Apology from Healthcare Improvement Scotland

Hole Ousia

On the 30th January 2015 an apology was received from the Deputy Chief Executive and Director of Scrutiny & Assurance for Healthcare Improvement Scotland.

Here is my reply of thanks:

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To: Robbie Pearson
Deputy Chief Executive
Director of Scrutiny & Assurance
Healthcare Improvement Scotland
Gyle Square
1 South Gyle Crescent
Edinburgh, EH12 9EB

Dear Mr Pearson,
Re: Letter to Mrs Muirhead, 29 January 2015
I wanted to write to thank you for copying me into your response letter to Mrs Muirhead dated 29th January 2015. I note that Healthcare Improvement Scottland (HIS) have upheld the complaint. I want to thank you for  apologising for “this incident.” It does make a difference to hear this. I am relieved to hear that Healthcare Improvement Scotland “are reviewing our social media guidance to strengthen understanding, and to ensure that it is consistently complied with across the organisation.”

I hope you will understand, as…

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‘Medical corruption in the UK’ Fiona Godlee, BMJ; Response from Dr Peter J Gordon

Medical corruption in the UK Fiona Godlee, editor in chief, The BMJ, 29 January 2015; BMJ 2015;350:h506

“Last year The BMJ launched an international campaign against corruption in healthcare. A single article was the spark: a personal view about the endemic culture of kickbacks to doctors in India (doi:10.1136/bmj.g3169). The campaign received widespread support from Indian doctors and the media, and it seems to have led to some positive change, if not yet enough. In an unprecedented move India’s then health minister acknowledged that corruption was a big problem. The government set up a special committee and has banned gifts to doctors and conference sponsorship by drug companies. The Indian Medical Association is working on a new code of medical ethics for private hospitals. And the Medical Council of India, which regulates India’s doctors, has committed itself to act against any doctors reported to have received kickbacks.

A linked editorial made it clear that India was not alone in having a deeply embedded culture in medicine of tolerance to and even promotion of corruption (doi:10.1136/bmj.g3169). If anyone doubted this, recent news from the United States suggested that healthcare corruption was equally endemic there. On top of evidence that the US loses billions of dollars each year to medical embezzlement (http://econ.st/1BuAiFW), high profile cases are now making clear the mechanisms and the human cost. Six doctors in Chicago are currently being prosecuted for allegedly taking kickbacks. Their alleged crimes includes referring patients to hospital who didn’t need admission and performing unnecessary but lucrative tracheotomies, leading to avoidable deaths (doi:10.1136/bmj.h22).

Nor, sadly, is the United Kingdom immune. A BMJ investigation published this week reports clear evidence of UK doctors receiving covert financial inducements to refer patients to private hospital groups. Some London based doctors have benefited by tens, sometimes hundreds, of thousands of pounds (doi:10.1136/bmj.h396).

No doubt the beneficiaries will include some of the pillars of Britain’s medical establishment. Also no doubt most of those involved will believe that they themselves cannot be bought. But even if that were true, it is the perception of conflicts of interest that matters, as well as the reality. How many doctors enjoying free use of consulting rooms will have explained to a patient: “I am referring you to this hospital (or moving you to this other hospital) because I have a contract with them that rewards me for doing so”?

Some of the beneficiaries might argue that the UK’s General Medical Council has no specific guidance on private sector inducements, and they would be right. The GMC’s failure to provide such guidance, and its apparent reluctance to act on information about kickbacks that was presented to it in 2012, are the focus of a linked editorial (doi:10.1136/bmj.h474). But even without clear guidance or action from the GMC, it seems obvious that referral for any reason other than because the patient’s best interests require it contravenes professional ethics. Gornall reports that some doctors were offered inducements but declined for this reason. And one notable private hospital group keeps well away from inducements, preferring to compete on the quality of the service it provides.

The profession must take the lead to protect patients and maintain public trust. The GMC should act, and a public register of UK doctors’ financial interests is long overdue.”

————————————————-

Response: ‘Re: Medical corruption in the UK‘ by Peter, J. Gordon, Psychiatrist for Older Adults, NHS Locum, 31 January 2015

“Fiona Godlee, Editor of the BMJ, has concluded that: “The profession must take the lead to protect patients and maintain public trust. The GMC should act, and a public register of UK doctors’ financial interests is long overdue.”(1)

In response, Niall Dickson, Chief Executive of the GMC, has stated that: “Our guidance is comprehensive and clear in respect of the responsibilities of individual doctors and we have taken appropriate action against individual doctors in the past where there has been evidence that our guidance has been breached”. (2)

I have petitioned the Scottish Government for a Sunshine Act regarding health professionals’ financial conflicts of interest. (3) This was considered most recently at the meeting of the Petitions Committee on 27th January. The evidence accumulated so far demonstrates that existing Scottish Government guidance, in place since 2003, has never been followed in NHS Scotland. FOI response from the GMC confirms that no doctor has been formally investigated in Scotland for breaching guidance on financial interests. (4)

Niall Dickson has stated on behalf of the GMC that “Parliament has not given us powers”. It would seem that Fiona Godlee has correctly identified what needs to be done, and it is clear that governments will need to act.”

References:

(1) Godlee, F. Medical corruption in the UK. 29 Jan 2015 http://www.bmj.com/content/350/bmj.h506
(2) Dickson, N. The GMC responds to the special report in the BMJ on regulating doctors’ financial and commercial interests; 29 Jan 2015 http://www.bmj.com/content/350/bmj.h396/rr
(3) Gordon, P.J. PE01493: A Sunshine Act for Scotland http://www.scottish.parliament.uk/GettingInvolved/Petitions/sunshineact
(4) General Medical Council response to Dr Peter J Gordon. F13/5915/EH; dated14 Jan 2014

 

As Social Creature

PROOF OF GOD! ...and other tragedies.

 

Jan 23 (6 days ago)

She stood in the bulb-lit bathroom, looking at the circles under her eyes and smiled because ‘haggard’ looked alright on her. The tiles on the floor rattled under her feet; she’d need to re-grout them when she got home from the trip. She didn’t feel worried about traveling, or coming home. She felt completely calm, save for a small tightening excitement in her chest.

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When she thought about it, the way that she had figured out – finally – what it was she ought to set out to do, she felt a little like weeping. It was a relief to feel certain about something.

The day was rainy and cold. The mountains in January were grey and brown, dark winter green, and the rain felt like ice, but wasn’t freezing. It wouldn’t snow today. Her flight would leave on time.

The day before, she…

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social movements are from the grassroots, rising up, collective action – “recovery movement” another top down affair

Another Email sent this morning to the See Me Scotland Director, copied in to various “others” and forwarded on to a few:

“I feel compelled to write to you about the strapline “Building a Social Movement”. Because it’s an impossible task.

For we can’t “build” a social movement. It’s an organic thing that happens by osmosis. A grassroots uprising. As a result of various factors, a collective enterprise involving natural leadership and seeds of discontent.

I was checking out Oxfam Scotland, your previous employer, and notice some of their straplines:

“Speaking out is powerful. It can change minds and influence decision makers.”

“… so when injustice causes poverty, we stand against it”

“We know people have the power to change their lives and the lives of those around them. All they need is a little help.”

I agree with all of these statements and it’s how I behave as a writer, activist and campaigner in Scotland’s mental health world. It was the same when I was a community development worker in Lanarkshire then in Fife and Perth, before I entered the twilight zone in January 2008, by getting on board with the “recovery movement”. Another top down affair. Although I didn’t know it at the time, having believed the blurb about peer support being a civil rights movement. Which it is, but not in Scotland. Rather it is a government arm with Penumbra on the right wing.

For seven years I have tried to be meaningfully involved in mental health matters, collectively and on a level playing field. But it’s impossible because the powers that be will not allow the real experts by experience to have a voice or to be heard. We are sequestered or patronised or excluded or scapegoated. Pushed into “Write to Recovery” by the SRN cronies. While empires are built and people are promoted to the level of their own incompetence. Just like in the real world of statutory and government agencies.

Anyway these are my thoughts on the See Me strapline and looking back over my time in the trenches.

Yours sincerely”

 

A Sunshine Act for Scotland

Hole Ousia

I cannot promise sunshine (who can) but here is a pattern that appears in the daylight of my today.

Hole Ousia found new direction after Alexander McCall Smith recommended “A Pattern Landscape”

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This post is based on the recent considerations (27th January 2015) by the Petitions Committee on my petition for a  “Sunshine Act”

Kenny Macaskill, MSP gave this response to my petition:

Kenny MacAskill & Jackson Carlaw: A Sunshine Act for Scotland from omphalos on Vimeo.

Kenny Macaskill states to the Petitions Committee: “we have got to give them some opportunity” [Scottish Government]  … “I don’t think that can be done quickly as it is quite complex”. HDL-62

HDL (2003) 62 was issued 13 years ago. It was addressed to every NHS chief executive in Scotland.

Kenny MacAskill states that “it does seem to me [for there to be] a willingness to look into this”

Evidence reveals…

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‘Do you know what your patient is thinking?’ response on BMJ 28 Jan15

bmjimageRe: Do you know what your patient is thinking?‘, BMJ response, 28 January 2015

Mitzi A J Blennerhassett, medical writer/author, Slingsby, York

“When we are ‘new’ patients, we usually find ourselves in an unequal situation, with less knowledge about our condition than our doctors, dependent upon them for information as well as for their clinical expertise. Even as a seasoned patient activist, with ‘expert’ knowledge and experience about my medical condition, I still find myself disempowered in clinical consultations, mostly unable to say what I am thinking or feeling. This disempowerment is even stronger when I sense I am being patronised: frustration and outrage begin to overtake my wish for rapport and mutual understanding.

Imagine being unable to access treatment for midline lymphoedema that is seriously affecting your quality of life – clothes do not fit – the extra weight exacerbates painful conditions. Yet when you comment that it seems unacceptable you cannot access lymphoedema treatment for this side effect of the nhs cancer treatments the response is ‘but it was those very treatments that have kept you alive all this time’.

I wanted to say, ‘I do not need reminding that I am lucky to be alive – and I am reminded of the treatments by the daily pain of side effects’. Yes, I am lucky, but I should not have to preface all my requests for treatment side effects with thanks for being alive.

Doctors’ words can be well-meaning – perhaps trying to make patients see the positive side of life – but it felt as if I was being told to be grateful. The lack of understanding took my breath away, but before pent up tears choked me into silence I managed to answer, ”That’s like saying to someone, ‘What are you crying about? You’ve had a mastectomy and lost a breast – but you’re still alive!’

I was reminded of the doctor who, after aggressive cancer treatments, dismissed my request for my prognosis and TNM staging with, ‘What’s the matter with you …why don’t you go out and get on with your life!’

As a patient advocate, I have been very fortunate to be able to work alongside patient-centred health professionals trying to improve health services. I suppose I have become used to being treated with respect and having normal social interaction with doctors. Nowadays, it is easy for me to distinguish between those health professionals who have had experience of user involvement and those who have not. And it hits hard when, as a patient, I come up against such old-fashioned attitudes.

It was the need to let doctors and others know what I had been thinking and feeling during my experience of cancer that prompted me to write my book, and to include discussion sections after each event looking at the effects on me, along with research references for better practice. Almost without exception, patients and doctors’ feedback has been that it should be read by every doctor and nurse because it allows the reader to ‘get inside the patient’s head’.”