The NHS Complaints Procedure,
from a D.o.H. Guideline states : " The purpose of the NHS Complaints
Procedure is not to apportion blame " ( p13 para. 4.28) This must
surely mean that since no one is to be held responsible, there can be no
accountability and therefore no quality control? Furthermore, The
Independent Review is not disciplinary or punitive in nature and
is unable to refer anyone to the GMC. The final stage, the Ombudsman's
Office, is unable to investigate any serious complaint for which there
is a remedy in law. What possible purpose has such a Complaints
system served? It has been a denial of our Human Rights to a fair hearing
and, since October 2000 when the European Human Rights Act became Law ,
the present NHS Complaints System is officially unlawful and no one should
be referred to it . (See SIN's Publications : "The Emperor has No Clothes
- critique of the NHS Complaints System; & " The Patient's Voice
For Equity" sections 4 and conclusion).
is no blame (accountability) or retribution( sanctions) within the NHS
Complaints Procedure . There is no redress or justice for the patient
The handful of damaged
patients who can afford to resort to Law or who can obtain
Legal Aid, find that only a small number of this handful ever
achieve success ( 17% according to Lord Woolf). Patients have for a long
time been suspicious that the judiciary system has been weighted in favour
of the medical profession. These suspicions have been confirmed by
Lord Woolf's Lecture when he exposed the fact that the judiciary system
has been "excessively deferential "to doctors; giving them
"unwarranted automatic assumption of beneficence" and
exposed the absurdity and gross injustice of the Bolam Test. Lord
Woolf stated that "it was clear to the courts that the hospitals
and the medical profession could not be relied on to resolve justified
complaints justly ( Read our summary of Lord Woolf's Inaugural
provost lecture at University College London on 17th January, 2001 in "Our
vast majority of people using the Legal Route, there is no blame
(accountability) or retribution ( sanctions) . No redress or justice for
the vast majority of the damaged patients. Nor is there any recording of
medical errors, nor any effort to bring poorly performing doctors under
The Chief Executives
of Trusts and Health Authorities have always had the necessary sanctions
at their disposal to discipline a poorly performing doctor ;or to
send such a doctor to the GMC for clinical negligence; or to instigate
a criminal investigation; or to set up a Formal Independent Inquiry
into an adverse medical incident whenever a patient lodges a serious complaint
against a health professional. Rarely, if ever, is any of these options
REGULATES THE CHIEF EXECUTIVES WHEN THEY FAIL IN THEIR DUTIES? Again, there
is no blame ( accountability) or retribution ( sanctions) taken and the
patient is left without redress, justice and in many cases without
genuine specialist medical care
Patients attempt to go to
the Department of Health itself in order to ask the Secretary of
State to set up an Inquiry if they believe that their medical care
has been seriously substandard and that indeed medical care has been denied,
which is unlawful. Such requests are sent to the Regional Offices
and here, civil servants, simply rely on what the Trusts and the Health
Authorities state. Never is the patient allowed to make personal
representation and in the experience of the damaged patients no one, either
at the Trusts, Health Authorities or Regional Offices are prepared to undergo
a thorough, impartial and accurate investigation of patients' serious complaints.
fact the evidence suggests that the Trust/ Health Authorities and the Regional
Offices have only one aim and that is to put as many secure lids
as possible on serious medical errors, because as Lord Woolf conceded
in his lecture: the major goal of the NHS since its
inception , was to keep down compensation paid to patients through
poor medical practice, regardless of this being a gross injustice
to damaged patients.
REGULATES THE CIVIL SERVANTS WHEN THEY FAIL IN THEIR DUTIES TO SUPPORT
JUSTIFIABLE INQUIRIES INTO PATIENT ABUSE? Again, no blame (accountability)
or retribution (sanctions) and no justice for the damaged patient
trying to negotiate this bureaucratic maze
A few patients attempt to
use the GMC to expose sub-standard and malpracticing doctors but with very
little success, since the percentage of doctors having sanctions taken
against them is extremely low (e.g. in one year 13 doctors out of
the 2000 complaints received were struck off (0.65 %), and then for
only 10 months when they could re-apply for registration). This is
a disgracefully low figure when one considers that 68,000 unnecessary deaths
are occurring per year and 170, 000 patients are left permanently
damaged annually by medical errors. It would be naive, taking these
figures into account, to believe that this tiny proportion of 13
in one year reflected the true number of negligent and malfunctioning
doctors. Certainly, the GMC has lost credibility and public confidence.
REGULATES THE GMC? WHY IS ANY DECISION REACHED BY THIS BODY "FINAL",
AND WHY CAN ONLY PROCEDURAL MATTERS BE SUBJECTED TO A JUDICIAL
REVIEW? Only minuscule blame( accountability) and retribution
(sanctions) achieved by patients using this Public Body.
Surely, what has been
described above, to all intents and purposes, has amounted to a NO BLAME
CULTURE FOR THE MEDICAL PROFESSIONS , NHS MANAGERS & CIVIL SERVANTS.????
For too long patients
have suffered the backlash from this which has trapped them in
an ensuing culture of denial and cover-up. What possible good has this
state of affairs achieved either for patients or for the medical Profession?
SIN maintains that for years there has been no accountability and
hence no quality control and our standards of medical care have reflected
this, since in many specialities we have the lowest standards in Europe.
20th. August, 2001
Semantics of the No
SIN takes exception to the
use of emotive words such as "blame" and "retribution". The use of such
words serves no useful purpose, in our opinion.
The dictionary definition
of "to blame" means:
"to be held responsible
for anything which goes wrong." " to be held accountable"
"retribution" means: recompense,
repayment, punishment, sanctions, penalty
Are the Secretary of State
for Health, the BMA, the GMC and the D.o.H. really advocating that they
want a culture of no responsibility and no sanctions when things go seriously
wrong in the NHS? What role would the GMC have in such a culture? This
document was signed without any consultation with patients. How can
this be squared with the Sec. of State for Health's repeated statements
of the need for patient empowerment and patient participation?? Nor was
there any mention of the obligation to inform the patient who had been
a victim of a medical mistake.
Sin and, we believe, most
patients wish to see a culture of personal responsibility and accountability
with sensible remedial actions/ sanctions when things go seriously wrong,
with patients being fully informed. Sensible sanctions can
be an effective way of encouraging people to conform to a code of conduct.
According to Prof. Alberti, President of the Royal College of Physicians,
a report from Chesterfield showed 150% increase in error reporting by threats
of disciplinary action! Although Prof. Alberti said: "apparently
effective, but perhaps not the best approach", the damaged patient may
that when an individual health professional is unwilling to report
a medical error or is unaware that an error has occurred, and
when informed continues to be unwilling to acknowledge it,
then it should be mandatory that
all other health professionals,
aware of the error, report it immediately.
is a moral obligation
20th August, 2001
is the Joint Statement agreed upon by the Government
and representatives of the Medical Profession on how standards of care
will be raised in the NHS.
The seven point pledge of
this joint declaration is as follows:
1.To continue to show a commitment
from the top to implementing the programme of quality assurance and quality
2. To take every opportunity
to involve patients (sic)and their representatives in decisions about
their own care and in the planning and design of services.
3. To work towards providing
valid, reliable, up to date information on the quality of health services.
4. To work together
in determining clinical priorities.
5. To create a culture
within the NHS which is open and participative, where learning, and evaluation
are prominent and which recognises safety and the needs of
patients as paramount
6. To recognise that
in a service as large as the NHS things will sometimes go wrong. Without
lessening commitment to safety and public accountability of these services,
to recognise that honest failure should not be responded to primarily by
blame and retribution, but by learning and by a drive to reduce risks for
. 7.To recognise that the
professions and the Government share a common interest and commitment to
improving the quality of services for patients. Minor disagreements
on points of details must not be allowed to obscure this common goal.
believes that there should be two additional pledges:
To ensure that the patient is fully informed if an error has occurred,
and given an accurate assessment of any damage sustained..[
see SIN's "Aims & Objectives no.5]
To recognise the rights of patients themselves to report medical
errors to the new national system of reporting mistakes and near misses
[ The National Patient Safety Agency] This Agency , as reported in both
the Guardian & the Independent, 18th April, began work in July 2001.
hopes that the long standing "no blame culture" which has existed until
now, will be replaced by one of openness and honesty, underpinned
by accountability and personal responsibility throughout the
Heath Service. Certainly this pledge suggests that, in spite of some couched
language, the stage is set for a change of approach to medical
mistakes and near misses. The proof of the pudding, for the iatrogenic
patient, will be in the eating!
20th August, 2001
"the no blame & cover - up culture" has flourished for years
CULTURE OF COVER-UP
IN THE NHS
A culture of cover-up IS
a "no blame culture" without accountability. What follows is verbal confirmation
that this was the case pre-Bristol Babies Scandal.
RADIO 4, THURSDAY 22ND. OCTOBER 1998, 7.18AM
INTERVIEW ON BRISTOL
SURGEONS Re: INQUIRY INTO TRAGEDY OF BRISTOL BABIES ( this is
a short extract)
interviewsWinston Peters, President of Hospital Consultants
& Specialists Association
Peters, who is President of the Hospital Consultants & Specialists
Association. Mr Peters, you know that there are, and obviously from people
who are related in some way to the victims - heart felt hopes that there
will be a culture change. What can you say about that?
Winston P..... The
Profession has a very positive desire to see patient care improved. A
few years ago *"whistle
Blowers" were condemned by managers, by doctors and by government. **Now
they are being heard early, action is being taken. But you have to remember
that THERE WAS A PREVIOUS CULTURE WHERE THESE PEOPLE WERE SUPPRESSED
our members are finding that nothing has changed post - Bristol]
Mac: Well, there was a culture where the medical Profession policed
itself, wasn't there? And lay people who had an interest in matters like
this were often pushed to one side?
P: THAT IS TRUE.***
The profession is working with the government to develop institutes which
produce guidelines for clinical excellence - these will be policed by another
organisation that has wide ranging powers and directly reports to the Secretary
of State.......there is a 10 year programme starting now, in fact it started
a year or so ago, to regulate the way the profession is monitored and the
profession is taking steps itself.......
patients & their relatives are some of the best whistle- blowers and
they too have been suppressed. They have been treated in the same
way as whistle blowers of the medical profession. Doctors who whistle blow
suffer a character assassination and lose their careers.
Patients who whistle blow about serious sub-standard care also endure
a character assassination and end up putting their medical care in jeopardy
- many seriously ill patients are being denied care in the NHS today because
some doctor got it wrong!
is simply not true eg.1999 & 2000 Prof.Peter Dawson,&
Dr. Anil Jain. Whistle blowing doctors ( & nurses) are still suffering
and are not being heard
statements are being made, but few are being implemented on the ground!
The Aviation Analogy
With the need to report and
record adverse incidents within the medical profession comparisons have
been drawn with the aviation industry where such reporting of adverse incidents
is standard practice. However, the pilots and aviation personnel have
much more incentive to report such incidences given that their own lives
are as much at risk as the passengers who fly with them. This is obviously
not the case with the medical profession. And indeed, the past scandals
of Rodney Ledward, Richard Neale the Bristol paediatric cardiac
surgeons revealed that many of their colleagues and nurses were fully aware
for years of adverse incidents relating to these doctors and yet failed
to report these matters of grave concern to the appropriate body,
thereby colluding with and being responsible for the unnecessary
deaths and damage of many patients.
It is estimated that 68,000
deaths per year occur in our hospitals due to medical errors. It is claimed
that half of these patients would have died anyway because they were terminally
ill, however, that still leaves 34,000 who die each year unnecessarily!
amounts to two jumbo jets crashing every week ( not to mention the
170,000 estimated permanentlly damaged patients per year). If this were
to happen in the aviation industry people would be in the streets
and demanding an overhaul of this industry!. Therefore, the analogy with
the aviation industry has limited usefulness.
Perhaps a better analogy
would be with the car repair business. Certainly if 68, 000 people were
loosing their lives on the roads every year because of errors made
by car mechanics, then would the victims' families and the Dept.
of Transport be condoning and signing up for a no blame culture?
( There are between 3000 and 4000 deaths on our roads annually, very few
being reported as due to poor or incompetently carried out mechanical
repairs).However, great efforts are made in advertising etc. to reduce
this number and a proper investigation, with all witnesses' testimonies
carefully logged, is carried out every time one occurs, to establish accountability,
with action being taken where appropriate against the responsible
parties. This would include any mechanic whose faulty repair was
judged to have caused the accident.