“Trickles down from the upper echelons”

I read this letter by Dr William Durward, a retired NHS Scotland Consultant with interest. It was published in the Herald, 7 November 2018, and was written in response to the concerns raised by Dr Bethany Jones:

Dr Bethany Jones, resigned in 2013, from NHS Highland over allegations of ‘managerial mismanagement’ because she and colleagues had been “ignored when highlighting patient safety concerns caused by a focus on target-driven medicine.”

I was not aware of any of the details of this NHS Highland situation until reading it in the paper this week. It has upset me to read it, as the year after Dr Jones resigned, I resigned from NHS Forth Valley after working for over 13 years as a Consultant in Old Age Psychiatry. I did so for reasons remarkably similar to Dr Bethany Jones.

This short film  carries some of the main points made by Geoff Huggins, Head of Mental Health for the Scottish Government, to the enquiry of the All-Party Parliamentary Group on Dementia. Held in the Commons Committee Room 17 on the 13th March 2012. The meeting was entitled "How to improve dementia diagnosis rates in the UK"

The situation that I faced resulted from a Scottish Government Target (HEAT target 4) on the early diagnosis of dementia. As a result of this Target I found that I was being ‘encouraged’ to diagnose patients at risk of dementia as actually having dementia. This despite established evidence that at least 50% of those ‘at risk of dementia’ will never develop dementia.

I found myself under relentless pressure from a range of senior NHS employees, including the National Lead for Patient Safety in Primary Care, and GP in Dollar, Dr Neil Houston to diagnose dementia outwith Internationally accepted clinical criteria. Dr Houston was part, of what I have since come to appreciate as a ‘clubby nexus’ of senior NHS Scotland employees who mixed with the ‘upper echelons’ of Scotland’s political world (principally through Healthcare Improvement Scotland).


At this conference in June 2020 ,I shared my experience of advocating a Timely approach to the diagnosis of dementia in NHS Scotland:

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