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Lessons learned from Gosport hospital scandal | Letters

Jeremy Hunt said the blame culture in the NHS must change to avoid more scandals like those tragically exposed at Gosport War Memorial hospital (Report, 21 June). Of course, there must be consequences where neglect or deliberate actions have caused harm, but to shift to a “learning culture” he must incentivise accountability among staff to foster a culture of openness and honesty. Lessons are only learned through honesty, transparency and an acceptance that accountability doesn’t necessarily lead to blame and punitive measures. Staff are the NHS’s biggest asset and by getting its workforce culture right, not only will Hunt improve patient safety and prevent future scandals such as the one at Gosport hospital, he will reduce the burden on staff that is making so many want to leave the NHS after so many years of service.
Dennis Bacon
Executive chairman, Pulse UK, Norwich

Safety is disaster-led. After the Herald of Free Enterprise ferry sank in 1987, killing 193, marine safety regulations were tightened. Shipping companies were made responsible for safety of life at sea, in addition to the duties of captain and crew. Safety improved. Working as a ship’s doctor from 2003-15, I witnessed a new development. A monthly prize was awarded to the crew member who reported the most significant safety concern leading to learning or a change of practice. A volte-face in the NHS would be to reward whistleblowers, especially those whose testament led to an increase in safety. We need to fundamentally change the current situation in which staff are still nervous about the personal consequences of whistleblowing, and are often unsupported or worse. How about an annual prize for the NHS organisation which has made the most safety improvements as a result of staff-reported concerns? Carrot and stick.
Dr Ruth Taylor
London

Bribing or gagging well-intentioned whistleblowers, who have the interests of the patients at heart, is no way to improve quality control in the NHS, a matter which in my opinion has never been adequately addressed. The main problem is that the whistleblower feels they have no one to turn to. The post of matron has largely been abolished, and the medical profession has become the servant of managers, who are lay people, rather than the other way around, a fact which is reflected in their respective salaries.

Surely NHS staff should be given a statutory right to complain to management if they find it necessary, and have their complaint recorded and acted upon in a transparent manner, instead of having to endure the present culture of victimisation.

I recall as a junior doctor, working at a hospital in the south of England, complaining that when I was on call for cardiac arrests – a very urgent matter requiring immediate attention, obviously – no on-site accommodation was provided for me. The outcome? I was hauled up before the hospital manager and senior surgeon and accused of being a communist. Presumably communists have higher standards of care and compassion.
Dr Andrew Norman
Poole, Dorset

In her article Call for action against senior officials over hospital deaths (22 June), Sarah Boseley refers to “life-shortening drugs” such as diamorphine. It is important to stress that although overdosage can be fatal, as long as they are given in appropriate dosage, carefully titrated against the patient’s need for pain control, these drugs do not shorten life. The common perception that they do can be very unfortunate if consequent reluctance to prescribe or accept them results in inadequate pain control in advancing but non-terminal cancer.
Dr Peter Wemyss-Gorman
Lindfield, West Sussex

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Lessons learned from Gosport hospital scandal | Letters

Jeremy Hunt said the blame culture in the NHS must change to avoid more scandals like those tragically exposed at Gosport War Memorial hospital (Report, 21 June). Of course, there must be consequences where neglect or deliberate actions have caused harm, but to shift to a “learning culture” he must incentivise accountability among staff to foster a culture of openness and honesty. Lessons are only learned through honesty, transparency and an acceptance that accountability doesn’t necessarily lead to blame and punitive measures. Staff are the NHS’s biggest asset and by getting its workforce culture right, not only will Hunt improve patient safety and prevent future scandals such as the one at Gosport hospital, he will reduce the burden on staff that is making so many want to leave the NHS after so many years of service.
Dennis Bacon
Executive chairman, Pulse UK, Norwich

Safety is disaster-led. After the Herald of Free Enterprise ferry sank in 1987, killing 193, marine safety regulations were tightened. Shipping companies were made responsible for safety of life at sea, in addition to the duties of captain and crew. Safety improved. Working as a ship’s doctor from 2003-15, I witnessed a new development. A monthly prize was awarded to the crew member who reported the most significant safety concern leading to learning or a change of practice. A volte-face in the NHS would be to reward whistleblowers, especially those whose testament led to an increase in safety. We need to fundamentally change the current situation in which staff are still nervous about the personal consequences of whistleblowing, and are often unsupported or worse. How about an annual prize for the NHS organisation which has made the most safety improvements as a result of staff-reported concerns? Carrot and stick.
Dr Ruth Taylor
London

Bribing or gagging well-intentioned whistleblowers, who have the interests of the patients at heart, is no way to improve quality control in the NHS, a matter which in my opinion has never been adequately addressed. The main problem is that the whistleblower feels they have no one to turn to. The post of matron has largely been abolished, and the medical profession has become the servant of managers, who are lay people, rather than the other way around, a fact which is reflected in their respective salaries.

Surely NHS staff should be given a statutory right to complain to management if they find it necessary, and have their complaint recorded and acted upon in a transparent manner, instead of having to endure the present culture of victimisation.

I recall as a junior doctor, working at a hospital in the south of England, complaining that when I was on call for cardiac arrests – a very urgent matter requiring immediate attention, obviously – no on-site accommodation was provided for me. The outcome? I was hauled up before the hospital manager and senior surgeon and accused of being a communist. Presumably communists have higher standards of care and compassion.
Dr Andrew Norman
Poole, Dorset

In her article Call for action against senior officials over hospital deaths (22 June), Sarah Boseley refers to “life-shortening drugs” such as diamorphine. It is important to stress that although overdosage can be fatal, as long as they are given in appropriate dosage, carefully titrated against the patient’s need for pain control, these drugs do not shorten life. The common perception that they do can be very unfortunate if consequent reluctance to prescribe or accept them results in inadequate pain control in advancing but non-terminal cancer.
Dr Peter Wemyss-Gorman
Lindfield, West Sussex

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

The doctor from Myanmar faced with 1 million patients and a plague of rats – podcast

Growing up in an isolated village in western Myanmar was tough, with no running water or electricity, and little access to healthcare. The nearest hospital was several days’ walk away. SaSa was determined to become a doctor, but just as he reached the end of his training, the bamboo on which his community survived was wiped out, triggering a huge increase in rats, who ate what little food was left. The overwhelming challenges of trying to bring medical help to the remote region inspired SaSa to found the organisation Health and Hope, which has since enabled hundreds of villagers in Chin state to become community health workers.

NHS funding: where will the money come from and how will it be spent?

Theresa May has announced an increase of £20bn a year to the NHS’s budget. She said that the decision signalled the government’s commitment to the health service ahead of its 70th birthday.

What has led to the funding plan?

Since last year Hunt has been arguing two things: firstly, that, after eight years of 1% budget rises, the NHS needs to start receiving significant extra funding as soon as the economy allows; and secondly, that the service needs a long-term funding plan and the recent policy of small increases and in-year injections of extra, in effect “winter crisis” emergency funding, needs to end.

Will some of the rise come from a ‘Brexit dividend’, as has been claimed?

Not exactly. Last November Simon Stevens, the chief executive of NHS England, told ministers the NHS needed to start receiving 4%-a-year budget increases as soon as possible, given the service’s increasing inability to meet key patient treatment waiting times and desire to make real progress in key areas, such as cancer, mental health and primary care.

He also in effect demanded the government deliver on the promise made during the EU referendum campaign that Brexit would free up £350m a week extra for the NHS.

Q&A

What are the financial pressures on the NHS that have built up over the last decade?

Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year.

Read a full Q&A on the NHS winter crisis

Since then leading leavers, including Boris Johnson and Jacob Rees-Mogg, have called on May to honour that pledge, even though it was not a government promise and was not in the Conservative manifesto last year. Others have pointed out that official forecasts predict that leaving the EU will weaken the public finances, at least in the short term.

Why does Stevens see rises of 4% as so important?

It’s not justthe NHS chief that backs that figure as the minimum the service needs to cope with the rapid increase in demand for care and also to transform how it works. Health thinktanks, organisations representing NHS providers and almost every group representing doctors back the annual 4% rise as do influential independent bodies such as the Institute for Fiscal Studies and the Office for Budget Responsibility.

Also, although the NHS has received rises averaging 3.9% a year since 1955, that has slowed to just over 1% a year since 2010.

Recent research by the IFS and the thinktank Health Foundationshowthe NHS’s average annual increase since its creation in 1948 has been 3.7%. The last eight years represent a period of unprecedented austerity, in relative terms.

In cash terms, 4% annually over at least four years would mean the NHS’s budget of £125bn increases to more than £146m by 2022.

How did all this lobbying influence May’s thinking on the NHS?

A: In March, when she addressed the Commons liaison committee, May committed to giving the NHS a multi-year funding settlement, though gave no more detail.

Both Hunt and Stevens have talked about the health service’s need to have certainty that it will receive substantial extra funds for the next 10 years. However, it is likely the deal will give the NHS specified, guaranteed increases only until the end of this parliament.

Why was May’s commitment to a long-term plan important?

It came a day after 92 MPs from all parties, including many select committee chairs, told the prime minister in a strongly worded letter that the NHS needed to get back to receiving the sorts of annual budget increases that it enjoyed until the coalition’s austerity programme began in 2010.

Her pledge intensified a behind-the-scenes battle between Hunt and Hammond over exactly how much money the NHS should get. Hunt has been pushing for the rise to be as close to 4% as possible, whereas Hammond initially said anything above 2.5% was unaffordable.

The fact that it looks like the final increase will be at least 3% a year suggests that Hunt has had significant success in the battle for May’s ear. He has warned her that the increasingly visible problems in the NHS – including the biggest winter crisis last year, deepening understaffing and the inability to meet A&E and cancer treatment targets – will only intensify without a radical rethink in the government’s approach to the the service, and that would carry obvious political risk.

But Hammond seems to have gained more control of the process as the announcement has drawn close. Hunt is now concentrating his lobbying on the chancellor, not May.

What will the new money be spent on?

On Thursday Hunt told the annual conference of the NHS Confederation that, whatever the sum, it would be used to deliver “a small group of bold ambitions”, including new waiting time targets for mental health care, improve Britain’s poor cancer survival rates, make maternity care safer and complete the government’s declared mission of integrating health and social care services in England.

Where will all this extra money come from?

No one knows yet. Hammond will set that out in his next budget, in November. There will also be a new, detailed plan for how the NHS will spend the money – the improvements it will make in return for May’s largesse – around the same time.

Hundreds of Australian doctors call for dying refugee to be brought from Nauru

Hundreds of doctors have signed a petition calling on the immigration minister, Peter Dutton, to bring a refugee dying of advanced lung cancer to Australia for palliative care.

The 63-year-old is being held on Nauru and is a member of the persecuted Hazara minority in Afghanistan. He has been formally recognised as a refugee. But the Australian Border Force told the man, known as Ali, that he could not come to Australia for palliative care, despite pleas from doctors on Nauru, who say the care there is inadequate.

After reading reports by Guardian Australia about Ali’s situation, Dr Sara Townend wrote to Dutton and launched a petition she urged other doctors in Australia to sign.

“Australia has accepted this man as a legitimate refugee,” her letter says.

“This means Australia is obligated by international conventions to care for his physical and mental health, whether he is on the mainland, or off shore. Nauru is not an appropriate place for this man to die. The Australian Border Force tacitly acknowledged this by offering to transfer him to Taiwan for palliative care. He requires expertise beyond what is available on Nauru.”

Ali has told the Australian Border Force he will not go to Taiwan because he has no friends or family there, was concerned there would be no translator from his language, Hazaraghi, and that there would be no one to perform the Shia Muslim rituals after his death.

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“If he goes to Taiwan, where there are no Hazara, he will die isolated and without community,” Townsend wrote. “This is no way to die. If he remains on Nauru, he faces a potentially catastrophic death, without medical expertise to ease his pain and symptoms.

“His only chance of a good death is to come to Australia so that he can have both community and medical expertise.”

The petition was shared on social media on Saturday by the advocacy group, Doctors For Refugees. By 3pm Sunday 812 doctors had signed.

Epileptic boy’s mother barred from bringing cannabis oil into UK

The mother of a child who has up to 100 epileptic fits a day has had potentially life-saving cannabis oil confiscated from her by customs officers at Heathrow airport after trying to “openly smuggle” the substance into the UK.

Charlotte Caldwell was not cautioned when she was stopped after a flight from Toronto, Canada, and has vowed to obtain more cannabis oil to help her 12-year-old son, Billy, for whom she says it has proved to be an effective treatment.

Last year Billy became the first child to be prescribed medicinal cannabis oil on the NHS. He then reportedly went 250 days without a seizure. However, his GP was later ordered by the Home Office not to renew the prescription or face disbarment.

Caldwell said she feared that the cycle of fits “would eventually kill” Billy. She said she would meet the Home Office minister Nick Hurd on Monday afternoon to plead to get the oil back. She added that Billy was due his next dose at 3.30pm and warned of the dangers of missing his first treatment in 19 months.

Caldwell, from Castlederg in Co Tyrone, Northern Ireland, told reporters that the customs officers were “absolute gentlemen … really, really nice”. One had tears in his eyes as they took the drug from her, she said.

“I’ll just go back to Canada and I’ll get more and I’ll bring it back again,” she said. She described the contraband as “a small bottle of oil that’s keeping my son alive”.

Caldwell told a press conference: “It’s Billy’s anti-epileptic medication that Nick Hurd has taken away. It’s not some sort of joint full of recreational cannabis, it is his anti-epileptic medication that he has taken off me at the airport today.

“I will just go back to Canada and get more and I will bring it back again because my son has a right to have his anti-epileptic medication in his country, in his own home.

Sky News (@SkyNews)

Mother Charlotte Caldwell “absolutely horrified” as customs officers at Heathrow Airport confiscate cannabis oil she uses to treat her son’s epilepsy pic.twitter.com/qWONj5h7jC

June 11, 2018

“We are not going to stop, we are not going to give up, we have love, hope, faith for our kids and we are going to continue.”

MPs and experts condemned the move and said it highlights the deep injustices people face due to what they say is Britain’s outdated drug policy.

“Rather than cracking down on parents who are trying to help alleviate the suffering of their children, we should be legislating according to the evidence and giving people the treatments they need,” said Caroline Lucas MP, the chair of the all-party parliamentary group on drug policy reform.

“There’s swathes of evidence to show that cannabis products can help treat epilepsy – and continuing to criminalise people for using it is both deeply cruel and an absurd waste of police resources.”

David Nutt, the former government chief drugs adviser who has advocated for the legalisation of medicinal cannabis, said Caldwell had proved cannabis oil effectively cured her child and could save his life.

“Cannabis is a medicine in 20 other countries and was a medicine in the UK until 1971,” he said. “Why not make it a medicine again.We have a politically, not medically, based cannabis policy in the UK and this is why people like Billy Caldwell have to go through this torture.”

A Home Office spokesperson said: “The Home Office is sympathetic to the difficult and rare situation that Billy and his family are faced with.

“Whilst we recognise that people with debilitating illnesses are looking to alleviate their symptoms, Border Force has a duty to stop banned substances from entering the UK.

“The policing minister will meet Ms Caldwell this afternoon.”

It emerged last year that the UK was the world’s largest producer and exporter of cannabis for medical and scientific use. The vast majority is exported to countries with more liberal laws on medicinal cannabis usage.

The World Health Organisation’s expert committee on drug dependence has committed to reviewing the scheduling of cannabis under the United Nation’s 1961 convention.

Epileptic boy’s mother barred from bringing cannabis oil into UK

The mother of a child who has up to 100 epileptic fits a day has had potentially life-saving cannabis oil confiscated from her by customs officers at Heathrow airport after trying to “openly smuggle” the substance into the UK.

Charlotte Caldwell was not cautioned when she was stopped after a flight from Toronto, Canada, and has vowed to obtain more cannabis oil to help her 12-year-old son, Billy, for whom she says it has proved to be an effective treatment.

Last year Billy became the first child to be prescribed medicinal cannabis oil on the NHS. He then reportedly went 250 days without a seizure. However, his GP was later ordered by the Home Office not to renew the prescription or face disbarment.

Caldwell said she feared that the cycle of fits “would eventually kill” Billy. She said she would meet the Home Office minister Nick Hurd on Monday afternoon to plead to get the oil back. She added that Billy was due his next dose at 3.30pm and warned of the dangers of missing his first treatment in 19 months.

Caldwell, from Castlederg in Co Tyrone, Northern Ireland, told reporters that the customs officers were “absolute gentlemen … really, really nice”. One had tears in his eyes as they took the drug from her, she said.

“I’ll just go back to Canada and I’ll get more and I’ll bring it back again,” she said. She described the contraband as “a small bottle of oil that’s keeping my son alive”.

Caldwell told a press conference: “It’s Billy’s anti-epileptic medication that Nick Hurd has taken away. It’s not some sort of joint full of recreational cannabis, it is his anti-epileptic medication that he has taken off me at the airport today.

“I will just go back to Canada and get more and I will bring it back again because my son has a right to have his anti-epileptic medication in his country, in his own home.

Sky News (@SkyNews)

Mother Charlotte Caldwell “absolutely horrified” as customs officers at Heathrow Airport confiscate cannabis oil she uses to treat her son’s epilepsy pic.twitter.com/qWONj5h7jC

June 11, 2018

“We are not going to stop, we are not going to give up, we have love, hope, faith for our kids and we are going to continue.”

MPs and experts condemned the move and said it highlights the deep injustices people face due to what they say is Britain’s outdated drug policy.

“Rather than cracking down on parents who are trying to help alleviate the suffering of their children, we should be legislating according to the evidence and giving people the treatments they need,” said Caroline Lucas MP, the chair of the all-party parliamentary group on drug policy reform.

“There’s swathes of evidence to show that cannabis products can help treat epilepsy – and continuing to criminalise people for using it is both deeply cruel and an absurd waste of police resources.”

David Nutt, the former government chief drugs adviser who has advocated for the legalisation of medicinal cannabis, said Caldwell had proved cannabis oil effectively cured her child and could save his life.

“Cannabis is a medicine in 20 other countries and was a medicine in the UK until 1971,” he said. “Why not make it a medicine again.We have a politically, not medically, based cannabis policy in the UK and this is why people like Billy Caldwell have to go through this torture.”

A Home Office spokesperson said: “The Home Office is sympathetic to the difficult and rare situation that Billy and his family are faced with.

“Whilst we recognise that people with debilitating illnesses are looking to alleviate their symptoms, Border Force has a duty to stop banned substances from entering the UK.

“The policing minister will meet Ms Caldwell this afternoon.”

It emerged last year that the UK was the world’s largest producer and exporter of cannabis for medical and scientific use. The vast majority is exported to countries with more liberal laws on medicinal cannabis usage.

The World Health Organisation’s expert committee on drug dependence has committed to reviewing the scheduling of cannabis under the United Nation’s 1961 convention.

Epileptic boy’s mother barred from bringing cannabis oil into UK

The mother of a child who has up to 100 epileptic fits a day has had cannabis oil confiscated from her by customs officers at Heathrow airport after trying to “openly smuggle” the substance into the UK.

Charlotte Caldwell was not cautioned when she was stopped after a flight from Toronto, Canada, and has vowed to obtain more cannabis oil to help her 12-year-old son, Billy, for whom she says it has proved to be an effective treatment.

Caldwell said she feared that the cycle of fits would eventually kill Billy. She said she would meet the Home Office minister Nick Hurd on Monday afternoon to plead to get the oil back.

She said the customs officers were “absolute gentlemen … really, really nice.” One had tears in his eyes as they took the drug from her, she said.

“I’ll just go back to Canada and I’ll get more and I’ll bring it back again,” she said. She described the contraband as “a small bottle of oil that’s keeping my son alive”.

Last year Billy became the first child to be prescribed medicinal cannabis oil on the NHS. He then reportedly went 250 days without a seizure. However, his GP was later ordered not to renew the prescription.

Caldwell, from Castlederg in Co Tyrone, Northern Ireland, told a press conference: “It’s Billy’s anti-epileptic medication that Nick Hurd has taken away. It’s not some sort of joint full of recreational cannabis, it is his anti-epileptic medication that he has taken off me at the airport today.

“I will just go back to Canada and get more and I will bring it back again because my son has a right to have his anti-epileptic medication in his country, in his own home.

“We are not going to stop, we are not going to give up, we have love, hope, faith for our kids and we are going to continue.”

It emerged last year that the UK was the world’s largest producer and exporter of cannabis for medical and scientific use. The vast majority is exported to countries with more liberal laws on medicinal cannabis usage.

Epileptic boy’s mother barred from bringing cannabis oil into UK

The mother of a child who has up to 100 epileptic fits a day has had cannabis oil confiscated from her by customs officers at Heathrow airport after trying to “openly smuggle” the substance into the UK.

Charlotte Caldwell was not cautioned when she was stopped after a flight from Toronto, Canada, and has vowed to obtain more cannabis oil to help her 12-year-old son, Billy, for whom she says it has proved to be an effective treatment.

Caldwell said she feared that the cycle of fits would eventually kill Billy. She said she would meet the Home Office minister Nick Hurd on Monday afternoon to plead to get the oil back.

She said the customs officers were “absolute gentlemen … really, really nice.” One had tears in his eyes as they took the drug from her, she said.

“I’ll just go back to Canada and I’ll get more and I’ll bring it back again,” she said. She described the contraband as “a small bottle of oil that’s keeping my son alive”.

Last year Billy became the first child to be prescribed medicinal cannabis oil on the NHS. He then reportedly went 250 days without a seizure. However, his GP was later ordered not to renew the prescription.

Caldwell, from Castlederg in Co Tyrone, Northern Ireland, told a press conference: “It’s Billy’s anti-epileptic medication that Nick Hurd has taken away. It’s not some sort of joint full of recreational cannabis, it is his anti-epileptic medication that he has taken off me at the airport today.

“I will just go back to Canada and get more and I will bring it back again because my son has a right to have his anti-epileptic medication in his country, in his own home.

“We are not going to stop, we are not going to give up, we have love, hope, faith for our kids and we are going to continue.”

It emerged last year that the UK was the world’s largest producer and exporter of cannabis for medical and scientific use. The vast majority is exported to countries with more liberal laws on medicinal cannabis usage.

Suffering from Brexit anxiety? You could get free counselling

A group of psychotherapists have volunteered to offer free counselling for people with anxiety related to Brexit.

The organisers say the initiative is aimed at preventing people “being sucked into a vortex of gloom and doom” over the prospect of the UK leaving the EU.

It came after a survey of 1,300 remain voters found many were still traumatised by the result of the referendum.

Asked to express their emotions about the vote the most common words used in the survey were “devastated”, “angry”, “depressed”, “betrayed” and “ashamed”.

Brexit anxiety word cloud


Brexit anxiety word cloud. Photograph: Dr Helen De Cruz

A team of five registered therapists and psychologists from north London’s Existential Academy have agreed to offer people up to 10 free sessions of therapy.

The initiative, known as Emotional Support Service for Europeans, is being led by Emmy van Deurzen, a professor of psychotherapy at Middlesex university and a passionate remainer.

She said the survey revealed many people “feel their lives have been totally changed” by Brexit. In a blogpost for the British Psychological Society published on Friday, she wrote: “The vote has struck at the core of their identity and continues to dominate their everyday experience. Some are still in shock and can’t quite believe this is happening.”

The scheme is likely to be dismissed as “snowflake nonsense” by those who back Brexit. But Van Deurzen claims some people are “tearing out hair in despair” .

And she warned that those who don’t seek help risk their anxiety getting worse. “Being sucked into a vortex of gloom and doom is not good for any of us, and it is vital to remain positive, constructive and purposeful,” she said.

Van Deurzen said the vote had already had a profound effect on many of the estimated 3.5 million European citizens living in the UK.

“We know that hundreds of thousand are so deeply hurt and upset that they have already left the UK or are planning to do after Brexit,” Van Deurzen wrote.

She adds: “Sometimes it almost seems as if we are on trial, as if a social experiment is being rolled out to test our personal resilience and sanity.”