THUMBS DOWN TO BRITISH
HEALTH CARE BY EU DOCTORS
doctor quits NHS in disgust" - The Sunday Times 3rd Nov.
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.
What did Dr. Sanouiller discover?
What did a Dr. Ingo von Lucken from Germany discover?
- he immediately identified 110 people who were receiving sub-standard
treatment and 12 who had to be recalled urgently!
- he claimed that 90% of patients treated at Outpatients
Clinics were receiving inadequate care, with up to 15% being 'put
- he found his efforts to cut four-hour waiting times at outpatients
clinics at St. Mary's Hospital were resisted
- none of his recommendations were implemented
- not enough staff to monitor chronic conditions of kidney function,
diabetes, cardiac or even for basic eye tests
- he wanted to put the patient first, which is the dictum in France,
but the system here did not allow him to do that
- he found that the current difficulties of the NHS are
not just about funding, there is also a problem of behaviour, lack of
co-operation and resistance to facing new challenges.
- doctors in Britain are paid up to 50% more than their French counterparts
( and this is before the new deal which has been refused)
- he runs a medical recruitment company and can no longer
hire doctors from France and Germany to work in the UK, because
they will not be able to do the job right - obviously the motivation
is not money for these doctors!
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.
HALF PAGE STATEMENT IN HOUSE OF COMMONS MAGAZINE
ACCESS TO POLICY MAKERS
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.
FIRST STATEMENT IN
HOUSE OF COMMONS MAGAZINE
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.
Mr ALAN MILBURN - REFORM AT LAST
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
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
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:
DOCTORS ARE ALREADY PAID 50% MORE THAN FRENCH DOCTORS
- The is a new fund
of £300 million earmarked for the Reforms
- Salaries could
increase by 15% to 24%. For example a Consultant Radiologist, now getting
£71,000 would get an increase of 18% taking the salary to £83,780.
- for this money
consultants would have to do more hours in the NHS. Taking the above example,
the Consultant Radiologist would have to work for 40 hours per week rather
than for the present 38 and a half hours. On the surface this would seem
to be a very good deal.
- extra time 'on
call' - would give an automatic increase of another 10% taking the
salary up to £92,158 ( if our calculations are correct) This example
taken from Financial Times 2nd November,2002
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.
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".
The 'merit award' system is seen
by critics as a covert old boys'/girls'club that has no
- Mr Milburn is to force through hospital consultant reform
- no more negotiations
- the £300 million will be used for this purpose +
- Mr Milburn also plans to seize the £130 million used
as "merit awards". This is money (from the D.o.H / taxpayer). which is
under the control of the Royal Colleges to distribute as "merit
awards" to which ever consultant is deemed suitable. Some of highest
'merit awards' are worth more than £65,000 a year!
transparent criteria for making such awards but depends on 'status'
(On a Channel4
News programme shortly after the Bristol Scandal .
broke, the 'merit wards' system was described as being used to promote
favours). Only recently have lists
of those consultants receiving these awards
ACTIONS HAVE THE CONSULTANTS THREATENED?
- Mr Milburn
is reviving a scheme to introduce a new specialist doctor's grade,
equivalent a a 'junior' consultant. This tier will be eligible for the
pay rise rejected by consultants and also for 'merit' payments. Mr Milburn
will have a total of £430 mill. at his disposal.( ref. Sunday
Times 3rd. Nov. 2002)
- To take industrial
action and to withdraw their labour. The last time this was done was
in the early seventies when Barbara Castle tried to bring in reforms.
- To withdraw
from the NHS altogether and to set up 'chambers' and behave as barristers thereby ensuring that the
NHS would have to buy in their services on private contracts. The disadvantages
of this route are at least twofold: (i) The very high cost of setting
up private 'chambers' and (ii) the loss of the very generous State run
NHS pension scheme. Source: FT 2nd.
4th January, 2003
"Latest figures reveal NHS
has more bosses than beds" Sunday Times Dec 29th 2002
"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,
" 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."
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
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
a Patient Compensation Fund Imminent?
" Milburn eyes no-fault system for settling
by Kamal Ahmed, The Observer 29th Dec.
This is Good
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:
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'
"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.