Sunday Times 21 December 2014
A PAEDIATRIC surgeon who tried to expose “barbaric and amateurish” circumcision of boys, including babies, is facing disciplinary action for raising his concerns with the patient safety regulator.
Shiban Ahmed has fought for more than a decade to get the Care Quality Commission (CQC) and its predecessor, the Healthcare Commission, to protect children from cheap circumcisions carried out by poorly skilled GPs. In some cases, boys aged six to 10 are tied to tables or forcibly held down while a local anaesthetic is injected directly into the penis. The anaesthetic often proves ineffective and the operation follows with the child still screaming in pain.
Ahmed recently presented a dossier of cases to the CQC. He also accused the regulator of failing in its duty after learning of new examples of “cruel” and unsafe operations in clinics he had previously reported.
The CQC responded by contacting his employer, University Hospitals of North Midlands NHS Trust (UHNM), to allege that he had breached patient confidentiality.
Last week the trust said it was referring him to the General Medical Council (GMC), which has the power to strike him from the medical register.
Ahmed became aware of dangerous circumcisions when he was asked to carry out corrective surgery after botched operations. He believes the only safe place to circumcise school-age boys is in hospital with a trained surgeon.
The cases often involved boys from Muslim families. In most of Britain circumcision for cultural reasons is not available on the NHS and, as the procedure costs at least £1,400 in hospital, parents turn to GPs who charge £200-£300.
Many of the problems were in Birmingham, where the operation is available on the NHS and where the health service pays GPs £190,000 a year to perform circumcisions at a cost of £90 per child.
Some young patients nearly died after circumcisions and Ahmed recalls having to remove part of a boy’s penis. Others lost so much blood they needed intensive care.
The surgeon started touring mosques to publicise the dangers, making clear that he was not opposed to circumcision, which has moderate health benefits, but wished to see it done safely.
He also set up a private clinic to offer circumcision under general anaesthetic at a similar price to GPs. He says he takes no fee from the operations.
As a result of his outreach work, families reported their experiences and he asked consent to pass cases to the CQC.
As some of the case histories were given to him by telephone, Ahmed says he took advice from the information commissioner and the GMC before recording the conversations and passing them to the CQC in a dossier of 22 cases.
“My children were tied down onto the table,” says one of the written statements in his dossier. “My children went through great discomfort through the pain of the operation as well as that of being tied down by heavy strings.”
Another complainant says: “I lost a lot of blood to the point where my life was in danger.”
Two surgery receptionists had earlier told Ahmed how a boy undergoing circumcision ran screaming to a lavatory and locked himself in, bleeding heavily. The child’s father fainted and “pandemonium” broke loose.
“I am still seeing children with the most terrible complications,” Ahmed said. “Some are so bad they cannot be corrected and have left babies and children maimed for life. I cannot understand how the NHS is allowing this.”
Ahmed submitted a file of cases two months ago to Amanda Reynolds, an acting inspection manager at the CQC. They included the recorded telephone calls.
Listening to the recordings, she was uncertain if the correct consents had been obtained and decided to treat them as covert. Reynolds wrote to Ahmed, raising her concerns, but also sent her email to the trust which began looking at the case. However, Ahmed was unable to explain himself to the trust because he had consent from the families to discuss their complaints only with the CQC, not with his employer.
Last Monday, Nick Coleman, the trust’s “responsible officer”, told Ahmed he was forwarding his case to the GMC for investigation.
Ahmed is a serial whistleblower who has made allegations in the past of unsafe surgical practices at Stafford Hospital and at Alder Hey Children’s Hospital in Liverpool.
His concerns at Alder Hey led to an investigation by the Royal College of Surgeons, but the full report has yet to be published. He is suspended by Alder Hey and UHNM for allegedly disclosing patient details to the CQC.
Fiona Bell, an NHS campaigner, called on Jeremy Hunt, the health secretary, to intervene. Hunt has previously said that NHS whistleblowers should be protected.
“I will be writing to Mr Hunt to seek assurances that this brave doctor is not sanctioned in any way for raising concerns to protect children,” she said. “I was told the government supports NHS staff raising concerns so I would expect protection for Mr Ahmed.
“One would expect those who have harmed children to be investigated by the NHS and CQC as well as by the police and social services.”
UHNM said: “Clinicians at the trust are working with the CQC to provide support for one of its non-NHS inquiry’s [sic] following a request for our assistance.”
The CQC denied reporting Ahmed to his trust, even though Reynolds appears to have alerted the trust in her email dated November 4.
“The Care Quality Commission is very concerned about reported cases regarding the safety of circumcisions brought to our attention by Mr Ahmed,” the regulator said. “We listened to these concerns and responded quickly by carrying out a number of inspections at services. We have taken action in relation to what was found during the inspections.
“The CQC has not reported Mr Ahmed to the GMC or to his trust and has not invoked any disciplinary action against him.”
A leading child doctor said that restraining boys for circumcision was illegal and “in the same bracket as female genital mutilation”. Dr Martin Ward Platt of the Royal College of Paediatrics and Child Health said: “It would ride a coach and horses through the rights of the child.”