BUREAUCRATIC MURDER IN BRITAIN'S NHS

Leaked e-mails from a leading NHS hospital indicate the depth of surgeons’ anger at the effects of targets on clinical care. The exchange of messages followed the death of a patient at Derriford Hospital in Plymouth after a gall bladder operation. To meet the target that no patient should wait for more than six months for an operation, the man had been transferred from the care of a consultant and the operation was carried out by a less experienced surgeon working under the supervision of another consultant. Such transfers are common practice for patients appearing on the Patient Target List (PTL) — that is, those who are close to breaching the waiting-time target.

Surgeons have complained that it takes the care of the patient out of their hands, but hospitals argue that the only way they can meet targets is to have common waiting lists. After the death at Derriford, a vigorous online discussion ensued among surgeons. One said that he would want a few answers if his own family had suffered bereavement in similar circumstances. The first message, from a consultant surgeon, described how he had made a mental note to allow plenty of time for a patient’s gall bladder operation, “a dissection that would be, at the very least, challenging”. He then discovered that a registrar working under another colleague’s supervision had taken the case. After surgery, the patient’s condition rapidly deteriorated and he died in intensive care. Describing the case as “another complete disaster from a PTL”, the consultant wrote: “These and other cases should only be done by adequately trained gastro-intestinal surgeons and we must act now to make sure this is the case.”

In response, a second surgeon wrote: “PTLs as they are currently worked are clearly dangerous. I think to avoid disaster we must go back to consultant-to-consultant transfer, case by case, as the only safe means of treating patients.” He added that he was asked to help after the gall bladder operation went wrong. “It is clear from looking through the notes it would be (a) difficult original operation with a high possibility of complications. The system in my opinion appears to be unsafe.”

The same day a third surgeon joined in. “PTLs and the rush to sort patients are a nightmare and the life-bane of me and others. Sadly, I do not see any party in the forthcoming election taking targets away” Within 24 hours three other consultant surgeons and an ear, nose and throat (ENT) specialist had joined the attack on treatment targets. The first criticised managers at Plymouth Hospitals NHS Trust, which runs Derriford Hospital. “It seems to me that the strategies the trust has employed have ignored quality of care whenever it seems expedient to do so,” he wrote.

The second urged consultants “not to be bullied into substandard practices” and added: “This is our only way left to influence things as all other rational discussion seems to fall on deaf ears.”. Commenting on the unsuccessful operation, the third wrote: “How sad! I would want a few answers if it was my near one or dear one. The ENT consultant wrote: “The impact of target-chasing has been disastrous on the ENT service. We have given up any hope of changing things.” The e-mails were posted on a Derriford Hospital internal link within the past two months. They were leaked, with the names obliterated, to a West Country news agency.

The hospital said yesterday: “Pooling of patients under most circumstances, to improve their speed of access, is considered good practice. “It is unusual for anyone to raise such a serious concern as this particular case discussed in e-mail, and as soon as our clinical managers became aware, a full and proper investigation was set up by our medical director. This is ongoing. The concerns raised are out of the ordinary, are being investigated and need to be taken into context against the trust’s record.” That record includes a doubling of consultants and a low mortality rate.

David Rosin, a consultant surgeon at St Mary’s Hospital, Paddington, and a vice- president of the Royal College of Surgeons, said: “Many trusts run common waiting lists, but cases should be transferred to another consultant. Waiting lists have been used as a means to win votes.”

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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