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?

Updated: 2663 reasons why the Parliamentary Ombudsman is not working

Sir Robert Behrens

Earlier this year I reported on a letter sent by Sir Robert Behrens, the Parliamentary Ombudsman, to MPs on the Commons Public Administration and Constitutional Affairs Committee on why he could not implement a three year programme to improve the service for another year.

The letter revealed that Michael Gove, the Cabinet Office minister, had decided not to go ahead with a three year funding plan to make it happen until 2022. As a result the Ombudsman would be expected to concentrate on complaints about Covid19 and would not have the budget to do much about improving the service beyond laying the bare bones of the idea.

I suspected that the service might be overwhelmed and asked for the figures on the number of people on the ” waiting list” to get their complaint heard and the number of cases where people were awaiting a decision. The media office declined to give me the information immediately and converted my press inquiry into a Freedom of Information request to delay it for 20 working days.

Physical queue could stretch from Millbank Tower to Westminster Bridge

We now know why. Figures released under that FOI request reveal that the Ombudsman show that a staggering 2663 people are in a virtual queue to await to be assigned to a caseworker. If everybody physically turned up ( not allowed at the moment due to the pandemic) it would stretch from the Ombudsman’s office at Millbank Tower right along the Embankment to the Houses of Parliament and possibly across Westminster Bridge.

They also released the figures awaiting a result from their complaint. That is 2699. So almost as many people are waiting to get to get a case worker to look into their complaint as the number of people waiting for a result.. That might explain the latest figures from the Ombudsman Office’s own performance standards review which shows that only 51 per cent gave a positive reply to the point “We will give you a final decision on your complaint as soon as we can”. It means 49 per cent weren’t impressed with that claim.

The Ombudsman’s Office have also told me that nowhere in their building is there ” any recorded information confirming that “the public will get worse service this year”. This seems to me more of an act of self denial than a possible statement of fact.

The Ombudsman seem to be relying on two mitigating developments to help them overcome this frankly appalling scenario.

Planned new NHS Complaints Handling Service

They are plans for a new model NHS Complaints Handling Service that will aim to take the pressure off the Ombudsman’s Office by trying to sort out patients’ complaints before they have to go to him. But as the section on this new procedure on the Ombudsman’s website discloses that these are only draft guidance. Participation by health bodies is voluntary and as yet plans for pilot projects have not been finalised. My guess is that probably the best health trusts will pilot it, the worst won’t want to know.

The Parliamentary Ombudsman’s latest controversial senior appointment: Rebecca Hilsenrath

The second move is the appointment of a £80,000 Director of External Affairs, Strategy and Communications to drive through the new strategy and report to Gill Fitzpatrick, chief operating officer. There is a full description on the headhunters website, Hays, of the job. Today ( April 12) the Ombudsman confirmed that the post had been filled by Rebecca Hilsenrath, the former chief executive of the Equality and Human Rights Commission, who officially resigned last week. Three months ago Ms Hilsenrath was in the centre of a row that she had twice breached lockdown rules by going with her family to her Welsh country cottage. You can read about the allegations and her resignation in two articles I wrote for Byline Times articles here and here. By all accounts this is a very curious and controversial appointment.

Altogether the situation at the Ombudsman’s Office does not present a pretty picture. A cynic might say it is not a priority to put money into watchdog bodies because all it does is highlight problems when things go wrong. And a government that would love to stay in power forever wants to present the idea that the UK has world beating public services and hide anything that might detract from that propaganda.

The Parliamentary Ombudsman File

Here are previous stories on this blog on the issue

https://davidhencke.com/2021/03/20/revealed-the-ombudsmans-much-delayed-justice-train-for-50swomen-lost-pensions/

https://davidhencke.com/2021/02/21/parliamentary-ombudsman-dont-contact-us-well-contact-you/

https://davidhencke.com/2021/02/10/will-your-complaint-get-heard-as-the-government-forces-the-parliamentary-ombudsman-to-curb-its-service/

https://davidhencke.com/2021/01/25/why-the-archaic-parliamentary-and-health-ombudsman-needs-a-modern-make-over/

How the genteel retiree world of centenarians was shattered by the ruthless modern model of social care capitalism

Mary Fielding Home, Highgate Pic credit: Mary Feilding Guild

This spring a group of very elderly, sharp minded and bright people will be evicted from a care home where they hoped they would end their lives by a ruthless capitalist who epitomises the new privatised world of social care providers.

The home is unusual in many respects. It caters for bright academics and authors and is a living community of a university of the third age – the oldest is 104 and still going strong. It also occupies a site on the borders of Highgate and Hampstead in London with a book value of £3.8m -a tempting find for any developer.

The group have been placed in this position by the failure of the unique trust, the Mary Feilding Guild, a charity set up in 1962 but dating back to 1882, to make ends meet. The combination of Covid 19, the closure of one of its properties on the site, not being in a position to take new residents, and the need for major modernisation all contributed. The value of the charity’s investments fell from £1.8m to £824,142 in one year.

So the trustees decided to sell it as a ” going concern ” with the aim of finding someone who would keep the residents there and have the funds to improve and modernise the home. Enter Mr Mitesh Kumar Dhanak or Mr Mitesh Girharlal Dhanak as he now prefers to be called. He offered to buy it as a going concern.

Mitesh Dhanak Pic credit: Precious Homes

Within five days of owning it for as yet undisclosed sum he decided to evict everyone by the end of May, declare the staff redundant, demolish the entire home and put a planning application for a new home to Haringey Council.

Mr Dhanak, 63 next month, is not a trained social care or health specialist. He is an accountant with a degree from Sheffield University. He set up his first business Precious Homes in 1994.

His views on the sector were outlined at a Care Conversation webinar on 14 October last year: ” “In terms of the KPIs ( Key Performance Indicators )that funds would look at, it’s property backed, it’s resilient cashflow, it’s government backed – it ticks all the right boxes.” He added later: “Unfortunately, the British press loves the horror stories. It’s about lobbying the government and making sure that our voice is heard and our contribution is recognised. It’s incumbent on all of us to try to do that.”

Now Mr Dhanak has created a complex group of interlocking companies – holding according to Companies House – 27 appointments. All of them are virtually one man bands – himself and a secretary and nobody else – making it difficult to follow his story.

They embrace a small number of care homes for adult care plus the elderly with Alzheimer’s Disease and a property company with investments from Neasden in North London to Barnsley and St Albans. He also got into an enormous tussle with Revenue and Customs when he moved some homes tax free into his pension based in Guernsey- but after a bitter battle he proved the tax people had made an error in law and he won.

The services he provides are rated Good by the Care Quality Commission and he has ploughed money from bank loans into providing a good standard. He also is a trustee of the Cheltenham Playhouse.

The centre of his operations are Precious Homes at Magic House close to Palmers Green. Each each company follows a similar pattern. They are £100 off the shelf companies and within days of him either setting them up or taking over from another operator their assets are mortgaged to the banks – his favourite ones being Coutts and Clydesdale Bank.

His latest £100 company which took over the Mary Feilding Guild home ,Highgate Care is a good example. He has already mortgaged the site to one of his own companies Precious Homes. But this time he has decided to go to a tax haven to get a second mortgage from the Waymade Capital, a Jersey based company run by brothers Vijay and Bhikhu Patel.

The company also has interests in health care, pharmaceuticals, and property and the brothers, both Kenya Asians, originally made their money by setting up a chain of pharmacies which they sold on to Boots. Vijay was awarded an OBE in 2019 under very controversial circumstances. An investigation by the Times revealed he had rebranded generic drugs and overcharged the NHS. This was not picked up by the committee awarding him the honour.

It wrote “Atnahs, a company he co-founded, acquired the rights to old medicines and increased prices by up to 2,500 per cent, costing the NHS at least £80 million. A packet of antidepressants rose from £5.71 to £154 and an insomnia drug soared from £12.10 to £138.” The company now has a financial interest in the Highgate home.

No answers to questions on finance or the price he paid

Mr Dhanak declined to answer through his communications agency any questions about the financing of his ventures or the price he paid for the property.

He did provide an explanation for his change of mind. “The team held meetings within days of completion as there was no desire to mislead residents or staff once a decision was made. Within five days, nearly 40% of the residents have already found potential new homes and we are confident that this trend will continue with the support of the Highgate House team.”

“Since the sale was agreed, the new owner in consultation with professional advisors reviewed the existing model and considered a number of options, including operating the home in its current format and concluded that regrettably it would not be possible to continue to provide care in the same way.  The home has been financially unsustainable for a significant period of time and the Mary Feilding Guild trustees would be aware that a new owner would have to make significant changes.”

owner intends to demolish property, says trust

The trust have also issued a statement: “We now understand that the new owner intends to demolish the existing property and build a completely new home on the site. Four days after completing the sale the purchaser announced a three-month notice period to the staff and residents after which the home will remain empty.

“However, it will take at least seven months to produce a detailed design, obtain planning permission, and commence construction. During this time the home could have been kept open for existing residents, and staff, rather than force them to move, and making staff redundant. The elderly residents will now be forced to seek alternative accommodation during the COVID restrictions, therefore severely limiting their choice.

Please don’t evict them by the end of May

” We are appealing to the new owner to reconsider this wholly unnecessary decision to shut the home immediately. We believe that it is not unreasonable to delay the closure procedure, to one month, before a start on site is possible. This would allow residents and staff reasonable time to consider their options, and by this time the pandemic should have eased.”

The lessons from this saga are two fold. The trust’s lawyers appears to me to have been very naive in not demanding guarantees for their residents in writing. And Mr Dhanak’s business strategy depends of an ever rising property market and ever bigger sums of money being available to local authorities for social care. If there is a major hiccup in either or both of these – the banks are going to demand their money back pretty sharpish and lot of vulnerable people are going to be evicted.

In the meantime Mr Dhanak can retire to his beautiful home in Hampstead Garden Suburb purchased for £2.5 million with a Clydesdale Bank mortgage, according to the land registry,. Here’s a nice picture of it.

Exclusive: General Medical Council investigation exonerates Dr Usha Prasad of any medical failings

Dr Usha Prasad

Dr Usha Prasad, the cardiologist currently appealing against her dismissal from the Epsom and St Helier University Trust, has been exonerated by General Medical Council of any medical failings or putting patient safety at risk.

The decision by the GMC not only rejected a dossier of complaints from the trust but decided that the issue was closed and will not be re-opened again by the GMC.

The decision is part of a long running saga that has been going on for nine years and heightened by an anonymous letter sent by Dr Perikala, a staff doctor, who made the patient safety allegations in an anonymous letter to the General Medical Council, Care Quality Commission, Daniel Elkeles, the chief executive of the trust and Jeremy Hunt, then the health secretary in 2015.

The GMC initially declined to investigate Dr Perikala’s anonymous complaint but the trust has persisted in pursuing her at the GMC.

dr james marsh pic credit: Epsom and St Helier University Health Trust

I understand Dr James Marsh, the trust’s medical director, and Dr Richard Bogle, the lead cardiologist at the trust, compiled a dossier of no fewer than 43 cases which they claimed should be investigated. The GMC narrowed it down to seven cases and sent them for review to a very distinguished consultant at the James Cook Hospital in Middlesbrough whose career has spanned work at Papworth Hospital and Addenbrooke’s Hospital in Cambridge. The very detailed report came back completely exonerating her of any failings. She has also received glowing references from Pinderfields Hospital where she is currently working as a cardiologist after the Epsom trust dismissed her.

Dr Richard Bogle pic credit:www.richardbogle.com

The GMC’s decision comes just as an internal inquiry into her appeal is under way. This is being heard by Claire McLaughlan   an independent consultant, and Associate Director of  the National Clinical Assessment Service with an interest in the remediation, reskilling and rehabilitation of healthcare professionals. The case was also being followed by Dr Zoe Penn, Medical Director NHS England ,London Region and Lead for Professional Standards. She is sitting on the panel with Claire McLaughlan. Ms Mclaughlan runs a private business with her husband in Hampshire.

The fact that the hearing is taking place now is questionable since Professor Stephen Powis, national medical director of NHS England, told health trusts NOT to hold such hearings when the NHS is under pressure from the pandemic. I checked with the press office of NHS Resolutions and they have supplied me with the guidance for such hearings. They really should only be held if there is an absolute necessity and immediate risk to patient safety. Now with the GMC deciding there is no current and immediate risk to patient safety in Dr Prasad’s case – this makes the hearing even more questionable.

Officially the GMC will not comment on personal cases but they did confirm her clean bill of health entry on their public register which is reproduced below. All entries on this register have to be kept up to date on a daily basis. The saga continues but the case being made by the trust looks pretty weak after this decision by the GMC.

There are three earlier blogs on this issue.

They are: 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

 

Since this blog was published I have had this strong message of support from Justice for Doctors. Here it is:

Dear Mr. Hencke, you are doing an excellent job by highlighting the problems with our NHS and how splendid doctors like Usha Prasad had been treated. It was very courageous of Usha to challenge the wrongdoings and the harsh decisions by our health institutions at a time when the GMC are calling retired doctors to rescue the overstretched NHS.

Without dedicated and committed doctors like Usha Prasad, our NHS will crumble and collapse. The misleaders and bullies will remain to demolish what goodness is left in our NHS. Unfortunately, most doctors retire or change location whenever they were unfairly challenged. Moving away will not solve the problem but encourage bullies and harassers to thrive and do more damage.

In our view, Dr. Prasad has won the moment she decided to stand firm and challenge the discrimination, the harsh and unfair decisions. We congratulate both of you for raising awareness about what goes on in our hospitals and congratulate Usha for her courage and conviction.
Thank you
On behalf of Justice for Doctors

Afghanistan’s horrendous choice: War with women’s rights or peace with servitude

Photo by Engin Akyurt on Pexels.com

Today is International Women’s Day and as my contribution I am focusing on Afghanistan as both the UK and the US cut their support to this country

I have recently come across a searing Congressional report from the United States Inspectorate on Afghanistan Reconstruction on the state of women’s and girl’s equality there.

Everybody knows the years of conflict which has cost British and American lives to rid the country of the Taliban regime and their horrendous treatment of women.

But this report shines a different light on the current plight of women just as the UK and the US are about to leave the country should a deal be possible between the war lords and the Taliban.

The United States has spent £564m in aid over nearly 20 years on women and girls

It reveals that during the never ending conflict from 2002 to 2020 the US has spent some £564.6 million on women and girls. On one level the achievement for women has been startling. From virtually no girls in schools under the Taliban there are now 3.5 million girls receiving an education. And a third of the country’s 210,000 teachers are now women but mainly in urban areas like Kabul.

There have been improvements in maternity care despite a horrendous death rate among pregnant women. Prenatal care coverage rose from 16 percent of pregnant women in 2002 to 61 percent in 2015. Postnatal care coverage increased from an average of 28 percent between 2005 and 2010 to 40 percent in 2015. And the number of trained midwives rose from a pathetic 467 in 2002 to roughly 4,000 in 2018.

There is, like many other areas, a huge disparity between urban and rural areas. Some 16 per cent of women died in childbirth in Kabul rising to an alarming 65 per cent in one rural province in 2002. This has improved with various estimates from the UK, Irish and World Health Organisation by between 19 per cent and 50 per cent, because reliable statistics are difficult to verify.

What has not improved particularly in rural areas is the attitude towards women. The US government also tried to encourage women to join the army and the police – this was the least effective of their programmes. “Targets have been highly unrealistic and unachievable. Although there has been a modest increase in the number of women police officers, women in all parts of the security forces face threats to their personal safety and pervasive harassment and discrimination,” says the report.

KABUL, 22 October 2019 – UNAMA Central Region Office in Kabul organized Global Open Day event, to facilitate discussion on women, peace, and security. The event was attended by 36 participants representatives from women rights activists, Government actors, schools’ teachers, local shuras, and university students. UNAMA CRO head of office In her opening remarks emphasized the importance of the Global Open Day as a forum to review the implementation of the UN Security Council Resolution 1325 on Women, Peace, and Security. UNAMA Photo / Fardin Waezi.

The US aid has had more effect in getting women involved in politics and the community. The report says: “Afghan women have assumed leadership roles at the national, provincial, district, and community levels. At the same time, they face threefold threats: continued or intensified violence, the risk of Afghan peace negotiations leading to erosions of women’s rights, and a dire economic and humanitarian situation exacerbated by the COVID-19 pandemic.”

Covid 19 has caused big problems in Afghanistan. The report says: “The lack of testing capability means that up to 90 percent of collected samples are untested, and therefore go unreported. Of the limited number of tests conducted, Afghanistan’s positivity rate—the percentage of tests that reveal COVID-19 infection—was nearly 43 percent as of July 2020, one of the highest in the world.”

The World Bank is alarmed that widespread poverty will become worse as the Afghan economy is hit by the pandemic cd see those living in poverty rise to 72 per cent of the population. Cultural problems make treatment for women worse. “Due to deeply entrenched sociocultural norms, many Afghans are reluctant to allow their mothers, wives, daughters, or sisters to visit a doctor directly, or at all, if that doctor is a male.”

The future is not rosy in other areas for women. The report found “Some of the gains made for girls in access to education may not be sustainable, since a large portion of the education sector in Afghanistan is dependent on international donor funding for maintaining and expanding those gains.”

No level playing field for men and women in meetings

And it is not a level playing field in political meetings. One woman told the report “When we have meetings and both men and women raise their hands and show their cards, the respect that is given to men is not given to women. The time which is given to men is not given to women. When a woman speaks, she is not allowed to speak more than three minutes, but a man is allowed to speak more than 15 minutes.”

Women are still scared in many parts of the country to go out alone as they can face harassment and violence from men. SIGAR interviewed 65 people from all Afghanistan’s 14 provinces and both men and women said it was society’s constraints that held women back.

The time which is given to men is not given to women. When a woman speaks, she is not allowed to speak more than three minutes, but a man is allowed to speak more than 15 minutes.”

Afghan woman

Many interviewees—male and female—said that social and cultural norms are one of the biggest barriers to Afghan women’s advancement, particularly in rural areas. “Men in our community think the role of women is to sit at home and cook. If their mothers tell them to behave well with their wives, so they do, and if their mothers order them to beat their wives and misbehave, so they also do,” said a woman from Nangarhar Province.

President Biden will decide soon whether to completely pull out of Afghanistan which was the policy of the Trump administration. The UK, according to a leaked report to Open Democracy will cut aid sharply to Afghanistan shortly. Once again it will be women who will lose out and many of their fragile gains could once again be lost. As the report said if the Taliban and other war lords regain full control “the effort to promote women’s rights may be hampered by a growing narrative in Afghanistan that the country can either have women’s rights at the cost of peace, or peace at the cost of women’s rights.”

The full report by SIGAR is worth a good read.