Concerns voiced over Scottish NHS '˜marking its own homework'

When her elderly father was admitted to hospital after becoming dehydrated and emaciated under the care of his GPs, Jaqui Rae did not know where to turn.

Health Secretary Shona Robison put forward plans for an independent whistleblowing officer last November but legal experts warned the new role must have the power to compel public bodies. Picture: John Devlin
Health Secretary Shona Robison put forward plans for an independent whistleblowing officer last November but legal experts warned the new role must have the power to compel public bodies. Picture: John Devlin

Retired bar steward William Rae had suffered a devastating stroke in May 2014 but hospital doctors in Edinburgh were confident he would make a recovery. Yet after two months of supposed recuperation in a step down unit, Rae had lost nearly a sixth of his body weight, dropping to under seven stone.

GPs at Oxgangs Path Surgery, in Edinburgh, did not refer him back to hospital until July, by which time he was doubly incontinent and malnourished, Scotland’s ombudsman found last year.

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Although the surgery has since apologised and pledged to take the ombudsman’s recommendations into account, Rae, 56, said the incident had a devastating impact on her father and he never fully recovered before his death.

Now she is backing calls for an independent regulator to be established for the Scottish NHS with investigatory and disciplinary powers to hold health boards to account.

This week a whistleblowers’ organisation known as A Safe and Accountable People’s NHS (ASAP NHS) will write to the UK government demanding a public inquiry in the light of what they see as the Scottish Government’s failure to enforce existing health and safety legislation.

About five people die every day in Scotland from preventable causes such as hospital superbugs, dehydration and kidney failure, the group has estimated.

NHS Scotland is scrutinised by both Healthcare Improvement Scotland (HIS) and the Scottish Public Services Ombudsman but concerns have been raised that neither has the appropriate powers.

Critics also say HIS is not independent of NHS Scotland. A recent OECD (Organisation for Economic Co-operation and Development) report said Scotland’s current system risked the inspector “marking its own homework”.

Scotland is also the only part of the UK where the Health and Safety Executive cannot bring its own prosecution as it has to go through the Crown Office first.

Rae, of Mortonhall, Edinburgh, said: “I think it’s very important. While the ombudsman upheld my complaint, I always wanted to know what would be done to follow up to ensure things change.

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“I think a lot more of these cases would not happen if there was more independent regulation. So many things are swept under the carpet. I had to fight for everything for my father and I didn’t have anyone to turn to.

“I don’t want anyone else to have to go through that kind of agony again.”

Tougher regulation could have prevented high-profile scandals such as the Clostridium difficile (C.diff) outbreak at Vale of Leven Hospital which resulted in 34 deaths, as well as soaring death rates at NHS Lanarkshire hospitals, said Roger Livermore, a former Crown Office prosecutor for the Health and Safety Executive.

Livermore said: “I worked on policy to regulate healthcare during the 1990s. When I moved back to Scotland five years ago I found that regulation had somehow vanished in Scotland.

“It just beggars belief that there is no independent regulator in a sector that is one of the most dangerous of all.”

He said the NHS had fallen behind much more typically dangerous sectors such as railways and the offshore oil and gas industry, as these have been made safe by strong regulation.

Livermore, who lives in West Lothian, said: “The Scottish Government will not recognise that there are avoidable deaths in the NHS, which is part of the problem. Of course there are within the health service.

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“We will never have effective healthcare without a regulator.”

Initial calls were made for a public inquiry last year, when the group wrote to the then Scottish Secretary Alistair Carmichael with their concerns.

They now plan to write to the UK government, the Attorney General and the Department for Health, among others, with their concerns.

The Scottish Government has pioneered a dedicated Patient Safety Programme, which focuses on improving safety in hospitals, maternity units, tackling mental health and primary care, and preventing the spread of hospital superbugs.

Ministers reported a 23 per cent fall in surgical mortality since 2012. However Livermore said: “The Scottish Patient Safety Programme is just a catalogue of all the things they should have been doing already. It’s nothing dramatic – it’s just playing at safety.”

ASAP NHS also wants adequate protection for whistleblowers to speak out over problems within the NHS.

Plans for an independent whistleblowing officer were put forward by Health Secretary Shona Robison last November but legal experts warned the new role must have the power to compel public bodies.

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Rab Wilson, a former psychiatric nurse who exposed a catalogue of errors at NHS Ayrshire and Arran, said: “There is no accountability within health boards and no one to hold them to account.

“We need an inquiry into the lack of a regulator ethically, morally and within the law. The fact we have no independent regulator is unreal.

“It keeps being kicked into the long grass.

“It’s clear we need this but we are being stonewalled.”

Dr Jean Turner, patron of the Scotland Patient’s Association, backed calls for independent regulation but said inherent problems within the system were playing a role.

She said: “I really think that things would be improved if people would take complaints on board as they come in.

“We want people to be accountable, whatever job they do. It is important that staff are allowed to come forward if there are problems and don’t feel afraid.

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“There are problems with continuity of care and shortages of experienced staff which means people are so short of time.

“I don’t think the ombudsman has enough power. Everyone knows you can’t save everyone but as long as everything that could have been done is done then most people will be as satisfied as they can be with the outcome.

“I am supportive of the idea provided it is actually independent and there are experienced people carrying it out.

“We need to have a more rigorous approach to ensure the culture that has developed within the NHS over the last 40 years can change.”

Politicians backed calls for a regulator.

Neil Findlay, Labour candidate for Almond Valley, said: “Scottish Labour has for some time been calling for an independent healthcare regulator in Scotland.

“This especially comes into focus when staff members expose issues within the NHS that have a real and genuine impact on the wellbeing of patients.

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“And what is more, these concerns are often ignored or swept under the carpet and the person raising them is victimised.

“This is why we need an independent regulator of the NHS in Scotland.”

Scottish Conservative health spokesman Jackson Carlaw said: “These are obviously very damning allegations.

“Patients in Scotland deserve much better than this and public safety is paramount especially when it comes to our NHS.”

An SNP spokesperson said: “Patient safety is one of the primary concerns of everyone working in the NHS and we have a robust regulatory framework in place to ensure that all patients can have confidence in the health service.

“Our world-leading Scottish Patient Safety Programme has contributed to a 23.6 per cent reduction in surgical mortality since 2012 – saving lives through the consistent application of best practice.”