently only 43% with the condition get a diagnosis, and so 57% are denied the treatment and support they need.

By the age of 80 about one in six of us will have dementia, and one in three people in the UK will have dementia by the time they die. It is a progressive condition that gets worse over time and sufferers increasingly rely on carers as it advances. There is currently no cure although there are treatments that can slow the progression of some types of the condition in some cases. Usually, only about one in three people show a positive response to such drugs. The longer we live, the more of us will get dementia and – for all the government’s focus on the illness – the NHS and social care system simply doesn’t have the funds to care for those most in need, and it’s going to get a lot worse. No wonder Cameron – who put the NHS centre stage 5 years ago – doesn’t want to hang around to see it.

MD’s book – ‘Staying Alive – How to Get the Best from the NHS’ is published by Quercus

April 7, 2015

After 34 months, GMC is reviewing the patient safety aspects of our complaint against Dr Barbara Hakin
Filed under: Private Eye — Dr. Phil @ 8:18 pm

The GMC wrote to me and others on 1 April 2015 stating it will be undertaking a review of the ‘patient safety’ aspects of the complaint against Dr Barbara Hakin in her role as chief executive of the former East Midlands Strategic Health Authority because the original review “may have been materially flawed” and that a “review is necessary for the protection of the public or otherwise necessary in the public interest.”

The complaint was made by Andrew Bousfield and myself on 19/7/2012. Here is the letter of response to the GMC from Gary Walker, the former NHS trust chief executive and NHS whistle-blower, whose career was destroyed in the process of raising legitimate patient safety concerns. He has not been able to secure another NHS post since. His letter outlines serious failings in the GMC investigation.

Letter to the GMC re Dr Hakin case

March 24, 2015

Private Eye Issue 1387
Filed under: Private Eye — Dr. Phil @ 11:14 am

When will we ever learn?

On March 3, Dr Bill Kirkup published his report on the failures in maternity care at Furness General Hospital (FGH) between 2004 and 2013 (Eyes passim ad nauseum). It received scant media attention, possibly because repeated serious NHS failings have lost their ability to shock. The investigation found 20 instances of significant or major failures of care at the hospital which could have contributed to the deaths of 3 mothers and 16 babies. The report concluded that one mother and 11 babies could have been prevented from dying if they had been given different clinical care.

The report found serious failures at every level of the NHS from the trust to the Care Quality Commission (CQC), Monitor, the Department of Health and the Parliamentary and Health Service Ombudsman (PHSO). Kirkup uncovered a ‘lethal mix’ of factors that led not just to avoidable deaths but a culture where midwives at FGH and the trust itself to cover up what happened. Unsurprisingly, the lessons from previous deaths went unlearned and the harm repeated itself. The report found that following serious incidents there had been ‘instances of distortion of the truth’, ‘distortion of the process underlying an inquest’ and a ‘significant and regrettable attempt to conceal an evident truth, that a cardinal sign of infection in a newborn baby was wrongly ignored’. Most patients and parents will forgive a human error made under pressure, but they will never forgive being lied to, and the harm being covered up such that others are harmed too.

Most damning however is that the PHSO, Dame Julie Mellor, considered these very concerns and published her findings last year. She concluded “I have found no evidence that the Trust, when preparing for the inquest, failed to comply with the law or act in accordance with established good practice. I have seen no evidence that the Trust’s solicitor acted inappropriately, and no evidence that the midwives colluded to present ‘false evidence’ about their knowledge of the implications of a low temperature in a baby. In short, I have found no evidence of maladministration.” How can Mellor have got is so wrong? Mellor’s predecessor Ann Abraham also declined to investigate the death of baby Joshua Titcombe (an early victim of FGH) when the case was referred to her back in 2009. She then took no steps to ensure the issues were followed up by others in the system. As at Bristol, Mid Staffs and elsewhere, had it not been for courageous and determined truth seeking relatives, the harm would have remained concealed.

Kirkup concludes that ‘…the PHSO failed to take opportunities that could have brought the problems to light sooner…’ The Ombudsman’s role is to investigate complaints from those who have received poor care in the NHS in England. It would be hard to imagine poorer care than that which lead to the avoidable deaths of 11 babies and one mother in a single hospital department. Clearly the PHSO, and the culture, organization and resources supporting her, are not fit for purpose. Will she hold herself to account?

Health secretary Jeremy Hunt set out ‘immediate actions’ in response to Kirkup. NHS England medical director Bruce Keogh will to review the professional codes of “both doctors and nurses and to ensure that the right incentives are in place to prevent people covering up instead of reporting and learning from mistakes”. His team will include the GMC, which took 41 months to investigate a complaint by MD about lead consultant paediatrician Dr David Elliman, who was alleged to have failed to act on the serious concerns of Baby Peter whistleblower Dr Kim Holt and others. Why it took nearly three and a half years to close the case with no further action is omitted from the case examiners’ reasoning.

Hunt’s pledge to consider an independent medical investigation team to go in quickly when serious concerns are raised would have amused Dr Bill Pickering. Pickering died in February, but first advocated such an inspectorate in 1998, to swiftly and fairly investigate all serious clinical complaints and whistleblowing concerns (Eye November 1999, February 2000). MD remains a keen supporter, but will not hold his breath. In February 2014, Keogh ordered a ‘review’ into serious allegations of poor care at Bristol Royal Hospital for Children. 13 months later, most of the core group of parents who met Keogh in February 2014 have not yet received confirmed dates to meet inquiry chair Eleanor Grey. Any lessons that could have been learned will be long since lost in the mists of time. The NHS and its regulators are wilfully blind. They don’t do proper, timely, thorough and fair investigations to uncover and prevent patient harm. Until they do, patients will continue to be avoidably harmed.

March 11, 2015

Private Eye Issue 1386
Filed under: Private Eye — Dr. Phil @ 5:10 pm

Blow the whistle if you Dare

Dr Hayley Dare, a highly regarded NHS clinical psychologist, has been raising concerns for some years in the country’s biggest mental health trust, West London Mental Health NHS Trust (WLMHT). She spoke out about poor patient care and staff welfare. For example, in August 2012, the Trust’s Forensic Director closed a ward on the Women’s mental health unit without warning. This led to a 72-year-old woman having to sleep in a windowless, isolated padded room because there was no normal bed for her; she died a fortnight later. The Trust’s investigation into Dr Dare’s allegations was never published but Dr Dare’s concerns were subsequently upheld in court.

Dr Dare raised her concerns through the appropriate channels but was subjected to a campaign of bullying from senior management. This included a poison-pen letter threatening her and her children and accusations about her mental health. Dr Dare has an unblemished 20-year career in the NHS. As a specialist in women’s forensic care, she provided therapy to severely psychologically unwell women with long histories of abuse who had become a danger to themselves and to others.

Following an unexpected reorganisation, Dr. Dare’s post was put at risk of redundancy. Dare took the Trust to an Employment Tribunal. In December 2014, but she lost this case because it was considered that she had not acted in ‘good faith’, a now redundant legal tactic used to dismiss whistle blowing cases in Court. The law has now changed to focus on the content of the concerns raised, and how the whistle-blower is treated after raising them. Alas the change came too late for Dare. Dr Dare raised concerns through management for almost 2 years before she formally blew the whistle. 18 months after initially raising concerns, she was taken aside by a senior manager who threatened to cut her job and told her to stop putting her concerns in writing. This threat to her job was used to argue that she had not acted in ‘good faith’.

In December, the CQC issued a highly critical report of the trust, placing it at ‘elevated risk’ for having more than four times the number of complaints expected. It placed six further aspects of its work as at risk, including deaths of patients detained under the Mental Health Act. Out of 51 mental health trusts, it has the worst record for staff experiencing violence both from patients and colleagues, according to official NHS staff surveys in 2012 and 2013. Thirty per cent of staff experienced harassment, bullying or abuse from other members of staff in 2013 and just over one in four (26 per cent) experienced discrimination. Almost one in 10 (8 per cent) employees experienced physical violence from colleagues.

Dare’s tribunal heard how WLMHT chief executive Steve Shrubb was secretly recorded describing Dr Dare as a “very, very disturbed woman” and that she reminded him “of my first wife”. He added “I’m buggered if she thinks she’s going to screw me for a load of money and I’m buggered if I’m going to spend money sticking her in another trust.” Mr Shrubb added that if she was allowed to resume work at the trust in a different directorate, he would “give it three months before she then fingers someone else as being a bully… I’ll put money on it”. Shrubb alleged Dr Dare had had an affair with another senior member of staff, who was also “really problematic”. Director of Workforce Rachael Moench describer Dare as “so manipulative… she’s a victim through and through”.

In fact, Dr Dare is one of the most genuine and committed clinicians and whistle-blowers MD has had the privilege of interviewing. Her loss shows how employment tribunals are such dangerous places for whistle blowers to seek justice. You can be right, lose your job and face bankruptcy. After losing her case, the trust sent Dr Dare an aggressive demand for £93,500 costs on a Friday night (before and Independent on Sunday story), although legally it should have said it would be subject to an affordability assessment. Would any other worker at WLMHT now dare to do as Dr Dare did?

March 5, 2015

Staying Alive – The Book
Filed under: Staying Alive — Tags: , , , , — Dr. Phil @ 8:00 pm

Staying Alive: How to survive the NHS - Advice From a Doctor Book Cover

In this committed and compassionate book, Phil Hammond – a doctor, journalist, campaigner and patient – argues for a bidet revolution in the NHS – from the bottom up, with patients leading the charge. What we can do for ourselves to live well often far outweighs what modern medicine and the NHS can do for us. And when we do need to use the NHS, getting involved, speaking up and sharing our expertise can improve not just our care, but the care of others. We won’t always succeed, but we can learn from failure as we try to get the best care possible in our precious and precarious health service.

Dr Phil shares his own experiences of working in and investigating the NHS for 30 years, and combines it with the experiences and tactics of inspirational patients and carers, some of who have survived and thrived in the NHS, some who are planning a gentle death at home and some who have suffered greatly but are determined to improve the NHS so others don’t have to suffer.

  • The NHS is facing a crisis in care and a £30 billion black hole in its finances over 5 years. Politicians can’t fix it, but patients can.
  • Of the things that can be changed to improve our health, 70% depend on the way we live, 30% depend on the right healthcare. Most lives need living, not medicalising.
  • Getting the right care, right first time, improves both your life and the NHS for others – and patients can help to get it.
  • An invaluable book for people who use and work in the NHS, and those who want to get by without it.


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Got your own tips for surviving the NHS? Share them here



Publicity and reviews from:
The New Statesman
The Daily Mail
The Sunday Times

“This is a fantastic book about how to live well. Phil Hammond’s goes beyond the usual tips about diet and exercise – we hear about the power of positive thinking, as well as how to get the best out of the health service. And this book is packed with real stories – from people who have become survival experts through their own experiences. Their stories are heartwarming, enlightening and useful.
Phil Hammond has a knack of being brutally honest and very funny at the same time. This is quite simply the most useful book about health and the health service that I’ve ever read.”

Professor Alice Roberts – Anatomist, author & broadcaster, Professor of Public Engagement in Science, University of Birmingham

“Phil’s words are informative, always honest and insightful. He gives us salutary lessons in what to look for, what levels of care we should expect, and are entitled to, how the NHS should work, and what to do if it’s not working for you. But perhaps the real strength in this book is the way he lets other people tell their stories. Whenever a patient’s experience can illustrate his point, there is one. Often there are a few. Towards the end of the book there are several that will uplift you, empower you, and one in particular that will break your heart. Phil is not one to shy away from NHS failure; he wants us to know what to look out for, what to be wary of, as well as when to know that we are being cared for safely and well. He knows that only by being informed about what to watch out for can we, together with the people who work within the organization, make the NHS the brilliant thing it can and should be. The brilliant thing it mostly is. Every home should have a copy of Staying Alive. I wish he’d written it before I started my patient journey. I’m glad you have it before you start yours.”

Wendy Lee – writer and patient leader

“Phil has become trip-advisor, tour-guide, navigator and the writer of a new bible on good-care, bad-care and a general what’s-what in the NHS. We expect Phil to be light hearted and in this book, he is. We expect him to be razor sharp and he is. We expect him to know a thing or two about being a doctor and he does. Everything we expect is in this book and more. From your legal rights to the right way to approach a doctor (shake his hand), this book has it all. Life style advice, healthy living and what to do when it all goes wrong. From common-sense to cervical-screening. Chronic diseases and the time when pull yourself together might not be a bad idea.
Do we ever really know what care we should be getting? Few do. This book will make sure there are a good few more! There are real life tragedies in this book, patient experiences alongside good news of the success the NHS delivers on a daily basis. This book should be on prescription, required reading for every family in the land and be on the top shelf of the medicine cabinet. This book has it all. It is the Swiss Army Knife book of the NHS. Prepared for everything.”

Roy Lilley – health writer, commentator and carer

“I read it cover to cover in three days; it’s a brilliant book which all of us should read – patients and professionals.”

Dr Alf Collins – specialist in chronic pain and person-centred care

“Enjoyable and very accessible, Hammond makes the argument for a new relationship between the patient/public and the NHS very powerfully. This argument is in my view vital for the future sustainability of the NHS and good health. CLANGERS is an approach to managing our own health and healthcare that could help the NHS and the people it serves”

Sir David Nicholson – former chief executive of NHS England and patient

“A storming book. Everyone serious about keeping healthy or overcoming serious ill health should read this book. The call to patients to look after themselves and sort themselves out without NHS intervention is a powerful one.”

David Grant – cancer survivor and patient leader

“This is an honest and simply wonderful book. Buy it, read it, read it again, and give it to others. It not only helps you to ‘stay alive’ – it helps you lead a much better and healthier life. From cradle to grave, this book shows you how you can ‘team up’ with our wonderful NHS – from supported self-care to making decisions about treatment and operations, and so much more. Dr Phil Hammond has ‘nailed it’ again and beautifully makes the case for his overarching message: that ‘great healthcare is all about kind, honest and trusting relationships.’

But don’t just take his word for it; the book is full of insightful and moving stories from patients, carers and others that Phil does what “the NHS needs to do: listen to patients”! Despite having worked in the NHS for over 20 years, I’ve learnt something new on almost every page.”

Dr Knut Schroeder GP and founder,

“Dr Phil Hammond has the prescription for a healthier life for you and has some pretty good ideas on how the NHS could be improved for all of us. Recommended.”

Marian Nicholson – Director, Herpes Viruses Association.

“Want to get the best from the NHS? How many strong, independent adults turn to shy, tongue-tied patients, and don’t ask questions for fear of seeming presumptuous. I did when my kids were ill – and I’m a doctor! Now Dr Phil Hammond has written a fabulous practical guide in his book Staying Alive – how to get the best from the NHS. Like me, he loves the NHS – but he knows we all need some help to navigate our way through it.

Dr Sarah Jarvis – GP, writer and doctor for The One Show and

“If you use the NHS (i.e. all of use), you MUST read this book. If you’re a doctor you NEED to read this book. If you’re an NHS manager this book is VITAL”.

Dr Chris Steele – GP and doctor for ITV’s This Morning

“To describe “Staying Alive” as a bidet revolution does not do it justice. It is more colonic irrigation than bidet. Dr Phil wants to turn the NHS upside down and wash out the bureaucratic complexity that both infuriates and disempowers. He wants patients to be informed and powerful not ignorant and grateful. Ironically, he believes that it will be patients that save the NHS. Amen to that! “

David Prior – Chair, Care Quality Commission

“Ever kicked yourself for not being clued up before going through something risky and serious? For missing opportunities to prevent something bad from happening? Phil Hammond’s here to run with you on a journey of powerful stories, stats and wisdom. The destination? An activated and informed patient that can see the big picture, ready to support those around them, and ready for the NHS.”

“This gives you a good understanding of what it’s like to be a patient, what you need and can do to get it right, and what doctors are afraid to tell you but wish you knew. Hammond says that falling into illness is like falling in a river, which ‘can lead to numbness, anger, denial and confusion. But when you’re ready, you need to stop treading water and learn how to swim.’ This is just how to do that, stop yourself from getting in the river in the first place, and best ask the NHS boat to pull you aboard.”

“Want to get an insight into what it’s like to be a patient? Want to be a better patient? Want to support patients better? Read this book. It also tells you how to stay alive and well. And that care workers and carers should not be meek and mild. We are advocates. This sums up the book – a manual on how to advocate for yourself and those you love.”

Tom Stocker – patient and activist


Opinion Piece in the Nursing Times:

‘Patient experience is the secret to staying alive in the NHS’

14 May, 2015

So who did you vote for? As the NHS promise auction unfolded, I smiled as each fantasy unravelled.

Politicians know they don’t have a hope in hell of providing a seven-day NHS (Tory), a sameday GP appointment for anyone over 75 (Tory), or a midwife by your side every minute of labour (Labour). Even if the money were available, how would we suddenly grow 8,000 more GPs, 20,000 more nurses and 3,000 more midwives (Labour and UKIP)? And is being able to see a GP on a Sunday afternoon really the best use of the NHS’s precious resources (Tory)?

My guess is that I did more for my own health – and that of the NHS – by walking to and from the polling station than by placing my cross. But then I also believe that for 90% of symptoms, you’d be better off with a dog than a doctor.

What we can do for ourselves to stay well often far exceeds what the NHS can do for us – we just need to give people the confidence, courage, hope and support to realise it. Whoever’s in charge of the NHS, it can’t survive without a massive shift to self-care and a bidet revolution in healthcare: from the bottom up.

I’ve written a book, Staying Alive – How to Get the Best from the NHS, about how patients can get the right self-care and NHS care. Well, actually patients and carers wrote half of it. I know a bit about mental health and resilience (my Dad suffered from depression and took his life when I was seven) but I’ve never been poor or seriously ill, and I’m in no position to tell people how to live their lives and how to behave when they become patients.

So I spent a lot of time listening to people who have survived and even thrived as patients, in and out of the NHS, and combined their tips and tactics with my insider knowledge. And I also listened to those whose NHS care had gone terribly wrong, and their advice on how to stop it happening to others.

Those with the most difficult, stressful lives are used to taking tough decisions every day. With the right information and support, they can use these skills to make the right choices when they use the NHS. Nearly all the patients and carers I spoke to wanted to improve the NHS, not just for themselves and their family, but for other patients. Most have had a satisfactory to excellent experience of the NHS and wanted to share their thoughts and ideas with others. And those who had poor or disastrous “care” were very driven by the needs to stop it happening to other people.

In 30 years in the NHS I’ve lived through 15 top-down structural reforms driven by ideology rather than evidence. My book isn’t party political because I strongly believe politicians of all sides should grow up and collaborate around evidence, compassion and patient experience.

If all we ever did in health and social care was listen to the suggestions and concerns of frontline staff, patients and carers, and act on this to continuously improve the service, the NHS would be the best in the world. We still need to put more money into it, but we need to be certain that money benefits patients.

And to deliver patient-centred care, patients need to reveal themselves as people – what matters most, their hopes and fears – and we have to listen.

As poet Mary Oliver put it: “Tell me, what is it you plan to do with your one wild and precious life?” No one said on his or her deathbed: “I wish I’d spent more time hanging around the NHS.” Most lives need living and loving, not medicalising.

• Nursing Times readers can order a copy of Staying Alive – How to Get the Best From the NHS for £10 (instead of £14.99) at, using the code: STAY.

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