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Everything we have been saying is true: SIN has been vindicated, as have all the other brave patients who have been protesting about the dangerously low standards of medical care in the NHS. Now European doctors are exposing these poor standards which are caused more by entrenched arrogance, unprofessional attitudes and a blatant disregard for the needs and safety of patients - rather than by a lack of money!

Alain Sanouiller, 42, a senior French doctor who has studied at Harvard and has been a doctor in the Foreign Legion, was brought in to shake up GP services in Central London and he also worked in several Outpatient Clinics, has resigned in disgust after only a few months. He was based at Westminster Primary Care Trust which covers staff working at Buckingham Palace as well as Whitehall and the Palace of Westminster, St Mary's Hospital etc. - hardly the poorest parts of London! Managers of the Westminster Trust have blamed his departure on a 'personality clash'. He plans to reveal his experiences in the French media.

Dr. von Lucken is a German orthopaedic specialist who worked in an NHS hospital. In one week he halved the waiting lists, examining 87 patients with hip, knee and ankle problems out of a queue of 200 who had been waiting up to six months. Dr von Lucken from Hanover said he was treated with open hostility at the Royal Hospital Haslar in Gosport, Hampshire, particularly by senior consultants.

German Medicine Net, another firm that has brought doctors to Britain to tackle NHS waiting lists, have found that efforts have been repeatedly thwarted by resistance from local hospital specialists.

A study by the Paris based organisation for Economic Co-operation and Development earlier this year found that the British health care system was one of the least effective in Europe in terms of the amount of work carried out by doctors. The NHS was ranked alongside the health service of Hungary, one of the poorest nations on the Continent.

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This appeared in the Labour Party Conference Issue dated 30th September, 2002. SIN was informed that this magazine would had a readership of 15000, because it was given out to all the delegates at the Party Conference. In addition it is sent to all the Ministers, civil servants, Chief Executives and to the Welsh Assembly the Scottish Parliament and to the European Parliament.

This statement appeared just after the SIN Demonstration ( 15th April 2002) and was published in the 30 th April 'Health Issue' and also in the House of Lord's Colour Magazine, which has a shelf life of one year.

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After 50 years the NHS faces reform at last - new consultants' contracts, which took two years of hard negotiating with the BMA, the doctors' Trade Union, have been drawn up together with more money. It was Aneuryn Bevan who had the hard task of getting the fledgling NHS off the ground in 1948, and he made the memorable statement that he was only able to achieve this by "stuffing the mouths of the consultants with gold".

The BMA 'Consultant's Committee had arranged a series of meetings around the country to explain the new reforms to groups of consultants. The Consultant's Committee, under the Chair of Dr. Peter Hawker, recommended acceptance. A vote was taken. Northern ireland and Scotland accepted the reforms - the consultants of England rejected the Reforms by a 2 to 1 majority. The Chair of the BMA Consultants' Committee resigned.

Why the discrepancy? One theory is that England, being more populated and wealthier has more private practice and so the English consultants disliked the fact that the new NHS contracts would restrict the time available for lucrative private practice.

It is very difficult to ascertain the exact nature of the proposed Reforms, but from various media outlets it would appear that the Reforms a great deal more money for more contracted NHS:

In the NHS Plan 2000 the Secretary fo State for Health had warned that; " new contracts would ensure that the right to undertake private practice will depend ,,,,,on fulfilling NHS service requirements." One would have thought that this was a reasonable proviso.

Quote from senior D.o.H. sources: "This is not about going to war with the BMA ( Trade Union) or with the consultants. It was about finding a system which rewards the productivity of those doctors who do most for NHS patients." FT 2nd. Nov. 2002. Who could disagree with this?

Another D.o.H. quote :"Consultants elsewhere in the world and in the private sector here get paid for work done, not just for turning up". " From now on, consultants who get results will be paid for delivering that better service. We will consult on this, but ultimately we intend to impose changes and get rid of Spanish practices like consultants counting travelling time to their private work as NHS time."

Another quote from D.o.H.: "We do not intend to discuss this new plan with the BMA. First we do not know who to discuss it with and second, the national contract is dead".

"Latest figures reveal NHS has more bosses than beds" Sunday Times Dec 29th 2002

Extracts:
"Official figures reveal that for the 199,670 beds currently available there are now 211,650 staff classed as managers, adminstrators or clerks - an all time high....

NHS managers more than doubled in the past decade to 27,000 whilst the number of beds fell by almost 59,000.

A consultant in London, said: " We have people called patient pathway managers - uneducated individuals being paid £35,000 - £40,000, and trying to work out what they are meant to be doing."

Management journals are packed with advertisements for NHS "information analysts", "service managers" and " access managers" as well as " programme facilitators". Salaries for these posts range up to £60,000.

The Chief Executive from the Confederation of NHS Managers, Gill Morgan, said:
" One person may be responsible for collecting four pieces of information but if lots of people are doing that, you risk a situation where vast amounts of data are being gathered, possibly for no reason."

To add to the numbers, a new tier of auditors is being recruited to track the extra £40billion of healthcare expenditure accounced in this year's budget."

SIN's comments:
In spite of the steady increase of managers over the last decade, medical errors have proliferated - 34, 000 patients dying needlessly every year in UK hospitals and 46,000 patients being needlessly seriously and permanently damaged.

5000 dying every year in UK hospitals because of super -bugs.Standards of hygiene and patient care have been exposed as disgraceful. Instances of appalling abuse of the elderly have come to light with many being wilfully starved and dehydrated.

Standards in UK health care are some of the lowest in Western Europe with little or no protection for the damaged patient because there is no accountability

What good have all these managers been? SIN believes that fewer but stronger mangers are needed to scrutinise clinical governance and to have the gumption to challenge poorly performing or abusive health professionals and to oversee that hygiene standards are satisfactory. We also believe that it is necessary to scrutinise the £40billion extra money allocated this year to improve the NHS - the NHS has a reputation of being a 'blackhole' into which money disappears without trace.

Money is often not the problem it is poor management. Severe sanctions should be taken against any manager who fails to investigate thoroughly and impartially any complaint brought by an agrieved patient or relative. Chief Executives of Health Authorities and Trusts have the power to: discipline any malfunctining health professional; to report any health professional to a professional regulatory body; to start criminal proceedings and to ask the Sec. State for Health for an Inquiry. Few, if any do this -instead they actively protect the malfunctioning health professional thereby putting patients at risk. Poor management must take responsibility for the present low standards of health care within the NHS. The prime concern for these managers must be to maintain quality health care for patients.

January 4th 2003

Is a Patient Compensation Fund Imminent?
" Milburn eyes no-fault system for settling NHS Claims"

by Kamal Ahmed, The Observer 29th Dec. 2002

This is Good News!

SIN has been campaigning for a victim's compensation fund for nearly 4 years. This has been one of our major 'Aims & Objectives'. Patients and their relatives can accept that a medical mistake has occurred, but they cannot cope with the trauma caused by the denial and cover-up which inevitably follows and the withholding of the truth and remedial medical care for a seriously ill patient because the victim is perceived as being a potential litigant, and to give medical care would be to expose the damage sustained. SIN believes:

".....that a victim's compensation fund will transform the present culture of denial and cover-up to one of openness and honesty when mistakes are readily admitted. Irrespective of the cause of iatrogenic damage the patient has a right to the truth and should receive appropriate compensation. The establishment of such an initiative will be a milestone in the history of the NHS and will revolutionise the equity of the doctor/patient realtionship, bringing the UK into step with its European counterparts and the NHS into the 21st. Century. All this will mean changing the 'mindset' of 50 years. This new approach to iatrogenically damaged patients is imperative to ensure that the basic human right to adequate health care is upheld. (Article 25 Universal Declaration of Human Rights, UN 10.12.48). ( Quote from SIN's Paper 3 'Balancing the Scales' Para 7.3 March 2002)

If such a scheme was introduced, a damaged patient could then be told the truth about their medical condition and have immediate access to remedial health care because they would no longer be perceived as being a potential litigant. Certainly, at the moment, no health professional rushes round to inform the patient or relatives that serious damage or death has occurred due to a medical error. At the moment they have to fight for truth, justice. and health care!

The Chief Medical Officer suggested that SIN submit its ideas for such a fund in view of the fact that the D.o.H. was reviewing the whole of the medico-legal payout system for damaged patients. SIN was pleased to submit in March 2002 our Paper 3 " Balancing the Scales" which puts the case for a victim's compensation fund. This Paper is available on the website for anyone who is interested to read.

Extracts from the above newspaper article ( our comments in red):
" The multi-million (multi-billion?) pound system of medical negligence claims is to be overhauled and replaced by a 'no-fault' ( we are not sure what this means) compensation scheme and staggered payments under plans being considered by the D.o.H.

In a major reform of the way victims are compensated for hospital mistakes, Alan Milburn, the Sec. of State for Health is now considering a streamlined process which will mean patients will no longer have to spend thousands in legal fees battling through the courts to prove their cases. ( SIN is certainly in favour of this).

Officials involved in drawing up the plans said that they wanted to get away from the 'blame and shame' culture ( what 'blame and shame' culture ? - very few if any malfunctioning health professional is named and shamed.However, there is an insidious culture of 'denial and cover-up' which is pervasive througout the NHS and this new scheme should, hopefully, bring this to an end) of the present system in which the NHS shies away from admitting liability for fear of huge payouts ( 'defending each case to excess', as Lord Woolf put it in his inaugural lecture - or defending the indefensible as we would put it - no qualms, though, at using up huge amounts of tax-payers money in unnecessarily long legal battles).

One scheme under consideration is capping compensation claims at £500,000 with extra help and support for those who have suffered medical errors Critics say that a 'no-fault' scheme could mean lower payouts for patients and deny people their right to a 'day in court'. (The vast majority of damaged patients get nothing, and since hardly anyone can afford to go to court, few achieve this mythical 'day in court'. According to Lord Woolf only 17% of those who do take legal action actually win their cases. As far as the huge payouts are concerned, -which are given headline news - these are for the very few and we believe they simply suck in more innocent victims into the medico-legal merry-go-round when the only sure winners are the lawyers and expert witnesses.. SIN would say that the medico-legal route is 'rigged' against the patient. Lord Woolf goes so far as to say it is biased in favour of the medical profession and to quote: "...the courts can no longer rely on the hospitals and the medical profession to resolve patients' justifiable complaints justly".

There are also plans for a small claims system which would fast track minor cases and an indpendent mediation service which would allow patients and doctors to avoid lengthy and expensive court cases. ( Mediation has been avaiblable for a number of years and the D.o.H. has expressed its surprise that it has been used so little. The reason for this, of course, is that patients have been unaware of its existence although medico-litigation firms and organisations such as AVMA,( Action for Victims of Medical Accidents) claiming to be in support of damaged patients, have been well aware that Mediaiton has existed, but have failed to make this currently available mediation service known to its clients. Could it be that the medico-legal fraternity are aware that mediation would speed up legal cases and thereby reduce their potential fees? Patients might well be able to dispense altogether with their services? There is widespread criticism of the standard of the medico-legal representation in he UK).

NHS liability for medical claims has also been soaring. Earlier this year it was revealed that if the health service had to pay out on every claim presently outstanding it would be left with a bill of more than £8billion. ( This suggests that the NHS Litigation Authority is fully aware of all the justifiable outstanding cases of damage warranting compensation. Why not simply be honest and fair and pay the bill? It is very difficult to obtain the true figures for NHS litigation costs. A figure of £4billion pounds for last year has been mentioned (tax-payers money). However, most of this we believe will be for legal fees, in addition there is probably a similar sum being paid out by the Legal Aid Board ( tax-payers money, again) and from private funding. If this is so, then the real annual bill is nearer £8billion - and most of this we believe is going into the pockets of the lawyers. We are all for down grading the legal route - after all the Trusts and Health Authorities are only too well aware of the truth about every case of damage - why not try a bit of honesty and allow the patient to benefit and not the lawyers? It is the tax-payer who is funding this huge litigation bill.

We understand that anyone whose case is funded solely by Legal Aid, is unable to scrutinise the bill - the lawyer can present any amount unchallenged to the Legal Aid Board. Effectively it is a 'blank cheque'! We have heard of one case which involved a lawyer obtaining the patient's records (which the patient could have got for about £50) paginating them, obtaining a favourable expert witness' report and a barrister's conference, when it was advised that the case be dropped. The bill to the Legal Aid Board for all of this ? - a wopping £150,000 !!! Unbelievable! We are amazed that the patient was ever allowed cast eyes on this bill).

David Lammy is the Health Minister in charge of the criminal negligence system, made it clear that the Government wanted to act on the burgeoning cost of the pay-outs. Lammy said that the Chief Medical Officer, Sir Liam Donaldson, had been asked to review the present system and come up with recommendations. His report has now been passed to Milburn and an announcement is expected early in the new year.

In 2001 Professor, Sir Ian Kenndy's report on the deaths of babies undergoing heart operations at Bristol Royal Infirmary demanded an end to multi-million pound compensation claims so that doctors could admit mistakes without being dragged through the courts. ( Only a fraction of cases ever get to court!). " We are keen to see greater use of structured settlements or periodic payments instead of lump sum payments, "Lammy said. " These allow part of any award to be paid in the form of tax-free installations for the duration of the claimants life."

SIN suggested that " First and foremost there should be a legal obligation to inform patients of any treatment related damage and the patient to be given counselling if needed. The level of compensation to be determined from a scale of damages predetemined by a national tariff. Most cases should be settled within 3 to 6 months. All health professionals involved in medical mistakes should have counselling available and should also be obliged to meet the patient in order to apologise, if this is what the patient wishes. This would be therapeutic for both patient and health professional. All seriously damaged patients and the relatives of those who have died should also receive counselling. Genuine and appropriate specialist remedial care for the iatrogenic patient will be guaranteed". Taken from SIN's Paper 3 'Balancing the Scales' March 2002

"SIN does not advocate a 'no blame culture' and believes that 'blame' is an emotive word that should not be used. 'To blame' mean to hold someone or something 'accountable' or to hold someone or something 'responsible'. To advocate a 'no blame culture' actually means advocating a 'culture of no responsiblility', a culture of 'no accountability'. Which respectable profession could ethically demand this and expect the public to accept it? We are not proposing vindictive sanctions, but as the medical profession does have the power of life and death, it is only reasonable that such a profession is carefully monitored and controlled. SIN and, we believe, most patients wish to see a culture of personal responsibiltiy and accountabiltiy with sensible remedial actions/ sanctions taken when things go seriously wrong and patients being fully informed. " Quote from Paper 3 'Balancing the Scales'. March 2002

SIN believes that parallel with the patient being informed when a medical error has occurred causing serious damage, a full investigation should taken place to establish the cause of the error and accountability so that 'lessons can be learned'.

Over the years, the costs for compensation will be reduced as procedures will be in place to reduce the number of serious medical errors causing deaths and damage. Patient safety will improve considerably. We reiterate: patients can cope with the original mistake, it is the subsequent denial and cover-up which causes the trauma - no health professional or administrator should be obliged to lie or to become involved in unethical and unlawful cover-ups.