Consultant’s devastating critique of Woolwich Hospital’s intensive care staffing in Chris Day whistleblower tribunal hearing

Trust lose battle to ban consultant anaesthetists giving factual evidence

Dr Megan Smith, consultant anaesthetist and barrister. Pic credit:

A devastating exposure of the health and patient safety dangers at Woolwich Hospital’s intensive care unit in 2013 and 2014 was made by a highly experienced anaesthetist and lawyer on the second day of the tribunal case brought by Dr Chris Day against the Lewisham and Greenwich NHS Trust.

At the opening of the hearing the NHS trust had tried to ban Dr Smith and another consultant from giving evidence to the judge on the grounds that the information was irrelevant, needlessly extending the hearing and a waste of taxpayer’s money. The trust itself has already spent nearly £1m on lawyers in fighting Dr Day’s whistleblowing claims of understaffing and risk to seriously ill patients at the hospital.

She told the hearing : “You would not find an anaesthetist or ICU doctor in the country who would accept those ratios. There was a clear and present danger to patient safety – no question about that.”

In her evidence she listed Dr Day’s concerns:

They were:

2.1.1. Doctor patient ratios were inappropriately high and a risk to patients at Woolwich ICU;
2.1.2. ICU trainees who were rostered to cover the ICU (as well as critically ill patients on the wards and in the Emergency Department (“ED’)) had insufficient clinical experience, training, and competence to fulfil a role of such responsibility which put patients at risk and compromised patient safety;
2.1.3. Senior medical supervision of these ICU trainees was inadequate and a risk to patients at Woolwich ICU which put patients at risk and compromised patient safety.

2.1.4. The Respondents’ managers failed to investigate these safety related matters adequately;
2.1.5. The Respondents’ managers provided false information about the claimants protected disclosures;
2.1.6. The Respondent’s managers provided false information to those investigating these safety related matters.

She went on to list the attempts Dr Day to alert people to the problems. They were:

Dr Roberts in a phone call and email on 29 August 2013

Dr Brooke in a meeting on 29 August 2013 and by email dated 2 September 2013;
Dr Harding, Assistant Medical Director for Professional Standards in an email forwarded on 3 September 2013;
Joanne Jarcett, the off-site duty manager, in a phone call and email on 10 January 2014 and a further email on 14 January 2014;
In addition, the Claimant informed Joanne Janett via email on 14 January 2014 that hospital managers were providing false information and were failing to investigate and deal with patient safety issues in the Respondent’s ICU;
Statements made by the Claimant on 3 June to the ARCP panel (which included a senior doctor from the Trust, Dr Harrison) about patient safety at Woolwich lCU, the hospital arrangements for 10 January 2014,
the events of that night and subsequently and attempts by Trust management to discredit him and present the issue as his competence rather than patient safety.”

Dr Chris Day

She then outlined national standards for intensive care units which were in force in 2013 and compared them to the provision at Woolwich Hospital. She said this meant “In general, [the Consultant/Patient ratio should not exceed a range between 1:8 – l:15 and the ICU resident Patient ratio should not exceed 1:8”

She said: “What he [Dr Day] was saying was that at all times when he was working as the resident night time ICU doctor he was expected to cover 18 ICU beds, assess new critically unwell patients on the wards in the hospital and in the ED, and review a list of ICU outlier patients on the wards who had been flagged as potentially requiring admission to ICU and therefore warranted close monitoring and regular review.”

Woolwich Hospital ICU was “prima facie unsafe”

She concluded: “The Respondent’s ICU was, prima facie, unsafe and (if more than a one-off incident) was something that was required to be rectified by the recruitment of more (and in some cases more experienced) junior doctors.”

She then examined the training and knowledge of junior doctors new to working in ICU’s and again found Woolwich Hospital wanting.

“When ICU trainees first begin their training, they are unlikely to possess many (or any) of the core lifesaving skills and competencies that a qualified higher level ICU trainee or consultant possesses. This means that it is completely inappropriate for these trainees to be left alone to manage the ICU out of hours until the department is satisfied that they possess the required levels of skill and competence.

On Dr Day she said: “Doctors with the level of experience that the Claimant had at the time in question
would not have (and would not be expected to have) anything other than basic airway and lifesaving skills. These can save a life as a temporising measure, but definitive airway access (tracheal intubation) and cardiovascular resuscitation have to be secured quickly or the patient will come to harm. These skills (which are routinely provided by the ICU team) are far more advanced and can only be gained by those new to ICU by being taught and fully supervised in performing them until they have achieved a prescribed level of competence (in 2013/2014 the criteria {or such competencies were set out by the Royal College of Anaesthetists” and other colleges.

She severely criticised the lack of supervision at the hospital and the turned to the hospital’s failure to investigate Dr Day’s concerns about patient safety.

Allegations would have been of grave concern

She said: ” The allegations raised by the Claimant would be of grave concern to any medical professional and any serious incident/governance/ risk manager. The primary concern would be for the safety of the patients in the ICU, particularly given subsequent (apparently avoidable) patient deaths. However, the institution ought also to have been extremely concerned about reputational damage and its standing
with those commissioning its services with whom it would have had legally enforceable contractual agreements. I would expect an immediate and thorough investigation to have been initiated.”

She concluded that the press statements by Lewisham and Greenwich NHS Trust at the time did not show Dr Day’s allegations had been properly investigated.

“it seems to me that the Respondent’s press statements and statements on its own website at best underplay the seriousness of what was occurring in the ICU and at worst were misleading in relation to the same.”

She said :The report that was commissioned in 2014 by the Respondent appears to accept and condone the running of the ICU in breach of expressly stated national standards that were put in place in order to ensure that ICU patients received excellent and, arguably more importantly, safe care. The conclusions of the 2014 report are, in my view, completely at odds with these evidence-based principles and are entirely inconsistent with the principles of the delivery of safe and excellent patient care.”

A second anaesthetist consultant will give evidence on Monday.

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6 thoughts on “Consultant’s devastating critique of Woolwich Hospital’s intensive care staffing in Chris Day whistleblower tribunal hearing

  1. Thank you so much for your accurate and detailed reporting . Can you sell this to a national paper?
    Best Wishes
    Margaret Day
    Chris’s Mum


    • I’d love to be able to – I am aware from some of analytics on my blog that both the Guardian and the BBC have seen the blogs but they are not biting. It reminds me of the campaign I did for 1950s born women over the raising of the pension age when the media did nothing until the court decision granting permission for a judicial review. Then they piled in and the man from the BBC thanked me for my blogs as I had done all the research for him!


      • Journalists seem to fall within three spheres of operation. Firstly those who commentate and do little else, secondly those who are investigators and thirdly those who investigate and campaign. I am so pleased you fit into the third category David. I am watching this case with a particular interest as it would seem that NHS Trust employees are prohibited from raising concerns with the Parliamentary and Health Service Ombudsman. The current Ombudsman is seeking ‘own powers’ to commence investigations, but the reality is there is no obligation for NHS Trusts to act on his recommendations. The current government has kicked the issue of Ombudsman reform into the long grass

        The case of Chris Day highlights the need for an independent public enquiry into complaint handling in the NHS with all complaints, whether arising from staff or patients, to be overseen by an independent external body with the power to recommend dismissal, to the Secretary of State, of the senior managers who have deliberately covered up the many patient safety issues so readily identified at Morecambe Bay, Mid Staffs and Shrewsbury and Telford to name but a few of the many.

        May I make a plug for your readers to check out the website ‘PHSOthetruestory’


  2. Bravo Dr Megan Smith! This is the first time I have felt encouraged that, maybe, the pendulum is swinging back and the honest, decent folk are reclaiming the higher ground and The Boris Example of ‘lie first’ is not universally recognised. It never ceases to amaze me the amount of time and effort these organizations are prepared to put into dishonestly quashing the truth – far more than it probably would have cost them to do the job right first time. in addition to teaching the good ol’ British values of fair play, decency and honesty, there is a real need for some effective management training throughout this land, starting with Boris. Keep up the good work David, although it’s depresssing to learn how low this country has sunk, it is so much better to know what you are fighting. Good luck Chris (and Margaret), I sincerely hope ‘Right’ prevails..


  3. This dangerous practice is happening in all hospitals thanks to the Tory’s agenda of defunding and destroying the NHS to make way for the private sector and we all know how that will end!


  4. Pingback: Whistleblower doctors fury over Roddis Associates suitability to run medical ethics courses for the Medical Defence Union | Westminster Confidential

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