5 February 2013
An NHS scandal: Part I
shame of a Scottish
A year ago this month, the then Scottish information commissioner, Kevin Dunion, delivered the most devastating judgement of his career – an indictment of gross failures of management and governance in an important public body. Twelve months on, the body in question – Ayrshire and Arran Health Board – seems not to have learned from this chastening experience.
Kevin Dunion's judgement, which I have read in full, is an astonishing document. It catalogues a degree of negligence in Ayrshire and Arran Health Board which ought to have had heads rolling all over the shop. Most of the heads are, however, still very much intact. I understand that the continuing lack of accountability frustrates and infuriates the cabinet secretary for health, Alex Neil, who lives in Ayrshire. But it seems that democracy counts for little when it comes to the regulation of the NHS in Scotland.
The information commissioner was moved to act as a result of the vigilance and tenacity of a single public-spirited individual. His name is Rab Wilson. He is a mental health nurse doing difficult work, but he is rather more than that. He is brave. He refused to be intimidated by his own employers when they accused him of being 'vexatious' in his pursuit of the truth. It was a form of bullying. He stood up to it and won. Up to a point.
Later in the week I'll come to the limitations of his victory. But it is worth reminding ourselves of the basic history. Mr Wilson was concerned not to receive a report – what they call in the NHS an 'adverse event' or 'critical incident' report – on an incident in the hospital in which he works. He believed that the rules laid down that members of staff directly involved, as he was, were entitled to receive a copy of the official report into the incident. The management decreed otherwise.
Let's be clear about the meaning of a 'critical incident' or 'adverse event'. It's nothing trivial. It is defined as an 'unexpected or avoidable event that could have resulted, or did result, in unnecessary harm or death of a patient or staff'. There are too many of these incidents in the NHS in Scotland; recent research indicates that as many as one in 10 of all hospital admissions result in one. NHS Ayrshire and Arran has recorded its fair share – when it bothers to record them properly in the first place.
To say that the management did not appreciate Rab Wilson's persistence is to put it mildly. Undeterred, he submitted a freedom of information request for access to anonymised reports of all such incidents from 2005. When this was refused, he appealed to the information commissioner. Kevin Dunion's office discovered that although 132 of the cases reported as critical incidents or adverse events between 2009 and 2012 resulted in death, there was only 'limited evidence' of a systematic approach to the investigation of these fatalities.
Mr Dunion's office also encountered 'substantial difficulties' in obtaining a complete set of records covering the period. Key information was somehow 'not available'. Some cases had been 'removed' from the database. In others there was no indication that the required action plan – a set of recommendations for preventing such occurrences in the future – had been put in place or even considered. The information commissioner deplored the 'considerable reluctance' with which the board parted with documents, but it went beyond mere reluctance. When his office requested access to the action plans, the board's response was that it did not possess any.
Patients had died. Did their deaths count for less than the desire of the health board to cover its own back? The absence of action plans appeared to point that way.
As the information commissioner piled on the pressure, there was a bizarre development. Suddenly NHS Ayrshire and Arran – a board appointed by the Scottish ministers; a board accountable to the public – chanced upon 56 action plans 'apparently by accident'. Where had they been all this time? And, just as pertinent, were they all they seemed? The information commissioner decided that some had been prepared, not in the immediate aftermath of the incidents but only after Mr Wilson started to cause trouble – a revelation which betrays the board's contempt for its own patients and staff.
Kevin Dunion had to consider the possibility that the action plans had been concealed – a serious criminal offence. He concluded in the end that it was a case of cock-up rather than conspiracy. But the information commissioner left the senior management with nowhere to go: they had made claims which turned out to be 'wrong'; given assurances to his office which turned out to be 'unjustified'; and offered explanations which turned out to be 'unreliable'. He did not openly accuse NHS Ayrshire and Arran of being liars, but he came very, very close.
Following the withering verdict of the information commissioner, the Scottish Government ordered an inquiry by the so-called scrutiny body, Healthcare Improvement Scotland, into the affairs of NHS Ayrshire and Arran. I have read its report in full. It is badly written, woolly in its conclusions and intellectually poor; if this is typical of the work of Healthcare Improvement Scotland, I am surprised that anyone takes it seriously. But it did have a significant result. By failing to damn them as they should have been damned, it offered the senior management of NHS Ayrshire and Arran a narrow escape route.
A year later, surprisingly little has changed. The chief executive retired with a pension of £60,000 a year (according to the annual accounts). There is a new chairman, a retired ICI executive, who communicates in riddles, as we shall presently discover. But the other major players at NHS Ayrshire and Arran stay in post, on eye-watering salaries at that. And Rab Wilson? He continues to be obstructed in his search for the truth.
Thursday: Part II of An NHS scandal
Kenneth Roy is editor of the Scottish Review
SR accepts no advertising and depends on the generosity of readers to continue its work.
Click here to become a Friend of SR.