• Woman's Hour Interview

 
• SIN Conference Report

 
•     Summary  of SIN's activities

 

Alan Bedford, a spokesman for the NHS Confederation which represents Health Service Managers, is also Chief Executive of East Sussex, Brighton and Hove Health Authority and joins us on the line from Lewes. Gillian Bean is co-founder of S.I.N. - Sufferers of Iatrogenic Neglect, a patients campaign group - she's on the line from Nottingham.

P. Gillian, it sounds on the surface a good idea to get as many patients as possible sorted out at a local level without having a legal battle and expensive enquiries.

G. Yes, indeed it does - and thank you very much for inviting us on the programme - but we have found , in the experience of our members, that local resolution may well work when its a very minor complaint but if you are dealing with a serious complaint about substandard medical care then in fact, in our experience, it is very loaded against the patient and we cannot get a fair hearing.

P. How is it loaded?

G. Because after the local resolution you may or may not be able to meet with the consultant, usually you cannot. You then go to a meting with the medical director present . You find that when the transcripts of these meetings are issued, they are a travesty of what has really happened. There are omissions, usually of what the complainant has wished to point out, there are misleading statements, there are indeed at times fabrications. Now the patient then has to complain about the transcript which is only issued on the approval of the clinician.

P. A number of problems there in terms of the actual procedure. And also, Alan Bedford, there's been a couple of studies done by the Public Law Project and Help the Aged where patients generally felt intimidated because they felt there was a kind of imbalance of power between the patient and the doctor.

Ch.Ex. We understand that patients who have had disappointing experiences during their treatment are going to feel very suspicious that the complaint is going to be dealt with properly. But I have to say that I don't recognise the process that Gillian describes at all. I think the system, if properly run, is very fair to the patient. There's an element of independent review at many stages in the enquiry. I mean, for example, if there is an independent review panel, it is chaired by an independent person, independent of the Health Authority.

P. Now you're talking about the second stage.

Ch.Ex. Yeah, so I think the lady we were speaking to must be saying the same thing as well. There is an awful lot of independence. The Health Service would not in any way condone misleading statements. But there is a very careful considered process and I think it is working well, although it could work an awful lot better. 

P. Well, Gillian, patients can always go to independent review can't they if they have got problems? 

G. Yes we can, although I would suggest to Mr Bedford that he gets in touch with our group so we can furnish him with evidence which will show very clearly that what I have said are the facts of the situation.

P. Okay. What about the broader point that there is independence in the complaints procedure? 

G. You can go to an independent review, however you have to bring in a convenor. This is a member of the board, a non-executive member of the board, so they are hardly impartial. The convenor decides on the terms of reference, not the complainant, and will have to get advice on a clinical matter.

P. So, Alan, if you've got someone who is a member of the Health Trust or the Authority who's deciding whether the complaints proceed, is that impartial?

Ch.Ex. Well, I can understand that some patients would think it isn't impartial, but the convenors are non-executive directors of Health Authorities, they are not members of staff. They are appointed by the Secretary of State to have an independent overview.

P. They're not paid?

Ch Ex. There is an honorarium for non-executive directorship to cover the time that they are giving. But in my experience they take the role very seriously. They have to consult an independent chairman, nothing to do with the hospital whatsoever, before they come to the conclusion about whether an independent review is set up. But I think, but what I'd like to say is the most important thing as far as hospitals and community services are concerned is that they operate a complaints procedure with sensitivity, that they do understand and show they understand how anxious the complainant can feel.

P. Is that the experience of people who come to your group?

G. Oh no it isn't, quite the reverse. They are in absolute despair and trauma because they also find that their medical care is jeopardised because they have complained. And in fact, the non-executive member, the convenor, has to seek clinical advice and goes in fact to the medical director of the very Trust against which the complaint is being made; and it is that clinical director who will decided whether there is a clinical problem and you can then go to a professional review. But in fact it means that this independent professional review has very few sanctions. 

P. That's rather a frightening idea Alan for patients, the idea that their medical care could suffer if they dare to complain?

Ch Ex. Well I would be horrified if I ever discovered that anyone's medical treatment had suffered as a result of their complaint. I understand that many patients are anxious about complaining against clinicians in case it somehow affects their treatment. But I think I would have to say that 999 out of 1000 clinicians would act in the most professional way possible, would understand the complaint had passed the natural process that we should expect.

P. Gillian, what would you like to see to replace the current procedure?

G. Right. I refute all that actually and even if you go to the ombudsman, he is not actually allowed to investigate a complaint where a complainant has a remedy by way of proceedings in a court of law. So our members find you cannot take a serious complaint through the complaints procedure.

P. Okay, so what's the answer then?

G. Right. An independent statutory authority to fully investigate complaints. This authority should have the power to take disciplinary action against any doctor or manager who fails to fully co-operate and/or mislead during the course of any investigation.

P. Alan, why not have an independent authority like that?

Ch. Ex. I think if we had an independent authority, it would mean setting up a huge, new, expensive bureaucracy rather than dealing with complaints near the point of the complaint. The people who know most about the service are those working in the local service and provided that there are safeguards like bringing in independent clinicians, independent chairpeople, independent reviews at the appropriate time, its much better to deal with things locally than create some new bureaucratic monstrosity.

P. Surely Gillian, just finally, more red tape is the last thing the NHS needs?

G. Well I would agree if it worked, but it doesn't work. And the other thing we wish to have is a total review of how iatrogenic damage is dealt with in this country. We suggest that doctors instead of trying to cover up and deny mistakes, will admit they have mistakes and get a victims compensation fund set up, part paid for by the taxpayer and part paid for by the medical-legal organisations.

P. We'll have to leave it there. Gillian Bean, Alan Bedford, thank you for joining us and if you'd like more information about what we have been discussing, call the information line on 0800 044 044.
 

A very successful Conference was held by S.I.N. ( Sufferers of Iatrogenic neglect) in Birmingham on 25^th. September. S.I.N. is a pioneering UK group with a rapidly growing membership to support patients who feel that medical mistakes or intervention has worsened their health problems. The Conference was very well attended with representation from seven other UK patient support groups, some of which deal with specific medical conditions. All of these attending the conference were dissatisfied with the health care they or their relatives had received under the NHS. 

From these few press headlines:

"HOSPITAL DOCTORS LEARN HOW TO KILL, WHILE THE LAW-MAKERS LOOK AWAY". Sunday Times 28^th march 1999-09-28 Melanie Phillips

"HALF THE DRUGS USED TO TREAT SICKCHILDREN ARE UNTESTED" Jenny Hope, Daily Mail

"PURGE OF ROGUE DOCTORS "- Guardian 23^RD. 1998, David Henke

"STAFF BULLIED AND INTIMIDATED AT HEALTH TRUST, STUDY FINDS" Yorkshire Post 3^rd. Sept. 1999 by Mike Walters.

"DOCTORS FACE SPOT CHECKS ON DRINKING": Sunday Times 1/8/99, Oliver Wright

"THOUSANDS IN WORSE HEALTH AFTER HOSPITAL":Sunday Telegraph 8/11/98, Victoria MacDonald

"SICK TOURISTS TOLD TO FLY HOME RATHER THAN RISK NHS" The Sunday Times 29/8/99

MISTAKES ARE MADE EVERY DAY IN OUR HOSPITALS & GP SURGERIES. THIS IS A FACT. At the recent BMA Conference in June this year it was estimated that 800 mistakes were made every day in our hospitals. This amounts to over a quarter of a million annually. These do not include GP mistakes. Of these a proportion of patients will have suffered serious damage. The delegates are concerned that the problem of iatrogenic damage - i.e. medically induced damage is not being addressed. Patients can accept that mistakes occur, they cannot accept the denial and dangerous cover up which inevitably follows.

It was obvious from presentations and individual comments that the NHS Complaints system was failing to address these serious problems relating to clinical judgement. It also highlighted the lack of accountability of doctors and senior management. This serious state of affairs was endorsed by a representative of the Ledward Victims Support Group who wanted to know: "Why did no one listen to patients' complaints about Ledward's surgical incompetence for 18 years? Only when a doctor blew the whistle, when he was no longer able to cope with patching up Ledward's mistakes, was action taken". MANAGEMENT AS WELL AS HEALTH PROFESSIONALS SHOULD BE HELD ACCOUNTABLE.

Common experiences in accessing medical records Under the Access to Health Records Act 1990 included:

The 40 days maximum time given for release of records, as laid down by law, was HABITUALLY breached. Delegates wondered why Medical Record Departments were allowed to break the law?

Records were incomplete and the items missing were always related to the iatrogenic damage.

Overwhelming numbers of delegates reported that their medical records both GP & Hospital had, to their knowledge, been changed. This is immensely serious. A question was asked in the House on 16^th March, 1999. The reply from the Minister of Health, Mr. Denham to the House " There was no evidence that tampering occurs to an extent that would warrant a national assessment". S.I.N. will call for a reconsideration of this statement.

For those few who can afford to go to law, the way is fraught with difficulties and obstacles:

Delegates revealed that they had been so dissatisfied with legal representation that they had been forced to use three or four solicitors. Many considered suing their solicitors.

There was great difficulty in finding medical experts and when found their reports were often ambiguous and misleading, which thwarted legal action.

The Conference highlighted the variety of causes of iatrogenic damage. S.I.N had members in all categories.:

Misdiagnosis
Inappropriate or unnecessary drugsLack of treatment or inappropriate treatment
Unnecessary /wrong and/or incompetent surgical procedures.

The Conference concluded with the delegates agreeing that new safeguards for the protection of patients are urgently required following the collapse of confidence in the NHS Complaints Procedure and The General Medical Council ( GMC). The action plan suggested to ensure future patient protection was as follows:

The need for a setting up of an Independent Statutory Inspectorate with patients' rights to heath care laid down in law, with the committee to include patients from the patients' support groups. Management as well as health professionals to be held accountable.

The access to Medical Records immediately after any consultation, signed and checked by patient.

Protection for whistleblowers- both health professional and patient. Patient groups were recording that doctors had been in touch giving and seeking support because they were experiencing widespread and continuing intimidation from colleagues and management.

S.I.N. and all other Patient Groups attending the Conference expressed their full support for all good doctors and nurses and in particular the doctors who have had the courage to whistle blow in order to protect their patients. The health professional who whistle-blows puts his/her career in jeopardy whereas the whistle-blowing patient who complains about substandard medical care is victimised and effectively denied genuine specialist medical care .

Concern was expressed at the high cost of medical litigation, the current bill running at £2.8bn with only a small fraction of this amount reaching the damaged patient. Attention was drawn to John Elder's book: "Who cares about the Health Victim?" * which clearly set out alternative and more civilised ways of coping with iatrogenic damage currently in use in other democratic countries.