Exclusive: Three year cover up of avoidable heart patient death at Epsom and St Helier Health Trust revealed at employment tribunal

Cardiologist Dr Richard Bogle admits trust should have told the coroner and the Care Quality Commission about the death at the time

Former consultant also says old X ray machines at Epsom Hospital put staff and patients at risk from radiation when they are fitted with pacemakers

Dr Richard Bogle, the former head of the cardiology department at the Epsom and St Helier University health trust, admitted to an employment tribunal that the trust should have reported the death of a 76 year old heart patient to the Coroner and the Care Quality Commission three years ago.

The doctor under cross examination from barrister Matt Jackson described the death as “tragic ” and admitted the trust should have informed both the coroner and the CQC. He said that although he was on ward duty he did not know anything about the patient and ” couldn’t have been expected to know about all the patients at St Helier hospital.”

The details came out at a recent tribunal hearing under Judge Anthony Hyams-Parish, brought by Dr Usha Prasad, a cardiologist who has been dismissed by the trust even though the General Medical Council has exonerated and re-validated her as “fit to practice” medicine. She decided to make two protected disclosures under the Whistleblowers Act after the trust covered up her findings on the death. You can read a series of previous articles on this blog about the battle Dr Prasad has had with senior staff at the trust.

The disturbing case of patient Mr P

The patient known as Mr P was admitted in August 2018.Dr Prasad’s witness statement said :”He died of heart failure on 5 September 2018 having been previously admitted from 5 to 15 of August to Ward 6 which is a ward run by cardiology and respiratory medicine at St Helier hospital. Mr P had been admitted with breathlessness and diagnosed with pneumonia. However, an echocardiogram had been ordered by Dr Foran (Cardiologist) which showed evidence of “severely impaired left ventricular systolic function…. [with a] drop in left ventricular function since last scan, previously mildly impaired.” The echocardiogram was performed when Dr Richard Bogle was assigned to the ward and the results could not have been known by Dr Foran. The pneumonia was successfully treated by the respiratory physicians and Mr P was discharged after about 10 days. The echocardiogram had shown signs of severe left ventricular failure but the results were not recognised by the chest physicians or cardiologists on the ward. The patient was discharged after having largely recovered from the pneumonia during his first admission and then was readmitted on 4 September with severe left ventricular failure from which he died shortly afterwards on 5 September 2018. The certified cause of death was heart failure.”

Dr Usha Prasad

Dr Prasad was assigned by Dr James Marsh, the medical director to write up a report on the patient’s death. Her conclusion was that it was a Serious Untoward Incident Level 5 – that is the hospital caused severe harm to the patient leading to his death. This would lead to a report to the coroner and the CQC. The coroner could look at how the patient died and the issues surrounding it to help prevent other deaths.

What followed were attempts by other senior consultants to water down the report and delay its completion which Dr Prasad refused to do. Those involved in this exercise included Mr Karim Bunting, the quality manager at the trust and Dr Simon Winn, Clinical Director for Acute and General Medicine, She was asked to make the report in her words “inaccurate” and Dr Winn drafted an alternative version. He accepted that a serious mistake had been made by not recognising the result of the echocardiogram but put the emphasis on the lack of communication between the respiratory physicians and the cardiologists. He did not accept it as an avoidable death.

It is not known whether the patient’s relatives were properly informed about the circumstances of the death or which version of the report they have been shown if any. There is a duty of candour if someone has died.

Epsom hospital Pic credit: Epsom and St Helier University NHS Trust

The second disclosure of failings at the hospital that came out at the tribunal concerns serious radiation risks from old X Ray machines at Epsom Hospital – which are used when pacemakers are inserted into patients. This puts staff and patients at risk.

Dr Sola Odemuyiwa, consultant cardiologist at Epsom Hospital from 1994 until 2016, He disclosed how an audit by Dr Abhay Bajpai, – specialist in pacemaker devices and electrical rhythms, appointed to take over pacing at Epsom in addition to his other duties – revealed stark contrasts in radiation levels between Epsom and St George’s hospitals. Using a dosimeter, he compared radiation insertion of a similar number of devices at St George’s. With similar average screening times, the total radiation received was substantially higher (up to a hundred times greater) at Epsom than at St George’s.

He says in his witness statement: “When I saw the histograms – the Micrograys of radiation from Epsom a skyscraper beside which the values from St George’s, looked slipper thin, (I attach the relevant data) my heart drummed against my ribs out of apprehension and angry self-reproach as I recalled with dismay how for twenty years I may have been gorging my organs on X-rays. My anxieties ballooned when I learned that Abhay’s readings came from Libra, the more modern of the two machines and that I was often given the older Endura machine, which emitted even higher levels of radiation.”

“Drs Yousef Daryani and Abhay Bajpai, my colleagues on the Epsom site continued to press the Trust over the safety of the X-ray machines. In February 2016, Abhay presented his audit data again at a meeting between Cardiology and Radiology departments. He thought the machines should be replaced. The senior radiographer said she could not change the past but that the machines were working properly.”

He then sought figures for radiation doses he had received during his career at Epsom Hospital.. “The Radiation Protection department at George’s were most helpful and sent me dose records from 2005 to 2008. Where are the data from 1995 I asked. They said they could not retrieve the data from the archive of the Mirion Technologies Dosimetry Services Division.”

The trust itself is adamant that there is nothing wrong with the machines. A long e-mail trail between the consultant and trust officials ended with the Trust insisting that the machines are safe and regularly checked.

Sally Lewis ” our image intensifiers are old and due for replacement “

Sally Lewis, a radiologist and medical examiner at the trust, wrote to Daniel Elkeles, then chief executive of the trust, saying there had been confusion about the reporting of the differing level of doses at Epsom and St George’s using different methods. She said if they had exceeded safety levels it would have triggered an alert.

She admitted; ” We are well aware that our image intensifiers are old and due for replacement … newer machines will with new technology produce lower dose readings which is something we always strive for.”

Dr Odemuyiwa disputes her findings. He said: “The manager misunderstood the report from the Radiation Protection Service. The absorbed dose of radiation, the amount of energy deposit in a small volume of tissue, and the equivalent dose, the impact that dose has on that tissue are numerically the same. The former is measured in mGy and the latter in mSv or milliSievert. Colon and prostate are more sensitive than the head for example.”

A year after leaving the trust he was diagnosed with prostrate and bowel cancer.

He explained to me in an interview: ” When you are fitting a pacemaker you are lying over the patient and are very close to the imaging equipment. If you are going to receive too much radiation the most sensitive organs to cancer are the prostrate and the bowel.”

Dr Odemuyiwa: ” When you are fitting a pacemaker you… are very close to the imaging equipment”

Since he announced his support for his colleague, Dr Prasad, Epsom and St Helier University Trust have declined to revalidate him so he cannot practice medicine.

The trust were contacted about what they intend to do after these revelations but have not responded.

Epsom and St Helier University Trust say on their pinned tweet on Twitter: “We put the patient first by giving outstanding care to every patient, every day.” Draw your own conclusion.

A second blog will look at what the hearing revealed about the issues surrounding the treatment of Dr Usha Prasad. The tribunal is expected to issue its findings in the New Year.

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Are top NHS officials Stephen Powis and Zoe Penn “fit for purpose”?

They can’t or won’t explain internal NHS procedures used to dismiss the perfectly competent cardiologist Dr Usha Prasad

The long drawn out saga over the dismissal of cardiologist Dr Usha Prasad by Epsom and St Helier University Hospital Trust reported earlier on this blog continues. I will be reporting soon on a lengthy Employment Tribunal recently finished where Dr Prasad made serious protected disclosures about patient and staff safety at the trust and senior consultants were cross questioned about the way they treated Dr Prasad.

In the meantime two retired cardiology consultants Professor Jane Somerville and Dr David Ward, who are championing Dr Prasad’s cause, have tried to get explanations from two of the most senior people in NHS England, Professor Stephen Powis, national medical director and Zoe Penn, Medical Director for the NHS London region and lead official for professional standards. Dr Zoe Penn took time out during the pandemic to sit on the internal Maintaining Higher Professional Standards panel which decided Dr Prasad’s future.

Claire McLaughlan , chair of the MHPS inquiry which found ” unfit for purpose”

At the heart of the matter is a ruling by the internal tribunal that Dr Prasad is ” not fit for purpose” to do her job. This was made by Claire McLaughlan, the never practised barrister who chaired the inquiry. with Zoe Penn. She has refused to explain what that term means which led to the two retired consultants going to the senior NHS officials for an answer.

What the panel could not rule was that Dr Prasad was ” not fit to practice” medicine even though the trust tried its best to be able to do so by sending 43 cases to the General Medical Council to show her failings.

The GMC not only threw out the Trust’s cases but decided to revalidate her to keep on working – taking away the power the trust had to stop her medical career.

Professor Powis’s response to this is: “Fitness for purpose is a phrase used to refer to behaviours which are not in keeping with the doctor’s ability to practise in a particular professional role but do not breach the threshold for GMC action, to be distinguished from those which are not in keeping with GMC
requirements on good medical practice and therefore may have an impact on a doctor’s licence or registration (“fitness to practice”).”

This is a cut and paste job from Claire Mclaughlan’s findings and takes us no further. It almost suggests the panel was upset that the GMC had ruled she was competent and made up something else to get rid of her.

Nobody can point to where in employment law this phrase comes from – let alone any case law of anybody being dismissed for being ” unfit for purpose”. Any employment lawyer who reads this blog is welcome to come forward to explain with some case law.

Disturbing Disclosures

The other disturbing disclosure from Professor Powis is the way he dealt with requests from the two consultants for an inquiry into the whole saga.

As they say : “How is it possible for Trusts to use cost threats, expensive lawyers and dubious (and unregulated) “independent management consultants” (aka hired guns) of the type used in this case, to push whistleblower claimants into submission and thereby achieve the “desired” outcome, i.e. their dismissal? It seems to us that this case is a particularly bad example.

They also say: “NHS Improvement has a duty to oversee behaviour of NHS Trusts. Will it continue to overlook the gravity of this and similar injustices? It is time for a review and improvement of NHS disciplinary and dismissal processes which should include senior NHS managers as well as medical personnel.
Professor Powis’s response was to refer the case to the regional medical director for London, Dr Vin Diwakar, a close colleague of medical director, Zoe Penn. He is a distinguished clinician and a former medical director of Great Ormond Street Hospital in London.

But was he the right person to do this review? He sits on the committee in charge of the re-appraisal and relicensing of medical directors in London with Zoe Bell. Given she was also on the same panel that found Dr Prasad was” unfit for purpose”, it is not surprising that Professor Powis in his own words was ” assured that a fair and independent process has been carried out.”

A really independent review would have called someone outside the London region to do this just as the General Medical Council did when a cardiologist from the North East reviewed her case. His solution would be like Epsom and St Hellier University Trust appointing a friendly cardiologist who would find in their favour at the GMC.

Professor Powis said: “It is not the responsibility of NHS England and NHS Improvement nor that of the
National Medical Director, or NHS England and NHS Improvement more generally, to intervene to resolve in individual employment matters,… although we will consider whether employment matters could indicate wider problems with how a trust is being run.”

Daniel Elkeles Pic credit: London ambulance NHS Trust

However perhaps the most damning issue he is silent about is the disclosure in Dr Ward and Professor Somerville’s letter about the behaviour of the former chief executive of the trust, Daniel Elkeles ( now at the London Ambulance Service) during this period.

I quote:”. It would appear that the CEO acted outside his powers by offering to bribe Dr Prasad to “drop all the actions you are taking against ESTH” and leave the Trust in exchange for which ESTH will “agree to cease the MHPS process”…..By offering these terms he was, in effect, cancelling the investigation. We think this is highly irregular. Do you agree?

What this shows is that Professor Powis is prepared to ignore unethical behaviour in one of London’s health trusts. Either this internal official process was necessary or it shouldn’t have been brought. It is not a bargaining chip to negotiate with a competent consultant. Frankly I think it is akin to blackmail – drop your complaints against the trust or we will make sure you will regret it.

What this nasty little saga shows is that unaccountable officials at the top of the NHS are either too frightened of health trusts or happy to go along with unethical behaviour in the NHS. It is also reveals that this complicated MHPS system is in need of a radical overhaul. It is like those at the top “unfit for purpose”.

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NHS Whistleblowers: Persecuted and trashed by managers to cover up patient safety issues

Issue much more widespread than the public realise

The recent Dispatches programme and article in the Times by journalist Matthew Syed highlighted the plight of whistleblowers in the NHS citing the case of Peter Duffy, a consultant surgeon, working for the Morecambe Bay Foundation Trust. Faced with failures at the trust in the emergencies department he expressed concern for two patients who subsequently died from kidney sepsis.

One would have expected the Trust to have remedied the situation. Instead they turned on him rather than admit any failings. As he told Matthew Syed: ” I was on the receiving end of allegations of bullying, abuse and racism. And so what I hoped would be an attempt to raise standards became an investigation of myself”.

It took five years of toxic attacks and tribunal hearings before he won his case for constructive dismissal. The sad thing is that this is not some isolated instance but appears to be growing in an NHS that is more concerned with its reputation than the safety of patients in its care and is preparing to spend millions of taxpayers money on lawyers fees to undermine any cases brought by whistleblowers. Furthermore it is prepared to spend literally years to wear down anybody who puts their face above the parapet.

Dr Usha Prasad

Readers of this blog will be aware of the case of Usha Prasad, a popular and competent cardiologist ( the General Medical Council has recently revalidated her) who has been driven out of the Epsom and St Helier University Health Trust ( now merged with St George’s Health Trust),

Today she starts a 16 day employment tribunal hearing as a whistleblower. She is backed by Dr Sola Odimuyiwa, from the hospital trust and two retired eminent cardiologists, Professor Jane Somerville and Dr David Ward, who believe her case is just one example of a malign system designed to cover up failures in the NHS. This week the latter two sent a letter to the Sunday Times which was edited down for publication. This is the full text:

“We thank Matthew Syed (Comment Oct 24) for his frank exposure of some of the “mistakes and weaknesses” of the NHS of which the persecution of medical whistle-blowers, as shown by the heinous story of the consultant surgeon, Mr Peter Duffy. He is one example of many.

It is a doctor’s duty of candour to draw attention to matters which are not safe for patients. This action, in good faith, prevents accidents thereby protecting patients. Hospital Trusts may not respond favourably to such complaints and may use their unbridled powers to instigate prolonged, expensive and vengeful disciplinary processes.

Medicine has learnt some of the lessons from aviation safety but the fair and open treatment of whistle-blowers is not one of them. Hospital Trusts are able to fund these processes because they can access public funds not available to the whistle-blower which is a gross imbalance of power. Shady external “management consultants”, who operate by their own rules, and expensive legal firms are hired by Trusts at great expense with the sole aim of ensuring the dismissal of the troublesome whistle-blower. This certainly affects the recruitment and retention of doctors the NHS so badly needs.

A serious consequence of this nefarious process has been the emergence of a cover-up culture in which the initial deficiencies or ‘protected disclosures’ are inadequately investigated.  There is no oversight or regulation of the way Trusts investigate whistleblowers. What informal processes there are may have been designed deliberately to avoid or deflect scrutiny. We have been unable to find a body or organisation to whom to report a Trust’s bad treatment of a whistle-blower. Attempts by supporters of whistle-blowers to engage higher regulatory bodies such as NHS England are usually met with indifference.

For the victimised, whistle-blowing doctor the outcome can be devastating. Their careers are stolen from them. The reputational damage prevents them from securing another job. Serious physical and mental health problems are not uncommon and family lives are destroyed.

We think the investigation of NHS whistle-blowers, of which there have been many notable cases over the past decade, should open and accountable. It is a scandal unknown by the wider public and in need of an independent inquiry.”

A national problem

You can see they believe this is a national problem not an isolated case. It can be backed up by a roll call of cases ( some of which are not yet finished). You can click on the stories reported in various newspapers to get an idea of the scale of toxicity on this issue.

Whistleblowing cases

Dr Raj Mattuhttps://www.theguardian.com/uk-news/2016/feb/04/dismissed-nhs-whistleblower-who-exposed-safety-concerns-handed-122m
Dr David Drewhttps://www.theguardian.com/society/2015/feb/11/nhs-whistleblowers-the-staff-who-raised-the-alarmhttps://www.amazon.co.uk/Little-Stories-Life-Death-NHSwhistleblowr/dp/1783065230?asin=1783065230&revisionId=&format=4&depth=1
Dr Kevin Beatthttps://www.standard.co.uk/news/health/nhs-to-pay-ps870-000-to-whistleblower-doctor-who-spoke-out-on-patient-safety-a4384211.html
Dr Chris Dayhttps://www.theguardian.com/society/2018/oct/02/nhs-whistleblowing-protection-tribunal-junior-doctors
Dr Ed Jesudason https://www.drphilhammond.com/blog/2018/06/28/private-eye/private-eye-medicine-balls-1468-march-16-2018/
Mr Peter Duffyhttps://the-medical-negligence-experts.co.uk/lancaster-surgeon-peter-duffy-nhs-whistleblower-book/
Dr Claire Connollyhttps://www.rllaw.co.uk/success-at-tribunal-for-nhs-whistleblower-dr-claire-connolly/
Dr Minh Alexander, who hosts a blog site about whistleblowing having been one herselfhttps://minhalexander.com
Pandemic whistleblowers inchttps://www.independent.co.uk/news/uk/home-news/coronavirus-uk-nhs-ppe-whistleblowers-job-losses-ppe-a9515856.html
Dr Usha Prasadhttps://davidhencke.com/?s=Prasad&submit=Search
Mr David Sellu, a surgeon in the private sector, was treated badly but he was not a whistleblower just a victim of the judiciaryhttps://www.theguardian.com/global/2019/jun/16/they-look-for-a-scapegoat-a-sugeons-battle-to-clear-his-name-dr-david-sellu

But this is not the end of it by many means. Since I took up Dr Prasad’s case I have become aware through a new group. Doctors for Justice, that there are as many as 35, yes 35, other cases. Nearly all the doctors at the moment are requesting confidentiality until their case becomes public at an employment tribunal hearing. There are many, many other doctors who have quietly quit trusts to find work elsewhere because they don’t want to have to fight their employers for years on end.

Under this system it is the patient that pays the price – and in a number of cases the ultimate price – death. That is why this blog is going to keep an eye on what is going on the NHS until someone has the guts to reform the system and take on a bureaucracy that seems more interested in preserving its reputation than improving patient safety.

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Death is a great leveller: Taliban agree to mass vaccination against polio and a campaign against Covid 19

Women to be giving jabs in a frontline role

The Taliban’s ideological stance against women having an equal role with men has had to take a back seat in the face of a potential major health crisis in the country. For once the extremist leaders are finding out they can’t fight disease without the participation of women.

In what must be a welcome breakthrough following negotiations between the World Health Organisation and the Taliban the leaders have agreed to a country wide vaccination programme against polio and for a new campaign to fight Covid 19 and measles.

Failure to do so would have opened the country -already reeling from the loss of Western and humanitarian aid – to the spread of life threatening diseases which have all but disappeared in more advanced countries. The prospect of widespread deaths from unchecked diseases as well as growing hunger and poverty has focused minds.

The new deal was revealed in an announcement from the World Health Organisation today.

The vaccination campaign, which begins on November 8, will be the first in over three years to reach all children in Afghanistan, including more than 3.3 million children in some parts of the country who have previously remained inaccessible to vaccination campaigns.  A second nationwide polio vaccination campaign has also been agreed and will be synchronised with Pakistan’s own polio campaign planned in December.

WHO welcomes programme

“This is an extremely important step in the right direction,” said Dapeng Luo, WHO Representative in Afghanistan.  “We know that multiple doses of oral polio vaccine offer the best protection, so we are pleased to see that there is another campaign planned before the end of this year.  Sustained access to all children is essential to end polio for good.  This must remain a top priority,” he said.

So far there has been only one case of polio this year under the previous government but with no vaccination programme a resurgence of the disease was likely. Instead now it could be eradicated.

“This is not only a win for Afghanistan but also a win for the region as it opens a real path to achieve wild poliovirus eradication,” said Dr Ahmed Al Mandhari, WHO Regional Director for the Eastern Mediterranean.  “The urgency with which the Taliban leadership wants the polio campaign to proceed demonstrates a joint commitment to maintain the health system and restart essential immunizations to avert further outbreaks of preventable diseases,” he said.

The overall health system in Afghanistan remains vulnerable.  To mitigate against the risk of a rise in diseases and deaths, all parties have agreed on the need to immediately start measles and COVID-19 vaccination campaigns.  This will be complemented with the support of the polio eradication programme and with outreach activities that will urgently begin to deliver other life-saving vaccinations through the national expanded programme for immunization.

The Taliban leadership has expressed their commitment for the inclusion of female frontline workers and for providing security and assuring the safety of all health workers across the country, which is an essential prerequisite for the implementation of polio vaccination campaigns.

WHO and UNICEF call on authorities and community leaders at all levels to respect and uphold the neutrality of health interventions and ensure unhindered access to children now and for future campaigns.

This is probably the one gleam of light in what has been an extremely bad autumn for the people of Afghanistan and a huge setback for women’s rights. The threat of mass deaths from preventable diseases has obviously alarmed the new regime.

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The “systemic maladministration ” facing the disabled applying for Personal Independence Payments -official findings

Margaret Kelly Northern Ireland Ombudsman

Northern Ireland ministry and Capita under fire

An absolutely damning report has been issued by Margaret Kelly, the Northern Ireland Ombudsman on the way hundreds of thousands of disabled people between the ages of 16 and 64 are assessed to see if they qualify for personal independence payments.

This two year investigation into the benefit is the first made by the Ombudsman using new powers under Northern Ireland legislation giving their Ombudsman the power to initiate inquiries if the Ombudsman thinks something is going wrong. This type of inquiry would be illegal in England, Scotland and Wales because Ombudsman do not have the same powers.

In Westminster Michael Gove, the Cabinet Office minister, is currently refusing to even introduce draft legislation to give Rob Behrens, the Parliamentary and Health Service Ombudsman. similar powers to start his own inquiries.

The findings apply to the 250,580 people who applied for the benefit in Northern Ireland but as the NI Ombudsman’s Office says ” there are many similarities to PIP across other parts of the UK.”

The report – which examined 100 cases in minute detail, made extensive inquiries of the ministry and Capita, and looked at statistics governing appeals concludes there has been ” systematic maladministration” by the Northern Ireland Department for Communities and Capita, who were administering the assessments.

Not “one off mistakes”

The report says these were not one off mistakes. Instead she” identified repeated failures which are likely to reoccur if left unremedied. It is therefore my view that there is more work to be done to improve the experience and outcomes for claimants, the robustness of decision making and public confidence in the system.”

She has made some 33 recommendations and has given the ministry and Capita six months to rectify them. She can’t compel the ministry to implement them but has said she will do a follow up report to see what they have done. The report also went to members of the Northern Ireland Assembly.

Ms Kelly said:
“Too many people have had their claims for PIP unfairly rejected, and then found themselves having to challenge that decision, often ‘in the dark’, and on multiple occasions, while not knowing what evidence has been requested and relied upon to assess their entitlement.

” Both Capita and the Department need to shift their focus to ensure that they get more of the PIP benefit decisions right the first time, so that the most vulnerable people in our society get access to the support that they need, when they need it. Furthermore, it will safeguard public resources by reducing both the time and costs associated with examining the same claim on multiple occasions.”

The report reveals a serious lack of leadership and guidance from the ministry, poor communication with claimants and a failure to get key additional medical information which would have helped them get the benefit. As a result many of them had their applications turned down only to appeal and get the benefit – at a cost of some £14m to the taxpayer. If the ministry and Capita had got the information in the first place there would have not have been the need for an appeal.

Capita had an incentive NOT to get further medical information to help claimants

She also discovered that disability assessors working for Capita had a perverse incentive NOT to get additional information to help the claimant because they would get a bonus if they completed the application quicker and getting extra information slowed down the process.

Capita were also criticised for poor communications with health professionals as well as claimants. When evidence was requested from Health Professionals named by the claimant, the request letters sent by Capita were often poorly completed and did not specify what information was sought.

In face to face assessments, the evidence from the consultations was often the primary and in some cases the only source of evidence relied upon by the Disability Assessors when providing their advice to the Department.

I came across this report because of a link to my blog from UKAJI, the United Kingdom Administrative Justice Unit, who have reviewed the long report. Their article is here.

I concur with their review which was impressed with the high standard of the research and the bar it set for future Ombudsman investigations.

To my mind this again shows the current weakness of the Parliamentary Ombudsman in Westminster. The present Ombudsman can only investigate complaints and therefore is left with a much narrower remit. By having powers to do a broad ranging investigation, much more detail can be investigated and issues that governments don’t want to address can be highlighted. Hence the conclusion in this report that the disabled have been subject not just to maladministration but ” systemic maladministration”. I bet disabled claimants are similarly treated in the rest of the UK but nobody has the resources to properly investigate their poor treatment. Let’s see what happens in Northern Ireland following this devastating report.

Top retired Cardiologist calls for whistle blowing to be a “routine and acceptable practice” throughout the NHS

Dr David E Ward, retired cardiologist

This is a guest blog by David E Ward, a distinguished retired cardiologist, formerly at St George’s Hospital, South London, in response to my last blog on the case of Dr Chris Day and a series of blogs on the case of Dr Usha Prasad

The treatment of bona fide whistleblowers working in the British NHS is egregious and primitive. This is amply exemplified by many publicised WB cases over the last 2 decades: Dr Raj Mattu, Dr David Drew, Dr Kevin Beatt, Mr Peter Duffy, Dr Chris Day, Dr Usha Prasad and many others (see Google). Just think for a second or two – is it appropriate to threaten the career, the livelihood, the families of these honest doctors who were only doing the “right thing” by drawing attention to what they honestly perceived were remediable shortcomings? In fact, it is required of doctors to report any perceived shortcomings (Hippocratic Oath and all that and more recently with the “Duty of Candour”).

How is it possible – in the democratic UK – to threaten a doctor with such punitive costs that they are forced to withdraw their legitimate claims or risk potential bankruptcy? Isn’t this behaviour something we might associate with some autocracies toward the east? In the case of Dr Chris Day, the sum spent on pursuing (persecuting) him must now be more than £1,000,000! All to extinguish the career of an honest doctor who sought only to improve the care of patients in his unit. Wouldn’t it have been more sensible (litotes here) to spend that huge sum of money on improvements to the unit in question? (see CrowdJustice, http://54000doctors.org/blogs/timeline).

Successive health secretaries did ” little or nothing” to help whistleblowers

Jeremy Hunt, former health secretary now chair of the Commons health and social care committee

Successive Health Secretaries have done little or nothing to support whistleblowers. Jeremy Hunt (yes, he who did so much damage to the NHS; see Caroline Molloy, http://www.openDemocracy essay) asked Sir Robert Francis QC to report on the issue (see Google) but then ignored most of his recommendations or feebly implemented some (for example, the Freedom to Speak Up Guardian which doesn’t really work, to say the least). The last SoS for Health and SC did nothing at all to support WBs to my knowledge (OK, there is a pandemic). The present one has probably never heard of any of the names listed above or even what whistleblowing within the NHS means! What is more disturbing is that other powers-that-be, for example the NHS Medical Director, the Head of the NHS (whoever that will soon be), other Ministers etc, seem to take no interest in this problem, none whatever. The Health and Social Care Select Committee could take an interest but it is chaired by Jeremy Hunt – who is too occupied with his own self-importance and whose record as SoS speaks for itself – so I don’t expect any action there. Perhaps these grandees are too far removed from day-to-day whistleblowing in the NHS. It wouldn’t take much time to find out what is happening at grass roots.

Time to create a public register of whistleblowing cases

Some tentative suggestions:

1. Create a register of WB cases. Whistleblowing investigations are almost invariably secretive. Why? Apart from clinical details what else need to be anonymised? All reported and ongoing whistleblowing cases should be logged in an open and accessible register kept by an independent (is that possible?) body, preferably independent of the Trust and possibly the NHS and its Byzantine structures. Progress of a case should be openly documented and questions may be submitted. Resolved cases would be available, uncensored, for retrospective scrutiny. Openness might deter shady deals behind closed doors (yes, they do happen). Above all the external investigators should be accountable to the Trust and their own professional organisations.

2. Make cost threats unlawful. No Hospital Trust should be permitted to use the threat of costs against a “little person” (i.e., doctor) who cannot possibly equal the financial power of the taxpayer-funded persecution to defend themselves (yes, for it is us, the taxpayer, who pays the bill for the outrageous sums mentioned above to “thwart” the WB but we have no say whatever in the process). If money is to be spent in this process it should be wisely and fairly spent and shared equally between the participants, that is the victim (the doctor) and the aggressor (the Trust).

3. Make Internal hearings demonstrably independent of both parties. All WB cases which are subject to “internal” hearings (for example Maintaining High Professional Standards panels) are vulnerable to potentially corrupt processes (as some of the above cases probably have been). They should be heard by independently appointed persons (this will require some checking because as we have seen not all so-called “independent” chair-persons are quite as independent as they may appear – see Dr Usha Prasad blogs here) and open to external scrutiny by independent authorities or suitably qualified persons. Minutes of internal hearings should be made accessible. (Employment Tribunal proceedings are already largely in the public domain).

Make falsified evidence a criminal offence

4. Make falsification of evidence by either party an offence (I think there is a name for this beginning with “P”). If defence of a whistleblowing claim by a Trust is found to be untrue or contain false or falsified “evidence”, or in some other way is dishonest (there may be some of that in some of the ongoing current cases mentioned above…) there should be appropriate retribution for the Trust and managers involved. Incidentally, it is usually managers who instigate the persecution and recruit the heavy (taxpayer-funded) lawyer-supported defence without accepting any personal responsibilities themselves. Also, the use of public money in this way could be regarded as fraudulent and a misuse of taxpayer funds.

5. Ensure the original WB claim is clearly stated. The original concern which prompted the WB to speak out should be clearly and concisely stated in language that the “man on the Clapham omnibus” (Lord Justice Greer, 1932) can understand. It should never lose its primal status. It defines the whistleblower in the first place. WB have, by definition, concerns about the environment in which they are working. They make what is termed a “protected disclosure” (Protected Disclosures Act 2014, Health Act 2004). It is remarkable that these concerns are not infrequently submerged (or completely forgotten) by the ensuing investigative process – which is often more about the Trust and its managers avenging a perceived insult by the WB than seeking solutions.

Health Trust managers use lawyers to “crush honest doctors”

Lastly, what is it that Trusts’ and their managers are so keen to defend seemingly at any cost? Very expensive lawyers are used to “crush” an honest doctor, the “little person”. A defence possibly costing much more than it would to correct the shortcomings exposed by the WB in the first place. Is it the Trusts’ or its managers’ reputations that are at stake? Would the CQC ratings be adversely affected if the Trust was found to be at fault? Are there hidden misdemeanours which might be revealed? Why do these proceedings always come across as a potential “cover-up” by the Trust? Shouldn’t the grossly disproportionate defensive stance itself raise serious questions worthy of further investigation?

It is high time the treatment of NHS whistleblowers is once again raised at the highest level (for example, in the House of Commons following the example of Sir Norman Lamb, see report above). Too many professional lives (not only doctors but nurses, physios etc) are being destroyed for no good reason. This is bad news at any time but in the middle of a pandemic it is nothing short of scandalous. Whistleblowing in the NHS is not taken seriously enough and may be a factor persuading some doctors to voluntarily leave the profession before time. In an open liberal society with everyone working for the good, “whistleblowing” should be a routine and acceptable practice. Sadly, it is cause of great distress and stigma.

BMA and ex health minister Norman Lamb back whistleblower doctor Chris Day in patient safety battle

Dr Chris Day now being backed and funded by the BMA Pic credit: Twitter

The tables are beginning to turn in a seven year battle which has cost £700,000 so far to the taxpayer between Chris Day, an anaesthetist in an intensive care unit ,employed by Lewisham and Greenwich Health Trust.

The case against the trust and Health Education England has been drawn out over seven years at employment tribunals and appeal tribunals. He was forced into a settlement in which he had to withdraw his allegations of patient safety being at risk at the ICU unit at Woolwich Hospital in return for the trust accepting he had genuine concerns as a whistleblower at Woolwich Hospital between 2013 and 2014. The trust , using expensive lawyers, threatened to land him with huge legal bills if he continued and started cross examining their witnesses. The allegations included poor staff ,patient ratios at the ICU and inadequate medical supervision. He also made the same allegations to Health England Education.

Trust forced him to settle by threatening him with huge legal bills

As he said: “After two and a half days of my six day cross examination I was contacted by my legal team and told that the NHS respondents had decided to inform me of their intention to seek costs for the entire four week hearing if I proceeded to cross examine any of the NHS’s14 witnesses and ended up losing the case,”

He had no option but to withdraw to protect his wife and family from bankruptcy should this threat be carried out.

“real prospect of success” says judge

But he has won the right to get the enforced settlement out aside and take his case to the Court of Appeal. In giving judgement the Rt Hon Lady Justice Ingrid Simler DBE stated in the Order of the Court of Appeal that “I consider this appeal has a real prospect of success. Permission is granted”. Simler LJ is a highly experienced Judge and she was previously the President of the Employment Appeal Tribunal.

Until now he was left with trying to raise money so he could afford to pay the lawyers to fight the trust. In the last week in what amounts to a major change of heart, the British Medical Association has decided to fund his battle. Internal sources say this may be the first time the BMA has decided to fund a doctor in a whistleblowing case.

A BMA spokesperson said:

“Chris’ case has brought into sharp public focus the challenges and adverse experiences which doctors can face when they make public interest disclosures to blow the whistle on safety concerns they identify, in the course of carrying out their job.

“Doctors have a responsibility to raise concerns they have about the safety of their patients and yet too often they are put in the position of having to blow the whistle on organisational failures when the organisation in question fails to act. The BMA’s own research shows a majority of doctors work in a culture of fear and are worried about recrimination if they speak out about patient safety concerns. The BMA has been calling for an open culture, where speaking out is encouraged and supported and where our NHS learns from concerns and errors, to improve safety for patients.

“The BMA carried out a comprehensive external review of its member support services and we are now making significant improvements in how we support whistleblowing cases and indeed all members who raise concerns within the NHS. This includes offering more specialised legal support given the complexity of such cases. We are grateful to Chris and other BMA members for their input to this review. Different processes would have been followed if Chris’s case was to arise today and we are pleased to be able to offer Chris the support he needs in the next stage of litigation in his case as well as in the wider interests of the profession and patient care”.

Chris Day said:

“I am pleased to announce that I will be accepting support from the BMA in the next stage of litigation in my case.

“I have always remained a member of the BMA and it is clear to me that the new leadership at the BMA is committed to supporting me and my family where it is able to do so. The Association has spent considerable time and effort understanding my situation and provided me with expert legal advice as I considered the best way forward.

“I know the BMA has undertaken a great deal of work to consider how it supports whistle-blower cases and it has sought to learn from the past. They have established new arrangements to ensure better support for potential whistle-blowers, including guaranteeing a meeting with a specialist solicitor and case manager that now takes place before any case is considered too weak to proceed or on cases that are initially considered strong enough to proceed where this view subsequently changes.

Sir Norman Lamb. Pic credit: Twitter

“I look forward to working with the BMA. The BMA has a critical role in ensuring that no doctor should ever be forced to choose between their career and the safety of their patients and I would encourage every doctor and medical student to join the BMA and take an active role in shaping their trade union. Doctors need a trade union now more than ever.”

Chris Day has also got the support of Sir Norman Lamb, the former Liberal Democrat health minister, who backed him while he was in government. Sir Norman is now the chairman of the South London and Maudsley NHS Foundation Trust., the neighbouring trust to Lewisham and Greenwich. Despite some concern in the NHS establishment he is to continue to support Chris Day and will be a witness.

Given the dire findings in the Usha Prasad case with Epsom and St Helier University Health Trust, reported in this blog, this development is the best news a whistleblower doctor can get.

High court judgement on 50swomen pension’s cannot stand – Jocelynne Scutt tells CEDAW People’s Tribunal

Dr Jocelynne Scutt

The president of the Cedaw People’s Tribunal, and a former judge, Jocelynne Scutt, said today that the decision by the Court of Appeal to turn down the judicial review into the handling of the rise of the pension age for 50s women will be overturned.

She was commenting on evidence to the tribunal from Christine Cooper, chair of accounting at Edinburgh Business School on the plight of 50s women and how CEDAR could redress the issue. She was giving evidence in a personal capacity.

Christine Cooper pointed out that the ruling -part based on the fact that the 1995 legislation allowed the Department for Work and Pensions to say they had no obligation to tell the 3.8 million women about changes to their pension would have wider implications for the rest of government policy if it was applied in other areas. For this reason alone it is likely to be challenged in other cases.

If the UN Convention on the Elimination of all forms of discrimination against women (CEDAW) was part of UK law it would seen as discrimination against a particular group on that ground alone.

Christine Coooer

Christine Cooper strongly defended the 50swomen saying ; ” This is a group of women who did all what was expected of them in society, brought up families and went back to work when they could. The way they have been treated is mad.”

She said if the government had spent the £6.5 million on an advertising campaign to get people to take out a second private pension instead on informing women about the change in 2001 they would have been more prepared. Instead it had only spent £80,000 47,000 leaflets many going to private finance advisers – the people who were most likely to know about it anyway. She said the worst affected people were those who were in low paid jobs, single women, divorced women, women from ethnic minorities and those who had worked part time.

She it was clear that there had been no impact study in 1995 on the effect it could have on the women and the impact study which covered the 2011 Pensions Act was based on how men would be affected. Most women only had months notice – while men had seven years notice of the rise in the pension age from 65 to 66.

She also revealed that the DWP does not keep any information on the gender pay gap ,the gap between the pension earnings of women and men. Instead a survey is done by Prospect, a Whitehall trade union, which revealed that the difference has remained stubbornly at 40 per cent for the last five years -meaning men will get a pension worth £7,500 more than women.

Occupational pension pots for women aged 65 are at present £35,800 – a fifth of the figure for men at the same age.

Government pressure to get trade deals will hit women’s pay – former civil servant

Janet Veitch- former civil servant with extensive knowledge of CEDAW

A former senior civil servant warned that both Brexit and the hostile environment against migrants were going to have a disproportionate effect on women’s rights.

Janet Veitch OBE  is a consultant in the UK and internationally on women’s rights, having worked for ten years for the UK Ministers for Women and as Director of the UK Women’s National Commission.

She is a founder member of the End Violence Against Women Coalition; Vice-Chair of ‘Equally Ours’ and an associate adviser on gender for the British Council. Janet was awarded the OBE for services to women’s rights in 2011.

Janet Veitch said that the UK leaving a market of 500 million people would profoundly affect the British economy because it had yet to find alternative markets. Pressure to get trade deals would lead to a downward pressure on wages and labour conditions, which would predominately affect women, as many were already in low paid jobs.

The ” hostile environment ” against migrants would also lead people to start to condone a critical attitudes against people who looked visually different to themselves. CEDAW might not be a complete panacea but it would force the government to do due diligence on a host of issues.

Horrendous statistics on how women are treated over maternity leave and costly child care

Joeli Brearley – campaigner on maternity rights

A horrendous picture of discrimination against pregnant women was outlined by Joeli Brearley to the tribunal.

Joeil,founder and CEO of ‘Pregnant Then Screwed’, a charity which protects and supports women who encounter pregnancy; maternity discrimination and lobbies the Government for legislative change. This was after being sacked when she was four months pregnant.  Joeli was awarded the 2019 Northern Power Women ‘’Agent of Change’’; and is an International Women Human Rights Defender.

She described the appalling position of pregnant women who were often sacked by employers but then found they could get no redress under the employment tribunal system She said they had, while heavily pregnant only three months to lodge a case, found it would cost them £8000 to do so and many had no knowledge of the law. As a result there were very few cases.

She said women were hit by two major issues -facing pay cuts if they lost their jobs as they had to seek part time work on low pay – and paying for the second most expensive child care costs in Europe.

Typical child care costs took 33 per cent of their salary while single mothers, it took 67 per cent of their earnings. The difference between maternity leave and male parental leave of just two weeks meant only three per cent of men took a major part in looking after the new born baby, even though many more men would have liked to do it. Those who did had a 40 per cent more chance of staying together.

She said the situation had worsened during the Covid 19 pandemic. She thought CEDAW would make a big difference.

Loneliness and misery for women in rural Britain

Nick Newland

Poor transport and health services, loneliness in the remote areas of the UK were all part of the problems facing women in rural England, Scotland, Northern Ireland and Wales.

Nick Newland is from the Association of Country Women Worldwide The organisation exists to amplify the voices of rural women, so that the problems they face and the solutions they raise are heard and acknowledged by international policy-makers and legislators. Rural women are the backbone of families/communities but they go unheard
in legislation, and they remain unprotected and unsupported. ACWW exists to change that.

He hoped CEDAW would lead to women have a much greater say in rural areas – and not just in the odd focus group -so they could get change in their area. He said transport was a major problem for many women – though it was better in Scotland and Wales than England.

He cited an example of one woman living in Monmouth who had to spend seven hours travelling to get a 15 minute jab against Covid 19 in Newport because of the bus timetable.

He also said that loneliness and isolation of women was a major issue – and had been made worse for women by the raising of the pension age. He said getting health care was also a big issue and there was a serious mental health crisis in rural Britain – some times aggravated by their farmer partners committing suicide. There were also cases of brain damage among women who had tried to commit suicide but had not succeeded.

” There is a desperate need for a national strategy , a better quality of life and equality for women in education and health.”

” We have already got one Pakistani here , we can’t take another one” – women’s refuge owner

Rosie Lewis at TUC backed rally

Rosie Lewis is Director of the Angelou Centre , Newcastle supporting the organisation’s services for Black women and girl survivors and has been involved in social justice activism for more than 25 years.

She has given evidence to CEDAW and to the Independent Inquiry into Child Sexual Abuse in order to ensure that the findings of both reflect the state response to violence against Black and minority ethnic women and girls. 

An appalling picture of the treatment of women from ethnic minorities now migrant women and children had been excluded deliberately by the government from new domestic abuse legislation was given by Rosie Lewis

She said they were now being excluded from access to justice, help from specialists and many professional organisations no longer want to know or help them. She cited the case of one woman fleeing a forced marriage being told by the person running a women’s refuge, ” We already have one Pakistani here, we can’t take another one.”

She said a city like Durham now had no specialist organisation that could help people in the surrounding rural areas.

She thought if the UK did adopt CEDAW in UK law it would raise awareness, and improve access to services for ethnic minorities.

Other witnesses.

There was also evidence given today from Catherine Casserley, a barrister specialising in employment, discrimination, and Human Rights law. Co author of ‘Disability Discrimination Claims: An Adviser’s Handbook’. She said CEDAW would make a big difference to the plight of disabled women, including increasing awareness, creating a willingness to change and give a proactive approach to achieving equality.

Cris McCurley, who studied Law at the University of Essex and is a Partner in Ben Hoare Bell LLP; and a member of The Law Society’s Access to Justice Committee. gave some damning evidence of the treatment judges gave in family courts towards ethnic minorities.

Rebecca J. Cook from Toronto University who has made a contribution to international women’s rights as an author, legal educator, editor, lecturer, and participant in numerous conferences sponsored by such organizations as the World Health Organization and Planned Parenthood. She gave a video interview on abortion issues facing women.

Lisa Gormley from the LSE Women’s Peace and Security Policy, gave a talk on violence against women and the role of the Istanbul Convention, which the UK has yet to sign up.

She is an international lawyer specialising in equality for women and girls. She has also worked closely for several years with the UN Special Rapporteur on violence against women, its causes and consequences Lisa a legal adviser in Amnesty International’s International Secretariat (2000-2014).

Finally there was also a video from Professor Diane Elson and Mary-Ann Stephenson analysing how much the government spends on women and the huge pay gap between women and men.

Mary-Ann is the Director of the Women’s Budget Group and has worked for women’s equality and human rights for over twenty years as a campaigner, researcher and trainer. She was previously Director of the Fawcett Society and a Commissioner on the Women’s National Commission.

Professor Diane Elson is Emeritus Professor at University of Essex; member of the UN Committee for Development Policy; and consultant to UN Women.  She has served as  Vice-President of the International Association for Feminist Economics and as a member of G7 Gender Equality Advisory Council (2018).  She one of the pioneers of gender analysis of government budgets.

Unfit for Purpose: The NHS appeal panel that upheld the sacking of Dr Usha Prasad

Earlier this month the appeal panel set up by the Epsom and St Helier University NHS Trust under Mrs Claire McLaughlan rejected the appeal by Dr Usha Prasad, the cardiologist, against her sacking. She is said to be ” unfit for purpose”. For many the verdict was thought to be inevitable given the enormous lengths the trust had gone to dismiss her, but the findings are worth highlighting because it is a perfect example of why this internal system is in disrepute and needs to be scrapped.

The unwieldly nature of the Maintaining High Professional Standards Appeal system set up in 2003 by the NHS is itself “unfit for purpose” as illustrated by an enlightening article in the Health Services Journal by Alastair Currie, a partner with the law firm Bevan Brittan.

“No sane NHS manager would use MHPS”

He wrote: “MHPS is a calamitous mess of a document,” and goes on to say:

“MHPS, at 59 pages, is a bloated mixture of inconsistent policy verbiage and labyrinthine procedure. It seems designed to promote High Court debate … and so it often does. There is a devastating trail of case-law left by MHPS, each case involving a doctor or dentist and their employer becoming miserably entrenched in MHPS for years before landing in the courts.”

“No sane manager wants to touch MHPS, let alone use it frequently or to intervene early in borderline bad practice. It is well known that any attempt to use MHPS risks years of disputes and litigation.”

So it is a supreme irony that the law firm Bevan Brittan is the very company that facilitated the MHPS hearing on the Usha Prasad case. While Alastair Currie denounced the system in the most colourful language, his colleague Tim Gooder, was fixing up the arrangements for the hearing. Still never get between a law firm and their business to make money. I wonder which ” insane” manager from the trust engaged them.

Now to the hearing itself. The report begins with a desperate defence that the three main members of the panel are independent. Claire McLaughlan emphasises that she is a non practising barrister. What she should have said, I am told, is that she is an unregistered barrister because she has never worked for a law firm and never completed any pupillage. The analogy which she should know is that a qualified doctor is not properly qualified until he or she has worked in a hospital.

Dr Zoe Penn has a high flying job as a medical director and lead for professional standards at NHS England and Improvement (London region). She, I understand, has refused to communicate any explanation of the decision hiding behind the “labyrinthine procedure” of MPHS.

And Ms Aruna Mehta, a former banker and non executive director of the trust, I gather was appointed to the trust without any competition for the post.

The panel could not find that Dr Prasad was ” not fit to practice” because she has been both exonerated and revalidated by the General Medical Council. They didn’t even bother to read all the detailed expert findings in the GMC report. So citing the bad relations in the hospital trust between medical colleagues they decided that Dr Prasad was not fit for purpose.

Back of an envelope decision

The relevant paragraph said: “The GMC were concerned with Dr Prasad’s fitness to practise whereas the MHPS panel were concerned about Dr Prasad’s fitness for purpose. The Panel are fully cognisant that these are two different considerations, with different tests, thresholds, processes and outcomes. Fitness to practise distinguishes behaviours which are not in keeping with GMC requirements on good medical practice and therefore may have an impact on a doctor’s licence or registration from behaviours which are not in keeping with a doctor’s ability to carry out a particular professional role. Although the latter do not breach the threshold for GMC action it does mean that a doctor is not fit
for purpose.”

Yet nowhere are these different tests and thresholds explained nor how a human being rather than a system or faulty goods can be classified as unfit for purpose. It is as almost Mrs McLaughlan made the concept up on the back of the envelope just to find anything to attack her. And also safe in the knowledge that the MHPS protects her from explaining herself.

Certainly there are purple passages slamming Usha Prasad’s perceived failings: “Dr Prasad made mediation unviable, refused to participate in a behavioural assessment, made a placement impossible, refused a sabbatical, did not engage with the Trust’s MHPS investigation, responded antagonistically throughout and submitted multiple grievances as a result of any challenge. She appears unable to accept help from her peers but sees everything through the prism of victimhood.”

Yet this is at total odds with reports from Pinderfields Hospital near Wakefield where has received glowing tributes for being able to work there with colleagues while on a placement from St Helier – the report seems to suggest that she is a Jekyll and Hyde figure.

The report does not exonerate other senior figures in the cardiology department. Dr Richard Bogle, who was head of the cardiology department, is criticised: “The Panel were concerned about some of Dr Bogle’s actions and non-actions while clinical leader and how little leadership he demonstrated. He displayed little empathy in relation to the anonymous letters. As the departmental leader he could have undertaken an investigation himself into the relationships within the department.”

Also the inquiry has to admit that the way the trust collected evidence against her to send to the GMC was dubious. “The 43 cases do appear to have been gathered in a haphazard, rather than properly random, fashion. This could be construed as a hunt for evidence rather than a proper audit of clinical care against known gold standard best practise which is properly comparative with others i.e. benchmarking.”

This sorry saga has ended with a popular and competent cardiologist dismissed from the trust and declared to be ” unfit for purpose” as a human being. The truth, as I see it, is that it is the system that judged her that is ” unfit for purpose” not Dr Prasad.

THE USHA PRASAD FILE: PREVIOUS STORIES

 A bizarre tribunal hearing on the treatment of Epsom’s health-trust’s sole woman cardiologist

Top cardiologists back Usha Prasad’s fight against ” badly behaving ” health trust

Botched internal inquiry hearing into Dr Usha Prasad at St Helier Hospital as doctors fight death from Covid- 19

https://davidhencke.com/2021/03/10/exclusive-general-medical-council-investigation-exonerates-dr-usha-prasad-of-any-medical-failings/

https://davidhencke.com/2021/04/21/hidden-justice-in-the-nhs-profile-of-claire-mclaughlan-a-doctors-career-terminator-and-rehabilitator/

Professor Jane Somerville; Pic credit: World Heart Foundation

Professor Jane Somerville, a distinguished cardiologist , who took part in the first heart transplant in the UK, has put up this comment on the situation:

This story highlights a serious problem within the National Health Service which needs urgently to be addressed by the Department of Health. The number of new whistleblowing scandals is steadily increasing. It is concerning when dismissal of a senior doctor following a “whistleblowing” event (as in this case) occurs at a time when insecure young doctors and new consultants are worrying about what sort of National Health Service has employed them – and in the middle of the worst pandemic for 100 years! In David Hencke’s excellent factual reports, a BAME consultant, easily bullied by the Trust despite being found by our regulatory body (the GMC) to be ” fit to practice” has lost her livelihood on grounds of not being “fit for purpose”. This interesting phrase does not appear in English Employment Law, and when used applies to services or goods. Perhaps the Trust wishes to show she is as useless as a cardboard box!

Why does the Department of Health or NHS England allow hospital Trusts to do this, to fight whistleblowing staff but fail to address their original concerns or even pay any lip service to them, using vast sums of taxpayers money (>£700k going on £1m in the case of Dr Chris Day, see @drcmday on Twitter) which the “little person”, the doctor under fire, cannot hope to match? In an exercise of gross imbalance of power and taxpayers’ money Trusts respond to whistleblowers by using panels of seemingly prejudiced and dubious panellists and often expensive lawyers.

These bullying Trusts have too much power and no one seems to be able or willing to control their excesses. This is not a unique case. There have been several very prominent examples in the national press over the past 2 decades. The Department of Health should be concerned about the oppression of their vital professionals, unequipped to fight back and often not helped by representative bodies (such as the BMA), or seniors who may themselves be too frightened of a Trust’s retribution. This cannot be a fair outcome for whistleblowers whose primary motives are to preserve and maintain patient safety, often requesting simple as well as fundamental changes and fair but thorough investigation of underlying problems. A Trusts’ response to whistleblowing often seems corrupted by internal bias. The Department of Health turns a blind eye or does not care. Sir Robert Francis QC was asked to report (2010 and 2013) on failings of Mid Staffs management and avoidable loss of lives. He made many (290) recommendations and introduced the Freedom To Speak Up Guardian. Only a few of 290 recommendations were adopted and FTSU process is not functioning as intended. The Dept of Health should be ashamed of ignoring its responsibilities to the NHS, its doctors (and nurses) and the British electorate. Not to mention the huge sums of taxpayers money expended to save face and cover up the initial problems as well as the labyrinthine process itself.

Professor Jane Somerville

Hidden justice in the NHS: Profile of Claire McLaughlan – a doctors’ career terminator and rehabilitator

Claire McLaughlan. Pic credit: Linked In

The National Health Service has a largely hidden system of justice when a health trust is involved in a dispute with a doctor. It holds internal inquiries and appeals in private to decide whether a doctor should be dismissed.

The people who chair and sit on the inquiry are drawn from a list that a health trust can choose. The same people are also chosen and paid by trusts to build up a case against a doctor. The people who get onto the list normally have had a career in the NHS but are now running their private businesses in Claire McLaughlan’s case offering rehabilitation to doctors who have fallen foul of their own health trust.

I have chosen Claire McLaughlan as an example because she has been and is involved in three high profile cases where doctors have challenged decisions by health trusts to dismiss them. They are Dr Raj Mattu, who won a spectacular £1.2 million settlement after being unfairly dismissed for warning about patient safety in a cardiology department; Dr Chris Day, who is still fighting his dismissal for warning about patient safety at an intensive care unit at Woolwich Hospital, and as readers of this blog will be familiar, Dr Usha Prasad, a consultant cardiologist at the Epsom and St Helier University Health Trust, who is currently awaiting an internal inquiry appeal over her dismissal from the trust.

I did offer Claire McLaughlan an opportunity to comment but have received no reply to my request.

From Royal Navy nurse to clinical assessment services

Claire McLaughan’s nursing career started in the Royal Navy before she became Head of Fitness to Practise at the Nursing and Midwifery Council and then moved to the now renamed National Clinical Assessment Service (NCAS) becoming, an Associate Director. There she developed the NCAS Back on Track Services for doctors, dentists and pharmacists between 2008 and 2014. 

She also did obtain a law degree and was called to the Bar but as far as I could ascertain never practised as a barrister despite calling herself a non practising barrister. Certainly the Law Society do not appear to have any records of her working for chambers.

She left NCAS and set up her own business which offers a huge list of services which are listed on her Linked In page. It begins “Claire provides bespoke, holistic services and access to resources relating to performance management, revalidation, remediation, reskilling and rehabilitation for health professionals and the organisations they work in.”

Her company CC McLaughlin Services ( website here) which appears to be run according to the website from their home in Stockbridge, Hampshire, ( though it has a registered office in Winchester), which they purchased according to the land registry for £600,000 in 2010.

The latest Companies House accounts for the firm show that she and her husband, fellow director, Charlie ,have a thriving business. Latest company returns show it made a profit of £137,000. Both directors pay themselves in dividends rather than salaries which is more tax efficient.

While working in the private sector she holds a number of NHS posts including Chair for NHS England’s Performers List Decision making panels( they decide the internal inquiries) She is also an Invited Review panellist for the Royal College of Paediatrics and Child Health and an appointed lay member of the Royal College of Veterinary Surgeons.

Given this stellar series of appointments it is rather surprising that in two cases she has been subject to criticism- and in one case had to apologise.

The first case involved Raj Mattu, a cardiologist with the University Hospitals Coventry and Warwickshire NHS Trust. He was dismissed after he warned of serious patient safety problems at Walsgrave Hospital. He lost his court battle but won an employment tribunal and was awarded over £1m damages in 2016.( see here).

Claire McLoughlan, who appeared for the trust, was criticised by employment judge Pauline Hughes for an important omission in her evidence. The extract in her judgement says:

Her second case was highlighted by Chris Day. She was paid by Greenwich and Lewisham NHS Trust to investigate his claims of patient safety concerns at and was working with M J Rhoddis Associates. They were paid over £40,000 for the work.

Dr Chris Day; Pic credit: Twitter

In a recent letter to the Care Quality Commission Mr Day said that he came to a meeting with them to explain the circumstances of his concerns – only to find afterwards that the record of what happened had been completely altered, important points were left out, his views were distorted and comments attributed to him which he never said.

He got an apology from Mrs Mclaughlan and the record was altered.

Now at the moment Mrs McLaughlan is about to issue her verdict as chair of an internal inquiry on the fate of Dr Usha Prasad, who has already been exonerated by the GMC, so there can no question of patient safety being at risk. There is the question why this appeal is being heard while we still have a pandemic and St Helier hospital has been hit badly by it. It goes against NHS guidance to have it now and Mrs Mclaughlan as chair of the NHS England Performers List should know. Obviously she has not followed NHS guidance in this instance.

Is it a chumocracy?

These internal NHS hearing are areas where journalists rarely investigate but to my mind raise a lot of questions which need answering. Is this rather closed system open to chumocracy? How curious that people can glide between the public and private sector running a successful business on the proceeds? How independent are these people if they are paid by the trust which obviously in all three cases wants to get rid of the doctor concerned?

And most importantly whatever findings come out – they can ruin the professional careers of doctors – and should that be left to a secretive system to decide their fate? And why is all this taxpayers’ money going on these long and drawn out proceedings which are money making troughs for all the lawyers concerned?