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.

Will your complaint get heard as the Government forces the Parliamentary Ombudsman to curb its service?

Rishi Sunak: Postponing the cash to improve the Ombudsman service

The Parliamentary Ombudsman has already – as I wrote in an earlier blog – faced a critical report from MPs on the way it handles some of its work.

And Michael Gove, the Cabinet Office minister, has also turned down any prospect of new legislation to modernise the service by combining its work with the local government and social care ombudsman.

Not content with that, Rishi Sunak, the Chancellor, has now postponed a three year funding programme which would have allowed it to introduce changes to improve matters.

Instead The Treasury has decided to give it just one year’s worth of funding and instructed it to concentrate on handling complaints arising out of Covid 19 pushing aside other grievances..

Details of this latest bad news has not been put out in any press release by the Ombudsman but has been hidden away in the correspondence section of the House of Commons Public Administration and Constitutional Affairs Committtee.

A letter from Rob Behrens, the Parliamentary and Health Service Ombudsman, to William Wragg, the Tory chair of the committee, reveals the not very bright future for people wanting to take the NHS to the Ombudsman or for the 1950s born women hoping for compensation for maladministration over the six year rise in the date they could claim their pension.

In the letter Mr Behrens says “We will postpone the launch of PHSO’s new three-year strategy until we can secure the three-year funding settlement necessary to deliver it. Instead, we will use 2021-22 as a bridging year to lay the foundations for the new strategy and focus on addressing the significant operational challenges facing PHSO’s service.”

Severely affected by Covid – 19

He goes on to describe what next financial year will be like:

“PHSO’s service has been severely affected by the ongoing COVID-19 situation in a number of ways, from the impact of school closures on the availability of staff, to pressures on the NHS that mean services are taking longer to respond to PHSO’s requests for information.
“As a result, PHSO is closing substantially fewer cases than usual and, in turn, this means a growing number of complainants are waiting for their case to be allocated to a caseworker.
“Although we have started to recruit some more caseworkers, it takes a minimum of six months to train new staff and even with additional caseworkers, it is clear that complainants will face increasingly long wait times unless we take further action.”

Delaying revealing the size of the complaints waiting list

I asked the Ombudsman to give me details of how many cases they were and how long they were taking. I also asked about the size of the waiting list. Simple questions enough if they are on top of the job. Instead they have decided to turn it into a Freedom of Information request which will give them a month or two to reply. I will report back when I have the figures.

In the meantime the letter says: “This means we will prioritise the quality and productivity of PHSO’s core complaints-handling service. We will also use 2021-22 to carry out preliminary work to support the new three-year strategy, such as improvements to some of PHSO’s core systems and processes, and highlighting
opportunities for Parliament to make essential improvements to PHSO’s legal framework, such as removing the MP filter.” The latter point is that all complaints have to go through MPs at the moment.

The whole situation is not good at all. But I am not surprised that the government is not keen on funding or modernising the service. A more efficient service will bring to light injustices – which means a bad press for government services – and ministers don’t like bad publicity. Far better to deprive the Ombudsman of cash and keep the announcement hidden in the correspondence column of a committee.

Updated:Why the archaic Parliamentary and Health Ombudsman needs a modern make over

Rob Behrens: The Parliamentary and Health Service Ombudsman Pic Credit: Ombudsman’s Office

If you have a complaint about a government department or the National Health Service your last port of call is Rob Behrens, the Parliamentary and Health Service Ombudsman. He is the current post holder of an institution set up 54 years ago by the second reforming Labour government led by Harold Wilson.

A report by MPs today is both critical of the performance of the Ombudsman – particularly over transparency – and of the government for not even considering new legislation to give the Ombudsman fresh powers and bring its work into the 21st century.

The minister blocking any change is Michael Gove, the Cabinet Office minister. He has ruled out any new law that could streamline the operation by combining its work with the local government and social care ombudsmen; give it powers to initiate investigations and strengthen its work dealing with complaints.

Michael Gove: Blocker in chief in making sure the Ombudsman can’t do his job properly Pic credit: BBC

No doubt as one of the country’s leading power couples – Michael Gove and Sarah Vine – are able to use their influence through the current ” chumocracy” to deal with any complaints they might have without having to resort to anybody like the Parliamentary Ombudsman But for ordinary people it is quite different

As the Chair of the Public Administration, and Constitutional Affairs Committee, Tory MP William Wragg MP said:

“The Committee appreciates the pressing priorities facing the Government, including, of course, the current pandemic. But reform of the legislation governing the PHSO is worthy of parliamentary time. The PHSO represents the final stage in a complaints process that can be traumatic for complainants and may include serious matters such as the death of a loved one. It is essential that people have faith in a transparent, effective organisation. The current out-dated legislation undermines this crucial ambition”. 

No action yet on long standing 50s women complaint

This leaves questions about how good Rob Behrens is in doing his job given the current restraints. He is currently looking at whether women born in the 1950s are entitled to any compensation for maladministration for failing to notify them of the raising of the pension age. And he is taking his time about it – despite MPs encouraging and recommending WASPI supporters to follow this route. Indeed the report includes a complaint from Frances Martin:

Her submission said:( I have left the capital letters) “There Is Still No Definitive Time Line For Finalisation, Nor, Importantly Has There Been Any Attempts To Provide An Impact Assessment, Notwithstanding, All Of The Above I Am Without Any State Aid Benefits Since Nov 2015, Am Redundant In A Jobs Blackspot And Have Been Excluded From Financial Assistance Through Rishi Sunak’s Furlough Scheme. As A Woman Of Over 60 Am At Greater Risk With Regard To The Covid Outbreak. None Of These Facts Seem To Have Been Considered By An Organisation Which Purports To Be Fair/Impartial Etc And Certainly Is Not Best Practice In Any Organisation That I Have Worked In Both In The Uk And Overseas.”

Both the MPs and the general public have raised a number of shortcomings. For a start he muddies the waters on the cases he takes up. The MPs report he conflates cases that “are not ready to be taken forward” and “should not be taken forward” so we don’t know what he is doing. He doesn’t report on the number of partial decisions.

He was accused of misleading Parliament by not proactively reporting that you can’t directly compare the figures for the number of cases referred to him over the last two years – because a new digital case system has made it impossible.

Since this blog was published there has been a sharp exchange of views between the Ombudsman and the chair of the committee over whether Rob Behrens misled Parliament by not proactively reporting the number of cases referred to him accurately. Mr Behrens accused the committee of being ” factually inaccurate” in suggesting this. William Wragg, the chairman, stood his ground and said MPs felt there were discrepancies in his evidence and it was important the Ombudsman updated information to MPs in a timely manner. He said that did not mean he was misleading Parliament. Letter exchanges are here and here.

He comes out well in treating people with dignity and respect and listening to their claims. But comes out badly for the time he takes to come to a decision and explaining it to the complainant.

More seriously he doesn’t seem to check back with the complainant that he has got all the information or give them a progress report.

” systemic disability discrimination in the Ombudsman’s office”

The report also contains some very critical comments from the public about the Ombudsman’s handling of some cases. MPs don’t investigate them but attach them to the report.

In one just known as A7 on the death of a disabled child in NHS care the person wrote: “In my and the experience of other parents of disabled children, rather than impartially investigating concerns concerning disabled children, with parity of esteem, investigations seem to be focused on justifying the actions of health professionals, however, unreasonable that behaviour is.”

The person added: “This seems to be a manifestation of the systemic disability discrimination found in poor parts of the NHS spreading to the PHSO office.”

Another from Dr Minh Alexander and Ms Clare Sardari on “a mishandled referral to the Care Quality Commission under Regulation 5 Fit and Proper Person, about an NHS trust director who had been found guilty of proven whistleblower reprisal and breach of the NHS managers code of conduct (an under-declared family interest), who was subsequently convicted of fraud and also criticised for her attempts to resist the proceeds of crime process.”

Ombudsman can’t “deliver accountability and good governance”

They conclude: “There was a lack of rigour by the PHSO in pursuing compliance with its recommendations for corrective action by the CQC, notwithstanding its lack of enforcement powers. It seemed to us that a procedural box had been ticked and thereafter, the PHSO was not interested in enough in ensuring that there was learning or genuine remedy of injustice.”

“We do not consider that the PHSO model is robust enough to deliver accountability and good governance in public life, because of insufficient powers and the lack of a duty on the PHSO to enforce improvements and corrections. It does not seem good value for money (budget 2019-20: £25.942 million) and we ask parliament to consider an alternative model of conflict resolution.”

I could go on with other examples. Suffice to say both Mr Michael Gove and Mr Rob Behrens seem to have a lot of explaining to do. Mr Gove for not bothering to do a thing about updating and strengthening the Ombudsman’s role and Mr Behrens for not being up front with complainants on how he is conducting his investigations.

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

Dr Usha Prasad

Epsom and St Helier University Hospital Trust has hit the headlines by allowing the Times (behind paywall) access to their intensive care unit to see the heroic work of doctors and nurses fighting to save people’s lives from the scourge of Covid 19.

This highly commendable act brings home to the public the work of the NHS saving lives and the heartbreak caused by the Uk’s appalling death toll from the pandemic.

Yet while all this was going on the trust chose to hear an appeal by Dr Usha Prasad in the very week when Covid 19 admissions are expected to peak taking away highly skilled consultants away from the front line caring for patients not only fighting the scourge of Covid 19 but from other life and death surgery involving heart, kidney and liver disease. They also tried to take away consultants working for other trusts and a private hospital to bolster their case against her.

Professor Stephen Powis Pic credit: NHS Improvement

The timing of the appeal hearing appears to go against advice from the top of the NHS as prescribed by NHS Resolutions and by Professor Stephen Powis, national medical director of NHS England, NOT to hold such hearings when the NHS is under such pressure.

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.

  The guidance says: “We recommend that serious consideration should be given at this time as to whether alternatives to exclusion or substantial restrictions on clinical practice can be considered, so that the practitioner is not removed from the workplace at a time when there is such immense pressure on clinical staff. “

In Dr Usha’s case there was no immediate risk to patient safety as she is currently a locum cardiologist at Pinderfields Hospital in Yorkshire. There have been no complaints there, quite the opposite, and neither have the General Medical Council ruled she is not fit to practice.

Yet the trust decided to rush ahead with this hearing and not surprisingly, in the current situation, came to grief.

The original plan was for a one day hearing with five witnesses for the trust in the morning and for Dr Usha Prasad’s witnesses in the afternoon. The hearing was organised by Bevan Brittan, a law firm ( more taxpayers money for lawyers). The chair was 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.

It went wrong from the beginning. Instead of starting in the morning, it didn’t start until the afternoon. Two of the five witnesses didn’t attend because, unsurprisingly, they had urgent clinical duties in the middle of a pandemic. None of Dr Prasad’s witnesses were heard as there was not enough time and there will have to be another day set aside for the hearing.

Dr Richard Bogle cardiologist: Pic credit; richardbogle.com

The five people who were due to attend for the trust were extremely busy. They are Dr Richard Bogle, cardiologist at Sr Helier and St George’s ( see CV here):Dr James Marsh, medical director for the trust; Dr Peter Andrews. clinical director and renal specialist; Dr Yousef Daryani, a cardiologist from Ashtead Hospital; and Dr David Fluck, medical director, from the Ashford and St Peters NHS Foundation Trust. The last two did not attend.

Dr James Marsh: medical director. pic credit: Epsom and St Helier University NHS Trust.

Who is missing for the trust is Dr Perikala, the more junior doctor, who made the patient safety allegations in an anonymous letter to among others, Jeremy Hunt, then health secretary presumably expecting he should rush down to St Helier Hospital and put a stop to Dr Prasad immediately. His letter – the subject of three employment tribunal hearings – for some reason does not factor in this hearing.

Altogether I find as a layman this is an extraordinary state of affairs- petty bureaucracy run riot. The tragedy is that this is happening when thousands of NHS patients are dying and medical staff are completely stretched. It undoes all the commendable work the trust has done to bring public attention to how the NHS is doing its best to help people in their direst hour of need.

Revealed: The poor health in old age scandal

Professor Chris Whitty, chief medical officer, gave evidence on the damning statistics effecting the healthy living prospects for the elderly Pic credit: gov.uk

Today the House of Lords published an extremely worrying report into the prospect for millions of elderly people being able to enjoy a healthy old age.

I had not realised that Theresa May’s government had committed in 2017 to the Ageing Society Grand Challenge – a promise by 2035 that everybody in the country should be able to enjoy an extra five years good health in retirement. I have a feeling like the notice of the first raising of the pension age it has had little publicity.

Readers of my blog who have followed the BackTo60 campaign to get 3.8 million women born in the 1950s full restitution for their lost pensions will greet this aim with a hollow laugh – given there is growing anecdotal evidence that many women in their early 60s are already falling ill while working before they can even claim their pension. I wrote a blog about the figures in 2018 – see here.

But what this report confirms is not only that life expectancy has flatlined since 2011 but prospects for a healthy retirement has got worse particularly for the poor. The report reveals that the chances for a man to get an extra five years healthy retirement will take not 14 years as promised by the challenge but an incredible 75 years. They will be long dead by 2096.

For a woman it is actually worse – chances of having an extra five years healthy retirement is receding and getting worse by the day.

Figures in the report confirm what the Office for National Statistics has disclosed that Britain is slipping down the league table of advanced countries for those living longer – with men, who on average die earlier than women, have a higher increase in longevity than women. See my blog on this here.

Growing equality gap between rich and poor areas

But what is deeply disturbing is the huge gap between those in wealthy and deprived areas.

The report says: “In England in the period 2016–18, the difference in life expectancy between the most and least deprived areas was 9.5 years for males and 7.5 years for females. The differences in healthy life expectancy are 18.9 years for males and 19.4 years for females.”

The report notes: “the health situation is somewhat similar to other countries that have experienced
political, social and economic disruption and widening social and economic inequalities.” The report also noted that “in some of the key social determinants, inequalities are widening in England”.

The largest killer of men is heart disease and for women it is Alzheimer’s Disease and dementia. Heart disease deaths are falling while dementia is on the rise which explains the changes in longevity.

In a 2016 analysis of 20 countries, females in the UK had the lowest rate of improvement in life expectancy, followed by those in the USA. For males, the UK had the second-lowest rate of improvement,
after the USA.

The report concludes:” Inequalities in healthy life expectancy are stark, with people in the least deprived groups living more than 18 years longer in good health than those in the most deprived groups.”

This also hit ethnic minorities very badly as evidence given by Professor Chris Whitty , the chief medical officer to peers. He told them: “People from ethnic minorities are more likely to live in poverty in older age; 29% of Asian or Asian British people and 33% of Black or Black British people over the age of 65 live in poverty, compared with 14% of White people.”

Will it get better or worse?

So what is to be done and will it get worse ? For a start it will get worse because of Covid19 as the report was mainly written before the pandemic took hold and it is known that Covid killed disproportionately larger numbers of the elderly saving the DWP over £600m a year in pension payouts. In a postscript to the report the peers from science and technology committee say both short term and long term effects are an unknown.

On the positive side new technologies and robotics and new drug trials to treat diseases promise to make life better for the elderly provided they can access them.

Peers warn that unless growing inequality is tackled by the government – these benefits could widen the gap between rich and poor as wealthier pensioners would be able to benefit while the poor would be left behind.

The report also exposes the lack of a government strategy at the top to tackle this.

Peers say: “The Government is not on track to achieve the Ageing Society Grand Challenge mission to ensure five years of extra healthy life by 2035 while reducing inequalities, and does not appear to be monitoring progress towards the mission. It is hard to see how the target could be met without significant changes to the way it is managed.”

For those who criticise the House of Lords as an irrelevant institution – this report shows the House working at its best – it is a very thorough, well researched report – drawing attention to an overlooked issue and warning the government that it needs urgently to act to take this seriously. Whether it will, given the complacency of some ministers, is another matter.

The full report can be accessed here.

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

Dr Usha Prasad

Just before Christmas I carried a blog on a tribunal held in Croydon looking into allegations of sexism and racism brought by Usha Prasad, the sole woman cardiologist employed by the Epsom and St Helier University Health Trust. The case centred round an anonymous letter by a junior doctor who believed she put patient safety at risk and sent it to the chief executive, the Care Quality Commission, the General Medical Council; Jeremy Hunt, then secretary of state, and one of her patients.

She lost the case at a bizarre hearing presided over by employment judge Katherine Andrews which would only discuss whether the letter was racist or sexist.

But now two very eminent cardiologists Professor Jane Somerville and Dr David E Ward, have come forward to speak out in her defence – and raise much wider issues about how our National Health Service is being run and how trusts are using taxpayers’ money to pay large sums to lawyers to silence people who raise uncomfortable issues they would rather brush under the carpet.

Professor Jane Somerville, now 87, is one of the country’s leading cardiologists. She recently was awarded the World Heart Federation Award for Outstanding Contribution to Cardiovascular Health for defining the concept and subspecialty of grown-ups with congenital heart disease (GUCH) and being chosen as the physician involved with Britain’s first heart transplantation in 1968.

David E Ward has recently retired as a cardiologist at St George’s Hospital, in South London.

Jane Somerville: Pic Credit: World Heart Foundation

This is Jane Somerville’s detailed comment:

“There are many serious problems that are illustrated from this sad report of the ruining of a young doctor’s career as a cardiologist. She was an obvious target for bullying, harassment, and victimization by management at all levels. Why? Because she was Asian (foreign), small and female. This is such easy picking for those in charge to establish a continuous stream of it as indeed is shown over years.

“What is of more concern is the failure of the regulatory bodies and support services on which we have been brought up in medicine to believe they will be there for us to help give advice and support when in need. Just to name a few involved in this case: BMA, legal representation, GMC, MPA or MDU and indeed, the civil law itself. This is particularly important as the offending trust can afford on taxpayers money to engage the best advisors and the young doctor cannot afford to enlist such help.

questioning integrity and fairness of the judiciary

“Now from this case, one is forced to question the integrity and fairness of the actual judiciary. This is something one hopes in a civilised country one would never need to do. However in this case it is clear to assume that what has been reported is true, that the judge was biased against Dr Prasad with more than one example and did not allow relevant evidence (letters) to be shown.

  “It is clear from the beginning of this case which started with simple complaints related to poor bureaucratic and system management which was influencing safety and comfort of patient management and continuing a few months later with acceptance from the trust with anonymous letters from her junior colleague and unacceptable behaviour in contacting one of her patients, that the trust was not interested in being even handed to her and worse, wanted to get rid of her.

bullying trusts

 ” In these current times of enormous difficulty and pressure in the NHS where it is clear that junior staff and nurses are needed and should be valued and cared for, that one must wonder why anyone would want to work in this trust or other trusts who have shown similar behaviour, victimising a young useful doctor. Despite what claimed, doctors who draw attention to something wrong for patients or staff safety (whistleblowing), have little or no protection in the bullying Trust.

The Department for Health with all its talk needs to address this matter urgently and stop just giving lip service to the excellent recommendations (Sir Robert Francis QC) that have been made to them. They must be made responsible for this bad behaviour by trust managers which alas is not unique to Dr Usha Prasad.

Dr David E Ward

Dr David E Ward commented earlier on my blog as aceofhearts44. He is now happy to repeat his view in his own name.

“I know Dr Prasad as friend and colleague. I and a senior eminent British cardiologist have been supporting her cause for sometime. It is astonishing that what was initially an anonymous complaint has led to a chain of events culminating in the dismissal of a small, female doctor of Asian descent. It smacks of bullying, victimisation and other behaviours doesn’t it?
Something is seriously amiss in this story. It needs to be exposed. It’s heartening that a respectable journalist has taken an interest (we tried unsuccessfully to get others involved). Let’s hope justice is done. Sadly I’m not optimistic. We will continue to support Dr Prasad in any way possible.”

Something seriously wrong in the NHS

These are not the only people who are concerned. I have had a number of people contact me – some in confidence – who are raising similar behaviour elsewhere – and want me to look into other cases. Since this is not a mass circulation blog – with the exception of the campaign I have backed for justice for the 1950s born women who are having to wait another six years for their pensions – it suggests to me that there something seriously wrong in the NHS and needs a thorough investigation. Otherwise I would not have such a strong response.