- We focus on raising awareness of the benefits of a law defining a Statutory Duty of Candour in healthcare.
- The NHS Complaints Process is not fit for purpose. We discuss this on several pages of our site.
- We publish links articles and self-help documentation on this site. See our LCNHS page for examples. There is also a wealth of information on Citizens Advice (NHS) including links to the Department of Health (DH) website which contains the NHS Constitution (2010). Revealingly, it is an aim for NHS employees to be “to be open with patients, their families, carers or representatives, including if anything goes wrong“. A good aim. Naturally the constitution should not, in our view, be quite so coy. This should be a duty rather than an aim, because only the competent and honest will take this aim seriously. The incompetent and mendacious will not, which leaves the competent and honest medical practitioner at a serious disadvantage when dealing with the consequences of incompetence and mendacity.
- We tell the stories of some of our members in detail, to let readers form their own view of the NHS Complaints Process.
- We discuss regulatory organisations, their merits and failings and publish the views of other organisations.
- We host tributes to our relatives who have needlessly died, and host members stories.
- We have an associated forum for members where support and advice (where we can offer it) is given and received.
We are non-political, with affiliations to no particular party.
How complex is the issue of culture? The culture that exists within a publicly funded organisation like the NHS and the culture of the society that such organisations directly depend on. To get an idea of how culture affects everything in society and for how long it has held sway, here is a lengthy video courtesy of Tragedy and Hope and a page with further links explaining the effect it may have on healthcare War Games. Scroll down to see how Big Pharma, clinical trials and medical ethics are affected by the cultures that support them. A hospital does not exist in a vacuum, it exists within a larger culture we term 'society'. In society a long and often repeated discussion supports a stance where deliberate manipulation using the whole art and device of oratory is used to drive away from ethical considerations and into a loss of cognitive function and critical faculty.
A question soon arises, just who are these people who have used and are using specious logic to justify their very existence, and why are they engaged in desperate attempts to covertly interfere with others, their lives, their perceptions and the aims of society itself? Why have they been so successful in the past and why has this success eventually and invariably resulted in catastrophic collapse when any given society can no longer withstand the gross effect of such manipulation? These questions are more suited to lengthy answer from philosophy and history so for now they are deemed to be beyond the current scope of this website.
The effect of culture on the NHS is simpler. It may drive clinicians away from patient centered care into attempts at social engineering (click for expansion of term). Contrary to long-held notions, healthcare and social engineering do not mix. Sixty-five years of the NHS has proven that, yet it still persists. New Registrars are taught to put he patient first, but all of that learning can be undone if they are mentored by consultants who have a patient last attitude.
Eugenics, economics and healthcare get mixed in a toxic brew where people 'play God' in accordance with a very low understanding of how an avoidable death truly affects everything.
Some brutally-phrased questions may enlighten us here. Why does it pay to deliberately shorten a life? Why bother attempting to save somebody who is in a critical condition? Why bother with safety? Why not take short cuts for efficiency? Why not hasten a death that appears to be inevitable? The answer is interlinked with the notion of culture within any healthcare organisation, and the profound effect it has on medical practitioners.
The NHS Culture
There is no economic advantage in deliberately hastening a death. Those who do not think through this critical question at all and have no real understanding make a terrible mistake. The entire organisational culture is damaged irreparably. It allows failure to flourish. It rewards incompetence and results in a fifth rate service funded at world class rates.
The inevitable outcome of mixing social engineering considerations and healthcare is that healthcare costs far more. The exact opposite of intuitive or shallow thinking which sees a cost saving in cutting short a life.
The evolution of the NHS culture might also be driven by private care providers where these tenets hold true:
- Simple, direct, efficient, highly motivated and skilled = valuable employee.
- ‘Clever’, mendacious, 'artful dodger' or unsuitable personality defects = worthless employee.
- Social engineering considerations have no real place in delivery of the service. They are replaced by market forces.
Duty of Candour
A Statutory Duty of Candour is a legally binding obligation for medical personnel to tell the truth about the care they give to patients and to refrain from falsifying medical notes. It is an obligation that extends to all involved. We have heard many interested parties state that this legislation is not necessary. These reasons are all incorrect and do not withstand the lightest scrutiny.
Briefly, a statutory duty of candour is a powerful tool that will enable removal of incompetent medics from a position where they routinely harm people. Currently, good managers find removal of incompetents difficult. An incompetent medic will lie and falsify medical notes, and get colleagues to cover their errors. Some NHS managers encourage this behaviour, and some impose sanctions to force medical personnel to lie. A statutory obligation sweeps the foundation for this practice aside. It should have been set in law before the NHS was founded. an 'oversight' argued for by people who were well aware of the high-risk nature of medicine in 1947. Medicine has evolved, but the legislation has not evolved with it – something that most NHS patients are unaware of until it is too late.
Why a statutory duty, not a voluntary duty?
We need to go a bit further than examining complaints managers and their retinue of staff who do nothing but deflect problems rather than investigating them; legal services managers who know nothing about a Trust's legal obligations to customers (patients) and highly-placed individuals who do not have, and never have had, the right attitude. Let me illustrate using the words of an NHS consultant who has had many years of experience:
The details of an intervention should not be discussed with patients or relatives; the need to know of such things may be entirely voyeuristic in some cases. My colleagues and I are paid to know and do such things and are trained to cope with the psychological pressures resulting from our actions. There are good reasons why the public should not be exposed to such knowledge. They do not deserve to be confronted with the realities that we face every day to keep them well.
This goes well beyond the term ‘paternalism’ and makes a mockery of openness honesty and integrity. It takes no account of the psychological needs patients and their families to have some idea of what it happening to them or their loved one. It also ignores the concept of informed consent. One is able to consent to ‘I need to take your appendix out because you have appendicitis’, because one’s education has equipped one with the basic knowledge of what an appendix is and what the consequences of not having it taken out will be. If one had not had that education, however, a good doctor would explain until the patient understood enough to consent in a meaningful way to the surgery. ‘I need to do Doctor Stuff’ simply isn’t good enough. Finally, this doctor is also assuming that the families of people who are unwell are in some way unaware of the realities of their disease, when in fact those people are probably the primary care-givers and may be only too aware of the consequences and realities of that illness. It can also be used to provide cover. A psychologist or psychiatrist might go as far as to describe it as classic psychopathic thinking; the thought processes of someone who should be kept well away from vulnerable or critically ill people. And yet the NHS cannot easily break his contract, even though he displays all that is wrong about the current NHS culture. So, what chance is there of a voluntary duty of candour surviving in such a culture?
Colleagues, managers and so on, would feel far less obliged to cover for others if it was explicitly stated in statute that they should not do so. In short, nobody would be able to force others to break the law on their own or others behalf. It is a matter of protecting the competent from the incompetent, rather than another statute that nobody implements. This duty would be a foundation from which attitudes could start to change.
Monday 13 February 2012, and the campaign gets lost in semantics. It is assumed that a duty of candour can be best achieved by having individual contractual obligations for employees. BBC reports on vote
Duty of Care
The duty of care is quite distinct from a duty of candour. Most people instinctively understand what this means. We expand on it by referring you to our Reformers page, where Sir Donald Irvine tells us what his view is: Reformation
The NHS Complaint Procedures
The NHS Complaint Procedures and Ombudsman are the current routes people are advised to follow when they have suffered an adverse event in NHS care and seek accountability, justice or simply the truth.
Many complaining about medical negligence and adverse incidents have been shocked to find that the system is not impartial or thorough. They rightly feel that justice has not been served and that truth has been concealed. Complainants tell of medical records being lost or altered, physicians lying or hiding the true facts, delaying tactics, questions not being answered, evidence not being investigated, and of being labeled as vexatious, wrong or mentally impaired, to divert or delay proper investigation. The NHS complaints system makes things worse when people are at their most vulnerable and need assistance most.
This website is a response by NHS complainants to all parties who make a living out of the NHS complaints system. Both competent members of the caring professions and the general public are badly served by a complaints system that does not have truth seeking as it’s primary objective.
They continue to fog issues, abuse complaint makers and lie. They commit perjury without turning a hair. Anyone who feels that the NHS Complaint Procedures did not deliver justice is most welcome to submit a resume of their experience. Experiences will be published on this website if so desired. Since the site was launched on 01 May 2010, the verified experiences members have had published here include a criminal act of deliberately killing a patient along with many instances of falsification of medical notes, lying and evasion and failures at all levels.
NHS Trusts and Clinical Negligence Advocates, through to the Regulatory bodies, the General Medical Council (GMC) and Nursing and Midwifery Council (NMC) routinely fail.
In fact we have never heard of an individual experience where the General Medical Council and the Nursing and Midwifery Council have acted decisively, based solely on a complaint from a patient or surviving relative. The NMC and GMC only appear to act if a Trust brings a complaint about an employee to their attention. They do nothing at all if an individual complains. These regulators appear to only act for the profession or NHS employers. Anyone who has had an individual complaint attended to properly by the GMC or NMC is welcome to present their resume for publication on this site. We have been unable to find one after searching diligently. This invitation is also open to the GMC and NMC. We strive to present facts not fancy. On 1st Feb 2012 the NMC responded to this challenge and you can read it on our NMC page here.
If you simply want a general browse before becoming immersed in the detail of some harrowing cases, I recommend starting with our page on Vernon Coleman. He shares a few myth dispellers including the evergreen 'we are underfunded and understaffed' notion. We have featured him on our website among other writers, because of his vast experience and propensity to tell home truths, which many would sooner not let the public know. Here is a good video of how to Stay Healthy