National Patient Safety Adviser battening down the hatches?

I don't like to indulge in tittle-tattle, but as all complainants and whistleblowers know, informal communication networks sometimes have a great deal more of the truth than the formal ones. So it seems somewhat paradoxical that apparently trenchant critics of the system who experienced obstruction are now apparently the worst culprits!
James Titcombe, the National Patient Safety Adviser at the CQC, is incredibly unpopular if the complaints I hear about him are anything to go by. He has blocked a large number of relatives and complainants who have criticized him for doing nothing, despite promises to the contrary. In fact, his behaviour seems like exactly the sort of behaviour he himself complained of.
He and other campaigners that have all had the patronage of the current government have been amazingly quiet about the Hinchingbrooke disaster, preferring to post about Andy Burnham. Rather inappropriate now that Jeremy Hunt must be held responsible for the current state of the NHS.

Fallout from Hinchingbrooke fiasco

Fallout from Hinchingbrooke fiasco

Of course it is not a valid conclusion from the failure of one hospital that privatization in the NHS is doomed to failure. The fawning over the experiment at Hinchingbrooke was always premature. Even now, the Daily Mail is resorting to conspiracy theories to explain the CQC report:

"at least one of the 35 inspectors is a member of campaign group Keep Our NHS Public and may have been unfairly critical."

Given the number of political appointees in the CQC, including a new chair who had previously Deputy Chairman of the Conservative Party and a mentally ill incompetent saved from sacking by the personal intervention of Jeremy Hunt himself, it seems unlikely that the CQC would have a team opposed to the Conservative agenda of privatizing the NHS. The Daily Mail seldom acknowledges mistakes however; it has never accepted it was wrong about MMR, for example.

Cure the NHS, the lobbying group started with the help of funding from Bill Cash Conservative MP, has been curiously quiet. We are told that they receive complaints from all over the country about poor care. It seems odd that Hinchingbrooke Hospital would be the exception. Either CTNHS are not in touch with the state of the NHS after all, or they have been covering up the inadequacies of Hinchingbrooke Hospital. They would only have to read the newspapers after all to find a case quite similar to that of Gillian Astbury.

How long will it be before Cure the NHS comment? After all, Julie Bailey gave this ringing endorsement of Hinchingbrooke Hospital, also in the Mail:
"What this shows is the potential of allowing those on the frontline to lead, as Circle do.
The potential is there within the NHS – the majority of people wouldn’t care who provides their services as long as it was safe."
Will they call for a public inquiry into care that seems to be at least as poor as that in Mid Staffs? All the criteria that were used to justify calls for a statutory public inquiry into Mid Staffs are also fulfilled for Hinchingbrooke Hospital. So those who called for a public inquiry into Mid Staffs that don't call for the same for Hinchingbrooke are guilty of rank hypocrisy.

Uses and abuses of the GMC

Uses and abuses of the GMC

The recent furore over the treatment of Mr Meirion Thomas has highlighted the fact that  a GMC referral can be a weapon in a personal dispute (just like clinical incident forms, for example). Interesting that the GMC was emphatic that it was not going to get involved in such matters, because "Meirion Thomas had a right to speak freely" according to the Daily Mail.

This statement seems at odds with previous decisions of the GMC. For example, it appealed the High Court decision in Meadow v GMC that it was for the courts to decide what the standards for providing expert evidence should be. 

Further, its apparent swift rejection of the complaints about Mr Thomas may seem surprising, given that his comments were widely seen as unreasonable and wrongly denigrating professional colleagues, contrary to GMC guidance in Good Medical Practice:

  35. You must work collaboratively with colleagues, respecting their skills and contributions.

  36. You must treat colleagues fairly and with respect.

  37. You must be aware of how your behaviour may influence others within and outside the team.

Of course, the GMC has changed its interpretation of intraprofessional duties of respect to allow the raising of concerns (a change which is long overdue). It seems to be stretching the definition of whistle blowing beyond endurance to describe Mr Thomas's diatribes as bona fide whistle blowing. 

Whistleblower - the tag that covers a multitude of sins!

Whistleblower - the tag that covers a multitude of sins!

I had an interesting conversation on Twitter with an NHS whistleblower who was quite adamant that the vast majority of whistleblowers are genuine. Of course that distinction hinges on your definition of a genuine whistleblower. For me, a genuine whistleblower is not motivated by grievance, but altruism. In fact, the source this whistleblower directed me to confirmed that the majority of whistleblowers are motivated by grievance.

It seems that this is the justification a la mode - dinosaur Mr Meirion Thomas has now swathed himself in the cloak of whistle blower-hood, according to the Spectator and the Daily Mail.

It may seem a bizarre argument to proclaim the right to free speech whilst monstering those who have exercise their free speech in response to Mr Thomas...well, let's face it, it is! Some of the wilder calls for action against Mr Thomas can be debated certainly, but it has always been a matter of professional etiquette to only make reasonable comments about professional colleagues. 

Mr Thomas was referred to the GMC, but the GMC promptly threw the case out. Some might be surprised at this unusual demonstration of common sense by the GMC. In fact it has been pointed out this position contradicts GMC guidance on social media, however misguided that is.

Sometimes someone gets flak not because they're a whistleblower, but because they're a "T****"!

(as per printed in the Daily Mail: the actual word used is a mystery - what expletives begin with T and have 5 letters?)

It's about the money, stupid

It's about the money, stupid!

The Telegraph has published a story about Leigh Day's involvement in the Al-Sweady Inquiry, where it was concluded that most of the claims were deliberate lies. It mentioned that Leigh Day are one of the major opponents to the Saatchi Bill. 

Some bill opponents have proclaimed that this is unfair, as the Al-Sweady Inquiry is a different matter altogether. I disagree. The point being is that lawyers get paid for litigation. In some cases, as the Al-Sweady Inquiry demonstrates, solicitors seem to fail to do some basic vetting. They ought to be acting as officers of the court, the champions of the wronged that they claim to be. Sometimes they fall well short. 

The claims of medical negligence lawyers that only costly litigation is capable of deciding what is good medical practice is self-serving. It also contradicts their claims to only sue "bad doctors". What the Saatchi Bill will do is stop speculative law suits, so it will hit medical negligence lawyers in their pockets. It is all about money. Something which Leigh Day and others make in spades, with no sign of this activity improving patient care one iota.

Nigel Poole QC illustrates the need for the Saatchi Bill quite neatly

Nigel Poole QC illustrates the need for the Saatchi Bill quite neatly

I have made the point previously that the medical negligence lawyers who disagree with the Saatchi Bill often also strongly believe that they and their colleagues only litigate against doctors that have harmed their patients, that there is no such thing as "defensive medicine", and that nothing needs to change in the medico-legal milieu in the UK. Everything is hunky-dory, doctors have to be kept in check by the lawyers, and any changes will lead to disaster for patients.

Many doctors will find this quite incredible, and one of the leading opponents of the Saatchi Bill, Nigel Poole QC, illustrates the reality of medical negligence quite neatly. In doing so, he destroys many of his arguments against the Saatch Bill. If even standard clinical practice is litigated by medical negligence lawyers, then it defies all logic that innovations will not be the subject of legal action. 

The case of Davies v UHNS is a striking demonstration of how medical negligence lawyers can and do pursue legal action even when there is no reasonable question that the clinical management given at the time was entirely appropriate. The application of the Bolitho test was straightforward, yet the trust and doctors were dragged through the courts. Despite the protestations of the medical negligence lawyers, they don't just sue the "bad doctors". They litigate because that is how they earn their money. Hence they argue that only the courts should be deciding what is good medical practice and what isn't. Even though they then argue that lawyers don't decide what good medical practice is, but doctors. Nigel Poole QC is no exception, and this makes my point. Thank you, Nigel.

Genes and behaviour - exciting new science or neurobollocks?

Genes and behaviour - exciting new science or neurobollocks?

More research has been published on MAOA and another gene HTR2B and their link to violence in Finnish prison inmates.  http://www.economist.com/news/science-and-technology/21629223-more-evidence-certain-versions-some-genes-can-encourage-violence-next?fsrc=scn/tw/te/pe/nextcanidate

MAOA was originally linked to violence through a Dutch family with several members incarcerated for violent crime who had essentially a non-active variant. The effect of the common variants of MAOA is much less dramatic, and the heritability of criminal behaviour generally is low. This should not be unexpected.

Do these revelations herald a new approach to the violent criminal? After all, it is common knowledge that some people are more volatile than others - indeed this variation is recognized by the common law, only to be dismissed as a basis for altering the threshold for provocation. Potentially genetic testing could be used as the basis for altering the test for loss of control (the statutory replacement for provocation) from objective to subjective.

The most likely outcome is that these tests might be used in sentencing hearings. Even there the potential is that this could be a double-edged sword. Judges might considered that these individuals either need more deterrence, or need to be kept out of society. Lawyers should tread carefully.