Liverpool NHS scandal shows how culture of denial harms patients

The Guardian   

If staff do not feel able to speak out about their concerns, something is rotten at an organisation’s coreView more sharing options

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 ‘Staff tried to keep services going but morale collapsed and sickness absence rose.’ Photograph: Christopher Furlong/Getty Images

The two most shocking revelations to emerge from the investigation into Liverpool community health NHS trust are that every part of the system failed, and it happened even as the trust was considering what it should learn from the Mid Staffordshire scandal.

The independent review by Dr Bill Kirkup into events at the trust between 2010 and 2014 shows the root cause of the trust’s problems was an inexperienced and bullying leadership obsessed with achieving foundation trust status, irrespective of the effect on patients. This toxic culture seeped into every part of the organisation, breaking the morale of frontline staff and inflicting serious clinical harm.

Those brave enough to raise concerns risked bullying, harassment and suspension.

It was a dysfunctional organisation from the moment it was created in 2010 with an inexperienced and inadequate management team. Two clinical commissioning groups and NHS England pushed it to achieve significant savings, which had a serious cumulative impact, but the trust made matters far worse with self-imposed cost cuts in pursuit of its managers’ dream of foundation status.

Kirkup points out that achieving annual cost improvements of 4% is the outer limit of what can reasonably be achieved; Liverpool tried to deliver a 15% cut in one year, apparently oblivious to the risks.

Governance was a mess. At times the finance director was responsible for clinical quality and the nurse director was the chief operating officer, so no one was championing patient care.

Staff tried to keep services going but morale collapsed and sickness absence rose. Pressure sores, falls and extractions of the wrong teeth were among the consequences. Reporting of serious incidents was discouraged. Middle managers under pressure to do the impossible lashed out at junior staff. There was a climate of fear, intolerance, disbelief and insecurity.

HR records reveal appalling treatment of staff, including arbitrary disciplinary processes and prolonged suspensions without reason. It was not uncommon to see staff crying in the car park.

Among the most egregious examples of abuse were the so-called scoping meetings, supposedly convened to investigate safety incidents. In practice they were “an interrogation and a frightening experience”. Staff reported feeling physically sick beforehand and approached them with trepidation. Across the organisation shouting and finger-pointing became the norm.

In what appears to have been an attempt at empire building, the trust took on responsibility for health services at Liverpool prison – which was recently condemned by inspectors as having the worst conditions they had ever seen. The trust’s failures in the prison harmed more patients.

Liverpool’s board discussed severe cuts to its workforce – notably nursing – at the same meeting it considered the findings of the Francis inquiry into Mid Staffordshire, the lessons from it apparently eluding them.

The strategic health authority failed to spot the problems. Subsequently the NHS Trust Development Authority identified concerns, then inexplicably reversed its assessment. The Care Quality Commission also failed to identify the problems until it was alerted by local Labour MP Rosie Cooper after staff spoke to her.

The trust has been broken up, but the lessons from its collapse need to live on. It shows again how, controlled by an oppressive culture pursuing unrealistic financial goals, an organisation can quickly mutate into one that harms the very people it is there to serve.

Senior clinicians need to keep a clear focus on their professional responsibilities and not be swayed by board denial or groupthink.

Non-executives need to get out from behind their board papers and keep in close touch with staff and patients. They are there to offer constructive challenge to the trust leadership, not to assist them in pursuing impossible goals.

But above all, the Liverpool scandal demonstrates yet again that an open culture which listens to staff needs to be at the core of every NHS institution. Instead, dissent was crushed and a culture of denial allowed patient harm to proliferate. A cursory glance at the annual staff survey would have been enough to reveal that something was badly wrong.

If staff do not feel able to speak up, something is rotten at an organisation’s heart.

 

https://www.theguardian.com/healthcare-network/2018/feb/10/liverpool-nhs-scandal-shows-how-culture-of-denial-harms-patients

NHS bosses who cover up serious failings could be banned from taking another hospital job

 

  • Cuts at Liverpool Community Health NHS Trust caused ‘unnecessary harm’
  • But its former chief executive and chairman were allowed new NHS jobs after 
  • Health Minister Stephen Barclay has announced review in response to news  

 

Health chiefs who cover up serious failings could be banned from taking another NHS job.

The move to end the ‘revolving door’ scandal comes after it emerged that two bosses who ran a failed trust where patients suffered ‘significant unnecessary harm’ have found new health service roles.

A damning independent report has said that the board of Liverpool Community Health NHS Trust was ‘out of its depth’ when it launched a misguided cost-cutting drive.

The cuts left pensioners suffering crippling bed sores and fractured hips from needless falls, while others had the wrong teeth taken out.

Despite these failings, the former chief executive and chairman of the trust are still working directly or indirectly for the NHS.

And it was reported last night that regulators even helped the chief executive find another six-figure NHS job.

The move to end the 'revolving door' scandal comes after it emerged that two bosses who ran a failed Liverpool trust where patients suffered 'significant unnecessary harm' have found new health service roles

 

In response, Health and Social Care Minister Stephen Barclay will announce a review of the ‘fit and proper person’ test. 

It was brought in following the Mid Staffordshire scandal, in which hundreds of patients died needlessly amid appalling failings in care.

He wants to see it toughened up to end the ‘revolving door’ controversy – where failed executives are shifted into other parts of the NHS – once and for all. 

Liverpool Community Health (LCH) runs elderly care, walk-in centres and dentistry services for about 750,000 people on Merseyside.

The report by Dr Bill Kirkup, which was commissioned by the NHS Improvement quango, found the board attempted to ‘conceal’ the problems. 

And whistleblowers who attempted to expose the truth were bullied.

The report said standards at LCH deteriorated dramatically after managers attempted to cut costs by 15 per cent in a single year in an attempt to chase foundation trust status.

Chief helped into fresh post – by watchdog 

Bernie Cuthel (pictured) stepped down as chief executive of Liverpool Community Health NHS Trust in 2014 over her failings, but she walked into a new NHS job soon after
 

Bernie Cuthel (pictured) stepped down as chief executive of Liverpool Community Health NHS Trust in 2014 over her failings, but she walked into a new NHS job soon after

Bernie Cuthel, the £130,000-a-year chief executive of Liverpool Community Health NHS Trust, stepped down in disgrace in 2014 after her failings were exposed.

But she walked into a new NHS job soon afterwards and regulators helped her to get the position.

Emails seen by the BBC show that the Trust Development Authority, an NHS regulator, found her a position at Manchester Mental Health and Social Care Trust on a 12-month secondment.

The TDA also provided her with ‘coaching support’, and said ‘the secondment would provide her with a period of rehabilitation, enabling her to reflect on learning from her experiences in Liverpool’.

Her salary at Liverpool was reduced by 10 per cent in Manchester because she was no longer in an executive position.

Now she works at the Betsi Cadwaladr NHS board in North Wales. She is also on the governing body of Nugent, a charity in Liverpool that offers a range of services to children and adults.

 

This makes a trust semi-independent of Department of Health control and gives boards greater power over their finances and the setting of executive salaries.

The report found that LCH was a ‘dysfunctional’ organisation. 

In an echo of the Mid Staffs scandal, the report said LCH had acted ‘inappropriately’ in pursuit of foundation trust status – setting ‘infeasible financial targets that damaged patient services’.

Dentistry budgets were cut by 44 per cent and 50 district nurses were made redundant.

Dr Kirkup’s report said the senior leadership at the trust did not realise it was ‘out of its depth’. 

It added: ‘Staff were overstretched, demoralised and – in some instances – bullied. Significant unnecessary harm occurred to patients.’

Dr Kirkup said the chief executive and chairman of the LCH board were in ‘denial’ about their role in the affair between 2010 and 2014 – and had refused to co-operate with the review.

A damning independent report has said that the board of Liverpool Community Health NHS Trust (pictured) was 'out of its depth' when it launched a misguided cost-cutting drive

Bernie Cuthel, the chief executive, resigned after the failings were exposed. 

But emails seen by BBC News show that the Trust Delivery Authority, an NHS regulator, found her a position at Manchester Mental Health and Social Care Trust on a 12-month secondment.

Chairman Frances Molloy is now boss of the Liverpool-based Health and Work charity, which has contracts with the health service.

Every LCH board member bar one refused to co-operate with Dr Kirkup’s inquiry. Mr Barclay is set to refer all of them to the Care Quality Commission regulator to see whether they fill the ‘fit and proper person’ test.

Shamed exec got new health deal 

Frances Molloy was the trust's chairman, but had to step down after her failings were exposed. She now runs a Liverpool-based charity with NHS contracts 

Frances Molloy stepped down as chairman of Liverpool Community Health NHS Trust in 2015 – a year after failings at the trust were exposed.

She now runs a Liverpool-based charity that has contracts with the NHS.

Her Health at Work organisation provides experts in improving health in the workplace, reducing absence and staff turnover. 

The charity describes her as its ‘inspirational and influential’ chief executive. 

The organisation’s website says its delivers ‘public sector contracts for NHS commissioning groups and Public Health England’.

Mrs Molloy lost her son Michael, 18, in a coach crash in 2012. She campaigns for changes in the law to stop buses and coaches using old tyres.

 

Sources said he believes it is wrong that people who tried to cover up the scandal, continued to deny it was a problem and then refused to co-operate with the official review into the failings should be allowed to work in the NHS.

Mr Barclay will also ask Dr Kirkup to consider whether the test should be rewritten to make it clear that such people should not be able to work anywhere in NHS England – or for any companies which supply it.

Rosie Cooper, Labour MP for West Lancashire, was instrumental in forcing an investigation into the failing trust after nurses looking after her father complained about their managers.

Last night she agreed that ‘faceless NHS bureaucrats’ responsible for serious failings should not be allowed to walk straight into another NHS job.

‘It is time for the ‘fit and proper person’ test to be significantly strengthened to prevent this happening,’ she added.

LCH declined to comment. It is now in the process of being wound up, with most services passing to another NHS trust, MerseyCare, in April.

Read more: http://www.dailymail.co.uk/news/article-5365303/NHS-bosses-cover-failings-banned-new-jobs.html#ixzz56jxR34JF
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Independent Review of Liverpool Community Health NHS Trust

 

Parliament logo     www.parliament.uk   House of Commons Hansard

Acute and Community Health   8 Feb 2018

12.34pm

    • With permission, Mr Speaker, I wish to make a statement on the independent review of Liverpool Community Health NHS Trust, which was conducted for NHS Improvement by Dr Bill Kirkup and published today.

      What happened to patients of Liverpool Community Health NHS Trust is, before anything else, a terrible personal tragedy for all families involved, and the report also makes clear the devastating impact on many frontline staff. On behalf of the Government I apologise to them, and I know that the whole House will want to extend our sympathies to every one of them.

      As Mr Speaker correctly identified, I wish to pay tribute to the hon. Member for West Lancashire (Rosie Cooper). The people of Merseyside know only too well the cost of attempting to silence the victims and campaigners for those seeking justice. As the report makes clear, her personal commitment to get to the truth on behalf of the victims of Liverpool Community Health NHS Trust, her personal courage in asking difficult questions of those in senior positions within the NHS, and the persistence and precision of her search for accountability, are all vindicated today. We in this House, and across the wider health and social care services, owe her a debt. I also thank Dr Kirkup and his team for this excellent report. As with his report on Morecambe Bay NHS Foundation Trust, it is a clear, forensic, and at times devastating account of failures in the care of Liverpool Community Trust by its management, its board, and its regulators.

      The report covers the period from the trust’s formation in November 2010 to December 2014, and it describes an organisation that was, “dysfunctional from the outset”. The consequences of that for patient care were in some cases appalling, and the report details a number of incidents of patient harm including pressure sores, falls leading to fractured hips, and five “never events” in the dental service—an incredibly high number for one organisation.

      The failings of the organisation were perhaps most starkly apparent in the services provided at Liverpool Prison, where the trust failed to properly risk-assess patients, including for nutrition and hydration, and it did not effectively manage patients at high risk of suicide. The review also identified serious failings in medicine management at the prison. There are many more examples of poor care and its impact on both patients and staff in the report, but what compounds the shock is the lack of insight into those failings displayed by the organisation at the time. This was the very opposite of a culture of learning, with incidents under-reported or played down, warning signals ignored, and other priorities allowed to take the place of patient safety and care for the vulnerable.

      We have seen this sort of moral drift before, most obviously at Mid Staffordshire and Morecambe Bay. As with Mid Staffordshire, the management at Liverpool Community Health NHS Trust put far too much emphasis on achieving foundation trust status. The review states that,

      “the trust undertook an aggressive cost improvement plan, targeting a £30 million reduction over five years. This represented a cut in resources of approximately 22%. We were surprised that such an ambitious financial reduction was not scrutinised more closely—by both commissioners and regulators.”

      There is a direct line from the decision to pursue foundation trust status in that reckless manner to the harm experienced by patients. Indeed, an earlier report by solicitors Capsticks reported in March 2016 that the interim chief executive who took over from Bernie Cuthel found in her first week that

      “there was an underspending by £3 million on district nursing. These teams were devastated because they weren’t allowed to recruit, some of them down to 50%”.

      This is a district nursing service in which Dr Kirkup reports that patients were experiencing severe pressure sores, up to what is clinically called grade 3. That was accompanied by many of the hallmarks of an organisation that has lost sight of its purpose. As Dr Kirkup states,

      “the evidence that we heard and saw amply confirmed the existence of a bullying culture within the Trust, focused almost entirely on achieving Foundation Trust status. Inadequate staffing levels, poor staff morale and appalling HR practice went unheeded. This was the end result of inexperienced leadership that was not capable of rising to the challenges presented by the Trust.”

      Following the Mid Staffordshire report, Dr Kirkup recognises that steps have been taken to introduce independent, clinically-led inspection by the Care Quality Commission. The Government have also introduced the special measures regime within NHS Improvement. Alongside this, we have put in place a number of measures to create a wider culture of learning and improvement. The Secretary of State has offered a great deal of personal leadership in helping to create this culture, including the establishment of an independent chief inspector for hospitals, whom I met yesterday and spoke with again this morning, and the recent introduction of measures to support trusts to learn from deaths and to improve patient safety.

      I am sure I am not alone in finding it astonishing that Dr Kirkup found there was a

      “small minority of individuals who refused to co-operate”

      with the review. I wholeheartedly agree with his view that

      “it remains the duty of all NHS staff to assist as fully as they are able with investigations and reviews that are directed toward improving future services”.

      All but one of the board of the Liverpool trust shirked their legal and moral responsibility to be candid about the organisation they governed. In large, complex organisations, responsibility and accountability are always distributed to some degree. It is the case that the higher up in an organisation someone is, the greater their degree of responsibility. In this case those individuals were Bernie Cuthel as chief executive and Frances Molloy as chair. It is clear from reading the report that they each must take a significant share of the responsibility for these failures.

      Hon. Members will, I am sure, have noted the conclusion to the clinical governance section of the report, which highlights the responsibility of the former chief executive of the trust for the system of clinical governance and its failures. It would appear from the report that while the former chief executive, Ms Cuthel, is now able to see that there were failures in clinical governance, she does not have as strong a sense of her own responsibility as one might expect. I understand that she is no longer employed in the NHS in England, but she does continue to hold a role working with the NHS in Wales.

      In response to this report, the Government intend to take a number of actions. First, the Government accept the recommendations in full. While this was a report commissioned by NHS Improvement, I will write to all the organisations named in the recommendations set out at section six of the report, asking them to confirm what steps they will take to implement the recommendations, or to set out their reasons for not doing so. I will ensure copies of that response are shared with the Health Committee.

      Secondly, one recommendation is specifically for the Department of Health and Social Care, as set out in paragraph 6.5 on page 64. This relates to a review of CQC’s fit and proper person test. I intend to discuss the terms of that review with the hon. Member for West Lancashire and will appoint someone to undertake that review within the coming days. I believe that review will need to address the operation and purpose of the fit and proper test, including but not limited to: where an individual moves to the NHS in another part of the United Kingdom; where they leave but subsequently provide healthcare services to the NHS from another healthcare role, such as with a charity or a healthcare company; where differing levels of professional regulation apply, such as a chief executive who is a clinician compared to one who is a non-clinician; where there is a failure to co-operate with a review of this nature and what the consequences of that should be; and reviewing the effectiveness of such investigations themselves when they are conducted. I will be pleased to hear the views of the hon. Member for West Lancashire, and those of the Health Committee, on these issues.

      Thirdly, I have asked the Department to review the effectiveness of sanctions where records go missing in a trust, or where records appear to have been destroyed.

      Fourthly, I have asked the Department for advice on what disciplinary action could be taken against individuals in relation to the findings of this report. Clearly due process needs to be followed, but it is important that we address a revolving door culture that has existed in parts of the NHS, where individuals move to other NHS bodies, often facilitated by those who are tasked with regulating them.

      Fifthly, I will ask NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust.

      Finally, I have spoken with colleagues at the Ministry of Justice and confirm to the House that they intend to investigate the issues arising from this report in respect of HMP Liverpool specifically and the prison estate more generally.

      All organisations and individuals make mistakes. Where this is used as an opportunity to learn and improve, we will do all we can to provide support. Where, however, there is any kind of cover-up or a blinkered denial of what has happened, Members of this House and the victims of that wrongdoing have a right to expect accountability. The hon. Member for West Lancashire has done the NHS a great service. I will place a copy of the Kirkup review in the House of Commons Library. The Government are acting in full on the findings of the report.

       
       

    • May I start by adding my appreciation for the tenacity my hon. Friend the Member for West Lancashire (Rosie Cooper) has shown in pursuing this matter over a number of years? She has led the way in tackling this injustice fearlessly and relentlessly. In that respect, she is an example to all right hon. and hon. Members in this place. I agree with the Minister that the report is a vindication of her courage, but is it not shameful that this scandal only came to light because a Member of Parliament was prepared to give a voice to those who were afraid to speak out?

      Today’s independent report on the Liverpool Community Health Trust lays bare a catalogue of failure that caused harm to patients across Merseyside between 2010 and 2014. It is a grim example of a repeat of the regulatory pressures and board management failures at Mid Staffs. What is of huge concern is that some of the failures came after the final publication of the Francis report. As we have heard, incidents identified in the report include the deaths of inmates at HMP Liverpool, patients having the wrong tooth extracted by trust dentists, and patients on intermediate care wards suffering repeated falls and broken bones or ending up with pressure ulcers. We have to make sure that the pain experienced by so many patients and their families is properly detailed and recognised. We must make sure the NHS is able to learn from these events and that systems are put in place to ensure they never happen again.

      I put on record our thanks from the Labour Benches to Dr Bill Kirkup and his team for the work they have done in carrying out this investigation and helping us to understand what has gone wrong. Today’s report says that patients of community services suffered unnecessary harm because the senior leadership team was “out of its depth”. Let us be clear what lies at the heart of this: unrealistic cost-cutting by the trust without regard to the consequences that led directly to patients being harmed. The report exposes serious problems around the scale of cost-cutting being imposed on NHS trusts. In the case of Liverpool Community Health, the motivation was the drive to achieve foundation trust status. The trust disciplined and suspended staff who blew the whistle about poor care and its controversial plans to slash staff to save money. What guarantee can the Minister offer that trusts are no longer being allowed to prioritise financial savings over patient care? What protections have been put in place for staff who raise concerns about cost-cutting?

      Today’s report notes the irony of staff reductions being agreed at the same board meeting that had earlier considered the implications of the Francis report. That alone should have raised alarm bells about the capacity of board members to challenge the trust. The NHS still faces huge workforce shortages, so what update can the Minister give us on how the 10-year workforce strategy has been received? What additional measures will the strategy include to guarantee safe levels of staffing in all areas of the country, in community as well as acute services?

      I am pleased that the Minister recognises concerns that managers responsible for these extreme failures can often go into leadership roles in other parts of the health service, or indeed for private providers to the NHS in another capacity. Will he advise the House how many people who refused to co-operate with the investigation are still employed in some part of the NHS? Is there anything in the existing terms and conditions or structures that can be used to require future co-operation? Is there any redress in existing policies and procedures that we can use against these people?

      The report said that regulators were distracted by higher-profile services such as acute care. The Health Service Journal said today that oversight failures were partly attributable to organisational changes that were taking place under the Health and Social Care Act 2012, so what will the Government do to ensure that national priorities are not allowed to interfere with local oversight?

      Finally, the report raises serious concerns about the quality of healthcare in prisons. HMP Liverpool still has significant challenges, and the new provider of the prison’s health service—the Lancashire Care NHS Foundation Trust—has just said that it cannot continue with the contract on the level of funding currently available. The Ministry of Justice will investigate these matters more generally, but will the Minister assure us that prison healthcare is properly supported and resourced in Merseyside and elsewhere across the country?

      Paragraph 1 of the review’s findings sums up the devastating impact of these multiple failings:

      “Staff were overstretched, demoralised and—in some instances—bullied. Significant unnecessary harm occurred to patients.”

      In the unprecedented financial squeeze that the NHS currently faces, we need assurances from the Minister that patients and staff will come before finance and that today will be the last time we hear such a damning message about what is going on in our NHS.

       
       
    • I thank the shadow Minister for his questions and the manner in which he put them before the House. His first key question was to what extent measures are in place to address this sort of issue, should it arise again. Post Francis, and following Sir Bruce Keogh’s review of 14 trusts with high mortality rates, a new regime has been put in place. There is a new chief inspector of hospitals, Professor Ted Baker, and a specific regime involving NHS Improvement, which commissioned this report. NHS Improvement has a new chair, Dido Harding, a very senior figure from the business community.

      That regime has put 37 hospitals into special measures so far. The methodology that is used to alert regulators to areas of concern has also been revised. For example, far more importance is now placed on staff and patient surveys. However, it remains to be explained why a trust could pay so many compromise agreements, for example, in response to so many staff disciplinary issues. I assume that many concerns were raised by trade unions locally, as no doubt the hon. Gentleman is aware. We must also consider the extent to which earlier reports, such as the Capsticks report, raised concerns that should have been addressed. That is why, in my statement, I signalled my desire to look at those issues and ensure that they are addressed by the fit and proper person test in particular. As he will be aware, though, that test pertains only to board-level appointments in the NHS, not to all roles. We will need to look at that scope, at the effectiveness of the investigation and particularly at the revolving door element of the problem, which he recognised.

      Turning to the other issues that the shadow Minister raised, we clearly need to ensure that due process is followed. I do not need to remind the House of the difficulties of any enforcement against for instance, Fred Goodwin in financial services or Sharon Shoesmith in child services. People rightly expect due process, and all hon. Members would ask for that. The victims will rightly ask, “How can the chief executive, with this catalogue of issues, move within the NHS rather than be fired?” I know that the hon. Member for West Lancashire (Rosie Cooper) has many concerns about that, as do the Health Committee and many other Members.

      I look forward to working with the hon. Member for Ellesmere Port and Neston (Justin Madders) in the spirit in which he raised these issues. We share concerns, and I know the House as a whole wants us to get to the heart of them.

       
       
    • I pay tribute to my colleague on the Health Committee, the hon. Member for West Lancashire (Rosie Cooper). She is a remarkable parliamentarian and advocate for patient safety. All of us on the Committee look forward to working alongside her to examine in full the Kirkup report’s recommendations, and I welcome the Minister’s commitment to a review of the fit and proper person test.

      On the wider issues that the report raises, it is clear that when staff and funding continue to be cut from community services, there are terrible consequences for patient care. Will the Minister assure the House that he will work closely alongside the Care Quality Commission to identify other trusts in which issues such as this are likely to arise because of the workforce and funding pressures that are now being faced?

       
       
    • I am very happy to work with my hon. Friend on this. As she will be aware from reading the report, it is explicit that the finances were there for the existing service. That is stated at the outset of the report. What drove the problems was a wholly unrealistic attempt to seek foundation trust status, with a cost improvement plan that was simply undeliverable. There was a massive reduction, without any attempt to reconcile that with serious issues on staff levels and vacancies. As the report explicitly sets out, when staff raised those concerns, they were bullied, harassed and on occasion suspended without due cause. The culture has changed significantly, and measures have been put in place for how the regime involving NHS Improvement would address such issues and look at cost improvement plans.

      On the extent to which the culture was driving the problems, I refer to the remarks I made in my statement. According to the report, the interim chief executive went in and found a significant underspend—£3 million—in the district nursing budget, at the same time as there were significant vacancies and patient harm. That culture was driving the issue, and that culture is what we need to put an end to.

       
       

 
    • I thank the Minister for early sight of his statement. I certainly echo his comments about our sympathy for the families and staff members who have been involved over the years. I pay tribute to the hon. Member for West Lancashire (Rosie Cooper), although the tenacity required from her perhaps sums up what is wrong with the present system.

      On Dr Kirkup’s observations and recommendations, as the Minister has acknowledged, some individuals did not co-operate with the investigation. Is there therefore a case for a law change to prevent that from recurring in the future, or at the very least for employment and registration sanctions ultimately to be applied to such personnel?

      On the fit and proper person test that the Government have pledged to undertake, will any agreed new standards be applied retrospectively to board members who are currently in place? Again, the Government have acknowledged the revolving door culture, so it is important that the test is done properly. Will they review executive pay for chief executives and senior staff? After Mid Staffordshire and this, what will be done to properly protect whistleblowers in future to allow them to come forward?

      Funding and resources are clearly really important. Dr Kirkup’s report lays bare the fact that the defining strategic objectives were foundation status and a £30 million saving, or a 22% reduction in resources, rather than the true goal of clinical quality. What will be done to ensure that regulators pick up on such contrasts in future, and what responsibility do the Government take for funding and the drive for efficiency savings?

      Lastly, does the Minister agree that this situation confirms the failings of the trust system, and that any privatisation of the NHS and profit before care cannot be allowed under future free trade deals?

       
       
    • The hon. Gentleman raises a number of important points, but particularly regarding whistleblowers. That was one warning signal that clearly failed here. The regulations have been changed, as he will be aware. In the past, there was a culture in which compromise agreements were applied with gagging clauses attached. That prevented visibility of the compromise agreements. That is why I asked, on receipt of the report, why the compromise agreements that were paid were not escalated to the board, and indeed what sight, if any, regulators had of those compromise agreements. Clearly financial payments will have been made, so there should be an audit trail.

      The hon. Gentleman asked what changes had been made. An area on which my right hon. Friend the Secretary of State has placed a huge amount of importance, and in which he has given a huge amount of leadership, is patient safety guardians and ensuring that there are people in trusts tasked specifically with giving voice to patients. One of the many sensible pieces of advice that my predecessor, my hon. Friend the Member for Ludlow (Mr Dunne), gave me was that when visiting a trust, I should have a one-on-one meeting with that individual, not only because of their status within the trust but to gather information from them. He did so assiduously on all his visits.

      The wider point is how, from a regulatory structure point of view, we can ensure that there are safeguards when there are cost improvement programmes and ask what visibility there is of them. NHS Improvement has set out a series of measures to ensure that trusts learn the lessons of Francis. Obviously the period covered by the report goes back as far as 2010, but it is important that the NHS learns from the issues that Dr Kirkup sets out.

       
       
    • May I add my tribute to the hon. Member for West Lancashire (Rosie Cooper)? She is a formidable parliamentarian and has done some very good work on this. The report is shocking. Back in March 2015, following other incidents, the Public Administration Committee produced a report investigating clinical incidents in the NHS, in which it recommended the setting up of the health service’s safety investigation branch. The Government have now published the draft Bill for that. When will it enter pre-legislative scrutiny, so that we can change the culture and have the open learning culture that we should have in our NHS, very much as is seen in the airline industry?

       
       
    • My right hon. Friend raises an important point on the draft Bill and the consultation. I am not in a position to announce a date; that will be announced by business managers in the usual way.

      My right hon. Friend is right to allude to that Bill as one of a suite of measures following Sir Bruce Keogh’s review and the Francis report, which are all part of changing the culture. I acknowledge the importance of those measures, but I want to signal to the House today that Dr Kirkup’s report identifies remaining issues that need to be tackled. He has done us that service, and that is where I am keen that we focus as a Government.

       
       
    • Thank you for your indulgence, Mr Speaker. I do not intend to test your patience today by dealing with the details of these matters; I will do that through Adjournment debates, questions, the Health Committee and other mechanisms available to me.

      I thank the Minister for his kind words and his comprehensive statement in response to the excellent work of Bill Kirkup and his team. I pay tribute to Dr Kirkup for his thoroughness and independence, and I thank him most sincerely, on behalf of the staff and patients in Liverpool who suffered really badly at the hands of what I want to call a dictatorship—the regime. Whatever it was, what was done was done in our name and the name of the NHS, and those people deserve justice.

      After the ACAS review, the CAP6 report and now the Kirkup report, with a National Audit Office report on the way and Nursing and Midwifery Council hearings due soon, it really is important that the NHS ensures that justice is not only done but seen to be done. Under Governments of all parties, the higher echelons of the NHS have closed ranks to protect themselves. That has got to stop. That senior people were able to inflict such harm on staff and patients and then just walk into other senior NHS jobs with six-figure salaries, and that in this case it could be arranged by the north regional managing director of NHSI, Lyn Simpson, is simply staggering.

      I still cannot answer the question that the Minister posed—why were the chief executive and the board not fired? Why were they not sacked? It is incomprehensible. Nothing has been learnt over the past four years. As of only a few weeks ago, NHSI is presiding over another potential LCH, over in the Wirral’s hospitals trust.

      I will obviously continue to pursue these matters with vigour on behalf of the staff and the patients, and I want to place it on the record for everyone who is affected that I do not see the Kirkup report as the end—far from it. The Minister has a legal and forensic background. How will he assure the House that these matters will be dealt with properly, and that cover-ups and backdoor deals have ended once and for all? The Secretary of State has said so many times, “This will stop. We are not going to keep moving failed executives around,” yet it continues to happen.

      I will say quite honestly that I asked a question of a Minister last year and he answered me in good faith. He said, “NHSI doesn’t participate in moving staff around.” Not only can we now prove that it is true that it does, but it nearly happened in the Wirral a few weeks ago. The message has got to go out: “If you do this kind of stuff, you are responsible. You will not escape.” The NHS must be accountable, and those in it held responsible.

       
       
    • I thank the hon. Lady for those comments. As I said, I have asked NHS Improvement and NHS England to clarify the circumstances under which roles were found or facilitated for individuals identified in the report as bearing some responsibility for the issues at the trust. I await the answer to that central question, which the hon. Lady posed.

      On the sense of cover-up, the Secretary of State has provided leadership in bringing about the culture change on patient safety. Following the awful situation in Mid-Staffordshire, it was recognised across the House that changes needed to be made on patient safety, and I think the NHS itself has recognised that. NHS Improvement has new leadership, who commissioned the Kirkup report themselves.

      On the changes that have been put in place, I alluded to the CQC regime and the chief inspector and the methodology. I spoke to the chief inspector yesterday. Every hospital has now been visited, using that new methodology, and obviously that programme will start to accelerate and target as further work visits are done. The methodology used for that has also evolved to include staff surveys, for example. So a number of measures have been taken, and the special measures regime is also very much at the heart of that.

      A number of steps are being taken, but the approach that underpins those is that although we must create a duty of candour, enabling people to learn from the mistakes that will happen in an organisation employing more than 5 million people, there should not be the sense that people can escape their responsibility by moving within the system. I have discussed that with people in the NHS, and I believe there is a wide recognition that the culture has changed significantly. But clearly, as we consider the issues that emerge from the Kirkup report, the House will need to see further reassurance.

      The hon. Lady asked how I and the Government will ensure that these issues are addressed, not covered up. First, no one doubts that the hon. Lady will use all the parliamentary tools to pursue this matter, including in her role as a senior member of the Health Committee. I am aware that other members of the Committee, such as the hon. Member for Liverpool, Wavertree (Luciana Berger), a former shadow Health Minister, will take a significant interest in this issue. I know that the Chair of the Health Committee will do so. I have regular discussions with her, and as we address the “fit and proper” test and other issues, I look forward to benefiting from the expertise on that Committee.

      It is clear that measures have been taken, and it is right that we recognise that much work has been done in the NHS to change the culture, to ensure that the warning signs are seen, and to ensure that something like this never happens again, but it is also clear that there are specific issues in the report to be responded to, and I very much share the desire of the hon. Member for West Lancashire that we do that.

       
       
    •  
    • Order. I remind the House that there is another ministerial statement to follow, and that although the debate on matters to be raised before the forthcoming Adjournment is not now intended to take place, no fewer than 19 Members wish to take part in the debate on community banking, so there is a premium on brevity. These important matters having been preliminarily aired, I now appeal to colleagues to ask single-sentence, pithy questions, without a great preamble, then we will progress towards other matters. I now call Sir Oliver Heald.

       
       
    • My hon. Friend will be aware, and indeed has said, how bad the situation was at Liverpool prison, where the trust had no understanding of what was required of it in its role as health provider. That put healthcare staff in a very difficult position. Does he feel that there is a need for better liaison between health and justice in relation to prison health facilities? Is the CQC really in a position to inspect them, or should there be joint inspections by Her Majesty’s inspectorate of prisons and the chief inspector of hospitals?

       
       
    • I spoke to colleagues in the MOJ yesterday about the issue that my right hon. and learned Friend raised in the first part of his question. I agree with him that the standards of care for those in prison should be the same as those in the NHS more widely. As he will know, NHS England took over commissioning for healthcare services in prisons in 2013; that is one of the changes that have been made. He will also know that the Dr Kirkup’s report drew attention to local factors, including a personal conflict of interests that goes to the heart of the relationship between the trust and the prison. However, he is absolutely right to allude to some wider issues from which we need to learn.

       
       
    • How many members of the board failed to co-operate with this scathing review, and can the Minister name them?

       
       
    • Only one member of the board co-operated with the review, from which we can deduce that all the rest did not. Given that I am relatively new to the Department, it would probably be wise for me to seek clarification on the extent to which individuals should be named, but I am happy to confirm that the chair of the board did not co-operate.

       
       
    • Does the Minister agree that the report shows that leadership really matters in our local NHS? What further steps can he take to ensure that hospital trusts fully understand the importance of transparency to clinical quality and patient safety?

       
       
    • My hon. Friend is absolutely right. That is why we are increasing the number of doctors in training by 25%. We are also looking into how we can increase the number of clinicians in leadership positions in trusts, and how we can reduce variance. That is one of the key issues. The NHS has some brilliant leaders, but the variance between trusts is far too wide.

       
       
    • Given that health is devolved to the Scottish Government, Mr Speaker, you may wonder why I am asking this question. Will the Minister reassure me first that the report will be shared with NHS Scotland and the Scottish Government, and secondly that, as and when senior appointments are made, there will be an ongoing, constructive and informed dialogue across the border? Now you will see why I asked the question, Mr Speaker.

       
       
    • I am happy to reassure the hon. Gentleman, but he has raised an important point. The question of people moving within the United Kingdom is not the only issue; another potential issue is the question of people moving to a charity or a private company that is providing services for the NHS, or taking up other roles in the healthcare landscape.

       
       
    • May I press the Minister a little further on his worrying suggestion that revolving doors are often facilitated by those who are tasked with regulating them? Will he also look at democratic accountability not just in the appointments of officials, but more widely in the NHS?

       
       
    • I referred earlier to my desire to work on these issues with members of the Health Committee, who include my hon. Friend, and I shall be happy to look into the points that he has raised. The previous statement was about the culture in the House of Commons. I think that what goes to the heart of my hon. Friend’s question and the matters that we are discussing is that issue of culture, and the need for the culture in pockets of the NHS to change. My right hon. Friend the Secretary of State has done a great deal to bring about such change, particularly in respect of patient safety, but I shall be happy to work with my hon. Friend to take that further.

       
       
    • What lessons can be learnt by Liverpool Community Trust—and, indeed, by other underperforming trusts—from the successful turnaround of some 20 trusts under the Government’s new special measures scheme?

       
       
    • My hon. Friend is right: although 37 trusts have gone into special measures, a significant number have not just moved out of special measures, but moved from “room for improvement” to “good”. That is relevant to a much wider challenge in the NHS, whether it involves procurement, workforce planning, or mentoring for junior doctors. I met the family of a junior doctor last week to discuss mentoring and support, particularly for those in their first year out of medical college. Trusts have shown leadership on a number of issues, and I think that the special measures regime has shown the scope to spread that best practice much more widely across the system.

       
       
    • I agree with the Minister that it is vital for us to expose and tackle failings in the NHS, especially when they put people at risk of harm. Does he agree with me that this case highlights the fact that money is not always the only answer? Effective leadership and responsible management are also important.

       
       
    • My hon. Friend is right. I think that at the heart of Dr Kirkup’s findings was the conclusion that what drove these events was not money—and he made that point specifically in relation to the finance for the initial services—but the desire to seek foundation trust status, which led to a wholly unrealistic cost improvement plan and an unwillingness to address the issues that arose as a consequence.

       
       
    • I thank my constituency neighbour, the hon. Member for West Lancashire (Rosie Cooper), for all the work that she has done on this issue.

      As has already been said, it is important for the right culture to exist in our NHS. However, it is also important for those who compromise patient safety to be brought to book and punished, and for us to know what action was taken, because otherwise the same thing will keep happening.

       
       

  • My hon. Friend is right. Professor Ted Baker, the chief inspector of hospitals, has drawn attention one of Dr Kirkup’s findings, which is that the CQC is now in a much better position to challenge and fine those responsible for unsafe care and poor standards. That also reflects the excellent work that Professor Baker and his team have been doing to ensure that inspections become much more rigorous in identifying issues such as those that we have been discussing today.

     
     
  • I am a member of the Justice Committee, which has taken a particular interest in Liverpool prison. Will my hon. Friend assure me that there will be a review of the suicidal potential of prisoners to ensure that the systems are right?

     
     
  • My hon. Friend is right to allude to the importance of learning lessons, especially given that there are many vulnerable people in prisons, and given the risks that accrue as a result. Yesterday I spoke to the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), who is responsible for offender management issues, and the Prisons Minister, my hon. Friend the Member for Penrith and The Border (Rory Stewart), visited Liverpool prison last week. I know that they have both taken a great interest in the report, and that they will take any further action that is needed.

     
     
  • Does my hon. Friend envisage an ongoing oversight role for Dr Kirkup that would enable him to help to put these failures right?

     
     
  • I should be happy to discuss any such future opportunities with Dr Kirkup. His excellent report builds on the work that he did at Morecambe, and I think there is a huge amount for us to take forward from its findings.

     

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Liverpool NHS trust ‘dysfunctional’ and unsafe, report finds

The Guardian 8 February 2018          Denis Campbell Health Policy Editor

Patients suffered ‘significant harm’ and staff who raised concerns were bullied, inquiry concludes

A nurse on a ward at a hospitalLiverpool Community Health NHS trust provided poor, unsafe and ineffective care to patients, the scathing report concluded. Photograph: Peter Byrne/PA

 

Patients suffered “significant harm” because of multiple serious failings by a “dysfunctional” NHS trust, an independent inquiry has found.

Liverpool Community Health NHS trust (LCH) provided poor, unsafe and ineffective care to patients, including inmates at HMP Liverpool, the scathing report concluded.

An independent panel, commissioned by the regulator NHS Improvement, also found that the trust had “a climate of fear” as a result of the harassment and bullying of staff who raised concerns.

The findings of the panel, led by Dr Bill Kirkup, are among the most damning of an NHS trust’s actions since Robert Francis QC’s landmark report into the Mid Staffs care scandal, published five years ago.

“The trust not only failed in its duty to provide safe and effective services, it concealed this from external bodies. Both patients and staff suffered harm for too long as a result,” said the panel, which investigated LCH’s conduct between 2010 and 2014.

The trust’s board “became blind to the real concerns that began to arise throughout the organisation” as staff voiced anxiety about plans to reduce its headcount and the impact that would have on patient care.

“Serious incidents causing patient harm were not reported, not investigated and lessons not learned. The result was unnecessary harm to patients,” the report added.

The panel highlighted a catalogue of failings by LCH, including that:

 It sought to achieve unfeasibly ambitious savings targets in a bid to become a semi-independent NHS foundation trust. While 4% is the usual upper limit of annual gains, it tried to save 15% of its budget in one year.

 The “drastic cost improvement measures” it decided to pursue mainly involved cutting staff, even though it was already understaffed.

 Staff who raised concerns about those plans suffered harassment, bullying and “extreme action”, including being suspended for months at a time without being told what they had done wrong.

But mounting problems at LCH went undetected for four years because NHS local and national bodies, including the Care Quality Commission and NHS England, failed to monitor it properly, the inquiry found.

“Patients put their faith in the NHS, and they should be able to trust that dangerous and dysfunctional services will be dealt with immediately. Sadly that has not been the case here and it took the help of a local MP to sound the alarm, and many years for the full facts to emerge,” said Jeremy Taylor, chief executive of National Voices, a coalition of more than 150 health and social care charities.

Ian Dalton, NHS Improvement’s chief executive, said he would not comment on Kirkup’s findings until March, despite their seriousness.

The Department of Health and Social Care said: “The leadership failings identified at Liverpool Community Health trust before 2014 were unacceptable and highlight the importance of fundamental reforms to patient safety that the government has made, including the CQC’s independent inspection regime and the special measures programme, which identifies quickly where hospitals have difficulties and puts in place a comprehensive package of support to help improve care for patients.”

The healthcare provided to prisoners at the Liverpool jail is being overhauled in light of flaws identified in care provided by LCH, NHS England said.

 

https://www.theguardian.com/society/2018/feb/08/liverpool-nhs-trust-dysfunctional-and-unsafe-report-finds

NHS staff call whistleblower line as bosses ‘ignore issues’

The Scotsman  Tuesday 30 January 2018
SCOTT MACNAB

Use of an NHS whisteblowing hotline is on the rise. Picture: TSPLUse of an NHS whisteblowing hotline is on the rise. Picture: TSPL

NHS staff are turning straight to a “whistleblowing” hotline because they are being ignored when they raise issues with their bosses, a new report out today has indicated.

Fewer NHS staff bother to go to managers in the health service because nothing gets done, the evaluation of the NHS Scotland Confidential Alert Line suggested.

Some staff have said they are victimised if they raise concerns over patient safety. The hotline was launched in 2013 and aimed to improve hospital safety after hundreds of incidents of concern, including more than 100 deaths, came to light.

It comes after a whistleblower recently exposed the fact that A&E staff at St John’s hospital in Livingston were wrongly recording the waits faced by patients, which made it easier to meet national NHS waiting times targets.

The latest evaluation of the hotline’s work in the six months from February and July last year indicate just 17 callers got in touch with the hotline. Although this was up slightly on the previous six months, it compares with 73 calls in the opening half-year after it was launched.

The latest report said: “In many cases individuals are contacting us because they have already raised their concern and feel it is being ignored and would like further advice on options for escalation or they feel they have experienced victimisation due to raising an issue.”

Of the total 17 public cases, seven callers had already raised their concern before contacting the Alert Line,” the report stated. “This is in keeping with general trends we have seen in previous reports and largely reflects the majority of calls we receive to the advice line generally,” the report added.

Patient safety was the “predominant concern” raised with the alert line. This has been a consistent trend across the six-month reports provided over the past three years, the report added.

A number of callers also got in touch in 2017 with concerns about abuse of a vulnerable person. But the report said there has been a “decrease in the number of staff who had reported their concerns before contacting the alert line compared with the previous report.”

“This is in keeping with general trends we have seen in previous reports and largely reflects the majority of calls we receive to the advice line generally,” the report added.

Patient safety was the “predominant concern” raised with the alert line. This has been a consistent trend across the six-month reports provided over the past three years, the report added.

A number of callers also got in touch in 2017 with concerns about abuse of a vulnerable person. But the report said there has been a “decrease in the number of staff who had reported their concerns before contacting the alert line compared with the previous report.”

Of the seven individuals who had already raised their concern before contacting with the hotline, three stated their concern had been ignored and only one said their concern had been denied.

Callers can seek advice from us even where concerns are admitted, for instance if they do not know how the concern is then resolved or if they are at risk of victimisation,” the report said.

Four of the calls from staff who worked with NHS Greater Glasgow and Clyde, while three came from other health boards in Scotland. T

he hotline was launched in 2013 after more than more than 300 reports into the most serious incidents in Scotland’s hospitals in 2011, including 105 deaths, were published by the BBC, and after the Francis Inquiry, which uncovered failings at Mid Staffordshire NHS Foundation Trust in England.

Read more at: https://www.scotsman.com/news/politics/nhs-staff-call-whistleblower-line-as-bosses-ignore-issues-1-4676704

Damning dossier from ambulance trust whistleblower claims Christmas and new year deaths were due to delays

East Anglian Daily Times  20 January, 2018    Michael Steward     michael.steward@archant.co.uk    @MichaelReporter

 

One patient is said to have gone into cardiac arrest at Colchester General Hospital after taking themselves to A&E due to ambulance delays. Picture: LUCY TAYLOR

One patient is said to have gone into cardiac arrest at Colchester General Hospital after taking themselves to A&E due to ambulance delays. Picture: LUCY TAYLOR

A damning dossier compiled by a senior whistleblower from the region’s ambulance trust has claimed at least 40 patients died or were harmed due to delays over Christmas and New Year – including one person who froze to death.

The damning dossier has been compiled by a senior whistleblower at the East of England Ambulance Service. Picture: SIMON FINLAY

The damning dossier has been compiled by a senior whistleblower at the East of England Ambulance Service. Picture: SIMON FINLAY

The region’s NHS came under intense pressure in less than three weeks between mid-December and early January, with ambulances queuing outside A&E departments and patients reporting they were treated in corridors.

But the whistleblower, who wants to remain anonymous, revealed 19 people died in the east of England during the period and they expected the total number of patients harmed or killed due to delays to soar to around 80 when all cases had been reviewed.

A copy of the dossier seen by this newspaper included a man who waited 16 hours for an ambulance in Lowestoft on December 27.

The man was outside and no ambulance was sent when the first call was made by police.

Suffolk Police made a second call when they found the man, who apparently appeared to have frozen to death.

East of England Ambulance Trust (EEAST) said when the call was first made they were told the man was conscious and breathing and had no obvious injuries. Therefore the call was categorised as a non-emergency call.

When they received the second call a paramedic arrived within eight minutes but the man was dead.

In north Essex and Suffolk the whistleblower’s document claimed six people died and one was harmed as a result of the delays in that period.

These included:

• December 19, in Newmarket, a patient waited four hours and 20 minutes and there was evidence of harm due to the delay.

• December 25, in Maldon, it took six hours, 39 minutes for back-up to arrive to assist with a sepsis patient.

• December 26, in Stowmarket, a call for an ambulance was made on Dec 24 and no ambulance was sent. The patient died on Dec 26 after a cardiac arrest.

• December 26, in Ipswich, a sepsis patient waited four hours and 43 minutes.

• December 29, in Clacton, a patient with a serious spinal injury waited seven hours and 56 minutes.

• December 29, in Thetford, a patient died after going into cardiac arrest and waiting one hour and 12 minutes.

• December 30, in Walton on the Naze, an ambulance was called to a fractured ankle with an obvious deformity – a limb threatening injury – and took six hours 11 minutes.

• December 31, in Maldon, a patient arrested on arrival to hospital after waiting six hours and 46 minutes with asthma-related symptoms

• January 1, in Bury St Edmunds, a patient who had a seizure waited three hours and 41 minutes.

• January 2, in Tiptree, a patient died after going into cardiac arrest and waited for 47 minutes.

• January 2, in Clacton, a patient died from a cardiac arrest after waiting three hours and 45 minutes.

• January 2, in Chelmsford, a patient having a stroke waited 16 hours 49 minutes.

• January 2, in Colchester, a patient went into cardiac arrest after self-presenting at Colchester hospital A&E due to ambulance delay.

After years of missed targets EEAST changed its response programme last year, but in the most serious cases crews are expected to arrive within seven minutes.

The whistleblower also accused senior executives of being on holiday during the crisis, and said some of the trust’s £2.5m surplus should have been spent on hiring extra staff.

EEAST denied this was the case and a spokesman said: “The trust absolutely refutes claims that there were no senior managers in over the Christmas period. In line with all ambulance trusts, this trust operates a gold command system, which consists a 24/7 on-call rota of the most senior operational managers who are highly experienced and well trained.”

He added: “The trust is on the public record stating that it has a gap between funded capacity and demand. It is good financial planning to ensure that the trust is in a position to hire any additional resources that may become available across the months of January, February and March. The trust is well placed to buy such resources where available. We are aware of the claims made by MPs but note no complaints have been received from patients or their families at this time. Nor have any concerns been expressed internally through our line management, whistleblowing or freedom to speak up processes.”

Trust had ‘plans in place’

A trust spokesman added they “had plans in place however experienced extreme levels of demand over the new year period in particular.

“The trust was unable to respond to a very small number of the 50,000 calls we handled over a 15-day period as quickly as we would like. The trust is undertaking a rigorous analysis of that small proportion of calls.

“Where any suspected cases of potential harm are identified, then the trust will exercise it’s duty of candour to notify patients or their families. It is worth noting that any cause of death not certified by a doctor can only be established if there is a coroner’s case. It is best practice to always review the effectiveness of any plans and the trust will be doing that.

“Depending on any preliminary insight, the trust will invite an independent review of our decision making process. The trust has also requested a system wide review of these periods of high demand and lost capacity.”

Call for independent review

Former health minister Norman Lamb said the whistleblower had raised “very serious issues” with him.

Mr Lamb, the MP for north Norfolk, said: “It’s really shocking in my view, these are all suggestions which have been put to me but they are things which have to be fully investigated. I think there needs to be a urgent review by someone outside the trust.”

Sandy Martin, MP for Ipswich, said: “It is almost impossible to prove that anyone may or may not have died as the result as a result of an ambulance delay.

“However, it is clear that a better resourced ambulance service would lead to less unnecessary death and life-changing situations.

“It is time for the government to get to grips and to give our NHS the £30billion that the practitioners themselves say that the service needs.”

Giles Watling, MP for Clacton, said: “I shall be calling for an inquiry. If it is a question of funding then I shall be calling for more funding but I will wait for the findings of the inquiry.

“But we do need to get to the bottom of this.”

Suffolk health watchdog responds

Andy Yacoub, chief executive of Healthwatch Suffolk, said: “Healthwatch Suffolk is fully aware of the severe pressures all our health [and social care] providers have faced together this winter.

“I believe that at times the ambulance service has looked after and transported well over 4,000 patients a day, which would put a strain on any service. That said, each and every patient that requires an ambulance in an emergency, should rightly expect a service that is responsive and of a good quality.

“Planning and the best use of resources, in collaboration with hospitals and other providers, is essential, especially for the pressures that winter periods bring.

“For example, at a time when our hospital’s A&Es are as busy as they have been, ambulances can at times be held up, before their patient can be safely moved into the care of the hospital staff.

“The best use of what limited resources there are helps to respond to our region’s patients’ needs in as timely a fashion as possible.

“Communication is a key to this, because when ambulances are ‘delayed’, the patient and their carer(s) desperately need to know. The appropriate use of the amazing First Responder volunteers is also essential.

“Healthwatch Suffolk is currently asking the public to share stories about the ambulance service they have received recently, whether this is good, bad or indifferent. Your voice matters and any themes and trends we identify will be raised directly with the trust’s quality and governance committee.”

 

Letter to CEO at Ealing Hospital

Sent via email

1 March 2015

Mr David McVitte

Chief Executive

Ealing Hospital NHS Trust

 

Dear Mr McVittie,

Re: Dr Sunil Ranjan Chowdhury DOB 4.9.31

My father, Dr Chowdhury, who was a retired doctor, suffering from multiple system atrophy (MSA), was taken to Ealing hospital by ambulance on Wednesday 21 January, when he suddenly became unconscious. My mother called the emergency service.

Although Central Middlesex hospital is the nearest hospital, A&E there has recently been shut down.

On arrival at A&E, mum and I were present and we advised the A&E of the medication my father was on. This included the type and dosage of insulin – he was diabetic. After several tests, the doctors advised us that his condition was OK and there was nothing that they were worried about. However, they would admit him.

On Thursday 22 January, I received a phone call from the pharmacy querying the type and dosage of insulin my father was on. I advised him.

On Saturday 24 January, when I went in to visit dad, I was advised that dad had not been fed for 2 days. They thought he may be aspirating. I was concerned and asked if that was the case why they had not fed him either intravenously or via a nasogastric tube. They did not reply, except to say that they were unable to do anything until the consultant returned to work on Monday. So, they had planned to starve a vulnerable adult for 4 days, before deciding on a feeding plan. After much fuss (from me), the senior staff decided to try and feed him with semi-solid food. Dad had this without any coughing or any problems – the nurse agreed that dad was not aspirating. So, they then commenced his feeding after 2 days of starving him.

In addition, I discovered on the same day, that he was not been given any fluids either. The drip remained unconnected. I queried this. The staff advised me that the there was a problem with the drip monitor. After complaining 3 times, staff eventually got this to work.

On Saturday 31 January, dad looked really poorly and was on oxygen. He did not have any lunch. However, his blood sugar was high at 15. We queried if he was given his insulin. The nurse couldn’t find anything regarding his insulin in his notes. It transpired that dad hadn’t been given any insulin for the last 10 days he was in the hospital.

I asked to speak to his doctor. I was advised that his consultant would not be in until Monday and that there was a locum covering. I asked to speak to her. She said there wasn’t anything she could do as his insulin was not written up in his notes.

Whilst looking through his notes, I came across another patient’s paperwork. A Chaudry with a different first name. I brought it to the attention of the ward sister, who removed and took the paperwork away.  How could this have happened? In addition, worryingly were my father’s details on insulin entered in another patients notes?

On Monday, the consultant spoke to my mum and said he did not know that dad was on insulin. This was despite the fact the doctor in A&E was advised and I had received a phone call from the hospital pharmacy. He was also worried that I would be putting in a formal complaint. One would have thought as a consultant he would be more worried how such a thing could have happened in the first place and investigate.

After discussing the matter with the consultant, mum asked me not to make a complaint while my father was still in the hospital as it could be detrimental to his ongoing treatment. She was clearly worried

His insulin started on Monday 2 February. Dad perked up on Tuesday and Wednesday. He was eating and chatting. However, sadly he passed away on Thursday 5 February.

As well as coping with his death, I had to repeatedly call the ward and patient services to get his death certificate. So that his death could then be registered and we could organise his cremation. It took 2 days and end of Friday to get this and this was only after I ended up physically in the ward to approach the team after my PET CT scan. Due to running around and dehydration, I ended up with severe haematuria and bladder infection and I ended up at Northwick Park hospital.

It is shameful that my father who had worked as a doctor for nearly 50 years and was really valued both by his patients and staff to the point that they remained in contact with him even after retiring for 15 years should have ended his days at Ealing hospital with such poor treatment.

I would like a clear explanation of how these failures occurred, and I expect that I should be properly involved in any root cause investigation

With regards

Sharmila Chowdhury

Whistleblower claims 20 people died where ambulances were late

Norwich Evening News   17 January 2018    

 

 Clive LewisClive Lewis
Clive Lewis told the House of Commons a whistleblower had come to him with the shocking claim after 12 days of increased levels of calls.

The whistleblower alleged that senior operations managers wanted to move the East of England Ambulance Service to the highest state of alert on December 19 but a final decision was not made until New Year’s Eve.

The Resource Escalation Action Plan (REAP) – which has four levels – was finally enacted although bosses decided against calling in help from elsewhere which could have seen the military answering 999 emergencies.

Raising a point of order the Norwich South MP said: “I hope to get your advice on an exceptionally serious issue that’s been brought to me by a whistleblower in my constituency relating to the East of England Ambulance Service.

“It has been put to me that the service became critically over-stretched due to high demand on December 19, and at that point senior operational managers wanted to move to REAP 4, the highest state of emergency, and seek mutual aid, most likely from the armed forces.

“However, that decision was not taken until 31 December, some 12 days later, and even then aid was not requested by senior management.

“I’ve been informed during this period that 20 people died in incidents where ambulances arrived late.”

It is not known whether the number stated by the whistleblower is for the whole eastern region or just Norfolk.

A spokesman at East of England Ambulance Service Trust said: “We recognise that some people experienced a delay in their care over the festive period and we, along with the wider health care system, experienced significant pressure.

“We always monitor our demand and capacity and take necessary actions to protect patients. The trust has a robust internal process and we are investigating appropriately. Since Christmas we have responded to in excess of 50,000 patients – less than 0.2pc of patients have experienced a significant delay.”

 

http://www.eveningnews24.co.uk/news/politics/clive-lewis-ambulance-dead-1-5359204

Letter to Prime Minister from consultants in 68 Acute hospitals in England & Wales

10th January 2018

 Dear Prime Minister, 

 We are writing to you as Consultants in Emergency Medicine, Fellows of the Royal College of Emergency Medicine and as Clinical Leads (Consultants in charge) of our Emergency Departments, representing 68 Acute Hospitals across England and Wales.

 We note your recent apology to patients and thanks for how hard we and other NHS staff are working.

 We feel compelled to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues and for the very serious concerns we have for the safety of our patients. 

 This current level of safety compromise is at times intolerable, despite the best efforts of staff. 

 It has been stated that the NHS was better prepared for this winter than ever before. There is no question that a huge amount of effort and energy has been spent both locally and nationally on drawing up plans for coping with NHS winter pressures. Our experience at the front line is that these plans have failed to deliver anywhere near what was needed.

 We acknowledge that our Trusts and local CCGs are doing everything they can to create capacity and more beds in the short term, and we are grateful to them for their continued assistance in such a time of crisis. We also acknowledge the help and support given to the Emergency Departments by our colleagues in other specialties and disciplines across our hospitals.

 The facts remain however that the NHS is severely and chronically underfunded.

We have insufficient hospital and community beds and staff of all disciplines especially at the front door to cope with our ageing population’s health needs.

 As you will know a number of scientific publications have shown that crowded Emergency Departments are dangerous for patients. The longer that the patients stay in ED after their treatment has been completed, the greater is their morbidity and associated mortality. 

 Recent media coverage has reported numerous anecdotal accounts of how appalling the situation in an increasing number of our Emergency Departments has become. These departments are not outliers. Many of the trusts we work in are in similar positions.

 Last week’s 4 hour performance target was between 45 and 75%.

Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space. 

 Some of our own personal experiences range from

• Over 120 patients a day managed in corridors, some dying prematurely
• An average of 10-12 hours from decision to admit a patient until they are transferred to a bed
• Over 50 patients at a time waiting beds in the Emergency Department
• Patients sleeping in clinics as makeshift wards

 We have known for a number of years that recruitment of staff to Emergency Departments has been challenging. The recent collaboration between the Royal College of Emergency Medicine and NHS England, Health Education England and NHS Improvement will provide a medium term solution to grow our clinical workforce as well as decrease the attrition rate.

 So as a matter of urgency we ask that you consider supporting strategies that will reduce crowding in our Emergency Departments. 

These include;

1. A significant increase in Social Care Funding to allow patients who are fit to be discharged from acute beds to be cared for in the community. 
2. A review of the number of hospital beds that are available for acute care. A number of independent organisations have confirmed that the UK has an inadequate acute bed base to meet the needs of its population. 
3. Prioritisation to implement the workforce strategy that has been agreed between the Royal College and the relevant arms length bodies.

In the meantime we would like to apologise to our patients for being unable to fulfil our pledge for a safe efficient service and acknowledge the hard work and dedication of the staff.

 You will understand with the public interest in this matter that we have released this letter to the press also.

 We remain hopeful and committed to improving the care of patients in Emergency Departments throughout the UK.

 “The NHS belongs to the people….it touches our lives at times of basic human need when care and compassion are what matter most”

The NHS Constitution, 1948.   

Note: we sign this on behalf of ourselves and our departments but this does not necessarily represent the views of our individual Trusts. 

 

Shaz Afzal – County Durham and Darlington NHS Foundation Trust 

Shariq Ahmed- WrightingtonWigan and Leigh NHS Foundation Trust

Vazeer Ahmed – Cambridge University Hospitals NHS Foundation Trust 

Abosede AjayiCharing Cross, ICHNT

Andy Ashton – St Helens and Knowsley Teaching Hospitals NHS Trust 

Ravi Ayya– West Suffolk Hospital

Ahmad Aziz – Mid Essex Hospital Services NHS Trust, Broomfield Hospital

Bill Bailey – Chesterfield Royal Hospital

Tom Blyth – Heart of England NHS Foundation Trust (Solihull) Birmingham

Dan Boden – Derby Teaching Hospitals NHS Foundation Trust

David Clarke – Royal Berkshire NHS Foundation Trust 

Jonathan Costello – Royal Free, London

Jim Crawfurd – James Paget University Hospital, NHSFT

Susan Dorrian – Heart of England NHS Foundation Trust (Heartlands) 

Birmingham 

Ola Erinfolami – Heart of England NHS Foundation Trust, Birmingham

Jane Evans – Norfolk and Norwich University Hospitals NHS Foundation Trust 

Shindo Francis – Milton Keynes University Hospital 

James Gagg – Musgrove Park Hospital, Taunton & Somerset NHSFT

Steve Haig  – Great Western Hospitals NHS Foundation Trust, Swindon

Elaine Harding – Lewisham and Greenwich NHS Trust

Miriam Harris – London North West Hospitals NHS Trust 

Ed Hartley – University Hospitals Coventry and Warwickshire NHS Trust 

Katherine Henderson – Guy’s and St Thomas’ NHS Foundation Trust

Chris Hetherington – South Warwickshire NHS Foundation Trust 

Caroline Howard – Southend University Hospital NHS Foundation Trust

Ann Hicks – Plymouth Hospitals NHS Trust 

Hywel Hughes – Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital

Nickie Jakeman

Ruchi Joshi – Walsall Healthcare NHS Trust 

Meg Kelly – United Lincolnshire Hospitals NHS Trust 

Tarek KherbeckThe Norfolk & Norwich University Hospital

Liam Kevern – Northern Devon Healthcare NHS Trust 

Milena Kostic – The HillingdonHospitals NHS Trust

Subramanian Kumaran – Shrewsbury and Telford Hospitals NHS Trust

Nick Laundy – Countess of Chester Hospital NHS Foundation Trust 

Stuart Lloyd – Bedford Hospital NHS Trust 

Stephen Lord, York Hospital, York Teaching Hospitals NHS Foundation Trust

Andres Martin – North Middlesex University Hospital 

David Matthews – Mid Cheshire Hospitals Foundation Trust 

Nick Mathieu – Torbay and South Devon NHS Foundation Trust

Ann-Marie Morris – University Hospitals of North Midlands 

Rachel McColm – Wye Valley NHS Trust

Lisa Niklaus – Barts Health NHS Trust

Julie Norton – University Hospitals of North Midlands 

Tom O’Driscoll – Betsi Cadwaladr University Health Board, Glan Clywd

Nick Payne –Frimley Health NHS Foundation Trust 

Rob Perry – Betsi Cadwaladr University Health Board, Ysbyty Gwynedd (GwyneddHospital), Bangor, North Wales 

Shewli Rahman – Burton Hospitals NHS Foundation Trust

Junaid Rathore – Royal Liverpool and Broadgreen University Hospitals Trust

David Raven – Heart of England NHS Foundation Trust, Birmingham

Ben Rayner – Hull and East Yorkshire Hospitals NHS Trust 

Tim Rogerson – Aneurin Bevan University Healthboard, Royal Gwent Hospital, Newport

Emma Rowland

Mustafa Sajeel – Heart of England NHS Foundation Trust, Good Hope, Birmingham

Ramy Saker – Frimley Health NHS Foundation Trust, Wexham Park 

Ravi Sant – United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston

Matt Shepherd – Harrogate and District NHS Foundation Trust

Toby Slade – Royal Cornwall Hospitals NHS Trust 

Dave Snow – Southport and Ormskirk Hospital NHS Trust 

Lisa Somers – Whipps Cross University Hospital, Barts Health NHS Trust 

Sarah Spencer – Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend 

Jo Taylor – The Dudley Group NHS Foundation Trust 

Nam Tong – The Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust 

Will Townend – Hull and East Yorkshire Hospitals NHS Trust 

Malcolm Tunnicliff – Kings College Hospital NHS Foundation Trust 

James Williamson – Warrington and Halton NHS Foundation Trust

Libby Wilson – University Hospitals Aintree NHS Foundation Trust

Athar Yasin – North West Anglia Hospital NHS Foundation Trust, Peterborough City Hospital 

Whistleblowing in healthcare

Health Management  Volume 17 – Issue 4 2017

 

Dr. Peter Wilmshurst, MB ChB, BSc, FRCP, FFSEM, FISM     Dr Peter Wilmshurst  MB, ChB, BSc, FRCP, FFSEM, FISM

Although healthcare workers have a responsibility to raise concerns about patient safety and unethical or illegal conduct, if they do so they are often treated badly.

Healthcare workers have a responsibility to raise concerns about patient safety and unethical or illegal conduct. Yet those who raise serious concerns are often treated badly by senior colleagues, their employing organisations and the bodies that should protect whistleblowers. This paradox is because whistleblowers raise concerns that, if made public, would embarrass the organisation or senior and powerful individuals, who are considered less dispensable than the whistleblower. Repeatedly we hear of scandals in healthcare, where whistleblowers were ignored or lost their jobs for raising concerns, but those responsible for both the scandal and its cover-up are promoted to more senior positions in the UK National Health Service.

 

Risks to whistleblowers

Through membership of Patients First (patientsfirst.org.uk) I have met many genuine whistleblowers, who raised serious concerns about patient safety and suffered detrimental treatment and lost their jobs. Achieving a just outcome for whistleblowers in such cases is usually impossible because of inequality of arms—unemployed whistleblowers with limited financial resources fight protracted litigation against employers that spend large amounts of taxpayers’ money on legal costs to conceal patient harm or to protect senior individuals.

I say “genuine whistleblowers”, because I recognise that there are some individuals who claim to be whistleblowers only after allegations were raised about their own conduct. However the converse is more frequently the case: after whistleblowers raise concerns spurious reasons are found to discipline or dismiss them. If one looks hard enough one can find a mistake that can be magnified to make a case to dismiss a whistleblower and claim that their sacking was unrelated to them raising concerns. I know of cases where NHS Trusts have employed private detectives to follow a whistleblower, have secretly searched a whistleblower’s office during a weekend, got the hospital IT department to give them access to the whistleblower’s work computer when the whistleblower was on annual leave, and audited a whistleblower’s mileage travel claim in order to allege that a minor disparity in mileage claimed amounted to an attempt to defraud the Trust. Whistleblowers are distrusted, because someone willing to expose concerns about safety or misconduct by a colleague, cannot be trusted to remain silent when a cover-up “is required” for the sake of the organisation or out of comradeship. Other NHS organisations will not employ people who management do not consider team players, because they do not comply with the Mafia-style “code of omerta”. The people who understand this best are appointed to sit on regulatory bodies. As a result, those who raise concerns are also often treated badly by regulators, such as the UK’s General Medical Council (GMC).

 

Treatment by regulators

The GMC instructs doctors that they must speak up if they have concerns about another doctor’s competence or integrity, but also has a disparagement rule that is used to prevent doctors expressing such concerns. I chaired a national committee and the committee became concerned about the integrity of a research publication. On behalf of the committee, I alleged research misconduct by the authors. The GMC chose to investigate whether I had disparaged the doctors. After months of investigation I was exonerated, but the GMC only reluctantly investigated the allegations I raised and found them true.

I have reported a number of doctors to the GMC. My complaints have resulted in some being removed from the medical register and others received lesser sanctions or “advice about future conduct”. I know that the GMC makes it difficult to complain. The GMC’s initial response is almost invariably that they will not consider the case. A complainant needs to know that they then need to get into a legal argument with the GMC to point out the flaws in its decision. I have gone through this process in cases when the GMC initially said that there was no case to answer, but eventually removed the doctors from the medical register. If the GMC reconsiders the case, the complainant must provide all the evidence: in one case I had to provide more than 32,000 pages of documents, which was onerous. The GMC also threatened me, the complainant, with a High Court action.

To understand the machinations and conflicts of interest that exist at the GMC, it may help to consider a case that I reported. Cardiologist Dr. Clive Handler was suspended from the Medical Register for embezzling money from a charitable research fund after I reported him to the GMC (Wilmshurst 2007). The medical director and Trust Board of the hospital where he worked agreed a settlement with him provided he left quietly. It included the Trust agreeing a payment to Handler and agreeing to conceal his fraud from both the police and the GMC. The remarkable thing was that the medical director who drew up the agreement was Professor Peter Richards, who was a senior member of the GMC. Richards was Chair of the Professional Conduct Committee—the GMC’s disciplinary body. He scheduled himself to chair Handler’s hearing. He had to stand down on the morning of the hearing when the GMC’s own lawyers objected because of his conflict of interest. The GMC refused to act against Richards for concealing Handler’s misconduct and let him return to chairing disciplinary hearing after the case. Would a judge who concealed criminal conduct be allowed to remain on the bench?

 

Risk of legal action

A whistleblower may also have to deal with defamation claims. They are very difficult to defend in the United Kingdom. In 1982, when I refused a bribe from Sterling- Winthrop to falsify research findings with their drug, amrinone, I was threatened with legal action (Wilmshurst 2007). I published data to show that amrinone was ineffective and unsafe. In 1984, Sterling- Winthrop told the United States Food and Drug Administration that there were so many life-threatening side effects with the drug that they had ceased to research or market it. In 1986, I discovered that Sterling- Winthrop were selling amrinone over the counter in parts of Africa and Asia, though it was considered too dangerous to have on a doctor’s prescription in Europe and North America. I worked with Oxfam to get proof, which was taken to the World Health Organization. Sterling-Winthrop was finally embarrassed into withdrawing amrinone worldwide.

In 2007, when I was co-principal investigator in the MIST Trial, I expressed concern at a scientific meeting that the trial data presented was inaccurate and incomplete. The sponsor of the trial, NMT Medical, which made the medical device used in the trial, sued me for libel and slander (Wilmshurst 2012). I stuck to my claims, and they sued me three more times. The claims lasted nearly four years and my legal costs exceeded £300,000. The claims ended when NMT went into liquidation (Wilmshurst 2012). I got Circulation to correct a scientific paper containing false data and a new version of the paper was published (Dowson 2008). I had refused to be a co-author, but the other co-principal investigator in the MIST Trial was first author, and he was suspended from the Medical Register for dishonesty (Dyer 2015). To get that outcome took six years of effort on my part.

I have received threats of legal action from a number of doctors that I reported to the GMC, but all withdrew their threats when told what evidence I would present in court. I was threatened with legal action twice by King’s College London when I exposed the cover-up of the misconduct of surgeon, A K Banerjee (Wilmshurst 2016). He was suspended from the Medical Register for a year in 2000 for research fraud after I reported him first. He got back onto the register for three weeks and I told the GMC that they had failed to deal with his financial misconduct and poor clinical skills. He was struck off the register, but he was allowed back on in 2008. He was awarded an MBE “for services to patient safety” in 2014. I raised objections with MPs and the Cabinet Office and the award was forfeited two months later. It is pertinent that when the Health Honours Committee decides to award a national honour to a doctor, they check with the GMC to see whether there is any reason why the honour should not be awarded. That did not work in the case of Banerjee.

 

And on it goes

The low esteem of NHS management for whistleblowers was brought home to me personally when I applied for a Gold Clinical Excellence Award at the time of renewal of my Silver Award (Clinical Excellence Awards are presented to consultants working in the NHS who perform over and above their role; the higher awards —silver and up—are decided on a national basis). I was not given a Gold, but soon afterwards received an anonymous message that my application had not been dealt with fairly. I appealed, and during the long process discovered that my regional sub-committee had been allowed to nominate four applicants for Gold Awards. My application had the third highest score, but the sub-committee nominated the doctor with the fifth highest score in my place. During the appeals process the Advisory Committee on Clinical Excellence Awards (ACCEA ) disclosed documents. I discovered that ACCEA asked the medical vice-chair of the regional sub-committee to explain why I had not been nominated despite my score. She made a series of false statements about me, and said that the committee felt that exposing research fraud was not a valid contribution. The doctor with the fifth highest score, who the regional sub-committee preferred, was a consultant gynaecologist who was allowed to continue to practise after being placed on the Sex Offenders Register for accessing child pornography. The appeal panel stated that the comments of the regional vice-chair about me and my application were “completely untrue” and upheld my appeal, but ACCEA did not give me a Gold Award. The medical vice-chair whose statements about me were found to be “completely untrue” was appointed to be a medical member of the General Medical Council (GMC). From this I inferred that many senior people in the NHS prefer a convicted paedophile to a whistleblower.

 

Conclusion

But perhaps NHS whistleblowers should not complain. I have investigated research misconduct in other countries. In one, four whistleblowers said that they had received death threats for exposing research misconduct by a well connected doctor. My experiences lead me to believe that in healthcare those who raise concerns are often treated far worse than the dishonest people they expose.

Described in Private Eye as the godfather of NHS whistleblowers, Peter Wilmshurst is a member of the Committee on Publication Ethics, of Patients First and of Health Watch. He was awarded the Health Watch Annual Award in 2003 “for courage in challenging misconduct in medical research”, and was the first recipient of the BMJ Editor’s Award in 2012 “ for persistence and courage in speaking truth to power”.

 

References:

Dowson A, Mullen MJ, Peatfield R et al. (2008) Migraine intervention with STARFlex Technology (MIST) Trial: a prospective, multicenter, double-blind, sham- controlled trial to evaluate the effectiveness of patent foramen ovale closure with STARFlex septal repair implant to resolve refractory migraine headache. Circulation 117: 1397-04. [Correction in: Circulation. 2009 Sep 1;120(9):e71-2.

Dyer C (2015) Migraine doctor loses appeal against finding of dishonesty. BMJ, 351: h6351.

Wilmshurst P (2007) Dishonesty in medical research. Medico-Legal Journal, 75(1): 3-12.

Wilmshurst P (2012) English libel laws and scientific research. Significance, December: 37-9.

Wilmshurst P (2016) Poor governance in the award of honours and degrees in British medicine: an extreme example of a systemic problem. BMJ, 352: h6952.

 

 To view full article in Health Management: 

 

Ex-health boss’s claims of ‘bullying and gagging’ in Welsh NHS

ITV News   James Crichton-Smith    HEALTH REPORTER, ITV WALES
Dr Tony RucinskiDr Tony Rucinski says he’s experienced a culture of bullying and unfairness Credit: ITV Wales

The former chief executive of the Board of Community Health Councils in Wales says he’s experienced a culture of ‘entitlement, gagging, bullying and unfairness’ in the Welsh NHS.

Speaking exclusively to ITV Wales, Tony Rucinski says he was told at the beginning of 2016 not to speak to the media ‘on the behest of the [Health] Minister’ and that a closeness between Welsh Government and the NHS means that difficult conversations about what needs to happen in the health system are not taken forward.

The health minister at the time was Mark Drakeford AM, who is now Finance Minister.

After being suspended, Mr Rucinski was then dismissed from his position with the Board of Community Health Councils (CHC).

According to the Community Health Councils website, “CHCs represent the independent voice of patients and the public who use health service in Wales and play an important role in influencing the way services are planned and delivered.”

interviewMr Rucinski has spoken exclusively to ITV Wales Credit: ITV Wales

Mr Rucinski said: “The reality is that you discuss some hard topics, but then comes in what I would call the small country conundrum.”

He added: “You end up finding that there’s an awful lot of closeness [between the Welsh NHS and government] and the people who choose the people who choose the people, a lot of it seems to feel a bit locked in.

“What that means is you get to situations where you’re in meetings and you’ll come up with a discussion or viewpoint and somebody will say ‘we can’t say that because the minister wouldn’t like it’. And that’s the end of that discussion.”

Mark Drakeford AMMark Drakeford AM was the health minister when Mr Rucinski was suspended Credit: ITV Wales

Mr Rucinski says he was ‘gagged’ from speaking out on issues affecting the NHS. He says he was told that this decision was made by the health minister. “I was told you’re being stopped from talking to the media on the behest of the minister,” he said.

“My boss said the minister had told her to keep me out of the media. I objected to that because in my point of view it’s A, in my job description and B, we’re an independent organisation and we shouldn’t be responding to political instructs to stay away from the media.”

The methods and tactics used by Welsh Government in order to prevent Mr Rucinski from speaking out, he says, are “just the tip of the iceberg”.

The ‘close’ relationship between government and senior figures within the Welsh NHS, says Mr Rucinski, could be seen through the frequency with which the health minister would meet with other NHS bosses and himself. “When I was in position, the chairs [of the CHCs] would meet with the minister at least every fortnight. So a very close relationship. I would see the minister on a ridiculously large number of occasions.”

Mr Rucinski Mr Rucinski says that ‘closeness’ between government and the NHS is harming progress Credit: ITV Wales

He added: “On the one hand you could say it’s a huge privilege, what a good idea because the minister can really keep a tab on things and make sure things happen but the flip side of that is if you’ve then got a culture where people are too afraid to speak out because it’s so close you don’t get the conversations being had that need to be had.”

Mr Rucinski was also critical of what he called ‘the small roundabout of senior jobs in Wales’. He said: “In order to get your next seat on that roundabout you have to recognise that there’s a very close relationship between those senior positions and the politics in Wales and that if therefore you come out of line you might put at risk your ability to get that next seat on the roundabout. Therefore the temptation is almost irresistible for a lot of people to not say the things that would highlight stuff that might put that next seat at risk.”

Responding to the comments, a Welsh Government spokesperson said: “Tony Rucinski’s comments are simply not true and we do not recognise the picture he paints of the culture within NHS and the Welsh Government. Dr Rucinski was initially suspended from his post. Following full independent investigation he was subsequently dismissed from his role as CEO of the CHC Board.

There was no evidence found to support Dr Rucinski’s claims of political interference in his role as CEO of the CHC Board following an independent review commissioned by Welsh Government.”

The Board of Community Health Councils have also been asked for comment.

Reacting to the claims made by Dr Rucinski, the Welsh Conservatives said they were ‘shocking’.

If true call into question the integrity of a great many people.

“If we are to truly improve service delivery then we have to enable open and honest debate or our NHS will continue to muddle along as it has done for nearly two decades.

“A strong government ought to welcome criticism because, as they say, it’s the grit that makes the pearl.

“It is legitimate to consider whether what Mr Rucinski describes is yet more evidence of the bullying and discrimination alleged by many to exist at the very heart of Welsh Government.”

– ANGELA BURNS AM, WELSH CONSERVATIVES HEALTH SPOKESPERSON

Plaid Cymru’s Shadow Cabinet Secretary for Health Rhun ap Iorwerth said: “The comments made by Mr Rucinski paint a picture of an insecure Government that won’t accept criticism.”

“Wales is a small country, and that can work to our advantage, but not if Labour are intent on creating a fiefdom where criticism isn’t allowed and where debate and discussion are closed down.

“We’ve had Labour Health Ministers for nearly 19 years. Labour won’t admit to the depths of the problems we have in the Welsh NHS because to do so would be to admit that they’re responsible. It’s clear that the NHS needs a change of government – Welsh patients need that change, and hardworking NHS staff deserve it too.”

– RHUN AP IORWERTH AM, PLAID CYMRU HEALTH SPOKESPERSON

The ambulance never came.

juniordoctorblog.com

Indisputably, life is complicated. However we are increasingly ill-prepared to receive and process complex ideas and problems. The challenges facing the NHS are multifaceted, intricate and blown up to a national scale. The campaign to raise awareness of the damage being down to the health service is often waylaid by an inability to crystallise our concerns into a single message that can penetrate through the spin and lies. Worse, the constant back and forth of statistics and numbers both fatigues the general public and dehumanises the subject matter.

The past few weeks have seen the NHS at a level of crisis like no other in its history. Colleagues across the country are reporting conditions no developed industrial country should ever tolerate in their hospitals.

At this point I would normally bring forth statistics illustrating this disaster: waiting times, trolley waits, operations cancelled, ambulance queues. We’ve all tried that. It’s not…

View original post 1,057 more words

Hospital chiefs ‘risking patients to hit targets’ Bed ‘boarding’ exposed in St John’s inquiry

Scottish ministers have been urged to investigate the extent of “boarding” in the NHS, after a whistleblower warned that the controversial practice occurs routinely at a hospital that is under scrutiny over waiting times.

Health boards were urged eight years ago to stop boarding, whereby patients are transferred from specialist wards to other areas of the hospital to free up beds, amid evidence that the practice can distress patients, hamper recovery and spread infection.

It has emerged, however, that staff at St John’s Hospital in West Lothian were ordered to “escalate” boarding a year ago to cope with accident and emergency (A&E) admissions. A key target set by the Scottish government is for patients to be admitted to hospital, if necessary, within four hours of arrival at A&E.

A whistleblower claims that in the past year, boarding has been rife at St John’s because senior managers are “hellbent” on meeting the target.

It is claimed that one dementia sufferer was so traumatised after being moved from her ward that she stopped eating and drinking and “lost the will to live”.

“Tremendous pressure has been exerted on staff to board patients because the management is hellbent on meeting the four-hour target,” said the whistleblower. “The practice is positively harmful.”

Anas Sarwar, Scottish Labour’s health spokesman, said: “These are deeply troubling reports that will concern patients across NHS Lothian and beyond. SNP ministers must investigate whether this is a one-off, or more prevalent across Scotland. NHS staff across Scotland are overworked, under-valued and under-resourced.”

The disclosure follows an investigation ordered by Shona Robison, the health minister, into evidence that waiting times at St John’s have been misreported. Staff at the hospital have raised concerns over boarding with Professor Derek Bell, from the Scottish Academy of Medical Royal Colleges, who is conducting the probe.

In 2009, a report commissioned by the Scottish government urged health boards to “eliminate” boarding as a solution to bed capacity problems, particularly during winter. A study on boarding by Dundee University in 2013 warned that changes in environment can increase the risk of falls and delirium among patients, raising the risk of serious injury and death.

Yet in December 2016, senior managers at St John’s issued an order to ramp up boarding to free up beds in the hospital’s medical assessment unit (MAU), which receives admissions from A&E.

An internal memo stated that people with impaired cognitive function were not exempt.

It read: “Ideally we aim not to board. However, when acute beds in MAU are not available because of downstream beds being full, it is safer to board established admissions than new admissions. With increasing pressure there needs to be an equitably applied escalation policy.”

Bell has also been told that patients in the MAU are subjected to “degrading” treatment because of pressure to move people out of A&E within four hours. The unit has gender-specific bays but it is claimed that men and women are routinely forced to share bed space and toilets. “It is degrading for patients and happens on a regular basis,” the whistleblower said.

Dr Tracey Gillies, medical director at NHS Lothian, said decisions to board patients were risk-assessed and agreed with clinical teams. “We work hard to ensure that more vulnerable patients, including older people and those with dementia, are not moved unless it is absolutely necessary.”

On gender mixing, Gillies said there were “rare occasions” when patients of the opposite sex were treated in the same bay, adding that “this is only done in extreme circumstances and they are moved to a more appropriate ward or bay as a matter of urgency”.

A spokesperson for Shona Robison: “We recognise that peaks in demand may require use of beds flexibly at times, however we are working to ensure that NHS boards are managing their capacity and ensuring that patients are admitted to the right beds at the right time with the right staff.”

NHS Lothian admits that its acute hospitals have “under- reported” patient treatment times. According to the latest weekly figures, 77.3% of patients were dealt with within the four-hour target.

‘Appalling’ treatment of NHS whistleblowers must be investigated: Staff ostracised by hospital bosses demand independent inquiry after ‘whitewash’ Francis Report

 

  • Freedom To Speak Up Review published report revealing culture of fear
  • Sir Robert Francis sought evidence from hundreds of doctors and nurses
  • Concluded whistleblowers ‘bullied and ostracised’ for speaking up
  • Scathing letter from three high profile whistleblowers calls for inquiry
  • Say their careers have been ruined and still no action has been taken 

NHS whistleblowers are demanding an independent inquiry into their treatment by hospital managers after a long-awaited report was declared a ‘whitewash’.

In a scathing letter to the report’s author, they accused him of failing to hold any managers to account and leaving patients at risk of serious harm.

The NHS’s ‘Freedom to Speak up Review’, which was published a fortnight ago, told how whistleblowers have faced a culture of ‘fear, bullying and ostracisation’ for daring to speak out.

But whistleblowers whose careers have been ruined said still no action has been taken to address the concerns about patient safety that they have been making for years.

Despite hearing awful reports about failures and cover ups over patients’ deaths, the report’s author Sir Robert Francis has ‘ignored’ their stories, they said.

Scroll down to read the letter in full  

NHS whistleblower Dr David Drew

NHS whistleblowers Sharmila Chowdhury

NHS whistleblowers Dr David Drew (left) and Sharmila Chowdhury (right) have written to Sir Robert Francis demanding an independent inquiry into their treatment by hospital bosses, after they spoke out to raise concerns over patient safety

‘We expected that you would have taken action in these matters which involved patient harm, death and fraud,’ the whistleblowers have written to Sir Robert.

‘Those responsible have not been held accountable. Lessons have not been learned. Patients and their relatives have not been told the truth.

‘We consider this failure to address our concerns a serious flaw in your review.’

The letter, which has been signed by three NHS whistleblowers, added: ‘We feel that we have not been taken seriously, which has been our experience as whistleblowers all along.

‘It seems appropriate to us that you allow independent scrutiny of all the submissions so that these matters can be addressed.’

Sir Robert was commissioned last June by the Government to head the review into whistleblowing in the NHS.

He previously led two inquiries into the scandal at Mid Staffordshire hospital, where 1,200 patients died needlessly.

Some 600 NHS staff spoke to the barrister and his team, who were also overwhelmed by 19,800 responses from other employees to an online survey.

Sir Robert reported that whistleblowers are too often derided as ‘snitches, troublemakers and backstabbers’.

He said many had, in effect, been blacklisted by the NHS, facing being ‘victimised’ by managers, forced out of their jobs and unable to find other work.

The barrister made 20 recommendations – including a ‘whistleblowing guardian’ at each hospital – which the Government has promised to enforce in an attempt to change the culture of silence in the health service.

Robert Francis QC, pictured, sought evidence from hundreds of doctors, nurses and other employees as part of the Freedom To Speak Up review into the treatment of whistleblowers in the NHS

NHS whistleblowers, however, have since confronted him, outlining their ‘serious concerns’ that his report has failed to address any of the specific concerns made by NHS staff about the alarming treatment of patients.

The letter has been signed by three high profile whistleblowers, including Dr David Drew, a top paediatrician who was sacked after claiming he had witnessed a cover up over a child’s death.

It has also been signed by Sharmila Chowdhury, a senior radiography manager who spoke out about a £250,000 fraud at her Trust, and a third colleague who asked not to be named.

Dated February 23, 2015, the letter states: ‘We have now had an opportunity to digest your report and have a number of serious concerns.

‘More than 600 individuals made detailed submissions to the quantitative review.

‘We suppose that many, like us, assumed that you would take these seriously as disclosures made in the public interest and act on them. That is what you told us when we first met you.

SIR ROBERT’S KEY PRINCIPLES

The Freedom To Speak Up review set out 20 principles to bring about change in the NHS.

They include:

Culture of raising concerns – to make raising issues a part of normal routine business of any well-led NHS organisation. Sir Robert suggests that every NHS trust should have an integrated policy and common procedure for all employees to formally report incidents and raise their concerns.

Culture free from bullying – freedom of staff to speak out relies on staff being able to work in a culture which is free from bullying. The report urges all trusts to consistently show intimidation and victimisation to be unacceptable behaviour.

Training – every member of staff should receive training in their trust’s approach to raising concerns and in receiving and acting on them.

Support – all NHS trusts should ensure there is a dedicated person to whom concerns can be easily reported and without formality. They should also provide staff who raise concners with ready access to mentoring, advocacy, advice and counselling. The report suggests each hospital appoint a freedom to speak up guardian to fulfill that role.

Support to find alternative employment in the NHS – where a worker who has raised a concern cannot, as a result, continue their role, the NHS should help them seek an alternative job.

‘You have allowed situations where patients are at risk and where managers act defensively out of self-interest to continue unaddressed.

‘Amongst the other 600 plus submissions there must be, and we know there are, more examples of fraud and unresolved patient risk.’

They went on to demand that the submissions are now properly dealt with under ‘independent scrutiny’.

After the report was published, there was particular unease about a key clause which advised whistleblowers not to speak to the press, saying they should only do so as a ‘last resort’ to avoid causing ‘considerable distress’.

Dr Drew told the Mail he was publicising the whistleblowers’ letter to Sir Robert because ‘the press seems to be the only way to squeeze the truth out’.

He added: ‘History will judge Francis badly. He failed whistleblowers and offered a get out of jail free for managers. And that adds up to failing patients. The whole point was patient safety but he ignored all our reports.’

In his review, Sir Robert said: ‘What I heard during the course of the review from staff, employers, regulators and unions and others leaves me in no doubt that there’s a serious problem in the NHS.

‘Too often, honestly-expressed anxieties have met with hostility and breakdown of working relationships. Worse still, some people suffer life-changing events, they lose their jobs, their careers and even their health.

‘We heard all too frequently of jobs being lost, but also of serious psychological damage, even to the extent of suicidal depression.

‘In short, lives can be ruined by poor handling of staff who have raised concerns.’

Health Secretary Jeremy Hunt told the Commons: ‘The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care.

‘The message must go out that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.

‘We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns.’

Last night, Sir Robert Francis said: ‘I was asked by the Secretary of State to review the way concerns are handled and how those who raised them are treated.

‘I was not asked to investigate or pass judgement on the concerns themselves and made it very clear to all concerned that I was not going to do so.

‘It would be inappropriate to comment on individual contributions, as these were shared with me in confidence.’

Health secretary Jeremy Hunt  told the House of Commons he accepts the 20 principles laid out in Sir Robert's review. He said legalisation to protect whistleblowers will be fast-tracked

Health secretary Jeremy Hunt told the House of Commons he accepts the 20 principles laid out in Sir Robert’s review. He said legalisation to protect whistleblowers will be fast-tracked

A Department of Health spokesman added: ‘Since Mid Staffs, there have been significant changes to make the NHS the safest and most transparent healthcare system in the world.

‘We are confident Sir Robert Francis’ recommendations will help create a more open and honest culture, and we want to change the law in this Parliament so staff feel more able to raise concerns — creating Freedom To Speak Up Guardians will also support them to do so.’

Responding the Dr Drew’s comments, a spokesman for the Walsall Healthcare NHS Trust said the issues Dr Drew raises have been addressed through two formal legal processes, ongoing since 2009.

He said: ‘In 2012 the case went to an Employment Tribunal and we are satisfied with the outcome of the case and that of the recent Employment Appeals Tribunal that dismissed Dr Drew’s claims.

‘We would like to reiterate that this case did not question Dr Drew’s skills as a paediatric consultant and on behalf of the Trust would like to say that we regret that the situation had to get to the Tribunal stage.

‘As a Trust we actively encourage and support our staff to raise an issue if they are concerned about patient care.’

Meanwhile, responding to Ms Chowdhury’s concerns, a spokesman for London North West Healthcare NHS Trust – which now includes Ealing Trust – said: ‘The Trust commissioned an independent report which was undertaken by Parkhill counter fraud services.

‘They found no evidence of wrong doing on the part of the two consultants named in the allegations.’

THE LETTER IN FULL: THREE NHS WHISTLEBLOWERS RAISE ‘SERIOUS CONCERNS’

Dear Sir Robert

Concerns about the Freedom to Speak up Review.

We are two of the whistleblowers who contributed to your Freedom to Speak up Review. We have now had an opportunity to digest your report and have a number of serious concerns. We deal with one of them in this letter.

More than 600 individuals made detailed submissions to the quantitative review. Most of these, as your report concedes, experienced victimisation after reporting concerns. In some cases you described this as ‘truly shocking’.

The concern we wish to raise with you here is about the disclosures made to you by these individuals. We suppose that many, like us, assumed that you would take these seriously as disclosures made in the public interest and act on them. That is consistent with the review procedure and what you told us when we first met you. Your report, however, makes no mention of the disclosures any of us made or what action you have taken.

Sharmila Chowdhury a senior radiography manager at Ealing NHS reported fraudulent claims by two senior consultants in excess of £250,000. She and two other whistleblowers have written to Sir Robert Francis raising concerns over his recent review of how the NHS treats staff who dare to speak out

Sharmila Chowdhury a senior radiography manager at Ealing NHS reported fraudulent claims by two senior consultants in excess of £250,000. She and two other whistleblowers have written to Sir Robert Francis raising concerns over his recent review of how the NHS treats staff who dare to speak out

Here are thumb-nails of the disclosures we personally made. These are serious and unresolved.

Dr David Drew: The cover-up of a hospital’s and a hospital consultant’s catastrophic failure that led to the non-accidental death of a 16-month-old boy. The hospital’s refusal despite comprehensive evidence to accept or investigate allegations of this cover-up. The failure of a Royal College of Paediatrics review panel to take evidence of this seriously and investigate.

Ms Sharmila Chowdhury: I was senior radiography manager at Ealing NHS when I reported fraudulent claims in excess of £250,000. This involved moonlighting whilst being paid by the trust, double claiming and claiming for overtimes not undertaken. I was dismissed following a false counter-allegation. I won my case at the interim relief tribunal. The large sums the trust was defrauded of have never been returned and the perpetrators and senior managers who covered this up have not been made accountable. I reasonably believe that this fraud may be continuing. 

Even these examples show that you have allowed situations where patients are at risk and where managers act defensively out of self-interest to continue unaddressed. Amongst the other 600 plus submissions there must be, and we know there are, more examples of fraud and unresolved patient risk.

Even if you considered, as you suggest in the conclusion of your report, that re-opening our cases would be too troublesome we expected that you would have taken action in these matters which involved patient harm, death and fraud. Those responsible have not been held accountable. Lessons have not been learned. Patients and their relatives have not been told the truth. We consider this failure to address our concerns a serious flaw in your review. We feel that we have not been taken seriously which has been our experience as whistle-blowers all along. It seems appropriate to us that you allow independent scrutiny of all the submissions so that these matters can be addressed.

We look forward to a speedy and comprehensive response.

Yours sincerely

Dr David Drew 

Sharmila Chowdhury

Read more: http://www.dailymail.co.uk/health/article-2971737/Appalling-treatment-NHS-whistleblowers-investigated-Staff-ostracised-hospital-bosses-demand-independent-inquiry-whitewash-Francis-Report.html#ixzz50zUF1ezB
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Whistleblower forces hospital A&E waiting times review 

STV News  17 November 2017

Hospital: A whistleblower contact Ms Robison in October
Hospital: A whistleblower contact Ms Robison in October CC / Anne Burgess 

The Health Secretary has ordered an independent review after a whistleblower claimed long A&E waiting times at a hospital were being under-reported.

Shona Robison told NHS Lothian to carry out a full investigation after she was contacted about St John’s Hospital in Livingston last month.

The whistleblower suggested staff in the emergency department felt pressured to achieve the four-hour access standard and the number of patients waiting longer than four hours had been understated in performance reports.

Early findings from the internal review showed staff at St John’s have been applying locally-produced guidelines on how to record patients who breach the four-hour access standard which do not comply with national guidance.

It meant some patients who may have been recorded as breaching the waiting-time performance target were not included in departmental performance reports.

These are serious allegations and the early findings are clearly a cause for concern.’

Shona Robison

After the interim findings confirmed areas of concern, Ms Robison asked the Scottish Academy of Medical Royal Colleges, chaired by Professor Derek Bell, to undertake an external review to investigate the full circumstances.

She said: “These are serious allegations and the early findings are clearly a cause for concern.

“That is why I have asked Professor Bell to lead an independent review of these allegations.

“We are working very closely with the board to ensure that lessons are learned from the investigation and recommendations made are fully implemented as soon as possible and shared across NHS Scotland.”

The review will report back to Ms Robison early in the new year.

The initial draft report noted no evidence of bullying or harassment was found during interviews with staff and that busy staff had produced their own reference guides for inputting information into the data recording system.

But the report stressed the guidance sheets were only “created with the best intentions of clarifying arrangements”.

Jim Crombie, deputy chief executive of NHS Lothian, said: “NHS Lothian is committed to the values of openness and transparency, and we have placed them at the heart of our organisation.

“We actively encourage our staff in NHS Lothian to highlight issues relating to patient safety and we take any allegations of misconduct or wrongdoing very seriously.

“We have a robust whistleblowing policy in place to ensure that all our staff are supported and feel able to raise any concerns, and I am encouraged that staff are able to discuss them.”

Mr Crombie said an internal audit team, headed by a senior non-executive director, was appointed as soon as the concerns were raised.

He added: “We will co-operate with and support the work being carried out by the external review team.”

Scottish Labour’s health spokesman Anas Sarwar said: “These are deeply troubling findings that will concern patients across NHS Lothian and beyond.

“It is absolutely right that they are independently investigated.”

‘Despicable’ fraud costs NHS in England £1bn a year

BBC News    1 November 2017

NHS wardImage copyright  GETTY IMAGES

More will be done to protect the NHS in England from “despicable” acts of fraud, the head of the health service’s new anti-fraud body has said.

Sue Frith promised a crackdown as she released figures suggesting the yearly bill for fraud in the NHS topped £1bn.

Cases include patients falsely claiming for exemptions on dental and prescription fees, and dentists charging for work they had not done.

Ms Frith said the fraud takes vital funds from front line care.

Ms Frith, the chief executive of the NHS Counter Fraud Authority, said it would be looking at new ways to fight the crime.

The analysis by her team estimated that £1.25bn of fraud is being committed each year by patients, staff and contractors – the first time the health service has put a figure on total fraud committed itself.

The sum represents about 1% of the NHS budget

Presentational grey line

The most common frauds

The two biggest single areas of fraud were related to patients and procurement of good and services, both of which was likely to cost the NHS in excess of £200m a year each, according to Ms Frith.

She said patient fraud included cases where people wrongly claimed for exemptions for the cost of things like prescriptions and dental fees.

Meanwhile, payroll fraud was thought to be costing £90m a year, while dentists were said to be claiming around £70m in work on NHS patients that has not been done.

Dental fillingImage copyright  DR P. MARAZZI/SCIENCE PHOTO LIBRARY

 

Ms Frith said: “People may think it is just a small amount, but in large volumes it adds up and has an impact. It is criminal behaviour.

“It is despicable people would even claim things they are not entitled to. This is money that should be spent on front line patient care.”

She acknowledged the NHS must do better at detecting and preventing fraud.

Last year investigators successfully pursued cases worth £9.6m, although another £30m of cases are pending.

But this is only a small fraction of what she suspects is out there.

Ms Frith said the £1.25bn was probably on the conservative side – previous estimates by experts have put it even higher.

She believes the new organisation, which is officially formed on Wednesday, will be able to improve on this detection rate.

It has been given independent status and allowed to focus solely on fraud.

Its predecessor organisation, NHS Protect, also covered security.

Responsibility for security has now been devolved down to local NHS trusts and the budget for tackling fraud increased by over 10%.

This will also mean more field officers to be appointed to gather evidence, as well as a greater effort on fraud prevention by reviewing contracts and systems put in place to safeguard against fraud, she said.

Badly-behaved surgeons are ​putting patients’ lives in danger ​due to ‘culture of bullying’, report finds

The Telegraph  Science  

The Royal College of Surgeons Edinburgh (RSCE), which represents members across the UK, said a “visceral” atmosphere of fear among younger surgeons is leading to failures in concentration that directly harms patients

The Royal College of Surgeons Edinburgh (RSCE), which represents members across the UK, said a “visceral” atmosphere of fear among younger surgeons is leading to failures in concentration that directly harms patients.

In a new report, the college also warns the profession’s “macho” attitude makes it difficult to challenge bad practice, a culture which enabled disgraced breast surgeon Ian Paterson to mutilate victims unchecked for two decades.

It follows research published in June which found that one in six trainee surgeons are suffering from battlefield-type Post Traumatic Stress Disorder

Senior doctors have warned that the bullying culture among surgeons is negatively affecting recruitment, making entry into the discipline less competitive.

RSCE is calling for bullies to be removed from their posts and has set up a task force to send into affected hospitals.

The sentencing of surgeon Ian Paterson has once again raised the issue of bullying and undermining in healthcareProfessor Michael Lavelle-Jones

Dr Alice Hartley, a Newcastle-based registrar who co-chairs the college’s trainee committee, said a senior colleague had flung instruments at her during an operation after she asked a question, a situation she described as “not uncommon”.

In another incident, a surgeon slapped her hand as she was preparing to make an incision.

She said fear of older colleagues was forcing junior surgeons to cut corners, such as avoiding asking for advice in complicated cases.

“It’s getting more and more of an issue,” she told The Sunday Telegraph.

“If you’ve been shouted at first thing in the morning you carry that with you for the rest of the day. You won’t be concentrating on your job.”

Last year’s NHS staff survey found that, across all disciplines, one in five doctors had suffered bullying.

However, previous research indicates that surgical trainees are three times more likely to suffer abuse and that as many as 27 per cent of patient deaths during or shortly after surgery can be attributed in part to “disruptive behaviour”.

Victims who gave evidence to the RSCE said they had surgical leaders had spread false rumours and publicly humiliated them after they asked awkward questions.

Earlier this year West Midlands surgeon Ian Paterson was jailed for 20 years after being convicted of deliberately performing unnecessary and incompetent operations on 10 patients, although the true number of his victims is estimated to be several hundred.

Campaigners for the victims have called for the system, which allowed his butchery to go unchallenged in both the NHS and private sector, to be overhauled.

Last night RSCE leaders directly linked the current bullying culture with the risk of another rogue surgeon.

Earlier this year West Midlands surgeon Ian Paterson was jailed for 20 years after being convicted of deliberately performing unnecessary and incompetent operations on 10 patients
Earlier this year West Midlands surgeon Ian Paterson (pictured) was jailed for 20 years after being convicted of deliberately performing unnecessary and incompetent operations on 10 patients CREDIT:JOE GIDDENS/PA WIRE

Professor Michael Lavelle-Jones, President of RCSE, said: “The sentencing of surgeon Ian Paterson has once again raised the issue of bullying and undermining in healthcare, and highlighted the terrible consequences that this behaviour can have for patients.

“We want to change the culture of healthcare to ensure that this kind of behaviour becomes so unacceptable it can no longer go on.

“As professionals, we have a duty to protect our patients from damaging and unnecessary treatments, and, as professionals, we have a right to be protected from being bullied and undermined.”

The college wants the General Medical Council, which regulates doctors, to introduce compulsory training on bullying in Foundation Year training.

Chris Massey, GMC Chief Executive, said bullying and undermining behaviour should “never be tolerated”, but said the organisation’s standards already made it clear that medical training environments should encourage trainees to raise concerns about patient safety.

“We welcome the college’s efforts to build on those standards and tackle bullying and we are keen to support those delivering training to raise awareness of the issue,” he said.