v8 1r second edition independent report nhsg
DESCRIPTION
ÂTRANSCRIPT
2
An Independent Inquiry
into
Management at NHS Grampian
and the Consequences
for
Patient Care (Edition 2)
RING Campaign, Aberdeen 28th July 2015
1. Foreword 3 2. Introduction 4 3. The Sumithra Hewage Case 5 4. The Three Ophthalmologists 6 5. Analysis of NHS Grampian's performance 8 6. The Healthcare Improvement Scotland Report, 2014 16 7. The Royal College of Surgeons of England report 18 8. Patients and Colleagues of Prof Krukowski and Ms Craig 20 9. A Patient's perspective 23 10. Conclusions & Recommendations 24 11. Detailed Data and Sources 25 12. References and Links 28
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1. Foreword An increasing number of people believe that NHS Grampian currently operates policies of suspension of senior medical and nursing staff in a way that is contrary to the public interest. Typically very valuable staff members are suspended for many months on the basis of trivial or unsubstantiated allegations, suffer stress-‐related illness and loss of skills, and a high proportion are ultimately lost to the service. During this time, patients also suffer because of staff shortages. Temporary locum doctors are often engaged to fill some of the gaps, but there is good evidence that not all of these locums are adequately trained. Over the last few years, several departments have been damaged by these methods of management. In addition to there being evidence to support the view that NHSG has issues involving unconstructive use of disciplinary measures without regard to the service to patients, figures available from NHS sources themselves show that very large sums of money are being spent in employing locums to fill the shortages caused by these measures, and there is additional evidence to show that patients are suffering, firstly from delays in treatment or surgery, secondly from lack of the necessary levels of expertise to which they are entitled, and thirdly that a proportion of patients have suffered actual damage (and in a few cases, death), most likely as a result of one or more of these factors. NHS Grampian senior management consistently maintain that the allegations recently involving senior staff are "very serious", and yet on closer examination it can be discerned that other, less legitimate influences appear to be operating, factors which do not appear to be related to the public interest or to the maintenance of the best possible patient care. There is evidence in the form of documentation and the experiences of those affected to support the contention that management processes in NHSG badly need to be investigated and scrutinised. This needs to be performed by some higher agency, with legal powers to compel the production of evidence and the swearing-‐in of witnesses. This preliminary investigation looks into some of the origins of the current management style and perspective, and examines the direct consequences of what has been happening over the last few years. Some of the documentation on relevant matters is currently held in confidence, and by no means all is available to us at this time. Yet, on the basis of what we have seen through limited access, allied with our long experience and particular insights into how the NHS should be managed, as against how it is currently being run, we believe that there is sufficient evidence available, if it were to be adequately examined, to compel the authorities to ask both for a Judicial Inquiry and an investigation by Audit Scotland into management practices at ARI and the consequences for both patient care and expenditure from the public purse. RING Campaign July 2015 www.RINGCampaign.com
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2. Introduction https://en.wikipedia.org/wiki/Aberdeen_Royal_Infirmary http://www.abdn.ac.uk/smd/about/foresterhill-‐campus.php Aberdeen Royal Infirmary (ARI) is a 900-‐bed tertiary referral centre, a teaching hospital with close links to the University of Aberdeen and also to The Robert Gordon University. It shares ownership of a large site (the "Health Campus") jointly with University of Aberdeen. ARI has a proud record stretching back over two centuries, with a history of innovation and medical scientific discovery -‐ often in collaboration with the Universities -‐ which might well be envied by similar establishments in larger cities. The list is long but briefly includes the discovery of the streptococcus bacterium, the co-‐discovery of insulin, the identification of endorphins in the nervous system, the development of the first whole-‐body MRI scanner. This forward-‐looking mind-‐set of Aberdeen's doctors and academics over the centuries has been matched by their matchless commitment and dedication in the battle against disease, disability and death. People in the North East of Scotland and beyond have every reason to be proud of their hospital and of their doctors, and of the traditions of excellence and dedication which they exemplify.
>>><<< Quote on safety from Sir Brian Appleton, one of the assessors on the Cullen Enquiry into the Piper Alpha disaster: “Safety in not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with live or die.” (Piper Alpha had a 100% safety record in each of the 4 years before the disaster).
>>><<< “I am not aware of any significant control weaknesses or failure to achieve the standards set out in the guidance on governance, risk management and control”. Chief Executive Richard Carey Grampian Health Board NHSG Annual Report 2012/2013/2014
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However, the Executive Summary of the Health Improvement Scotland Aberdeen Royal Infirmary : Short Life Review of Quality and Service in December 2014 listed 23 management failings in these areas.
>>><<<
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3. The Sumithra Hewage Case https://issuu.com/donnieross0/docs/appeal_by_sumithra_hewage_v._grampi http://ringcampaign.com/nhsjigsaw/ The published Judgements of the Supreme Court in the case of Sumithra Hewage vs. Grampian Health Board (2009 and 2012) demonstrate how this courageous woman took on the combined might of NHSG and the Central Legal Office to win substantial damages for constructive dismissal and both sexual & racial discrimination. The cost to the public purse of this episode, which originated in (as documented and evidenced in court) completely incompetent management at ARI, and was inadvisedly defended through two appeals, amounted to approximately £3.2M. The management failings which led to the case were widespread, and exhibited some astonishingly bad behaviour, ranging from bullying through the "craven decision" to take no action on the part of the then Medical Director, whose evidence was "neither credible nor reliable", to outright lying by a manager, to "failure [on the part of the General Manager, a clinical leader, and the then Chief Executive Officer] to provide anything like the required level of support" to a very hard-‐working and extremely competent doctor who had been bullied and discriminated against by managers. Why is the Hewage Case still relevant?
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4.The Three Ophthalmologists Following the initial judgement of the Employment Tribunal (ET) in the Hewage Case and subsequently the final appeal (2009 and 2012 respectively), one of the key witnesses in that case was targetted by medical management and his two senior clinical and research colleagues were suspended. These disciplinary actions were in response to conflict and discord in the department resulting from the establishment of a new system whereby patients' first point of contact would be opticians rather than medically qualified doctors, and concerns were raised about the safety of this arrangement, notwithstanding its possible advantages in other ways. From the perspective of an experienced medical manager, this situation presented an opportunity for urgent and effective intervention from the Medical Director and Clinical Lead to manage and resolve the situation in the interests of continuing patient care. Indeed, one of us wrote at the time, (from the viewpoint of a patient requiring treatment in that very clinical service) to the Medical Director and the CEO, pleading with them to resolve the matter in the interests of the patients who relied on these doctors. No reply was received! -‐ and on the contrary, it appears that conflict may either have been encouraged or not actively and properly dealt with, and the result was a shocking waste of valuable, competent, highly experienced people and an incalculable loss of vast potential for future departmental development. When all three of these immensely talented doctors finally departed, it was not only a huge loss to Aberdeen but a disaster for the people of the North East of Scotland. The Department of Ophthalmology was for a long period of time quite severely damaged in terms of both its ability to cope with workload and its group psychology, eventually healing itself through internally-‐driven reconfiguration along with its basic vibrant strength as an exceptionally hard-‐working and valuable clinical department. The cost of a long series of locum doctors employed to fill the gaps created by these management actions rapidly rose from £250Kpa in 2010 and 2011 to £1.19M in 2014, as a direct consequence of the failure to manage an internal conflict which itself had arisen from concerns expressed by the doctors about the clinical safety of a new system of care. As an example of what happens to "whistleblowers" in the NHS, that aspect alone merits close examination by those in higher authority who bear ultimate responsibility. Subsequently anyone in the hospital who dared to ask whether any senior medical manager is entirely suitable for a post of high responsibility after being so roundly criticised by 5 Supreme Court Judges, (as did a group of surgeons led by Professor Krukowski) has been disciplined, using "the full repertoire of disciplinary methods" (to quote the medical director), without any apparent regard for the consequences for patient care. Requests from senior consultant doctors for clarification from senior management about their continued support for the Medical Director were met with stone-‐walling, contemptuous anger, and (it is documented) threats both written and verbal. Several official reports later, and after the abrupt departure of NHS Grampian's Chairman, CEO, Medical and Nursing Directors and one or two others, there were high hopes for
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improvement. Unfortunately, the toxic management culture has evidently not been eradicated. There are now very serious concerns about the way in which the case against Krukowski and Craig was assembled and handled, which seems to the detached observer to bear marked resemblances to the management attitudes and behaviours which gave rise to the Sumithra Hewage Case. These resemblances raise two questions: first, is there is a link between the Sumithra Hewage Case and the subsequent series of disciplinary actions, in terms of on-‐going incompetent management and continuing malicious attitudes on the part of managers such as were evidenced in court? Second, monstrous though it may be to contemplate, can there be a link in terms of motivation for revenge on the part of someone whose integrity and professionalism had been so manifestly at fault that they drew explicit criticism in open court, against a key witness? A Judicial Inquiry is needed to bring clarity and transparency to what has been happening.
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5. Analysis of NHS Grampian's Performance This section draws mainly on figures available from the Information Services Division (ISD), and from NHSG's own published figures, with some information obtained through Freedom of Information (FOI) requests. NHSG financial and operating key metrics: Note: NHS Financial Year End is March, therefore FY2014 refers to the fiscal period ending March 2014 Poor leadership has caused significant damage to NHSG’s reputation as a centre of surgical and teaching excellence. This has led to chronically high consultant vacancy rates and a dramatic increase in the use of medical locums. The accompanying increase in clinical negligence compensation payments and provisions suggests the quality of patient care has suffered.
• Between FY2009 and FY2014, NHSG paid out a cumulative £21.7 mln in clinical compensation
o An average annual increase of +110% versus +11% average annual increase for ‘Other non-‐clinical services’ as a whole
o Clinical compensation per capita increased from £1.5 in FY2009 to £3.5 in FY2014 – an increase of +138% versus an increase in clinical services costs per capita of +10% over the same period
• Between FY2009 and FY2014, NHSG spent a cumulative £2.3 mln paid out in ‘other’
compensation
o An average annual increase of +403% versus 11% average annual increase for ‘Other non-‐clinical services’ as a whole
o Other compensation per capita increased from £0.02 in FY2009 to £2.4 in FY2014 – an increase of 14,382% versus an increase in clinical services costs per capita of 10% over the same period.
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• Between FY2009 and FY2014, NHSG received a cumulative £20.1 mln in income from Scottish Government (i.e. the British taxpayer) to cover clinical and medical negligence claims
o Residents of Grampian receive increasing taxpayer funds to cover clinical and negligence claims – the per capita amount increased from £0.5 in FY2009 to £5.2 in FY2014 – an increase of 1029%
• At 31 March 2014, Provisions for clinical and medical negligence claims were £15.9 mln (versus £4.6 mln in FY03/9)
o “The Board holds a provision to meet costs of outstanding and potential clinical and medical negligence claims. All legal claims notified to the Board are processed by the Scottish NHS Central Legal Office who will decide upon risk liability and likely outcome of each case. The provision contains sums for settlement awards, legal expenses, and third party costs”.
o Provisions for clinical and medical negligence claims have increased on average 16% per year between FY2009 and FY2014 versus +8% and -‐1% for total provisions and total liabilities respectively over the same period
o Provisions for clinical and medical negligence claims as a percentage of total provisions increase from 46% in FY2009 to 75% in FY2014. (The other main component of ‘provisions’ is future pension obligations).
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o Per capita Provisions for medical negligence payments have grown faster than the per capita increase in Agency staff costs.
o Provisions for total clinical and medical negligence claims per capita increased from £8.2 in FY2009 to £27.1 in FY2014 – an increase of 230% versus a 102% increase in total provisions over the same period.
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• Why is NHSG increasingly optimistic about the ‘reimbursement of provisions’?
o ‘Reimbursement of provisions’ as a percentage of total provisions, increased from 38% in FY2009 to 78% in FY2014
• Between FY2009 and FY2014, a cumulative £23.3 mln was spent on agency staff
o ‘Agency staff’ must comprise mostly clinical locums because:
! The use of agency staff has increased in response to sky-‐rocketing consultant vacancy rates
! the average cost per agency staff at 31 March 2014 £100,000
o Agency staff costs posted an average annual increase of +44% since FY2010 versus +2% for total staff costs
o Agency staff expense as a percentage of total staff expense almost tripled from 0.5% in FY2009 to 1.4% in FY2014
o The cost of agency staff per capita increased from £4.3 in FY2009 to £12.5 in FY2014 – an increase of 193% versus 5% for total staff costs over the same period.
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• Persistently higher vacancy rates at NHS Grampian are one effect of management turmoil and constitute a significant threat to the quality and consistency of patient care. The damage to reputation and ability to recruit may be long-‐lasting.
o The total medical consultant vacancy rate in NHS Grampian is 11.5% on a headcount basis (12.0% WTE basis) at 31 March 2015 versus 7.4% for Scotland headcount basis (7.6% WTE basis).
o The percentage of medical consultant vacancies outstanding for more than 6
months is 6.2% in NHS Grampian on a headcount basis (6.2% on WTE basis) versus 2.7% for Scotland on a headcount basis (2.8% on WTE basis).
o NHSG surgical (all specialities) consultant vacancy rate is 11.4% in NHS Grampian
at 31 March 2015 versus 6.7% for Scotland (headcount basis)
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o The percentage of surgical consultant vacancies outstanding for more than 6 months is 5.3% at NHS Grampian versus 2.1% for Scotland (headcount basis)
o Note the Ophthalmology consultant vacancy rate of 23.1% in NHS Grampian versus 8.8% for Scotland (headcount basis).
o The percentage of Ophthalmology consultant vacancies outstanding for more than 6 months is 15.4% at NHS Grampian versus 3.7% for Scotland (headcount basis)
o The Ophthalmology consultant vacancy rate at NHS Grampian has been volatile and elevated relative to the overall surgical vacancy rate at NHS Grampian and versus the Ophthalmology vacancy rate for Scotland as a whole for several years.
• The charts show clear evidence of a system in chaos, with a complete absence of efficient manpower planning. Arguably this situation is the direct result of observed and documented management incompetence.
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• The charts below show a relationship between rising consultant vacancies and the increasing cost of using locums to the taxpayer.
• The sharp increase in clinical negligence compensation payments has mirrored the increasing use of locum doctors. However there may be a number of reasons for this.
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• There is only one month of data available on Cancellations of scheduled operations in NHS Scotland. The data is a welcome initiative but further granularity on ‘non-‐clinical reasons by hospital’ for cancellations would be useful.
• Yet, given the long-‐term issues, it is not surprising that NHSG’s flagship hospital, Aberdeen Royal Infirmary recorded above average ‘cancellation based on capacity or non-‐clinical reason by hospital’ versus NHS Grampian and NHS Scotland.
3.2% for ARI versus 2.3% in NHS Grampian and 1.7% for Scotland in May 2015:
MoM % Chg in # of cancelled operations
% of cancelled operations
MoM change in % in basis points (100 bps = 1%)
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6. The Healthcare Improvement Scotland Report, 2014 http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/programme_resources/ari_review.aspx Health Improvement Scotland (HIS) were invited to visit NHS Grampian by the latter in 2014, in response to widespread concerns about many aspects of the Board's functioning, including their response to complaints, the evident lack of compassion in some (though by no means all) clinical areas, and the weak or absent leadership becoming increasingly evident at all levels of management. There were also serious concerns about the breakdown in relations between medical management and hospital consultants. Shortly after the series of visits by HIS to Aberdeen, the Chairman and Medical Director resigned, followed after an interval by the CEO of NHS Grampian, the Director of Nursing, and one or two other Board Executives. A number of recommendations were made by HIS, which were addressed by the new Chairman and then-‐interim CEO in their Strategy published in February 2015. We acknowledge that some progress has been made, and of course we recognise that it will take time to work through the many problems facing the new Board, a large proportion of which were generated by the inadequacy of their predecessors. However, to solve problems it is essential first to recognise that they exist, and it is the contention of RING Campaign that there remain serious failings of leadership, culture and dynamic within Aberdeen Royal Infirmary which are not being acknowledged or addressed and which will, in our firm and considered opinion, consequently remain as a generator of disastrous policies and management practices contrary to good patient care, good interpersonal relations, and good business sense. Simply identifying, suspending and reporting to the General Medical Council or General Dental Council "whistleblowers", individuals who express concerns about patient safety or the wisdom of particular courses of action or who in any other way pose "difficulties" for managers, is not a coherent way forward. On the contrary, it represents an absence of vision and imagination, and a gross failure to understand the connection between a vibrant and feisty workforce and the potential for growth and development constantly bubbling up in any large and energetic organisation. In short, the present course of ignoring the problems, and those who are trying to bring them to the attention of higher authorities, is a recipe for yet more organisational failure and yet more severe impact on the excellence of patient care and the proper use of public funds. Figures from the General Medical Council shed an interesting light on the way in which management at NHSG appears to use referral to the GMC as an attempt to resolve issues rather than tackling them properly. For example, recent figures obtained by The Herald show that in Grampian, in 11 out of 33 cases (33%) the doctors referred to the GMC were referred by the Health Board rather than through the actions of patients. This compares with 1 out of 11 doctors (10%) in Lanarkshire and 8 out of 38 doctors (21%) in Greater Glasgow.
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Of the cases referred to the GMC by NHS Grampian, 9 had no further action taken, one had a warning letter of advice, and two had some limitations placed on their practice. These results can hardly be taken to represent a high success-‐rate of NHSG's policy of referring doctors to the GMC, but it certainly tends to indicate that a very large amount of medical time and public money is being wasted on ineffectual management. RING Campaign therefore calls for a judicial inquiry to throw light on the real and remaining problems in NHS Grampian, so as to deploy more robust and effective methods of establishing the true facts. At the same time we ask that Audit Scotland be invited to make an exhaustive and stringent examination of how current management processes may be skewing the proper use of public funds, as the published ISD figures used in this Preliminary Inquiry strongly indicate.
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7. The Royal College of Surgeons of England Report http://www.nhsgrampian.org/grampianfoi/files/RCS_terms_and_recs.pdf In response to the rapidly deteriorating relationship between the then Medical Director and the consultant body, in particular but not exclusively the general surgeons, the RCSE was invited by the Medical Director to visit Aberdeen in 2014 to examine and report on the problems. It is worth noting that the main bone of contention between the MD and the surgeons appears to have been their insistence on getting answers to their questions to the CEO and Chairman of NHSG concerning the status of the criticisms made in the published judgement on the Sumithra Hewage Case: https://issuu.com/donnieross0/docs/appeal_by_sumithra_hewage_v._grampi http://ringcampaign.com/nhsjigsaw/ compounded by the belief amongst management that only a “small group of consultants” was responsible for raising concerns leading to the HIS Review. Concerns that were totally vindicated in the report. It so happens that this group of surgeons had included Professor Krukowski. He and others were threatened by the then CEO and by the MD with disciplinary action if they persisted in asking these questions. They did persist, and indeed they were disciplined. Most of the surgeons involved have since been reported for various alleged misdemeanors to the GMC in the recent past. When Professor Krukowski and Ms Wendy Craig raised concerns (as they were duty-‐bound to do as doctors under GMC guidance) about certain aspects of patient care involving mortality figures and other outcome measures, counter-‐accusations were made shortly afterwards, along with allegations concerning behaviour under Dignity at Work regulations. Senior management and others who have seen the RCSE report in full (it is confidential and the majority of the document has been "redacted") have stated that these are "very serious allegations" against Krukowski and Craig. The RCSE document has been described as a "catalogue of anonymous slanders" and not of evidential quality by a senior legal expert and by the GMC. This was a confidential report for NHSG relating to employment matters, and should never have been sent to GMC, particularly lacking any validation. However, it appears to have suited the Board to escalate the disciplinary situation rather than address the real issues centred on patient safety. We note that this was a process which had been originated, set up and organised by someone whose evidence in court during the Sumithra Hewage case had been described by five judges as "neither reliable nor credible" and his response to managers as "craven"; therefore RING Campaign has very serious doubts about the RCSE process as a whole. In particular, we would like to find out whether the original "whistleblowing" concerns of
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the two surgeons have been adequately dealt with, in the interests of patient safety and welfare, by an inclusive and detailed scrutiny of all relevant data by experts in the specialty, and that the counter-‐accusations were properly based, tested and verified. In our view, the best way of determining the truth in this situation is to hold a judicial inquiry. Without this, we cannot be sure that the process described has adequately served the public interest and the purposes of the NHS in providing high quality patient care.
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8. Patients and colleagues of Prof Krukowski and Ms Craig Over 2000 people have signed an on-‐line petition asking NHS Grampian to reinstate Professor Krukowski and Ms Craig. Many former patients have movingly described how those two surgeons have dedicated their careers, skills and compassion to care for them. We have also seen statements from colleagues describing the very high standards of these brilliant professionals who cannot do their job because of the decisions of the NHSG managers. The following is a short selection from the many unsolicited testimonials received either on the RING Campaign website or via the on-‐line petition: http://www.thepetitionsite.com/239/843/382/stop-‐the-‐unfair-‐suspension-‐professor-‐krukowski-‐and-‐dr-‐wendy-‐craig-‐at-‐foresterhill-‐ari/
>>>><<<<< Professor Krukowski has an outstanding reputation as a surgeon, an educator, and as a researcher. He has dedicated his career to the NHS and has provided the highest standard of care to the population of Aberdeen and beyond. I have always been impressed by his integrity and believe that both his and Wendy Craig’s suspension reflects a clear failure of management and is totally unjustified. Michael J Gough, Professor of Vascular Surgery, Leeds University.
>>>><<<<< Ms Wendy Craig was the consultant who looked after my daughter when she had emergency surgery last year (twice). My daughter is thirty years old and was traumatized by the experience. Wendy Craig took time and care with my daughter. Her professionalism, sensitivity and care could not be faulted. She was the one who made an unbearable situation bearable. My entire family owe Wendy Craig a huge debt of gratitude. Questions must be asked why this excellent consultant finds herself in this position. Surely the National Health Service needs people of this fine consultant’s calibre.
>>>><<<<< I was disgusted and saddened by the headlines in the Press & Journal on Saturday 30th May regarding the suspension of the Queen’s surgeon, Professor Z. Krukowski, and Miss W. Craig. I had the privilege of working with both these surgeons but I worked closely with the Professor for over 25 years during my 40 year period of theatre work as a specialist theatre nurse. To treat an expert in his field in this way defies belief after he has dedicated his life to saving the lives of many patients in the north east. Till the time I retired, ZHK was one of the most talented and respected surgeons not only in ARI but worldwide. He expected ultra high standards from his team, nursing and medical staff, and he got it. Miss Craig, who I also assisted at operations, is also a very talented surgeon and has worked so hard to achieve a newly appointed consultant’s post. Both individuals are completely dedicated to the care of their patients and the situation presented, points to a deeper problem in the system which requires urgent investigation.
>>>><<<<< I have known Zyg for more than 30 years. I have worked with him professionally and have always admired his surgical skills and his total dedication to patients and the NHS. He is a man of utmost integrity and so I am deeply shocked with the way NHS Grampian have
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treated him. I can only conclude that there is a petty mind behind these stupid actions Pradeep Ramayya, United Kingdom Kirsty Reid, United Kingdom Jul 03, 05:34 # 1,963 Reinstate these surgeons please. There are people awaiting important surgery. To add insult to injury ARI management have failed to put provisions in place for those awaiting surgery despite the fact that a month and more has passed since these suspensions. This is total incompetence on the part of ARI management and given that some patients are awaiting surgeries relating to potential cancer diagnoses and other serious conditions this is perfectly scandalous.
>>>><<<<< Sandra MacKenzie, United Kingdom Jul 04, 00:43 # 1,964 Suspending two well-‐respected surgeons for criticising procedures certainly does not instil public confidence in the way ARI is managed
>>>><<<<< Nicola Martin, United Kingdom Jul 02, 05:46 # 1,960 It's disgraceful that the well-‐being of patients is being put in danger due to the suspension of these surgeons for non-‐clinincal reasons.
>>>><<<<< Name not displayed, United Kingdom Jul 02, 05:12 # 1,959 i am awaiting surgery on a parathyroid gland and have entrusted my surgery with the professor or dr wendy craig. i am starting to lose faith also with the way the hospital is run. stop being so childish and reinstate both brilliant surgeons.
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Professor Krukowski is held in the highest regard by his surgical colleagues throughout the United Kingdom and beyond. I have witnessed the high esteem that he is held in by his trainees. His reputation is built on his excellent technical skills and his dedication to patient care. I cannot think of anyone with higher professional standards. James Hill, Manchester University Hospital
>>>><<<<< Tina Morton, United Kingdom Jun 14, 05:37 # 1,576 Please reinstate this brilliant surgeon. I was a junior Staff Nurse many years ago in a ward where Prof Krukowski worked. His dedicated manner and skills were inspiring; his patients recovered well, wounds were smaller than any others, his dedication to
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excellence was second to none and in an unassuming manner, taught many of us lessons for life. I have often reflected this, over the years. Only last summer, my daughter developed a thyroid mass; I knew there was only one man I wanted to operate on my precious daughter and was so thankful he was available to help. It is very hard to express the relief I felt knowing that she was under the care of Prof Krukowski's and in his very experienced, very skilled hands. His kindness and reassurance got us through a difficult time. We are certainly, forever in his debt and he will always be in our hearts. We are so lucky to have a surgeon like Prof Krukowski at ARI; should be begging him to stay at the hospital, not suspend him.
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9. A Patient's Perspective Surgeons, Doctors, Nurses -‐ all people we totally rely upon being there when we need them. As long as you are well, you just assume they will be available when you are ill. The one thing that patients do is form bond with their Doctor be he your GP or your Surgeon, male or female, it matters not. That bond is TRUST you trust these people to make you well again. Whether they can heal you or not, it does not matter -‐ you TRUST that they can. To have recently again had to face surgery, I was not in any way phased or worried by what I was to undergo. I was dealing with surgeons that I had dealt with before. I knew their skills and was confident of their care. Through the media I devastated to find that I could no longer access my surgeons. Although I had had my operation, I had been advised that I needed to undergo further treatment. Due to the dialogue I had with my surgeons I was aware of what I had to do and the timescale in which it had to be done. But who was in place to carry on the treatment required? No one! I received no communication from NHSG, no letter and no phone call. A deafening silence. My devastation started me thinking not only of myself but of all the others out there in limbo. We the patients that had been lucky enough to have had our procedure were either all clear or half way there. For those that were on the patient list I cannot imagine what they went through and are still going through for that matter. If they have already been diagnosed with a critical illness every day must be a nightmare of worry and stress which can only accelerate them into a deep depression. I found no provision had been made for my on-‐going care, and worst of all no provision had been made for those on the patient list. Management did not suddenly decide to suspend the two surgeons, they must have been planning it for some time. It appears to me that that they were so busy planning the suspensions that they totally forgot there were patients involved. For Management in a business where care is the critical word, not to have taken into account the impact on patients to me is an act of Gross Misconduct. In the NHS service the patient is the priority. The patient was not prioritised by NHSG Management, they were of no consequence whatsoever -‐ merely a spectator.
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10. Conclusions and Recommendations
1) There is an evident trend in NHS Grampian to take disproportionate disciplinary action against doctors without first attempting -‐ let alone exhausting -‐ normal tried and tested management techniques. This has led to alienation of doctors from managers, and made the normal management processes which rely on discussion, ventilation of grievances, attentive listening, negotiation and creative imaginative thinking, all but impossible.
2) The losses of valuable doctors -‐ and nurses too are part of this picture -‐ have been incalculable, representing what might look like a determined attempt to wreck individual clinical departments and the patient services they provide. The personal costs to the individuals can barely be contemplated.
3) The costs of these bizarre management policies and practices in terms of temporary replacement staff and paying doctors who are being prevented for very long periods of time is enormous. This is public money, raised by taxation, and it is being squandered wholesale.
We therefore recommend:
1) A moratorium on further referrals to GMC except where there is convincing evidence as viewed by a panel of external assessors completely independent of NHSG.
2) An amnesty to oblige NHSG to reinstate doctors who have been suspended under the circumstances described above.
3) Detailed scrutiny by Audit Scotland into how public money is being wasted at NHS Grampian through inadequate management.
4) A judicial review to examine the extent to which management has functioned over several years by employing disproportionate and unnecessary disciplinary methods to the detriment of the service and of patients, culminating more recently in the use an unsubstantiated report, and resultant processes, to suspend committed, hard-‐working and exceptionally valuable surgeons; and to put in hand the means whereby remedies may be effected both for past errors and for the present consequences of those errors.
RING Campaign 28th July 2015 www.RINGCampaign.com
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11. Detailed Data and Sources
• NHS Grampian Annual Accounts • ISD Scotland National Statistics • National Records of Scotland • http://www.nhsgrampian.co.uk/nhsgrampian/gra_display_hospital.jsp;jsessionid=EAD2505
BFA2AC70C09E31BB768453F46?pContentID=185&p_applic=CCC&p_service=Content.show& • http://isdscotland.org/Health-‐Topics/Waiting-‐Times/Publications/2015-‐06-‐30/2015-‐06-‐30-‐
Cancellations-‐Summary.pdf • http://isdscotland.org/Health-‐Topics/Workforce/Publications/index.asp?ID=1407
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12. References and Links NB The links referring to the Sumithra Hewage case have either disappeared or been disabled since the first edition of this report was published. They have therefore been replaced with alternative means of showing these vital documents, which are already in the public domain. The Scottish Courts have been asked to investigate and restore working hyperlinks to these documents. "Learning from Serious Failings in Care" http://www.scottishacademy.org.uk In the case of a professional, suspension is not a neutral act http://www.bailii.org/ew/cases/EWCA/Civ/2007/106.html The Sumithra Hewage Judgement https://issuu.com/donnieross0/docs/appeal_by_sumithra_hewage_v._grampi http://ringcampaign.com/nhsjigsaw/ Healthcare Improvement Scotland: Report on NHS Grampian http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/programme_resources/ari_review.aspx. The Report from the Royal College of Surgeons of England on General Surgery at ARI: http://www.nhsgrampian.org/grampianfoi/files/RCS_terms_and_recs.pdf Whistleblowers and the General Medical Council: The Hooper Report 2014 http://www.gmc-‐uk.org/Hooper_review_final_60267393.pdf Data Sources: http://www.nhsgrampian.co.uk/nhsgrampian/gra_display_hospital.jsp;jsessionid=EAD2505BFA2AC70C09E31BB768453F46?pContentID=185&p_applic=CCC&p_service=Content.show& http://isdscotland.org/Health-‐Topics/Waiting-‐Times/Publications/2015-‐06-‐30/2015-‐06-‐30-‐Cancellations-‐Summary.pdf http://isdscotland.org/Health-‐Topics/Workforce/Publications/index.asp?ID=1407 Ring Campaign: http://www.RINGCampaign.com