The Patients Voice for Equity
 
 

CONTENTS

Return to Publications

 

SECTION 1. Introduction

SECTION 2. Empowerment through the Health Professional

SECTION 3. Empowerment through Access to Medical Records

SECTION 4. Empowerment via the NHS Complaints Procedure

SECTION 5. Empowerment through the Professional Regulatory Bodies

SECTION 6. Empowerment through the Legal Route

SECTION 7. Empowerment in the Digital Age

SECTION 8 Empowerment through the CHC's "the official watchdog" for the Patient

SECTION 9. Empowerment through the Political Channels

SECTION 10. Empowerment through Removal of Professional Allegiance:

SECTION 11. Conclusion 

SECTION 12. References

 

Section 1. Introduction:

Return to Contents

1.1. ¹ It has become apparent over the last few years that all is not well in the NHS. Although several issues raised in this paper were first highlighted by Prof. Ian Kennedy in his book "The Unmasking of Medicine" in 1988, the public debate which he hoped would ensue never took place which has led to the present climate of patient outrage. Even since the start of the BRI Inquiry in October 1998 ¹numerous other medical tragedies have been brought to the attention of the public. Leaving aside these cluster scandals, which have been exposed in the Press, we are aware that there are numerous individual cases which have no means of bringing their concerns into the public arena. These make up a huge hidden iceberg of unnecessary iatrogenic suffering for both the living and relatives of the dead. The obvious fact that medical mistakes can and do occur has been for too long a taboo topic.

1.2. ²It has recently been estimated that the third largest cause of death after cancer and heart disease is medical error. ²A recent study has estimated that 300,000 patients every year in the UK will experience a medical error, of these, 70% (200,000) will suffer no permanent damage, 14% (40,000) will die unnecessarily, this is the equivalent of two jumbo jets crashing every week. However, this leaves 16% or 46,000 who will suffer serious and permanent damage to their health through iatrogenic injury. However, new D.o.H. figures out in June this year indicate that this data is an underestimate. ³Prof. Liam Donaldson (CMO) has announced that "one in ten patients attending hospitals suffer a medical error". As far as we are aware, we are the only patient support group dealing specifically with individual isolated cases of iatrogenic injury which involve all medical specialties.

1.3. "Empowering" the public, which is essentially empowering the patient, suggests that the patient has had for too long very little input into the doctor - patient relationship. For the iatrogenic patient in particular what little influence existed quickly evaporates and an adversarial relationship ensues which is catastrophic for the on-going health care of such patients. Before patients can be empowered the obstacles which have effectively dis-empowered must be examined. We intend to bring these to the Inquiry's attention and put forward recommendations to remedy this state of affairs. The obstacles to empowerment will be examined in the light of the experience of members of S.I.N. It is encouraging that Phase Two is taking into account the experiences of patients in general, for to have concentrated solely on the Bristol phenomenon would have overlooked many other serious problems in the NHS.

1.4 Establishing an equal partnership based on mutual trust and respect between patient and health care professional is SIN's ultimate objective and clearly equal access to knowledge is a prerequisite for this goal. At the moment there are many barriers to this civilised state of affairs which need to be acknowledged and remedied before progress can be made. When a patient attempts to have a medical error addressed these barriers become insurmountable.

 

Section 2: Empowerment Through the Health Professional

Return to Contents

 

2.1 Once a patient or patient's relative suspects that a medical error has occurred, he or she will try to discuss this matter with the appropriate health professional to obtain information about their on-going health concerns. If the health professional were to act in accordance with the GMC guidelines on good medical practice:

 

Section 3: Empowerment Through Access to Medical Records

Return to Contents

3.1. This failure of communication results in the aggrieved patient seeking information about their condition by accessing medical records. Since 1991 the patient has had a statutory right to access these documents. This was a major breakthrough in patient empowerment, remembering the old adage "Knowledge is Power". Nonetheless, SIN members report, with evidence, that the Trusts and GP Practices blatantly thwart requests for medical records. Mandatory time scales are regularly ignored; charge variations occur, and the ⁴medico-legal insurance companies gain access without patient consent and before the patient has had copies of the original documents, which is a gross infringement of patient confidentiality. Whilst the patient is thus dis-empowered by such acts, the Trusts, Health Authorities and medico-legal insurance companies overtly abuse their corporate and professional positions. The patient may be under the illusion that he or she has the right to confidentiality protected by statute, however, the NHS has only a common law duty in respect of confidentiality. SIN believes that confidentiality of sensitive, personal medical information should be protected by statute forthwith.

3.2. When records are eventually accessed the patient is traumatised by the discovery of derogatory, personal remarks and character assassinations. Some examples of derogatory personal remarks recorded by SIN members: "patient suffers from paranoia"; "in need of counselling"; "vexatious complainant" ; "read too many textbooks" " keeps a filthy house" "alcoholic" "drug abuser" " suffers from memory lapses" "over anxious" " in need of psychiatric help" "imaginary symptoms" "displays antisocial behaviour" "symptoms over exaggerated" " dysfunctional family" " munchausen type syndrome" " all in the mind" "work shy" " I don’t believe she is mentally ill in the ordinary sense of the word" "not easily managed" "laxative abuser" etc. 

3.3 The Association of Community Health Councils for England and Wales ( ACHCEW ) ⁵reported : " most CHCs have had clients who have discovered judgmental or other inappropriate remarks in their records ". This survey also draws attention to the fact that former Health Minister, Simon Burns, was aware of this problem in 1996 and suggested "the possibility of 'blanking out text' which includes inaccurate or misleading information". In the "Unmasking Of Medicine", Ian Kennedy states :"the World Health Organisation's definition of health as being 'not the mere absence of disease, but the total physical, mental and social wellbeing'." The unnecessary distress suffered by patients who know that their medical records contain derogatory, untrue, personal remarks - which incidentally are almost impossible to have 'blanked out' - cannot be over emphasised. One seriously damaged member wrote : "I have just had the 'pleasure' of reading my medical notes and I had to stop because I was so distressed and it was seriously affecting my self confidence….what can anyone do?". This quote epitomises the personal affront and psychological trauma suffered, and simply flies in the face of the WHO's definition of total wellbeing so far as patients' emotional equilibrium is concerned and effectively dis-empowers patients by reducing their credibility and self confidence.

3.4.The second shock is finding that summaries of consultations have been inaccurately recorded. ⁵ACHCEW in the same survey noted: " more than two thirds of CHCs say clients have discovered factual inaccuracies in their records".

3.5 Although patients have the statutory right ⁶to have inaccuracies corrected or removed, any attempt to enforce this right is futile, for even in the face of factual evidence which disproves the inaccuracy, no credence is given to the patient's account in medical circles. If the patient makes a correction this is given little credence and there is no mechanism whereby corrections are automatically circulated to all Record Holders. One member reports that access to medical records with a view to correcting errors, has been denied.

3.6 The ultimate shock and dis-empowerment, is that records and tests results are missing or, to the patient's knowledge, have been changed. These records invariably relate to the incident of iatrogenic damage. In the words of ⁷ Dr Phil Hammond:" 'hide the notes and burn the X-rays' is the stock solution to another tired old cock-up". A question on this subject was asked in the House of Commons on 16th March, 1999 [75922]. The reply from the Minister of Health, Mr. John Denham to the House: "there was no evidence that tampering occurs to an extent that would warrant a national assessment". SIN believes that tampering with medical records is widespread and is a matter of grave concern and calls for a full investigation of this issue. The present Deputy Ombudsman also commented ⁸ on this issue of missing records and agreed that it undoubtedly prevents any thorough and accurate investigation. Considering every member of SIN has experienced the shock of lost/changed medical records, is it not time for sanctions to be taken against holders who have failed in their responsibility for the accuracy and safe keeping of patients records, which are legal documents?

3.7. There are exceptions to these rules of access when right of access may be partially excluded for example : when information could cause serious harm to the physical or mental health of the patient or any other (unspecified ) individual. Members believe this exception, (which is understood to have been inserted to protect patients with mental health problems which could effectively put their lives at risk) is being extensively abused. For following the GMC Guidelines: give patients the information they ask for or need about their condition, its treatment and prognosis" [page 5 GMC Good Medical Practice] , it is obvious that adults of sound mind requesting information about their health care [a child's, in the case of a parent] are entitled to all their medical records. It is possible that this exception clause is being misused for the protection of health professionals.

3.8. Following our recent familiarisation with the ⁹Health Service Circular (HSC) 1998 /217 SIN is more concerned than ever about patients' rights to control the content and long term continuity of their medical records. The following extracts increased SIN's concerns.

Sub-section 1.3: "As records could be required in litigation virtually without limit of time, the Department recognises that some records may be destroyed that might otherwise subsequently have been required for litigation. The Department's view, however, is that the cost of indefinite retention of records would greatly exceed the liabilities likely to be incurred in the occasional case where defence to an action for damages may be handicapped by that absence of records". ( pages 4 & 5) 

3.10. Furthermore, section 3.1. of the HSC 1998/217: The use of Clinical Records, reads as follows:"GPs are required by their terms of service to keep adequate records. The records are used by doctors to help them in the diagnosis and treatment of their patients, and provide a history of a patient's encounters with his GP. This means neither that it is necessary to retain every piece of paper or record, every item of data received in connection with a patient, nor that everything which is added to a record can never be deleted. The Department's view is that the notes should record what is in the patient's best interests (sic) and the details of any product which has been used in the course of treatment. Otherwise, it is a matter for the judgement of health professional acting on the advice of professional bodies and organisations to consider what is adequate for the purpose." ( page 5)

3.11. The above statement, which stipulates the guidelines for "adequate" record keeping, has been made without any reference to the individuals whose personal medical history these records represent. This is a total infringement of patient empowerment and when such decisions are taken without reference to the patients' wishes and without their knowledge, exposes the lack of respect for the patient and reveals the pretence that a real doctor-patient partnership exists. It is surely dangerous to use loose, ambiguous, terminology such as: "neither that it is necessary to retain every piece of paper or record, every item of data received in connection with a patient". As the definition of "every piece of paper" is open to misinterpretation, the critical documents should be clearly specified and safe guarded in the patient's interest. In the light of potential medical errors and the temptation to remove evidence that the patient may consider to be vital, it is astonishing that GPs are given the right to delete anything they wish from a patient's records without consulting the patient.

3.12. The Law as it stands today , with regards to the negligent death of a child raises alarm bells, particularly if this ruling applies to adult deaths and patient damage.

"Whilst it is arguable that doctors had a duty not to falsify medical records under the common law ( Sir Donaldson MR: 'duty of candour'), before Powell v Boladz there was no binding decision of the courts as to the existence of such a duty. As the law stands now, however, doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even to refrain from deliberately falsifying records."

3.13. Patients should be aware that there are coded versions ¹⁰ OPCS-4 IDC-10 & Read Codes of their medical records in computerised data format. These, by law, should be easily accessible under the 1984 Data Protection Act. However, patients have found difficulties in obtaining these records. Although, it is these coded records which are used by Government for national statistics gathering, members have found that these also contain discrepancies between the coded data and fact. Consultations which have never taken place are recorded, consultant's details omitted; one patient coded as cancelling an appointment when it was cancelled by the consultant; tests and results not recorded or inaccurately coded. 

3.14. It would appear that SIN's concerns about the inaccuracies and the tampering with medical records have been known to the ¹¹GMC the CHC the ¹²MDU, AVMA and the ¹³Courts for well over a decade. As long ago as ¹¹1988, an ex-GMC Lay Member, attempted to persuade the GMC to include the falsification of case notes in the "Blue Book" as a warning to doctors that they may be charged with serious professional misconduct as a consequence. However, the GMC was "not willing to go as far as putting it in the Blue Book, which would warn doctors that action was likely to be taken against them". A 1998 ACHCEW survey, ten years later, showed that nothing had changed as " more than two thirds of CHC's say clients have discovered factual inaccuracies in their records".

3.15. The serious problems which patients experience through lack of control of their own medical records, particularly as a diagnosis involves the joint efforts of both doctor and patient, is a major obstacle to effective medical care, patient empowerment and can thwart natural justice. SIN's solution is the introduction of a mechanism which gives automatic and immediate access to health records. Although this may not eradicate the problem, it would certainly prevent medical records being altered retrospectively. 

3.16. SIN believes that medical records should be available after every consultation on request, checked, signed and dated by the patient. This would prevent the propagation of inaccurate information and would be a protection for both doctor and patient. 

 

Section 4: Empowerment via the NHS Complaints Procedure

Return to Contents

4.1When the amicable route of a face to face discussion with a health professional proves fruitless, then the patient, ( or relatives of a deceased patient) having received no satisfactory explanation for his or her continuing illness, (or death) has a further route to empowerment via his or her democratic right to embark on the NHS Complaints procedure, the supposed mechanism for regulation and accountability. 

4.2. The NHS Complaints Procedure has been subjected to ¹⁴several recent investigations, including SIN's critique called "The Emperor has No Clothes" which was submitted to the BRI Inquiry in August 1999. There was unanimous agreement that the present procedure is seriously flawed and offers ¹⁵no protection to the patient. 

4.3. At the First Stage of Local Resolution, Health Authorities and Trusts have several sanctions at their disposal which can be used against incompetent and/or mal-practising health professionals, upon exposure of any serious matter. In the experience of SIN's members they have never been invoked in favour of a single complainant. An aggrieved patient who remains dissatisfied is able to request an Independent Review [IR] . This, however, is only granted at the discretion of the Medical Director and the Convener, who is a non-executive member of the Board. The patient may believe that securing an IR will increase empowerment, however, in reality the reverse is true: ¹⁶'¹⁷The IR is not disciplinary or punitive by nature nor does it consider matters of negligence. Only the Trust or Health Authority has the power to refer any individual for disciplinary action or to a professional regulatory body. The executive management never takes legal action against any of their own employees on behalf of the patient. 

4.4. The independent clinical assessors used by the ¹⁷IR receive indemnity by the appointing Trust or Health Authority, which hardly increases patient confidence in the procedure. The most alarming anti-democratic aspect of all meetings held by management to investigate complaints, at both local and IR level, is the lack of veracity of the ensuing reports, which appears to be endemic to the system.

4.5. One family reported that a relative had spent two years "in describable pain and mental anguish" during which time the Trust refused to acknowledge there was any physical problem with the patient. A coroner's post-mortem found a large tumour. The family was unable to obtain the clinical reports following an IR into the patient's medical care by the Trust. Another member reported that, although he was able to show with evidence that clinical negligence had occurred, even with proof that records had been changed, the actual report of the meeting was a travesty. The presentation of a tape recording of the meeting, evidence of duplicity on the part of the management, was ignored. The honest way forward in such circumstances would be for the Trusts and Health Authorities to inform the patient or relatives in writing that their concerns were matters of clinical negligence and advise them that the Trusts or Health Authorities are unwilling to investigate further and to hold to account their own staff. ¹⁸In these cases, therefore, Trusts and Health Authorities are failing to use the sanctions which are at their disposal. These further examples of dis-empowerment of patients showing a total lack of accountability and quality control on the part of clinicians and management which demonstrates the absence of respect for patient integrity and safety: the consequences have been a deplorable lowering of standards in the NHS.

4.6. In acknowledgement of these serious criticisms ¹⁹the Health Service Select Committee's Inquiry into "Adverse Medical Incidents and their Outcomes" recommended that in future all reports of investigations from the Trusts and Health Authorities should be able to stand up to the full rigor of the courts. [Recommendation (k)]

4.7. For those with the tenacity to pursue their democratic rights further, a submission to the Office of the Health Service Ombudsman (HSCO) is the final stage in the farcical NHS Complaints Procedure. HSC Act of 1993 states that a "A commissioner shall not conduct an investigation in respect of action in relation to which the person aggrieved has or had:-(b) a remedy by way of proceedings in any court of law". ²⁰During the year 1997 -1998 the HSCO received 2700 complaints of which only 13% were investigated. These statistics illustrate the inadequacy of the NHS Complaints Procedure. To quote from the D.o.H. Guidelines: The purpose of the complaints procedure is not to apportion blame amongst the staff". What possible purpose does such a complaints system serve when there is no accountability in the case of poor performance? 

4.8. Currently the D.o.H has set up a Committee to produce a new version of the Complaints Procedure. SIN suggests that it should be an automatic requirement for this Committee to have a presence from, and consultation with, genuinely independent patient support groups, at every stage of policy development. This would be a major initiative in patient empowerment, since it would give patients, and particularly those who are aware of the flaws of the present system, access to influence policy changes and direct access to the policy makers.

4.9. That ²¹medical errors occur is now an accepted fact, and if only the slogan ²²"The Truth will set you free" used at the March BMA/BMJ Conference on Medical Errors were widely adopted, then provision could be made for doctors to admit their mistakes immediately. The obvious result would be the redundancy of the NHS Complaints Procedure and financial savings to the NHS litigation bill and an end to patient trauma and distress.

 

Section 5: Patient Empowerment Through the Professional Regulatory Bodies

Return to Contents

5.1. A further mechanism for regulation and accountability is available to the aggrieved patient who can take a complaint to one of the professional regulatory bodies either the GMC for doctors or the UKCC for nurses. One disturbing aspect of the monitoring activities of the GMC relates to investigations of health professional(s) arising from submissions by Health Authorities or Trusts without the knowledge of the patient(s) who have lodged the complaint and who, therefore, should be involved with the investigation and be a party to the outcome. This is another example of a serious dis-empowerment of the patient by excluding them from participation in what amounts to secret investigations by a public body. Complaints are currently running at 3,000 per year, and of these 14 were suspended which is less that 0.5%. and then usually for only 10months when the doctor can apply for re-instatement. The sanctions available to the GMC are by any consideration moderate. No action is taken in the vast majority of cases, others receive a "letter" of advice, others a warning. The GMC claim to be dissatisfied with the range of sanctions at its disposal.

5.2. Several of our members are highly dissatisfied with the present extremely secretive screening process, from which they are excluded. The following criticisms have been voiced:

5.4. Although, ²⁴in one case, legal advice was that there was sufficient evidence for a judicial review, the only means of redress against the GMC, the complainant was denied legal aid for this purpose, on the dubious grounds that had the complainant been a paying client the risk would not have been taken! SIN has also received serious complaints about sub-standard nursing care and similar criticisms of the UKCC.

5.5. Not only are damaged patients concerned about the lack of stringency of the GMC's procedures, but there is widespread public disquiet following several high profile cases in the press. ²⁵One of the most notable being the gynaecologist, Richard Neale who was charged with serious professional misconduct in Canada in 1985, and before the hearing he absconded to the UK. Although the GMC was informed of this matter, no thorough investigation was undertaken. Incredibly Richard Neale applied for a post of screener at the GMC and was appointed in 1998 to "assess OTHER doctors facing charges of incompetence". He achieved this post whilst masquerading as a Fellow of the Royal College of Surgeons! This surely says little for the GMC's quality control and of its own screening procedures into the credentials of prospective employees . ²⁶Astonishingly, a doctor who had been struck off in 1987 for patient neglect and a racist remark to a colleague, was elected to the Council. Another, who was allowed to stand for election, received sufficient support from his colleagues to reach third in the poll , although he had been previously disciplined for removing ovaries without a woman's consent. Surely, such actions show utter contempt for the good doctors and the patients who look to the GMC for protection? 

5.6. ²⁷In the case of Rodney Ledward, although he was taken to the GMC in 1985 by an early Ledward victim, the case against him was never investigated. The public resents the GMC trying to off-load the responsibility for the long "career" of Ledward onto the management of the hospitals. Other consultants regularly called in to rectify his blunders remained silent for years and omitted to inform the GMC, thereby failing in their professional duties to the patient. Management and the GMC are equally culpable. ²⁸The most recent was the Shipman case. Even though in 1976, Shipman was convicted of forging prescriptions to feed his own drug addiction, yet the GMC considered he was a fit character to practice medicine. 

5.7. Other complaints were submitted in the ensuing years, but no action was taken against him. ²⁹It has now come retrospectively to light that Dr. Shipman had a higher death rate than his colleagues during the seventies which was never addressed. We all know the consequences of this lamentable inaction by the GMC. Just how many standard deviations below the norm does a doctor have to be before he/she is struck off? Without doubt, in some instances, striking off should be for life. The GMC was publicly shamed after Shipman's verdict, when the Secretary of State had to remind this regulatory body that its "raison d'etre" was to protect patients. The GMC has brought the medical profession in to disrepute. Things have come to a sorry pass when at the ³⁰BMA's Annual Consultants' Conference a unanimous motion was passed of no confidence in the GMC and Peter Hawker, Chairman of the Central Consultants and Specialists Committee accused the GMC of failing to protect patients or to guide doctors. 

5.8. SIN has been campaigning for the last 18 months to increase patient safety and has recommended the establishment of an Independent Statutory Inspectorate (ISI) set up by the government. "which would have the powers to fully investigate any serious complaint within the NHS. We believe that this authority should also be given the power to take disciplinary action against any health professional (including managers) who fail to fully co-operate, and or mislead, during the course of an investigation…..history has shown that self-regulation does not and cannot work! Representation from damaged patient support groups to be included" We have concluded that this should be on the line of an "OFSTED" type roving inspectorate which could come to the help of an individual patient. Since the GMC is a public body, would it not be an idea for the country to decide whether or no this dysfunctional body should be abolished? 

5.9. Bodies which have recently criticised the GMC are:³¹The Consumer Association; and the ³²BMA. At the recent Inquiry by the Health Select Committee into "Adverse Medical Incidents and their Outcomes" :-" Some witnesses, in particular patients and their relatives and carers felt strongly that the privilege of self-regulation for the medical profession should come to an end. They argued that doctors and nurses were not properly accountable and "looked after their own"…… one suggestion was that there should be an Independent Health Regulator, rather as there is for other industries". Vol .1 page xxxiii para 64

 

Section 6 : Legal Route to Patient Empowerment:

Return to Contents

6.1 Having achieved no answers through the previous channels, the only alternative open to the iatrogenic patient is to consider the legal route. Many medical negligence cases are never brought to light because of the astronomical costs involved in this type of claim, so the mistakes of many incompetent doctors may never be exposed through this option. Only the few who are wealthy enough, or those who can obtain legal aid, can contemplate this long drawn out procedure. Cases last many years, on average six, with only a very small percentage ever receiving any compensation. One member has recently informed us that his ten year battle for compensation, at a cost of £36,000 and six solicitors down the line, has just collapsed following a very favourable expert witness withdrawing his support at the last minute once the expert witness had discussed the matter with the Health Authority. 

6.2 The main stumbling block to cases alleging medical negligence is the Bolam test which is over forty years old. The Bolam test is as follows: ³³"The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man may not possess the highest skill at the risk of being found negligent. It is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art". It would seem that this test covers a multitude of sins: does it for instance cover an orthopaedic surgeon performing spinal operations, a spinal surgeon operating on the brain, and the operations of unsupervised junior surgeons? Surely the degree of skill should be in accordance with the degree of difficulty of any medical treatment/procedure?

6.3 The Bolam test appears to be set in stone. Medicine is no longer thought of as an art but is a highly technical science using precise monitoring equipment and clinical testing apparatus to assist the health professional and to protect the patient. This should eliminate great variation in technique. When the Bolam test is employed in any current medical negligence case, it should be obligatory for any defendant expert witness acting on behalf of a fellow clinician who has digressed from standard practice, to justify and confirm his testimony to the court, with medical papers published at the time of the incident. Clearly, the Bolam principle is grossly outdated both in terms of massive changes in medicine and the increased medical information available to the public, especially via the Internet.

6.4 The time scale for medical - legal cases is unacceptably long. Surely, all the facts of any case should be available on accessing the medical records, and allowing for assessment, a realistic time frame should be six to twelve months. We quote the ³⁴WC Powell case when the Powys Health Authority took six years before admitting negligence on the tragic and unnecessary death of Mr. Powell's youngest son, yet all the facts would have been known within six months. This unnecessary delay cost the tax- payer several hundred thousand pounds, which was only the Health Authorities' share of the bill; it does not take into account bureaucratic and administrative costs of the Welsh Office, and Legal Aid to the plaintiff . This was an utter abuse of public funds with no one being held accountable.

6.5 A major dis-empowerment to patients in any medico-legal case is securing the services of an expert witness because of the professional "closing of ranks". This "closing of ranks" is a euphemism for collusion and British doctors seem to have a stronger allegiance to colleagues who may be guilty of negligence, than a duty of care to the innocent and trusting patient. It must be remembered that the UK world of medicine is very small and with a limited range of experts in each speciality, all of whom will know each other. SIN has anecdotal evidence that, whilst consultants are prepared to acknowledge verbally that negligence was the cause of iatrogenic damage they invariably refuse to put anything down in writing because of their professional relationship to colleagues. Such attitudes fly in the face of the very first and last duties for any doctor registered with the ³⁵GMC: "Be honest and trustworthy" "make the care of your patient your first concern" & "Work with colleagues in the ways which best serve patients' interests". This really constitutes a withholding of medical expertise and a ³⁶thwarting of natural justice, and explains why so many patients are forced to consider seeking expert witnesses from abroad.

6.6 It is wrong to mislead the British public that damaged patients are financially bleeding the NHS through irresponsible medical-litigation claims. The cruel facts are that only a tiny proportion of patients receive justifiable compensation for their iatrogenic injuries. Considering that almost 100,000 patients are either fatally injured or suffer serious irreparable damage in the UK each year, it is amazing that only ³⁷15,000 medical legal actions are currently on-going . Therefore only 1.5% of victims actually proceed through the legal route. It is apparent that only a fraction of the present £2.8bill. per year now spent in the UK on litigation, reaches the damaged patient, the vast majority going into the pockets of the legal profession and the medical expert witnesses. Medical litigation is a £multi-million industry for all concerned except for the patient. SIN members have come to the conclusion that professional confidentiality within the medical and within the legal professions and between the two professions is a myth. In view of the obstructions universally met by SIN members, it is recommended that the Health Select Committee, in conjunction with the Lord Chancellor's Office, should have an urgent inquiry into the whole medical-legal process and receive personal testimonies from SIN members and those members of the public involved in these legal conflicts. 

6.7 ³⁸The acknowledged denial and cover-up culture which permeates the present NHS poisons the whole patient and doctor relationship. The tenuous partnership quickly becomes adversarial as patients and relatives strive to obtain the truth. Establishing the truth is a dangerous pursuit for damaged patients for whilst they seek information via the NHS Complaint Procedure or through the legal route their on-going medical care is compromised. This is obvious because to give remedial medical care would acknowledge that iatrogenic damage has occurred which could diminish a colleague's reputation and lead to possible charges of incompetence or serious professional misconduct resulting in successful litigation. Several SIN members are so disillusioned by the "incompetence" and poor quality of their legal representation that they are currently attempting to sue their former solicitors. 

6.8 The submissions to the Health Select Committee during its Inquiry into Adverse Medical Incidents and their Outcomes showed that the ³⁹whistle-blowing patient who complained about sub-standard medical care was blacklisted by GPs and Consultants. This effectively means that iatrogenic patients are being denied access to appropriate specialist care which amounts to a breach of their basic human rights. The Prime Minister stated in a BBC2 Newsnight programme at St Thomas's Hospital, 29th February 2000, that it was mandatory to give patients clinical care on clinical need. One member reported that a doctor had told him he would not receive care because he was involved in [justifiable ] litigation. Another provided written evidence to show her son had been denied a life enhancing remedial operation because she was considered to be a "potential litigant"!

6.9 The iatrogenic patient is the modern day leper, an unwanted commodity in medical circles: they remind the profession of its own failures and consultants develop a defensive "nimby" syndrome : "not in my back yard". Where and when will the iatrogenic patient receive a welcome? The damage done by this systematic denial of mistakes cannot be over estimated. It results in unnecessary pain and suffering; destruction of peace of mind and family life; lives being put at risk and some patients paying the ultimate price. SIN has the following recommendation for the resolution of the iatrogenic problem: The current national medical litigation bill now stands at £2.8 bill., (although it is unclear whether this is inclusive of the Legal Aid bill to the nation), only a tiny proportion of which goes to the patient. SIN seeks an urgent review of huge sums of taxpayer's money now currently being used by Health Authorities on legal fees to defend the medical profession, when this money could be spent on patient care. A new approach to coping with iatrogenic damage is imperative. SIN recommends that a victim's compensation fund is set up, part paid for by the tax-payer and part by the medico-legal insurance organisations. If damage has occurred, the patient is informed, medical errors are acknowledged, and damaged is assessed. In parallel with this an investigation is carried out to determine the cause of the mistake and to establish accountability. The patient has a basic human right to the truth about his/her medical condition.

 

SECTION 7. Empowerment in the Digital Age

Return to Contents

7.1 Since the burden of proof rests with the patients, they attempt to empower themselves by accessing relevant information from the World/UK medical literature, many through the Internet. Although they may provide copious medical evidence to uphold their case and their concerns, this is very often ignored. It should be recognised that the majority of patients are sufficiently competent to make sense of medical texts relating to their own condition and information gleaned from world medical opinion should be respected. Patients best know their symptoms and standard, structured clinical diagnostic sheets completed by patients would increase empowerment and ensure against the propagation of inaccuracies. 

 

Section 8: Empowerment Through the CHCs: the official "watchdog" for the patient.

Return to Contents

8.1 Often, before embarking on the NHS Complaints Procedure, a patient with serious health care problems, may seek support from his/her local Community Health Council (CHC). SIN members have found levels of support from CHC's variable throughout the country; the majority have not found them useful. There is evidence that they are not confidential (although the HSCO assures the public they are), and indeed are not independent, being under the authority of the Regional NHSE Office. One member came to the conclusion that the CHCs were to quote: "Not the patient's watchdog but the hospital's lapdog". ⁴⁰An advice leaflet produced by one CHC proudly proclaimed that : " The member of staff you see is not asked to judge your complaint, nor to be neutral." The member followed the CHC's own advice leaflet to ask for a meaning of this apparent contradiction. He received no clarification, but as a result the leaflet was promptly reprinted minus the puzzling statement.

8.2 Another member was told twice: "It is very difficult to complain when you will need medical care for the rest of your life!" Meetings with the Chair and Vice-Chair of one CHC to discuss lack of medical care were not recorded, no minutes were taken and no statement of the meeting was issued. Furthermore the patients were not ask to sign the visitor's book. One complaint Officer refused to attend a meeting with the patient at the local Trust even though this was urgently requested, In spite of being asked several times the Officer refused to give a reason. Furthermore the meeting at the Trust was recorded and the Chief Officer had agreed to listen to the meeting. He then inexplicably withdrew from this agreement, again no reason was given, thus leaving the patient without any independent support although it was a very serious health problem. Members have reported that their democratic right s have been denied when CHC Councils have refused permission for the patient to address the full public CHC bi-monthly meeting . Even when a member of the CHC had been present when a Medical Director had confirmed that the patient had a serious medical condition, yet had received no care, the CHC refused to support the patient when the statutory statement of the meeting was not issued by the Trust. Another seriously ill member without medical care had been urged by her CHC to attend the A& E and to refuse to leave until she had been given an MRI scan. However, this advice was promptly followed by a warning : "but don't say the CHC told you to do it"

8.3 The public is lead to believe that the CHCs are there to support patients in their attempt to make use of the various mechanisms or procedures to address their health care problems. However, those few patients fortunate to obtain what appears to be support soon find that the CHC involvement carries little, if any weight, to empowering a patient going through any of the mechanisms. The Trusts and GPs know that there is nothing to fear from the CHCs, and indeed the CHCs are fully aware of the inadequacies of the NHS Complaints System [please refer to conclusion]. One must ask what purpose the CHCs have been performing since they were set up, especially as ⁴¹the annual running cost must now be over £25 million. ⁴²The Chair of the Health Select Committee, following from the Inquiry into Adverse Clinical Incidents and their Outcomes, was quoted as saying that CHCs should be: "either beefed up and given real power to deal with complaints or abolished and replaced with a new body". What is desperately needed is a truly independent patient support advocacy service which would be directly responsible to SIN's suggested Independent Statutory Inspectorate.

 

Section 9: Empowerment through the Political Channels

Return to Contents

9.1 Patients who have serious health problems try to enlist the help of their local MP. With very few exceptions, most MPs seem unable or unwilling to challenge the Trusts or Health Authorities.

9.2 When all possible course of actions have been explored, before contemplating taking one's case to the European Court of Human Rights, damaged patients appeal for help to the civil servants in the Regional offices or directly to the D.o.H. Within Quarry House, Leeds, the Complaints & Clinical Negligence Dept. receives letters from patients who are in difficulties and have discovered that the mechanisms in place to help are simply not functioning. This Department is well placed to have an overview of patients who have been medically abused and also bureaucratically abused by the Trusts, Health Authorities and the Regional Offices. Even the Regional Medical Officer for Health fails to meet distressed and seriously ill patients who are not receiving specialist care preferring to visit the Trusts or Health Authorities complained about.

9.3 D.o.H. claims that it is unable to interfere and can only give advice, usually in the form of leaflets, non-statutory directives or Health Service Acts, many of which fail to be honoured by the Trusts or Health Authorities. The Department does, however, becomes involved with "pseudo-investigations", which like the GMC fails to enlist the active participation of the damaged patient and certainly there is no evidence that the ⁴³Post-Bristol Winyard Directive is being implemented. The false phrase "your complaints have been thoroughly investigated" is repeated ad infinitum. 

9.4 Patients desperate enough to write to the Secretary of State for an inquiry into their lack of medical care, have their letters diverted to the respective Regional Offices, NHSE. The Regional Office then contacts the very Trust /Health Authority that has failed the patient. The distorted version of each institution is always upheld in spite of the Winyard Directive. The patient is never given the opportunity to challenge this evidence in person and is, in fact, unable to obtain any statement issued by the relevant Trust or Health Authority , even when requested under the "Code of Openness", and so no check for veracity can be made. Therefore the Trust's/ Health Authority's inaccurate account is circulated to deliberately discredit the patient and to protect the management and the health professionals. Patients find it impossible to obtain confirmation of the evidence which they have submitted to the Regional Office NHSE.

9.5 One seriously ill member has had false information disseminated from the Trust to the Regional Office and the D.o.H. to the effect that specialist diagnostic tests were negative, although none were in fact taken! Regardless of the distress to patients who are being denied medical care, this reckless propagation of false information effectively puts lives at risk, and is by no means rare. One civil servant at the D.o.H. when challenged about this matter replied: "We have to believe them when they tell us these things". Members have reported being denied their democratic rights to address the Trust Board at open meetings, being refused a private appointment and being humiliated by being escorted off the hospital premises by security guards.

9.6 Two members have commended one civil servant at the Patients' Charter Unit, in his efforts to establish the facts and so put the patient first. Although he, in spite of strenuous efforts, was unable to get any resolution and he, too, was defeated by the system.

 

Section 10: Removal of Professional Allegiance : The "closing of the ranks syndrome"

Return to Contents

10.1 Patients have come to the conclusion that this is the main cause of their dis-empowerment. This "closing of the ranks" is a euphemism for collusion and is often referred to as "the old boy/girl network". It is understood, from the medical profession and from other sources, that this is often used as a pseudonym for corrupt freemasonry.

10.2 The Bristol Babies' Scandal raised the subject of freemasonry which appears to have been rife at the BRI with the hospital having ⁴⁴"its own Masonic Lodge". ⁴⁵A newspaper article on Bristol entitled "Probe into hospital Masonic links" alleged that: " the brotherhood's activities led to poor scrutiny of under-performing staff. Frank Dobson, who was aware of these claims was said to be threatening tough action if the Inquiry supports them. It could mean ordering all surgeons and senior hospital administrators to declare membership of the society". Chris Mullin, Chairman of the Commons Home Affairs Committee, endorsing the views of Frank Dobson said that :"it would be right for the Inquiry to ask about the involvement of masons in the tragedy and then to decide whether their membership was relevant to what happened. He believes that any involvement of free masons should be made public." 

10.3 ⁴⁶The fact that the BRI paediatric cardio-thoracic surgical department was known within the hospital as the "killing fields" since 1988, suggests that "the total closing of ranks" prevented the exposure of the poor mortality rates. This continued for almost a decade until the concerns raised by Dr. Stephen Bolsin were at last given credence.

10.4 In a Channel 4 News item broadcast shortly after the opening of the BRI Inquiry, it was suggested that merit awards were linked to Masonic privileges. ⁴⁷Masons "of which there are a large number in medicine…were bound by codes of loyalty and secrecy". Freemasonry requires members to look favourably on the activities of other masons but such "brotherly allegiance" is incompatible with the professional regulatory body, the GMC, which demands that: "the safety of the patient must come first at all times". It is likely this "clubbing" is preventing the mechanism within the health care system from functioning properly in the interest of the patient. ⁴⁸The fear of the "old boy/girl " network has a profound effect on potential whistle-blowing doctors who fear their careers will suffer if they break ranks. This ill treatment of whistle blowers is yet another barrier to improving standards and protecting and empowering the patients.

10.5 ⁴⁹Patient concerns and awareness of the effect of the "oldboy/girl network" was highlighted in evidence put forward by witnesses giving oral evidence to the Health Select Committee: "they acted like a closed shop - the 'old boy network' and it still goes on. Why has it been going on all these years and why have they not been honest….?" ⁵⁰The Health Select Committee is so concerned about allegations of freemasonry within the GMC that, in its recent Inquiry into the Shipman affair, the Committee will be questionings the GMC about allegations brought by former GMC members of links with freemasonry.

10.6 The fear of upsetting the "old boy network" is well illustrated in a ⁵¹letter sent to SIN by an anonymous concerned health professional. This letter appeared in "Hospital Doctor" and advised all potential whistle-blowing locums not to break ranks. Although the hospital locum is well placed to make comparative assessment practices within different hospitals and departments, this letter advised them not to let their conscience get the upper hand by exposing incompetence and malpractice because:

"… the slightest hint of criticism or disapproval will lead to you being labelled a troublemaker and being blacklisted in the hospital and amongst the old boy network…..Don't do it mate! Don't do a Dr. Bolsin and blow the whistle on your colleagues, not unless you want to go down under to Aussie land".

10.7 ^51bIt is quite unacceptable that such conscientious doctors should have their integrity besmirched by scurrilous suggestions from the Trusts that they are 'trouble-makers' and 'incapable of working as a team member'; and that they should be suspended immediately from their posts, at considerable public expense. It would appear that one whistle blowing Radiologist was recently charged with the transgression of taking an 'unofficial audit' , the data of which was eventually confirmed by an NHS audit. It is remembered that the last well known person to take a similar audit was Dr. Stephen Bolsin. Would anyone now dare to suggest he should not have done this? 

10.8 Our members have great solidarity with all professional whistle-blowers because patients who whistle-blow about sub-standard care are treated to the same abuse. Patients' complaints are subjected to the same pseudo-investigations by Trusts and Regional Offices; like the doctors, the full facts and evidence are never addressed; like the doctors, patients are subjected to shameful character assassinations. Health professionals have their careers put in jeopardy, patients have their on-going health care compromised. If standards are to be improved in the NHS, then whistle blowing on poor medical practice, whether by health profession or patient, is not only essential but should be actively encouraged. Hence, victimisation of all whistle blowers doctors and patients alike should be stopped immediately. SIN believes that statutory measures currently available for the protection of whistle blowers should be enforced and sanctions taken against any manager who fails to give protection. Blacklisting of patients by G.P's and consultants should be a statutory offence.

10.9 The problems caused by 'closing of the ranks syndrome’ by turning a 'blind eye' has been recently exposed by the deplorable abuse of the elderly in several high profile articles in ⁵²March and ⁵³April this year in the Sunday Times. Clearly such treatment of the elderly is a breach of Article 2 of the Human Rights Act 1998: "Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally…"

10.10 It is very disturbing to read in an ACHCEW advisory document entitled: "Implications of the Human Rights Act 1998 for Patients and CHCs", which specifically refers to this Article, the following statement that " policies and practices which have an adverse affect on certain sections of the community, for example practices involving starvation and dehydration of the elderly, and a do not resuscitate policy for the over eighties, refusal to provide specific life saving treatment for the elderly…." obviously contravenes Article 2. Is the inference to be drawn from this that the CHC, the officially paid "watchdog" was aware of this aforementioned abuse of the elderly before it became public knowledge? If so, why was the exposure of this scandal left to undercover journalists and the efforts of the victims and their relatives?

10.11 If such obvious sub-standard care is blatantly metered out regularly to wards full of the most vulnerable elderly and goes unreported by those employed by the D.o.H., then what possible hope is there for the hidden, isolated iatrogenic patient to have their concerns addressed? Clearly, this state of affairs is wholly unacceptable for the damaged patient and those caring health professionals who are afraid to speak out because of the lack of management and colleague support. Whilst team training and effort is all well and good, the team can only be as good as the team leader and at the end of the day, individual responsibility is a moral obligation. 

 

Section 11. Conclusion:

Return to Contents

11.1 There is without doubt a crisis of confidence in the NHS: there has been a collapse of standards of hygiene and levels of compassionate care and in ⁵⁴many specialties our record of successful treatment is amongst the lowest in the Western World. The public have lost confidence in the Trusts, Health Authorities, Regional Offices, the GMC and the UKCC to protect the interests of the patient. It has been illustrated that the NHS Complaints Procedure, which has been the main route for patient empowerment, offers no protection and no redress against poor medical care. The most damning indictment of this Complaints Procedure is that it fails to comply with Article 6 of the "Human Rights Act 1998 entitled: " The Right to a Fair Hearing":- "In determination of his civil rights and obligations…everyone is entitled to a fair and public hearing, within a reasonable time, by an independent and impartial tribunal, established by law. Judgement shall be pronounced publicly…except where publicity would prejudice the interest of justice".

2. With reference again to ACHCEW's document entitled" Implication of the Human Rights Act 1998 for patients and the CHCs" the following is revealed:

 

 

11.3 In fact our human rights to an effective remedy in the case of failure to treat, or negligent treatment, or breach of privacy ( confidentiality) in heath care have in reality been denied to British citizens because of the wholly iniquitous structuring of the NHS Complaints Procedure. The expense to the tax-payer through the implementation of this confidence trick has been a profligate waste of money, and as far as the damaged patient is concerned a wicked waste of their precious time and energies. Although the CHCs are fully aware of the flawed nature of this Complaints Procedure, they continue to encourage innocent aggrieved patients to use the system. The net result of this lack of protection has been a catastrophic decline in standards and a total lack of quality control and accountability. 

11.4 SIN recommends that the committee presently devising the new NHS Complaints Procedure should be directed to consult genuinely independent patient support groups and in particular those representing damaged patients, before finalising the procedures to ensure that the new system complies with basic human rights for the protection of the iatrogenically damaged patient. The direct involvement in policy making structures within the NHS would be a major empowerment of the patient. 

11.5 SIN welcomes the recent government initiatives intended to improve standards such as N.I.C.E. (the National Institute for Clinical Excellence) , Clinical Governance and C.H.I. ( Commission for Health Improvements). It is understood that CHI is in its infancy and is unable to encroach on the functions of other established systems claiming to be there for the protection of patients such as the NHS Complaints Procedure and the GMC/UKCC and indeed has no sanctions itself. However, it has been proven that these systems are dysfunctional and do not operate in the patients' interests, and it is urged that the government acknowledges this current vacuum and delegates these functions to CHI. This would be an opportunity for an area of CHI to develop into an "Independent Statutory Inspectorate". 

11.6 It is also welcomed that when CHI instigates an investigation /inquiry into a Health Authority/Trust it undertakes to contact patients within the local area by advertising in the media. It is hoped that CHI will give these patients an opportunity to meet up with each other. We understand that CHI will have the powers to initiate an investigation/inquiry on behalf of an individual complainant providing certain minimum criteria are met. SIN believes that CHI should not be left under the total control of the health professional and suggests that patients have direct participation in its development. Discussion forums for health professionals and patients set up in different locations would facilitate the development of a more equal partnership and facilitate mutual dialogue. 

11.7 ⁵⁵ A major new initiative proposed by SIN is the setting up of a national data base of all NHS complaints to be controlled by CHI and to be published on the Internet. Upon receipt of a complaint every Trust, Primary Care group or Health Authority should allocate the complainant with a national reference number which would in turn be transmitted to CHI's internet data bank, the complainant receiving written confirmation from CHI. The Hospital Trust, Health Authority or Primary Care Trust to be named and SIN suggests that complaints are categorised as follows: maladministration; medical records; hygiene/poor nursing ; clinical care and, in the latter category, the specialty should be specified. Such data would alert CHI to under- performance and so become an early warning system for CHI to instigate an appropriate investigation/inquiry. CHI would be aware sooner rather than later to substandard care and immediate steps could be taken to prevent clusters along the lines of Ledward which do so much damage when left unchecked for long periods. Such a public register would be the first steps towards the break up of the sinister "closing of the ranks syndrome" which allows effective cover-up of medical errors. This would be the biggest advancement of patient empowerment since the inception of the NHS.

11.8 Damage is not always due to technical "negligence". Irrespective of the cause of the iatrogenic damage the patient has a right to the truth and should be compensated appropriately for any permanent injuries sustained without having to resort to legal action. This solution would transform the culture of denial and cover-up to one of openness and accountability. An equal partnership with the medical profession with the patient's integrity respected will only be achieved when patients have access to truthful and relevant information; control over their medical records; access to mechanisms of impartial accountability which function; the myth of clinical infallibility exploded; the end to professional allegiance and direct access to the policy makers. 

© Completed 9th June,2000

Submitted BRI Inquiry 2^nd. July, 2000

Co-Directors & Founder Members : SIN (Sufferers of Iatrogenic Neglect)

M. MacRae ( Mrs) Tel: 0192 4407 195

GM Bean ( Mrs) Tel: 0115 9431 320

e-mail: mag@sinfo.freeserve.co.uk e-mail: sinfo@boltblue.com

 

Section 12. REFERENCES:

Return to Contents

¹ Mr. Rodney Ledward struck off by GMC: "Doctor got off lightly, claim his patients": The Herald, Thurs. Oct. 1998.
Mr. Richard Neale: "The Victims died in ignorance of doctor's risky past". The Express, Fri. Oct. 1999.
Organ Retention : "The Hospital Body parts Scandal Grows": The Observer 5^th December, 1999.
Harold Shipman: "We need to know if he killed our loved ones too": The Express Wed. Feb.2^nd.1999.

² "Blunders by doctors kill 40,000 a year": The Sunday Times, 19^th Dec. 1999.

³ "55 Cancer patients get wrong test result": The Guardian 17^th June, 2000.

⁴ Written evidence from member

⁵ Association of Community Health Councils in England and Wales ( ACHCEW) Health Survey, July 1998

⁶ Section 6(a) & (b) Health Records Act 1990

⁷ The Observer Magazine 1997

⁸ Seminar 7 BRI Inquiry 28^th March 2000

⁹ Health Service Circular 1^st. December 1998/217

¹⁰ Office of Population Censuses & Surveys 4^th Revision 1987 (OPCS )

International Classification of Diseases ( 1DC10)

¹¹ "A Patient Voice at the GMC" - Jean Robinson 1998 - Health Rights Report1

¹² Journal of the Medical Defence Union 1992 No1 Case Histories page11: " No notes, no defence"

¹³ The Daily Mail, Feb.14^th 1997: "Jail for Dr. Blunder- GP missed dying man's symptoms, then forged medical notes".

¹⁴ John Elder: "Who Cares About the Health Victim" pub. Klaxon Books
SIN's Critique of NHS Complaints Procedure: " The Emperor Has No Clothes" Aug. 1999 GM Bean & M. MacRae.
Law Project : "Cause For Complaint". H. Wallace & L. Mulachy. Sept. 1999.
Health Select Committee: " Inquiry into Adverse Clinical Incidents & their Outcomes" Vols. 1& 2 , Nov. 23^rd. 1999.
Health Which?: "NHS Complaints" April, 2000 pages 8-12

¹⁵ Daily Mail Fri. July 16^th 1999: Frank Dobson, former Secretary of State for Health, page 24: " The present system of 
protecting NHS patients was, he admitted,' was a bit of a shambles' ".

¹⁶ NHS Complaints Procedure D.o.H. Guidelines page 13 para.4.28: " the purpose of the Complaints procedure is not to apportion blame".

¹⁷ Independent Review: A Briefing Pack for Clinical Assessors to be used in conjunction with the mew NHS Complaints
Procedure which came into effect on April1st. 1996: Institute of Health & Care Development, page 11 para. 5.2

¹⁸ NHS Complaints Procedure D.o.H. Guidelines page 14 para. 4.32: "referral to any of the following: i. An investigation under
the disciplinary procedure ii. One of the professional regulatory bodies iii. An Independent inquiry into a serious incident 
under Section 84 of the NHS Act 1977 iv. Investigation of a criminal offence.

¹⁹ Health Select Committee Sixth Report: "Procedures Related to Adverse Clinical Incidents & Outcomes in Medical Care

²⁰ HSC Output & Performance Targets 1993 - 1994 to 1997 -1998

²¹ BMA/BMJ Conference, " Reducing Error in Health Care & Improving Patient Safety", Tues. 21^st. March, 2000.

²² The Holy Bible: St. John's Gospel Chap. 8 v32

²³ Olwyn Gibbings, 86yrs, who died at Cardiff Royal Infirmary Nov. 1996: The Times, Thurs. Sept. 30^th 1999

²⁴ Written evidence from member

²⁵ Sunday Mirror, 24^th Oct. 1999: "70 Deaths: Doctor to Face Quiz"

²⁶ "Scandals likely to end GMC control over rogue doctors ": Sunday Times, June4th 2000 page 14.

²⁷ Personal communication to SIN from a Ledward victim.

²⁸ The Express, Wed. Feb. 2^nd. 2000, page 4& 5 : " We need to know if he killed our loved ones"

²⁹ The Guardian, June 17^th. 2000: "Shipman ‘honed killer skills’ in 1970’s"

³⁰ The Guardian, Fri, June2nd, 2000 "Consultants call for reform of GMC"

³¹ The Health Which?. Oct. 1999: "Special Report – the GMC, is it working for patients?"

³² BMA News Review, Sat. 11^th March 200, page 9 : "Disillusioned doctors say GMC is letting down profession".

³³ Health Care Law " Texts & materials" by Jean McHale & Marcia Fox with John Murphy 1997

³⁴ Health Select Committee’s report on "Adverse Clinical Incidents & Their Outcomes", 23^rd. Nov. 1999 Vol.2 page

³⁵ GMC : " Good Practice Guide"

³⁶ Daily Mail, Fri. July 16^th 1999 page 24: "Lawyers blame secretive doctors for forcing up the costs of such case…they accuse
them of trying to cover up for each other, requiring lengthy investigations to get at the truth".

³⁷ BMA Conference, June 1999.

³⁸ The "Today" programme radio 4, Thurs. 22^nd Oct. 1998 Re: Bristol Babies Scandal: Mr. Winston Peters, President of 
Hospital Consultants & Specialist Assoc, said: " Pre-Bristol…..whistle blowers were condemned by managers, by doctors 
and by government….these people were suppressed" 

³⁹ The Observer, Sun. Oct. 24^th 1999: " Doctors ‘blacklist’ dissatisfied patients"

⁴⁰ Copy of leaflet supplied by SIN member. 

⁴¹ Personal communication 1997 from Quarry House, Leeds: The Role of CHCs: Key Facts – Expenditure on CHCs"

⁴² The Pulse Magazine For GPs W / E Nov. 6^th 1999 Vol 59 No. 44 " CHCs may be beefed up or face scrap heap".

⁴³Instructions from D.o.H.: Handing Reports of Service Problems Post Bristol: "……individual clinicians my be putting patients
at risk…who has such concerns has a clear responsibility to ensure appropriate action is taken….you should do you best to 
find out the facts…the safety of patients must come first at all times".

⁴⁴ "Trust Me ( I’m a doctor" by Dr. Phil Hammond & Michael Mosley. Page 59

⁴⁴ The Mail on Sunday, 4^th Oct. 1998: " Probe into Masonic Links"

⁴⁶ "Private Eye", May 8^th 1992

⁴⁷ "Trust Me ( I’m a doctor) by Dr. Phil Hammond & Michael Mosley page 6:" Like the Masons, of which there are a large
number in medicine……bound by codes of loyalty and secrecy".

⁴⁸ Letter in Hospital Doctor 18^th June, 1998: " Locums suffer backlash when they speak out"

⁵⁰ Health Select Committee Sixth Report: "Procedures related to adverse clinical incidents & outcomes in medical care" Vol.2 page 132

⁵¹ Letter in Hospital Doctor 18^th June, 1998: Locums suffer backlash when they speak out".

^51b The Daily Telegraph , June 19^th 1999: "Cancer screening ‘whistle-blower’ suspended"
Daily Mail Oct. 20^th 1999: "Cancer shock at hospital where doctor spoke out"
Hospital Doctor, 15^th July 1999: " Doctor wins costs: he had been forced to go to the courts ‘to compel the trust to follow 
proper and fair procedures’ ".

⁵² The Sunday Times: "Revealed Cruelty of Staff in NHS Hospitals" 12^th March, 2000

⁵³ The Sunday Times : " Elderly are helped to die to clear beds, claim doctor" 5^th April, 2000.

⁵⁴ The Observer 24^th, October, 1999: " Why we fail on cancer" ; (extra money for NHS);
The Sunday Times ,12^th December 1999: "Critical Condition" 
The Observer,12^th December, 1999: "Killer that shames Britain" ( heart disease).

⁵⁵ This recommendation was added to the Paper on Friday, 9^th June. SIN welcomed the news bulletin on radio the
following week that the D.o.H. was considering a similar initiative. 

BIBLIOGRAPHY

Illich I. : Medical Nemesis 1975 the Trinity Press 

Kennedy I. : The Unmasking of Medicine 1981 George Allan and Unwin

Bennet G. : The Wound and the Doctor 1987 Martin Secker and Warburg Ltd.

Gould D.: Examining Doctors: Medicine in the 1990s 1991 Faber and Faber

Konner M.: The Trouble with Medicine 1993 BBC Books

McHale J.: Health Care Law: Text, Cases and Materials 1997 Sweet and Maxwell

Fox M.;Murphy J. 

Elder J.: Who Cares About the Health Victim? 1998 Klaxon Books

Hammond P Mosley M. : Trust Me ( I’m a doctor) 1999 Metro Books

Inman W.: Don’t Tell the Patient 1999 Highland park Productions

DOCUMENTATION

NHS Complaints Procedure D.o.H. Guidelines 

Institute of Health and Care Development NHS Executive : Independent Review 

"A Briefing pack for Clinical Assessors"

Health Service Circular 1^st. Dec. 1998/217 : "Preservation, Retention and Destruction of GP General Medical

Service Records Relating to Patients"

Association of Community Health Councils of England & Wales (ACHCEW):

" The Implications of the Human Rights Act 1998 for Patients and CHCs"

NHSE Leeds, Communication, April, 1997: "The Role of Community Health Councils ( CHCs)" 

Law Project : "Cause For Complaint". H. Wallace & L. Mulachy. Sept. 1999.

Health Select Committee: " Inquiry into Adverse Clinical Incidents & their Outcomes" Vols. 1& 2 , 23/11/1999.

Health Which?: "NHS Complaints" April, 2000 

Association of Community Health Councils in England and Wales ( ACHCEW) Health Survey, July 1998

Health Records Act 1990

The Health Which?. Oct. 1999: "Special Report – the GMC, is it working for patients?"
 

Return to Contents