Former PCT Chair States NHS Complaints Procedures Corrupt
This submission has been made to Mr. Lansley and Ms. Parsons, his Chief of Staff at the Department of Health. Former PCT Chair States NHS Complaints Procedures Ineffective and Frequently Corrupt. The only meaningful way forward, and of achieving stated objectives i.e. the safest, most effective and equitable health care at the lowest possible cost, in its widest sense, is a system run with openness, probity, and control. The complaints system is the sense organ of any organisation, and to be senseless, delusional, and or paralysed is generally regarded as a disadvantage.
I was formerly the Chair of a PCT. Having assessed the situation after appointment I took the view that I needed stronger governance procedures, and a stronger Board. I was supported in this objective by the Appointments Commission, and by the Strategic Health Authority. Unfortunately for a variety of unrelated political reasons the normal governance procedures were subverted by "informal mergers" and it was impossible for me, as Chair, to implement the governance structures I had been appointed to uphold in the first place, let alone use them to tackle issues I believed needed to be tackled. I thus resigned within a year. I resigned in a controlled and constructive way, made it clear why I had done so, gave long notice, and succeeded in at least strengthening the Board before I left. I was given a glowing reference, and received a letter from Sir William Wells thanking me for doing the right thing, and benefiting the NHS at considerable personal cost. Ironically I was appointed because I had a reputation for being highly analytical, getting to the heart of things, and acting. I refused to in effect endorse a system I felt was ungovernable, and said so.
I inherited a very serious case. The implementation of the PCT's complaints procedures was fundamentally flawed, to the extent that a preventable, predictable, and irretrievable accident had occurred despite a number of earlier complaints that made it clear this was an event waiting to happen. Once it did happen the emphasis was on fire fighting, seeking to curb and discipline the practitioners concerned, in itself a bureaucratic nightmare, while ignoring forensic examination of the circumstances surrounding the PCT's failed investigations procedures. Not addressing the latter clearly left future patients at risk in a Groundhog day. Those PCT staff involved initially failed to accept responsibility, or even consider they might be expected to. I told the Chief Executive I did not regard this as acceptable. In consequence I asked for and saw hard evidence that PCT staff and NEDs had been negligent in their handling of proceedings. Not least not following up on pathways they themselves had identified as essential, and not sticking to their own timetables. In this particular case this was not a deliberate cover up by the PCT, simply an example of a shambolic mess. A euphemistic report to the board, or even tea and biscuits and a chat, was prioritised over concerted goal-specific action. In effect nothing but words in the face of proven, and repeated, danger to patients.
I subsequently found out, accidentally and independently, that there was another very serious complaint running in the local system, which I was unaware of while in post. This case involved prolonged and systematic breaches of professional conduct and probity. The complainant was falsely accused of mental illness when in fact medical data had indeed been misused, and this was readily verifiable. The matter was eventually resolved, but following terrible cost to the complainant. Had I been aware I would have intervened.
I would advise complainants to ensure the Chair of an organisation does know, first hand, if a serious complaint is not being handled properly since in theory the Chair is ultimately responsible. Nevertheless in my direct experience the frequent attitude was that the Chair was there to rubber stamp much of what was required, and a Chair who sought to change things, or displayed any form of meaningful governance role was an inconvenience. In my experience some Chairs were after an easy life, and indeed I was told that many could not understand why I did not just take the salary, and save myself and everyone else the hassle of trying to run a proper governance structure, because everything changed every two years anyway. Plus those who did try to do anything meaningful (other than cover up all serious difficulties) were constantly obstructed. This, if taken to its ultimate conclusion, translates into an ungovernable senseless mess, getting along by covering up difficulties and consequences, and or hosing in borrowed/creatively accounted money, until the entire medical system finally collapses. In my view to be taken over by private companies and businessmen who will have a much crisper approach - the bottom line will be money. Anything that interferes with that objective will be brushed aside. It will be more streamlined, liberated, and the bottom line will be more honestly visible, if not the means of achieving it, but will it be better?
My wider evidence, derived using a number of professional hats, suggests there is no effective policing or sanction at any level in the medical system, all the incentives are to do "whatever it takes" to further immediate interests and to cover up. Unfortunately the net effect is to silence, misdiagnose, severely harm, even incarcerate, torture or in effect murder patients. By definition it does not appear common. In my well informed view it is. Both Doctors and Managers are culpable. Contentiously, and I am not as biased as I might appear, doctors are the most culpable, and frequently the biggest problem. Not least because they are trusted, when there is in fact no justification for being expected to take a doctor on trust. Many Catholic priests illustrate the general point.
There are plenty of issues concerning the complaints system, but two which need addressing with urgency. The fact even these have not been satisfactorily addressed, in the entire history of the NHS, speaks volumes.
1. The deliberate falsification of personal medical and related records by omission and commission, usually by medical professionals, as well as in some cases by managers, is endemic, and requires a change in legislation to make the act a crime, as it is in the USA. It is an abuse of power, often with far reaching and severe, perhaps unforseen, or delayed consequences, is a form of rape, a psychological betrayal, and should be treated as such. It must cease. At the very least there should be a centralised register of cases and those found guilty should carry this on their record indefinitely. Is it a Code of Practice not to rape or shoplift sweets, or even speed ? The existing legislation covering fraud does not automatically apply to medical records. Yet falsified records can mean death. There should be a fixed fine, just for the act, the consequences are another issue.
2. Lack of an appropriate complaints mechanism. There is no agency in this country which regards it as within its remit to act independently and appropriately in cases of systematic falsification of medical records, dishonesty, intimidation, and permitting or causing deliberate harm. That is to take a full witness statement, secure records, provide immediate assistance and protection to an individual patient, or others who may be affected. Using appropriately qualified staff. I have the evidence to prove this contentious statement. Police, GMC, and the Information Commissioners Office all believe it is each others responsibility, and yet all three believe local internal resolution is inappropriate and unlikely to succeed in such cases. I hold evidence demonstrating internal resolution, or relying on individual doctors who are themselves intimidated/colluding is indeed inappropriate. The GMC expects individual doctors to act, but even if they wish to they do not have the power, and historically are proven to be punished for acting. The Ombudsman will not deal with a case until it has been dealt with locally, even if a life is at risk. In any event it is debatable, given the evidence, whether the Ombudsman's service is itself effective or independent, and it is again not equipped to deal with fraudulent adulteration of records or corrupt and colluding doctors. The legal system is not set up to deal with falsified medical records, particularly if irreversible harm has not yet occurred, or cannot be proven to be directly due to falsification, however severe the case. In short Medical negligence does not apply, and few if any lawyers have the necessary expertise in data protection, human rights, and medical issues to mount alternative cases. Those that may have are overrun. In addition I have seen a case demonstrating legal aid does not recognise or cover issues raised by falsification of medical records, and no lawyer will take such complicated cases on a no win no fee basis.
Note that at present the very agencies one might expect to deal with such cases appropriately, but do not, are themselves accused of being complicit or in the worst cases engaging in such activities i.e falsifying medical evidence by omission, commission or obfuscation .
A patient who may, by definition, be ill cannot be expected to fight a cabal, or to use a complaints system predicated on honesty when much of the system is corrupt, or to fight a complex case for months or years. He or she may be lucky to manage daily living, let alone be responsible for supplying enough evidence to incriminate and close off bolt holes for dishonest doctors, by definition closing ranks. This applies to bereaved relatives as well, but what chance is there for justice for them when living patients are knowingly left to suffer and risk serious harm, even death, in full view of the system, despite their protestations, or in some cases ignorance.
There should be a national triage system. Any patient who is in danger i.e. whose physical or mental health is being severely compromised as a result of deliberate wrong doing should be given an immediate opportunity to supply a tape recorded or videoed witness statement, taken by an independent doctor with a mandate, the proven will, and the necessary statutory protection. Records and available evidence should be secured with immediate effect. As in physically obtaining everything available in hard copy. All other evidence should be proactively procured and secured. Accused doctors should be interviewed on oath, and tape recorded/videoed. This would happen for rape, but certainly does not for allegations of deliberate falsification of records, harm or intimidation in the medical system.
I am aware many readers will find this sensationalist or shocking. It is however the truth. If it is not the truth there are a number of intractable cases that can be solved virtually overnight. When this has been achieved I will footnote the relevant elements of this letter. By definition many of the agencies and bodies involved will vehemently deny this letter is correct, by definition I can prove they are wrong, or at least that there are outstanding cases fitting all examples. There are a number of charities who can endorse that this is the position, including AvMa.
Examples of scope for malpractice (not all proven in my personal experience) could include, at the extreme end, murder. How many doctors other than Shipman have been found guilty of murdering patients? Is it likely there wouldn't be any given the potential motives, the means, and the stakes? Exactly. Clearly deliberate or at least avoidable serious harm is another element. It is dangerous to make assumptions about what strategic manoeuvres, motivations, and methods might be employed. Doctors are intelligent, flexible, and creative. They also close ranks. In addition the intent may not be murder, but if it is an unfortunate by product of covering up, or serving vested interests, with undesired but predicable consequences it amounts to the same thing. If records are falsified, the sky is the limit, literally. Adverse consequences may be due to, as just some examples, wrong treatment, reluctance to access medical services, inability to access appropriate medical services, missing diagnostic tests, misdiagnosis, unrecorded risk factors/drug allergies, excessive or inappropriately used drugs. Another avenue is the misdiagnosis of mental illness, deliberately or avoidably causing mental illness such as PTSD, or depression, or "paranoia", falsely ascribing legitimate and readily verifiable physical illnesses to mental illness, ascribing genuine complaints concerning the medical system to mental illness, taken to extreme this could include section on false grounds,ECT,and community treatment orders on long term and disabling drugs. This approach, Soviet style, has the advantage of short circuiting the criminal justice system, and avoids the potential inconvenience of a dead body. This is a horrifying prospect, but unfortunately is one I have seen hard evidence for. Finally, covering up serious side-effects by omission or commission, or misrepresenting or misattributing any benefit of interventions when writing and processing medical records may not only harm the patient, but also others offered treatments on the back of such evidence.
In the longer term I believe removing reliance on trust, and therefore temptation is the kindest option. For example all substantial medical reports should be read by the patient or representative and signed off, if there is a disagreement concerning an opinion the patient should write what it is and the report should be designed to accommodate this, if the patient believes there is a factual inaccuracy the patient should be able to ask for this to be corrected, and the record will be invalidated unless this is checked and subsequently signed off. I see no reason why important or contentious consultations cannot be audio recorded and filed digitally. No one expects policemen to take statements and the individual concerned to have no idea what is being recorded and to have no say until the final product has been provided (if ever).
"The issues extend well beyond clinical considerations. In my first hand experience faulty NHS complaints and concerns procedures have cost the NHS many millions of pounds. They fail to offer redress, squander money on strategic manoeuvres to hide the truth, cause further trauma, allow the guilty but powerful to escape sanction, permit a shorted out unpoliced mess to perpetuate itself, and allow expensive mistakes to continue unabated. I am happy to provide the evidence to Mr Lansley "
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