While NHS Lothian has been trumpeting the arrival of its “new” strategic health plan for 2014-2024 “Our Health, Our Care, Our Future”, with its prosaic language and new management speak terminology (a new profession in itself!), it is the weasel words that we need to be aware of. So what’s in a word? Well, on past experience, an awful lot. In this case, it is the revised description of St. John’s hospital as an “acute hospital” site, rather than an “acute emergency hospital” that has started alarm bells ringing.
For those of us who know the history of St. John’s, the issue around the categorisation of hospitals is a key to what services they deliver. An acute hospital does not mean it will provide a 24/7 A&E department as we have now.
NHS Lothian, like many health boards the length and breadth of the UK, is facing challenging times in providing emergency cover through A&E departments. It is admirable that they want to set in train new strategies to try and avoid people going to A&E departments, and much of what they say makes sense generally.
But there are danger signs. The document says “Where we are unable to recruit the doctors’ skills needed in specialist areas of care, e.g. in emergency medicine, paediatrics and in smaller surgical specialities, these may be concentrated, to ensure that services remain at the highest quality and are safe.” Or, putting it another way, we will have to centralise services. So who might lose out?
The people of West Lothian have always been the poor relations to their Edinburgh neighbours. Yet no-one seems to have joined the dots yet between the new plan, and the rhetoric at board level.
At last month’s NHS Lothian Board meeting, papers show that there is much discussion around a plan to enhance the emergency department at the Western General. Tellingly, there is a comment that “the implications of any reconfiguration proposals for St. John’s” will have to be examined.
There are other comments about centralising specialist paediatric services at the new Sick Kids, something we warned about some time ago. There are ongoing staffing difficulties in paediatrics at St. John’s and warnings over future services are writ large in the board papers.
We cannot say with any certainty what will happen. We can only work with the information to hand and the Chairman’s comments when we met with him last year. He said we would “likely disagree on future proposals for St. John’s”. If the warning signs become a reality, the people of West Lothian will have another fight on their hands.
We continue as a small but dedicated band of volunteers: without the public, whose politicians continue to let them down, all will be lost. We don’t relish forecasting bad outcomes, but we haven’t been wrong yet.
News of a potential criminal inquiry into the allegations from a senior doctor whom NHS Lothian appear to have wanted to gag, comes on the same day we have received detailed allegations of further wrongdoing at the Board.
An anonymous letter claiming “the whistle blowing set-up is a joke, we are frightened for our jobs”, is signed “People frightened to whistle blow or breach gagging orders”, and contains a series of alleged financial irregularities. The letter claims these allegations were “drawn to the attention of Audit Scotland and the Counter Fraud Service some time ago, by some of our former colleagues, but we understand that as usual NHS Lothian waffled their way through the subsequent questions”.
The information relates to so-called golden handshake payments made to senior officials who were already due to leave the health board on medical grounds, or who had reached retirement age. The letter claims the recipients were not entitled to the payments, or had reached the point in their employment where compensation packages should not have been paid. This has echoes of the recent furore about excessive and contractually unjustified payments to management at the BBC.
The authors of the letter claim that “senior people-all current and former employees of NHS Lothian - continue to conspire to perpetuate the lies the public were told in 2012 and ongoing”. This is certainly an accusation we have a great deal of sympathy with. NHS Lothian was caught out again in 2013 lying about waiting times. As usual, they covered up our discovery.
As also shown recently, staff cannot rely on NHS Scotland, whose officials blithely claim credit for exposing the waiting times scandal, knowing full well they had ignored all the evidence of the cover up for at least a year. This letter cites that we “bravely exposed the NHS Lothian waiting times scandal and related horrors of a culture of bullying and failures of the most basic level in relation to corporate governance”. Those are the facts.
It is therefore desperately ironic that one of those at whom criticism is levelled in the letter for receiving a six-figure enhanced payoff, was the only person at NHS Lothian board level who admitted that “if it hadn’t been for [an ASSJH councillor] uncovering this [the waiting times fiddle] we would never have known”. It was refreshingly honest from a man on whose watch this happened, but then confession seems cathartic when sprinkled with liberal amounts of public cash. It’s rather a pity the same honesty wasn’t in evidence when he and his Board privately attacked the Councillor involved, while lying to other board members to get their support to report him to the Standards Commission.
We will pass on these concerns to the relevant authorities. The final word goes to those too frightened to be identified: “Thank you for continuing to campaign for truth and we hope you can use the above material to expose the ongoing scandal, and ensure those guilty are held to account, and the self-serving idiots removed”.
We will continue to try.
14th February 2014
“Claims from “whistleblower”sic are hot air.”
The Scottish Government’s Director of Health Workforce and Performance, John Connaghan, has claimed at a Parliamentary Committee that he exposed the waiting times fiddle at NHS Lothian. Officials from NHS Scotland including Director-General Paul Gray and Director of Finance John Matheson were called to Parliament to report on waiting times and the various patient treatment guarantees.
They failed to spot what was going wrong, and now they’ve added re-writing history to their CVs.
I am writing to you following the St. John’s Hospital Stakeholder Group meeting on 10 th. August, and last night’s quarterly NHS briefing to the West Lothian Association of Community Councils.
You will be aware of some of the circumstances surrounding the Stakeholder Group Meeting as you met with my colleagues Ellen Glass and two other members of the community previously. The following comments should be taken more as observations rather than a formal complaint.
THE TRUTH, THE WHOLE TRUTH, AND NOTHING BUT MORE NHS NONSENSE..........
In the week of national hysteria about a Royal birth, St. John’s has a new arrival to, ahem, celebrate as well. NHS Lothian euphemistically calls it a “newsletter” about St. John’s. The Health Board claims it is the ONLY place where you can get the facts about St. John’s. So just how accurate is this fresh-faced newcomer?
The first edition claimed that patient activity at St. John’s had increased over the past 20 years from 15,000 to 35,000. Surely some mistake? According to the Board papers published 3 days earlier, the service configuration for A&E is based on 51,000 attendances just for the A&E department alone at St. John’s. And there will be tens of thousands more patients attending all the other departments. So, a health Board "fact" turns to be a load of nonsense. This sets the tone for the entire newsletter!
As for the comment about investing in respiratory medicine to have 4 consultants, what the public are not being told is that the existing 3 consultants are all leaving for better jobs elsewhere in Lothian! The devil is in the detail and this class act in misinformation is the hallmark of an organisation which at its core is reluctant to be honest and truthful.
The Board claims that NHS Lothian is an “open and transparent organisation”. Tell that to the thousands of patients who are still waiting for treatment as a result of their waiting times fiddle. The cost of this financial disaster is now estimated to be over £70 million. We will pay and the private sector will get the investment!
They say there will be no changes to A&E and more patients will not be taken to the Royal. But hold on. The Board papers state “that [the] Scottish Ambulance Service are asked to divert patients with obvious requirement for procedural sedation”. So they may not be officially changing the diversion policy, but they are issuing unofficial guidance that will see more patients transferred to Edinburgh.
The second edition is even worse. It followed a meeting on Monday 29th July where members of the public outnumbered Community Councillors 4:1 for the West Lothian Association of Community Councillors briefing. The newsletter claimed that there were to be four public meetings held across West Lothian in August and September. Again we are aghast. At the meeting, NHS Lothian had told us they were going to hold EIGHT meetings. So they’ve even downgradeD the engagement process before it has begun!
And yet again, their claims on A&E are staggering. They claim everything is fine. But at the public meeting they announced they had only been able to recruit 5 of the newly created but grandly titled “Clinical Development Fellows” (junior doctors to you and I) to help stave off the downgrade of A&E. But their plans to save the service were based on being able to recruit 12 of these Fellows. So how do they plan to manage on just 5 and how will these Fellows be supported properly?
They claim they will have support from other areas in the hospital, including the Hospital at Night (HaN) team. But can we believe them? According to the Board papers from just the week before, they considered this option, but “the HaN team could not take on the responsibility for managing an additional volume of workload in the light of recent concerns about their existing workload”.
And lest there be any doubt about the proposed support from other areas of the hospital, the consultant physicians told management they could not do it. And this was confirmed at the St. John’s Stakeholder Group meeting on 10th July by Chris Stirling, the Site Director at St. John’s.
We welcome any initiative to get the message out to the public about what is happening at St. John’s. But when their “newsletter” is clearly in conflict with what their Board papers and officials are saying, then it is another historic waste of resources.
They are trying to circumvent their statutory duty to hold formal consultations on the forthcoming downgrades. They claim there is no downgrade, nor any major service change to consult on. When doing it by stealth and misleading the public, they are probably right. But then NHS Lothian sets its own rules, consults no-one and believes itself to be above accountability to Scottish Ministers.
When will these people learn there is an ever-growing number of the West Lothian population who will no longer blindly accept everything that NHS Lothian pumps out from its corporate lie, sorry, communications machine.
And like so often in the past, their lies will catch them out.
Read the latest Inside St. John's Newsletter here and compare the contents with the facts disclosed above in our ATSSJH newsletter.
In a week that has seen the unsafe environment at St. John’s Hospital put firmly in the public glare in the Sunday Times and Herald, we ask again: what is NHS Lothian going to do to prevent the downgrade of OUR A & E department before 1st August?
Don’t take our word for it: read the news articles about the serious concerns and risks highlighted by the junior doctors at St. John’s and elsewhere. In the case of St. John’s, these were the same doctors at breaking point senior people crassly claimed were going to support the A & E department.
And if you don’t believe that we are telling the truth, look at the words of Graeme Morrice MP. He says:
“As MP for the area, I have been inundated with constituents expressing their concerns about the potential downgrading of services at St John’s, in particular A&E and paediatrics. Obviously, I have made direct representations to both NHS Lothian and the Scottish Health Minister about this".
It seems clear to me that the various problems that are now coming to a head are as a result of ineffectual long-term planning and incompetent management at a senior level within NHS Lothian.”
The next in a series of public meetings to facilitate public discussion being denied to the population by NHS Lothian will be held on Monday 22nd July at 7.00pm. in Brucefield Church, East Main Street, Whitburn.
Please come along and listen to what is happening to YOUR hospital, and what YOU can do to prevent another DOWNGRADE.
A&E Downgrade at St John’s – West Lothian public barred from Stakeholder meeting!!!
On Wednesday the 10th. July NHS Lothian barred members of the West Lothian public from attending a meeting of the Stakeholder Group at St John’s! This was set up by the Scottish government precisely to ensure that the public could be present when important healthcare topics were being discussed. So when around 60 people, anxious to find out the fate of the A&E department, attended St John’s for the meeting Mr Forrest, on behalf of NHS Lothian, sent them packing. Not only were ordinary people excluded, but also their Community Council representatives! This confirms that the Board wants to downgrade A&E at St John’s by stealth and then prevent any form of debate being held in public.
This makes a mockery of the Stakeholder Group, and also of the Scottish Government. The Board assumes it can get away with anything and it is daring the government to rein them in.
The Stop the Downgrade Campaign issues their July 2013 newsletter
'NHS Lothian – financially incompetent and morally bankrupt
St John’s A&E set to be downgraded in August
Our A&E department will be downgraded in August. The Board has set out a “contingency” plan. This means that when there is a reduction in the number of trainee doctors it is St John’s that will lose out, unlike all the other hospitals in the region. What is being proposed?
The Board is going to withdraw the highly experienced A&E doctor that currently does the overnight shift at St John’s. This doctor will be replaced by one who is not specialised in A&E and is barely two or three years out of medical school. This inexperienced, non-specialist doctor will be “supported” by a TV link to the Royal Infirmary. When he/she can’t cope then other non-specialist doctors already working within St John’s will be called to help out. Meanwhile, the sickest patients attending A&E will be sent by ambulance to Edinburgh.
This is a downgrade to the existing high quality A&E department.
We have been saying it for years. The target driven, management dominated health service in Scotland is a disgrace. Short term, politically inspire expediency, and those are just some of the better qualities.
It is an utter disgrace that it has taken the retiral of the BMA's leader in Scotland to allow the truth to be told to those on high. But no matter how many times we say "we told you so", the question must surely be, “when are the politicians going to start acting”?
Because one thing should be obvious to everyone: this farce cannot continue. And lest there be any doubt, take a look at the minutes of the last Board meeting of NHS Lothian. They are littered with the comments of the intellectual detritus that populates so many of our public bodies.
Cllr. Frank Toner tabled a motion that was defeated 21to 2. Essentially the motion called for all alternatives to be looked at, and that the Board should not pass a paper where the only contingency plan was a downgrade at St. John’s Hospital. The Chief Executive advised the Board that it could not support a motion “which explicitly prevented the development of contingency plans for such a clearly articulated risk”. But the motion didn’t: it asked that ALL options be examined, and that they be robust and clearly consulted upon, not least with the Scottish Ambulance Service.
Then the intelligentsia got to work. Some weren’t comfortable that they hadn’t had advance notice of the motion, suggesting they all read their papers in advance anyway-which they don’t. Others claimed this wasn’t like the Council, and they should have advance notice, missing the point entirely that the motion was competent in terms of their own Standing Orders, and that they had already voted on it. What imbeciles.
This single piece of business highlights why there is growing concern amongst observers that not only has management speak taken over within the health service, but those tasked with scrutiny continually buy in to the misconceived notion that the advice of those in executive positions should be slavishly followed.
They have lost the plot, not to mention the route map for the challenging times ahead. And it is no longer just campaign groups like us who are saying it.
NHS Lothian's decision to close the homeopathy service may be seen by some as a common sense decision. After all, it is a service at the margins. But two factors make the decision unpalatable: firstly the questionable consultation, and secondly, the argument about cost savings.
We in West Lothian know what it means to have decisions foisted upon us without consultation (the removal of emergency surgery and trauma orthopaedics from St. John's) or to have the promise of consultation ignored (paediatrics and children's services in 2012). When questioned recently about why there was little if any word on consultation on other service changes, NHS Lothian responded that it was only service users who need be consulted. Which makes the consultation on homeopathy all the more remarkable.
NHS Lothian claim the overwhelming majority (around 74%) are not in favour of retention, from around 3720 responses. Interestingly, there are only 500 or so service users affected by this, so the arithmetic doesn't support their claimed methodology. Worse still, if the 3720 responses represent the usual rate of response in consultations, the number of consultees could be in the tens of thousands. For a service user group of 500, it really makes you wonder if the consultation was designed to elicit the 'right' statistical outcome.
As for the financial savings, these too do not tell the whole story. The press release claims a saving £240,000. However, the Board paper highlights that the actual saving is less than half of that, because there are fixed costs involved that cannot be offset by closure. And that's without the consequences of increased specialist care being needed if this particular specialty is more than the placebo many respondents claimed it to be.
NHS Lothian provided its Board with a 73 page report with lots of coloured graphs to justify another egregious decision on services. What a pity they haven't taken the trouble at St. John's where their clearly stated risk assessment and contingency arrangements include hacking further at our ever-dwindling services!
Do not take our word for it that all is not right with our health service-the following comments are from nurses at St. John’s Hospital. They think what is happening is wrong, and if they are worried for the future, so should we be!
‘Over the last few years we have worked in most of the wards at St John's at some point. Downgrading St. John's seems inevitable although we are hopeful that we are wrong.’
‘As things stand at the moment patients from west lothian are neglected as are their families.’
‘Medical patients sometimes wait several days post MI to get a bed through at the ERI to get PCI and stents. Once they have a bed allocated at ERI they then have to wait several hours for an ambulance as they are still not a priority as it is the same ambulances that deal with 999 calls. We have seen patients collected for transfer at 4am and 5am as that is the first time ambulances have been free. Nurses are afraid to postpone transfer till daytime as the patient could wait all day for a slot for transfer to ERI. Nurses are forever having to apologise for the delays in transfer. ‘
Please sign the petition to STOP NHS Lothian’s proposal to scale back the current 24/7 doctor-led Accident and Emergency Service at St John’s Hospital, Livingston.
* Sign the online petition and print postal forms here
9th. April 2013.
NHS Waiting Times.
Alex Neil MSP,
Cabinet Secretary for Health and Wellbeing,
St. Andrew’s House,
9th. April 2013.
Dear Cabinet Secretary,
NHS Waiting Times.
When I wrote to you on 22 nd. February, I thought that you might have afforded me the courtesy of a personal reply, if for no other reason than you might have wanted to take the opportunity to explain why you comprehensively misled the public. Of equal importance would have been an explanation of what you were going to do to address the ongoing waiting list fiddling. That was perhaps an expectation too far, since you clearly did not understand what had gone on in the past, so were unlikely to grasp what is going on in the present.
I take exception to the nonsense your civil servants have served up in response to my letter. There is no explanation for the glaring inaccuracies in your statement, and it is a whitewash of all things bad at NHS Lothian. Worse, it is presumably endorsed by you, and that being the case, will be a clear signal to NHS Lothian that it can be business as usual for them, and that spells disaster for all of us. Those of us who work to hold public bodies to account for no personal gain should be treated with a little more respect.
Perhaps your attitude will embolden them to continue to fudge public scrutiny, as they have recently done with us. Shortly before writing to you, we put an FOI request to NHS Lothian about the waiting times figures being reported to the Board. They did not appear to add up, and there was a question about “clock resets”. NHS Lothian offered to meet with me, but then everything went quiet. Despite requests for a response, and a request for review under FOISA, they are simply ignoring me.
As you will be aware, NHS Lothian now claims it discovered evidence of the inaccurate information as a result of a staff member being on holiday. A likely story and one that has provided the necessary distraction from the truth. They have avoided further public embarrassment by misleading us and the public. It is interesting that Andrew Jackson’s paper was presented to the Board on 27 th. March despite purporting to be dated 25 th. February. In view of the information being available, why wasn’t it released under FOISA, or why did the meeting offered with Mr. Jackson not go ahead?
I understand their desire to avoid another scandal, but the fact they are misleading the public is wholly unacceptable. Maybe they are following your example. Perhaps you would now be good enough to address the points in my letter. In the meantime, your civil servants could ask NHS Lothian if they have lied again, rather than wasting further public resources putting together the responses they give on your behalf.
For the sake of accuracy, I should mention that the peak period for the inpatient/daycase patients waiting over six months was in fact February 2012, rather than April 2012 as stated in your letter. But then I am relying on NHS Lothian Board papers which can of course be an inherently unreliable way of doing things.
Yet again, you read it here first. We identified that the waiting times fiddling was still going on in January. We published it here on 21st. February. We sent an FOI request to NHS Lothian on 13th. February asking for an explanation of the figures in the reports. NHS Lothian did not respond immediately. We wrote to Alex Neil on 22nd. February and published the letter here. We tipped him off that this was still going on.
We sent NHS Lothian a reminder on 15th. March. NHS Lothian wrote to us offering a meeting to discuss their figures. We accepted. We heard nothing further. We sent a reminder to Alex Neil on 26th. March that we still didn’t have a response from him. We received a holding letter the same day promising a reply. Since then, we have heard from neither NHS Lothian, nor the Scottish Government.
This latest nonsense cannot be excused. We brought it to everyone’s attention again months before this story hit the headlines. And again, just as when we uncovered the scandal in the first place, we receive no credit, nor any opportunity to comment.
Despite what is claimed by NHS Lothian and others in today’s excellent Edinburgh Evening News article, NHS Lothian and the Scottish Government knew something was amiss, and chose to go to ground and ignore those of us who continue to scrutinise in the public interest as volunteers.
Where are our local and national politicians in all of this? The short answer is that our continued work reveals too many inconvenient truths about public governance-or the lack of it. Where are those overpaid and woefully inadequate people the public voted into office? It seems they are ardently putting their minds to ignoring as much as possible.
And, Mr. Neil, you were told this was still going on, so why didn’t you answer us? And why don’t you get a grip on this situation and sack the board? Or would they know already where too many skeletons are buried?
Apart, that is, from the patients they may already have needlessly buried?
So said Professor John Iredale at NHS Lothian’s January board meeting; and while we agree that this may be the case, we sincerely hope that the solutions in other areas of the workforce will not be so hard to find, or more importantly, so appallingly handled.
It has been interesting to watch the SNP scurry to claim credit for “solving” the problems facing paediatrics. The interventions by the First Minister and Cabinet Secretary and the introduction of a sizable chunk of money are to be taken as evidence of their commitment. Or so they claim.
But hold on, aren’t these the same people who claimed in the early part of last year that there wasn’t a problem? Indeed they are. And wasn’t the former leader of West Lothian Council labelling those of us who dared to bring the issues into the public domain as “scaremongerers? Indeed it was.
NHS Lothian’s Board papers reveal that the Scottish Government is to introduce training programmes for paediatric and neonatal nurses. But this was suggested at the St. John’s Stakeholder group meeting in March last year. We don’t expect Cllr. Johnston to remember: he was an amusing shade of purple trying to damn his then colleagues as “scaremongerers”. And another suggestion we made over a year ago at the behest of paediatric and midwifery specialists was to involve suitably qualified GPs. They’ve now gotten around to that too.
What makes all the political rhetoric truly appalling is a recent FOI response. NHS Lothian has confirmed that they have been in discussions with the Scottish Government since 2008, with a short life working group led by the Government reporting back on recruitment difficulties in 2009. And yes, those findings of anticipated shortages were fed into the UK’s Migratory Advisory Committee to make immigration easier for foreign paediatric staff.
So where does this get us? Well, while there are actually lots more people looking to train in paediatrics and neonatology than the NHS has places for, the “workforce planning” around creating a sustainable environment for them is all but non-existent.
Last year the Board’s HR director wrote a hand-wringing missive of concern to the Government and highlighted that “[paediatric] jobs at St. John’s are not seen as attractive”. That really should be no surprise given the neglect and mismanagement inflicted by him and his colleagues. And if his TWO emails to the Government at the end of 2012 really cover ALL correspondence with the Government as requested, then these people don’t plan at all.
Scaremongering? The evidence suggests otherwise. The only thing scary about this situation is that Cllr. Johnston is COSLA’s health and wellbeing spokesperson; a director of Healthcare Improvement Scotland; and a non-executive director of NHS Lothian Board. All handsomely paid posts, no doubt.
If Cllr. Johnston’s ridiculously moribund performance on healthcare is a “microcosm” for the future of the health service and St. John’s, then God help us all!
So said senior NHS Executives in June 2009 when the Stop the Downgrade Campaign alleged that hospitals within NHS Lothian were in danger of creating significant risks to patients akin to Mid-Staffordshire. The usual suspects at the time accused their critics of “scaremongering” and “inappropriate attacks”. They said these types of comments demoralised staff.
Fast forward 4 years, and today we see that the Royal College of Physicians of Edinburgh has now expressed similar concerns. The President of the RCPE, Dr. Neil Dewhurst said in Monday’s Scotsman “The Mid-Staffordshire inquiry report made harrowing and depressing reading for all with an interest in standards of care and presents a litany of failings at all levels.
“While patients should be reassured that there is much high quality care provided by the NHS, there is potential for the events to be repeated in any hospital in Scotland or the UK. We must not allow this to happen.”
He and his colleagues go on to say “Let us be under no illusion that the problems encountered in Mid-Staffordshire were localised. The contributing circumstances have the potential for this to occur in any hospital under pressure.
“Now is the time for the NHS to foster a culture in which the delivery of this care is placed above all else. Nothing less than this is required to give patients the care and respect which they need to receive and we need to deliver.”
While the examples of neglect and poor care in Lothian do not yet reach the disastrously low standards in Mid-Staffordshire, it should be a wake-up call for those involved in managing health care delivery in Lothian and elsewhere. We do not expect those in charge today to rubbish such an eminent group as the RCPE.
So perhaps they will start to take seriously the contribution that is being made to the healthcare debate by those groups without whose scrutiny and oversight, a “Mid-Staffordshire” might have already happened in Lothian. And as we’ve seen during the intervening four years, that is now very much a matter of fact and record.
As the eminent doctors from the Royal College have said, there needs to be a shift in culture, with patients and medics being at the forefront of care. NHS Lothian’s Strategic Clinical Framework 2012-2020 to be discussed at today’s Board meeting should, if followed, go some way to achieving the necessary changes in emphasis.
No more the culture of managers ruling supreme, and making a complete mess of their remits with catastrophic consequences, then moving on to bigger and better things. Only in this skewed culture of ours could people make a killing from killing us. It needs to change and change now.
Cabinet Secretary for Health, Wellbeing and Cities Strategy,
St. Andrew’s House,
22nd. February 2013.
Dear Cabinet Secretary,
NHS Waiting Times.
I returned last night from a meeting to discuss issues around paediatrics in Lothian, and particularly at St. John’s, just in time to catch your appearance on Scotland Tonight. The meeting I attended was arranged by Blackburn Community Council and such is the strength of feeling about issues around healthcare, it was attended by over forty Community Councillors from across West Lothian. Your colleagues Angela Constance MSP and Fiona Hyslop MSP were there, as was Neil Findlay MSP and Cllr. John McGinty, together with the NHS Lothian Communications Director Stuart Wilson, and their Clinical Director Dr. Farquharson. Amongst other issues, waiting times was an inevitable topic of conversation.
With waiting times vividly etched on my mind, I was surprised by some of the answers you gave on the programme. You stated that “the patients themselves were pretty well unaffected” and “this was not about waiting times and the time people have had to wait for particular operations”. You further claimed that this issue was about “the recording, the IT systems, the computer systems” and that “94% of patients had their treatment within the waiting times guarantee” in the quarter where the Lothian’s scandal was “at its height”.
I am bound to say that in the face of the comprehensive evidence available, these are a series of seriously mistaken beliefs. This was very much about patients having to wait longer than they should have for operations, and large numbers of patients were directly affected. Despite NHS Lothian claiming they did not have the information, then giving selective details to us and the media, they were eventually forced to come clean. The fact of the matter is that even as recently as last month, NHS Lothian is still reporting breaches of the waiting times guarantees.
The figure you quoted of 94% may be correct, but I do not believe it is. ISD Scotland figures show non-emergency inpatient and day case activity within NHS Lothian at around 55,000 patients in the quarter ending December 2011, when the scandal was “at its height”. This would suggest around 3,300 patients were breaching the guarantees. ISD Scotland figures, quoted in the Price Waterhouse report in March 2012 suggest there were in fact just under 5000 breaches by December 2011. This had risen steeply from around 200 in September 2011; the point at which NHS Lothian realised it had been rumbled when we released the story.
The reason I make the point about what is a marginal error in percentage terms is that the numbers of patients affected are huge, not to mention that the underlying premise of your statements is hopelessly flawed. Why else would NHS Lothian, supported by the Scottish Government, spend £27m to date and rising to put it right? If this is a simple matter of data recording and no other issue, surely this unprecedented level of spending, a large part of which is in the private sector, would never have been necessary in the first place?
I understand the Scottish Government’s desire to draw a line under things and move on. However, unless and until we have complete transparency, this issue will not go away. This brings me to my final point. The Scottish Government has published new guidance on the way in which appointments and periods of unavailability should be dealt with. I would respectfully suggest that the guidance is not yet robust enough. The guidance states that the minimum period between a reasonable offer of treatment and the treatment date should be seven days, with a suggestion that a minimum of fourteen days should be adopted.
We have been informed that this is being translated in a fashion that could lead again to wholesale abuse of the system. It has been alleged to us that NHS Lothian are entering “notional” bookings on their system, but are not communicating these to patients. They are then informing patients at the last possible moment that an appointment is available, or of a second equally short term alternative. The effect of this is to deny patients sufficient warning, and allow the waiting time clock to be reset. This appears similar to the “bring back to book” process previously criticised. This may be within the new rules, but it seems to run contrary to the spirit of those rules. Perhaps this could be investigated?
On behalf of our small but dedicated group, we do wish you and the new Chief Executive of NHS Lothian well in dealing with the fallout of this and other unfortunate issues that have dogged the organisation for far too long. It may be that the structural changes that are shortly to be implemented will address some of our concerns. Hopefully this will present Mr. Davison and the Board with the opportunity to make appointments that are in keeping with the challenges ahead, leaving the unsavoury recent past and its authors behind.
7th February 2013
NHS Lothian Board papers December 2012
NHS Chief Executive states ‘The ERI is working under huge pressure as evidenced by the delayed discharges and medical re-admissions’
VOLUNTEERS are being brought in to help feed patients in Lothian hospitals, five years after a pensioner who came up with the idea won a battle with health bosses to help them herself.
Gladys Johnson noticed that patients were often not eating their food and were going without assistance with meals when she visited her husband George at the Royal Infirmary in 2005.As a result of the inadequacies around mealtimes, which have also been highlighted in critical reports following inspections of the ERI, she volunteered to help patients with their lunches following Mr Johnson’s death around two years later, just hours before his 77th birthday..
it is time to take our hospital back under local control. We deserve a say in how the NHS in West Lothian is run. Those in charge in Edinburgh care little about us and they have cost us dear through a combination of ignorance, arrogance and incompetence.
A new year has begun, but the same old stories continue to dominate the press. The waiting times scandal will consume many more millions of pounds in payments to the private sector, while available space lies unused at St. John’s. Due to catastrophic planning blunders, NHS Lothian have been forced to re-open parts of the mothballed Victoria Hospital in Edinburgh. And, contrary to what these corporate incompetents will tell you, the private sector didn’t have the necessary capacity at the outset of this journey to rectify the biggest scandal in the history of the NHS in Scotland. Internal emails from one of the biggest providers revealed that they would expand their private estate on the back of the public money "Professor" Barbour and his acolytes were about to shower on them. And God, what a shower they are!
Nurses working for NHS Lothian have been denied the chance to boost wages while counterparts from England are put up in swanky hotels as they pocket triple-time bonanzas.
Wales-based firm Medinet, which provides staff to work in NHS hospitals, is being used extensively by NHS Lothian and is expected to receive £4.7 million from health board coffers this financial year – almost three times the amount forecast just six months ago.
SICK or injured patients attending Lothian’s main accident and emergency department are facing waits of up to 18 hours before being seen, the Evening News can reveal.
The figures, branded “shocking” by MSPs, show that 2260 people have waited more than four hours to be admitted, discharged or transferred at the Royal Infirmary A&E recently, as the region’s NHS winter health crisis deepens. During December and in the first nine days of January, 339 patients were stuck for at least eight hours, including 60 who waited between 10 and 12 hours and 66 who were left for more than 12 hours.
One patient was forced to wait for 17 hours and 50 minutes before being processed through the department, the busiest of its kind in Scotland.
THE health board at the centre of a waiting times scandal has been forced to hand over confidential papers which could reveal full details of how patient lists were rigged.
Health Secretary Alex Neil demanded total transparency from NHS Lothian after The Herald revealed the chairman had plans to provide only limited details of private board meetings to Scotland's public sector watchdog, Audit Scotland.
Mr Neil immediately sent an official to inform Dr Charles Winstanley that his board must now supply officials with full minutes, agendas and background briefing papers from private board meetings dating back to 2010. Last night Dr Winstanley said he had complied with the request
A HEALTH board found guilty of fiddling waiting times has been accused of providing selective information to Scotland's public sector watchdog.
Internal emails from the chairman of NHS Lothian reveal plans to drip-feed Audit Scotland details of private board meetings.
It had gone to the board – which was involved in a scandal over manipulated waiting times in 2011 – with a routine request for papers.
But in a message to board members and senior executives yesterday, Dr Charles Winstanley said: "Audit Scotland are, of course, technically entitled to any information, but we would offer no more than minutes."
He emphasised the "brevity" of the notes which NHS Lothian is willing to share with the auditors.
Patients face winter chaos as hospital bed crisis grows
LOTHIAN’S hospitals are on the brink of a major winter meltdown which could cause chaos for hundreds of patients, it was warned today.
The Evening News understands that senior staff have been told health bosses have been close to declaring a “red alert” in recent days due to mounting pressure over beds at the Royal Infirmary and Western General Hospital. A full-blown crisis has so far been averted and NHS Lothian denied it had come close to calling a red alert, which would have seen some less urgent operations cancelled. But a health board insider said that a drop in temperature in coming weeks, creating icy conditions, could be all that is needed to throw the health service into turmoil.
NHS Lothian chief axed in wake of bullying culture claims
A SENIOR figure at NHS Lothian has been sacked over bullying and the manipulation of waiting list figures, the Evening News can reveal.
Jane Todd, who was director of operations, was suspended following the critical audits earlier this year that uncovered the scandals.
Ms Todd, who was based at the Western General Hospital, was responsible for providing waiting list figures to NHS Lothian chief operating officer Jackie Sansbury, which later turned out to be incorrect.
Lothian Labour MSP Neil Findlay called today for SNP Health Secretary Alex Neil to "step in and get a grip" at crisis-hit St John's Hospital in Livingston.
Mr Findlay's plea followed revelations this week that NHS Lothian has paid consultants a rate of £1,800 per day to sleep over on "night shift" duty because it cannot recruit full-time staff for its troubled paediatric service.
The Stop the Downgrade Campaign issues December 2012 Newsletter
"For almost a year, NHS Lothian has been trying to downgrade the Children’s Ward. The inside story can now be told. In February the Royal College of Paediatricians inspected the ward. Their purpose was to comment on the suitability of the ward for training doctors but the College went one step further. They indicated that the ward should be downgraded to an assessment area which closed in the evenings and weekends. Why would they do this unless they were primed to do so? By whom? Well, draw your own conclusions! Insiders are clear that this shock conclusion, way beyond the remit of the College, was made before the visit to St. John’s! The Health Board was looking for an excuse to downgrade the ward and now they had one".
28th. November 2012 - Children's services at St. John's
Letter to the West Lothian Courier 28th November 2012
Alex Salmond’s announcement last week of an additional £600,000 to protect children’s services at St. John’s Hospital was taken as a timely intervention by Government that would save the service. However, NHS Board papers being considered today (Wednesday) make no mention of the additional funding. In fact, the papers indicate that NHS Lothian considers the children’s ward cannot be sustained beyond February 2013.
It is a complex discussion, but the bottom line is that inpatient children’s services at St. John’s will likely be centralised to Edinburgh. NHS Lothian says that the quick and safe closure of St. John’s can be achieved, as demonstrated by the “temporary” closure this summer.
Higher than normal trainee maternity leave cited as the reason is not the fault of the Board, but workforce planning is their responsibility. NHS Lothian and their local apologists claimed earlier this year that once they recruited additional consultants, and five have been added, a consultant delivered service would be a better solution.
This service would be an inevitable consequence of trainee reductions come February. But now, according to NHS Lothian, this is not an affordable option. It cost them £65,000 per month over budget when trainees were removed from April to July. So why promise if it isn’t an option? This included triple time payments of £1,800 per night for consultants on call. At those rates, had NHS Lothian recruited earlier, they could have had three consultants for the price of one. And apparently, new neonatology consultants have told NHS Lothian that they will not cover the children’s ward.
The Board intends to hold a consultation exercise between now and February 2013. Quite why they’ve decided to go to consultation now is anyone’s guess. Only a cynic would say it’s the Christmas holiday period, and people will be preoccupied with other things. Maybe they hope Santa will deliver a solution from his sleigh. Before they slay another highly valued service at St. John’s.
Christmas is traditionally a time for children. We are making a heart-felt plea to the Board, the doctors and politicians of all hues: do something this Christmas for the children of West Lothian. Goodwill to all men should include mothers and children.
If today’s Board meeting does not commit to the future, West Lothian has to stand up and be heard.
Action to Save St. John’s Hospital Party
26th November 2012
£100m front-line cuts for Scotland’s NHS
HEALTH boards are working to save almost £100 million in drugs and staff this year, new figures showing the scale of the financial squeeze on Scotland’s NHS reveal.
All 22 regional and specialised boards are having to make cutbacks, prompting fresh warnings about reductions in services.
The new estimates, supplied to Scotland on Sunday by Audit Scotland, show the largest savings will be found by making clinical staff work harder – hoped to save £70m.
But the statistics also show boards are looking for savings of £51m in the drugs and prescriptions budget and £45m off staff costs.
Children’s ward at St John’s Hospital in doubt over permanent downgrading
FRESH questions have been raised over the future of the children’s ward at St John’s Hospital after it emerged the paediatrics service was set to be permanently downgraded.
The development comes just months after health bosses said the department was “stronger than ever” and will put further strain on the already under-pressure Sick Kids in the Capital.
The ward at the Livingston hospital, which also serves patients from parts of west Edinburgh, was controversially shut for three weeks in the summer due to a short-term staffing crisis, with 35 children sent to the Sick Kids instead.
Letter to the West Lothian Courier 16th November 2012
The issues around the children’s ward at St. John’s Hospital have not gone away. They were never likely to in the absence of an open and transparent debate about the future of the health service in Lothians. And that was never likely to happen when the apologists for NHS Lothian’s fundamental mismanagement of services held sway in both West Lothian and Holyrood.
The news that there is a further shortage of paediatric trainees comes as no great surprise. Maternity leave is an inevitable consequence of a service which is predominantly staffed by young women. The latest announcement comes only four weeks after NHS Lothian’s medical director told the St. John’s Stakeholder Group in October that there “was no information to indicate that any issues existed or were anticipated” in relation to maternity leave. What has happened in the interim that was unknown four weeks ago is unclear. Questions have been answered with a pregnant pause.
NHS Lothian board meets next week, and we will have to wait and see what they propose as a solution. Earlier this year the board recruited a number of consultants. We were given assurances that the appointment of these consultants would protect the service in future against instability caused by maternity leave. If NHS Lothian honours this obligation, the 24/7 service at St. John’s should be safe. But will it?
NHS Lothian has been working for some time with the Royal College of Paediatrics and Child Health. They have recommended a short stay paediatric assessment unit at St. John’s. Something akin to the reduced service introduced this summer as an alleged “temporary measure”. It will be interesting to see whether they opt for the inevitably much more expensive consultant delivered service they assured us would be delivered, or if they opt for the downgraded service already trialled this year.
And there are further major issues at St. John’s. The world renowned burns unit is also under threat. The burns unit was created as a stand-alone unit. Its private lift and dedicated theatre space enabled the sensitive treatment of severely injured and disfigured patients in a smaller private unit, where infection control was paramount in achieving the exceptional recovery outcomes evidenced over the years.
Proposals are already being discussed to half the number of beds and relocate these to a general ward, ostensibly so that maternity services can be upgraded. The Labour Party members of the Stakeholders Group have stated that they want more public consultation and the board has noted their concern. Yet again, downgrading in the guise of hospital redesign and enhancement is the order of the day.
The move toward the mainstream treatment of burns victims is seriously flawed. The reduction in beds risks being unable to cope with major incidents, as was identified in reviews in 1998 and 2004. The infection risks are significantly higher than they were when the burns unit was created, and there has been little if any consideration of this despite a warning from the former vice chair of the board that this could be an issue.
In fact, rather than engage in public consultation, the Board has already had discussions with the Scottish Government and Greater Glasgow Health Board to move the burns unit to Glasgow. Rather than advocate expansion of the service at St. John’s and the creation of a Scottish Burns Centre at our local hospital, NHS Lothian wanted to get rid of it altogether.
The reasons for their thinking are as yet unclear. The waiting times scandal, re-opening hospitals weeks after closing them at huge expense to deal with capacity issues, the maintenance backlog of £191,000,000, and a host of other issues continue to weigh heavily for NHS Lothian. The solution of downgrading and hiving off services to other areas is an easy but unacceptable solution.
NHS Lothian is no longer a health board in crisis: it is a crisis masquerading as a health board. The Health Secretary must now give consideration to removing control from the board and appointing commissioners to get things back on track. Nothing less will do.
Action to Save St. John’s Hospital Party
19th November 2012
NHS Lothian faces critical problems with hospital capacity and paediatric staff
Paediatrics Update-Closure of St. John’s Children’s Ward in its current form is Imminent
As the dilatory and incompetent board of NHS Lothian marches onwards and downwards from one financial or management crisis to another, more and more patients are forced to pay the price. Whether by having to travel to remote hospitals at huge personal expense to get treatment, or by having to wait for treatment well beyond the Government targets because of fraud, patients are bearing the brunt of corporate and institutional malfeasance.
The latest revelation that NHS Lothian expect to downgrade the children’s ward at St. John’s comes as no great surprise. We warned it would happen, and so it has come to pass. In February 2013, NHS Lothian will not have enough staff to sustain the current rotas at St. John’s.
This announcement will come formally in papers due to be tabled at the next Board meeting on 28th. November. But why should we be surprised? We have warned that this crisis was coming as early as 2009. And if we could see the writing on the wall if something wasn’t done, why didn’t the highly paid executives at NHS Lothian?
Our time on West Lothian Council may be at an end-for the moment. But we reserve the right to continue to comment on wider policy issues, or on matters which relate directly to our time on the Council.
In a breathtaking display of chutzpah, ex (sic)-Livingston MP Graeme Morrice and Neil Findlay MSP vented their “outrage” in the West Lothian Courier at the decision of the Standards Commission not to hold a hearing into allegations of “corruption”. Their ability to re-write the past has a frightening, almost Orwellian, quality to it.
They know full well that the Standards Commission was not investigating corruption allegations, but felt unable to hold a hearing because of a parallel police investigation. That investigation concluded after 3 ½ years with no evidence found of corruption. Front line policing was denied funding upwards of £1m in the course of that investigation, and now Mr. Morrice wants more money thrown at a clearly politically motivated witch-hunt.
MOONLIGHTING surgeons who make extra cash by treating their own private patients in NHS hospitals could have been costing the health service hundreds of thousands of pounds because they have not been following strict rules.
NHS Lothian scandal takes a new twist. Patients to go to Switzerland rather than St John's!
PATIENTS from Lothian are set to be flown to foreign countries for complicated operations because local hospitals are unable to treat them on time.
NHS Lothian has said it will have to offer patients hospital places in Europe or elsewhere in Britain, if it is to comply with new Scottish Government legislation which offers a legal guarantee of treatment within 12 weeks of diagnosis.
Following years of relentless removal of services from St. John's Hospital in Livingston and the huge public protest at the downgrading of local health care facilities, the Action to Save St. John's Hospital Party (ASSJH) was formed in early 2007. We stood several candidates in that year’s Scottish Parliamentary and local elections.
The result was a huge success for our Party. Not only did we have considerable influence in changing the political landscape in Scotland, but we also had three candidates elected to West Lothian Council. Unfortunately, at the May 2012 elections we failed to retain any of our Council seats. However, the campaign and the fight for St John’s go on.
A comprehensive package of services at St. John's Hospital is in the best interests of patients, staff, the local community and the wider region. Achieving this is our overarching priority. The ASSJH Party has brought issues regarding St. John's to the public and political arenas. We have succeeded in stopping the removal of further services from St. John's, including cardiology and oncology services. We have been at the forefront of delivering the new short-stay elective surgical centre, have overseen a huge increase in births at St. John’s, and enhanced local prostate treatment and care, as well as a whole range of other services.
However, there are now new threats to other parts of St John’s, including paediatrics.
In addition, we have exposed some of the biggest scandals in the history of the NHS in Scotland. We uncovered NHS Lothian’s fraudulent waiting times statistics, its culture of bullying and harassment, and the disastrous PFI contract at the Royal Infirmary of Edinburgh.
The Party remains dedicated to pursuing an agenda which will see existing services maintained and others repatriated to St. John’s, thus allowing it to maintain its position as a fully-functioning acute, emergency hospital at the heart of the pan-Lothian health strategy.