‘Official Interference’

This is my reply to a blog that was posted in the Holyrood Magazine:

Thursday 13th July 2017

Dear Tom,
I read the blog post titled ‘Official Interference’ written by you in the Holyrood Magazine on the 7th July 2017.

It is welcome to see this matter considered further. I can be a bit slow on the uptake but I wasn’t entirely sure of the main points that you were trying to get across? I am not sure what you mean by “the real story” being about “accusations” of “subjectivity”? I am also not sure what Holyrood’s views may be on the necessary independence of report writers and the public accountability of civil servants?

Let me be entirely open. I have found my experience of communicating with senior civil servants working for the Department of Health and Social Care (DGHSC) most unsettling. In my communications I have put patients first. I have been a longstanding  advocate for ethical considerations in healthcare.

As a public servant (NHS doctor) I have been as open and transparent about my experiences as possible – and I have shared all that I can on my website Hole Ousia.

Over some years I have become aware that my personal experience of communication with senior civil servants has been shared by a significant number of others, many of whom have been labelled by DGHSC as “vexatious” or having a “grievance”.

DGHSC civil servants would seem to follow an approach that Prof Walter Hume described as familiar “the various techniques used by bureaucratic organisations to avoid responsibility when things go wrong: these include silence, delay, evasion, buck-passing and attempts to discredit complainants.”

Following the Times report by Helen Puttick and the subsequent report in the Scotsman, I compiled this blog-post:

Honesty and Openness: ‘not an edited official tale’

I should say that I am just an NHS doctor who has a number of interests and that I have neither any skills in politics nor in journalism. I am however interested in ethics and this includes consideration of the integrity of those who occupy positions of genuine power (such as elected politicians and publically paid senior civil servants).

On becoming First Minister, Nicola Sturgeon stated:

“I intend that we will be an open and accessible Government” (26th November 2014)

When giving evidence to the Scottish Parliament, the Director General for NHS Scotland, Paul Gray said:

“I think transparency in the NHS makes sense” (29 January 2014)

I would suggest that there is a growing public concern about senior civil servants working for the Scottish Government in terms of what they say and do.

The Commission on Parliamentary Reform’s “Report on the Scottish Parliament” published on the 20th June 2017 outlined steps that might help improve parliamentary approaches to ensuring necessary accountability of the Scottish Government. I have been made aware, for example, of a number of Petitions under review by the Scottish Parliament that may have been closed as a result of behind-closed-doors “advice” by senior civil servants working for the Scottish Government.

I will stop there Tom. No need to reply unless you so wish.

One closing point. It is most demoralising for hard-working NHS staff to hear repeatedly repeated, parrot-like, from Scottish Government “spokespeople” of “record NHS levels of staffing”. This fighting of reality is not helpful and suggests the sort of “subjectivity” that perhaps you were alluding to in your piece for the Holyrood Magazine?

I will be staging a peaceful protest (I am not party political) about the integrity of senior officials working for the Scottish Government this August at the Martyrs Monument.

Kind wishes,

Peter

Dr Peter J Gordon (writing in my own time and in a personal capacity)

Honesty and openness: ‘not an edited official tale’

When Nicola Surgeon became First Minister of Scotland she said:

“I intend that we will be an open and accessible Government” (26 November 2014)

On the Front page of the Times of  the 7th July 2017 was a report by the Scottish Health Correspondent, Helen Puttick that outlined the considerable efforts, made behind closed doors, of senior civil servants working for the Scottish Government to “tone down” this Report by Audit Scotland.



Further pressure was made to influence the Audit Scotland Report:

In considering the findings of this FOI inquiry, the Editor of the Times said that “the public deserve to know the true story on NHS funding and not an edited official tale”

The Civil Service Code of Conduct for Scotland outlines these core values:

These core values are what the public should expect from its civil servants if they are to fulfil the intention of Scotland’s First Minister.

 


The Scottish Public: consulted on a Sunshine Act

The Scottish public were consulted on the need for a Sunshine Act for Scotland. Their response, in majority, was that this was necessary.

Almost a year-and-a-half on and the Scottish Government has provided no update to the Scottish people. This is disappointing given the Scottish Government’s assertion that “everyone matters” to them.

The lack of sunshine legislation in the British Isles is raised in this current BMJ News feature:

This response was submitted by Vagish Kumar L Shanbhag:

freedom to speak

The Director General for NHS Scotland:

  Peter's experience of the Director General for NHS Scotland

 

The Clinical Director of Healthcare Improvement Scotland:

     Peter's experience of the Clinical Director of HIS

 

The Director of Health and Social Care Integration:

Peter's experience of Director of Health & Social Care Integration

 

In my determination to put patients first I have been treated poorly.

These highly paid officials seem to be beyond accountability:

[I have always openly acknowledged that my view is no more important than any other. I am always careful to be clear in what cannot be said with any certainty. I am fully aware of my weaknesses.  I absolutely refute any charge that I am “vexatious”. I do not hold grievances. What matters to me is truth and fairness. I have found that the same cannot always be said of those in genuine positions of power]:

 

It can take courage to care. To resist the threats to your career and the misnaming:

 

Such abuse of power is not new:

 

You are invited to join me for this protest:

 

Would you like to join me?

 

INVITATION:

This is an invitation to join me on a peaceful protest to be held on Monday 21st August 2017 at the Martyrs Monument, Calton Hill Burial Ground, Edinburgh.

WHAT THE PROTEST IS ABOUT:

It is a protest for anybody who has had difficulty communicating with high public office in Scotland. For some this may have been with the Scottish Government – but it need not relate to any particular institution.

This protest is for anybody who has felt that those in a genuine position of power may have acted unfairly.

Professor Walter Humes, writing in Scottish Review, 21st September 2015:

“For some time I have been copied into email exchanges concerning how complaints against public bodies are dealt with. I have no personal stake in any of the specific sources of concern (which include patient care in the NHS and responses by Police Scotland, the Scottish Government and the Crown Office and Procurator Fiscal Service (COPFS) to requests for formal investigations). I do, however, have a long-standing interest in issues of public accountability and am familiar with the various techniques used by bureaucratic organisations to avoid responsibility when things go wrong: these include silence, delay, evasion, buck-passing and attempts to discredit complainants.”

THE FIRST MINISTER’S “INTENTION”:

The First Minister for Scotland, Nicola Sturgeon said: “I intend that we will be an open and accessible Government” 26 November 2014

Prof Walter Humes, 21 September 2015:

“Those who hold high office in public bodies are very adept at defending their own interests. They may claim to support openness and transparency but those principles are not always translated into practice. Bureaucratic Scotland often falls short of the democratic ideals which are said to underpin civic life”

WHY GATHER AT THE MARTYRS’ MONUMENT:

This film by me, “The Friends of Liberty“, explains why the Martrys Monument has been chosen for this protest. The location is next to St Andrew’s House, the seat of the Scottish Government. The Martyrs Monument rises higher and has a wider view than St Andrew’s House. The Martyrs Monument was raised through public donations.

WHY the 21st of AUGUST ?:

Reason 1: The foundation stone of the Martyrs’ Monument was laid on this very day, 1844.

Reason 2: on the 21st August 2017 there will be a full solar eclipse (sometime just before 8pm) revealing the power of one orb over another and our shared need for light.

THE PERSONAL STORY MATTERS:

Here is my experience with Scottish Government. I have been, and continue to be, an active advocate for ethical considerations in all aspects of healthcare in NHS Scotland. I am proud of what I have done and of who I am.

So if you have your own story please come along and share it. Together we can make a difference.

Acknowledgement:
It was Mrs Chrys Muirhead who suggested the 21st August 2017 as 
date for this protest. Her enquiring mind had led her to find that 
this date was both an anniversary of the laying of the Martyrs 
Monument foundation stone and also the very day, in 2017, when 
a solar eclipse will occur.

 

 

 

Lifeboat NHS

A film about freedom to speak up in NHS Scotland based on an edit of the evidence session of the Health and Sport Committee, Scottish Parliament, held on 13th June 2017.

This is just an edit. A subjective view. Nothing more and nothing less.

Stifling distortions












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Has your experience of comunicating with high public office in Scotland been difficult?

If so, might you join me for a demonstration at the Martyrs monument, Calton Hill, Edinburgh on the evening of the 21st August 2017?

My idea is to recreate a gathering around the Martyrs Monument on Calton Hill which stands next to, but taller than, St Andrew’s House (the seat of power).

The foundation stone of the Martyrs Monument was laid by Joseph Hume, MP, on  the 21st of August 1844, when 3,000 people gathered for the occasion.

This year, on the anniversary of this foundation, a total solar eclipse will take place.


Prof Walter Hume in the Scottish Review, 21st September 2015:

“For some time I have been copied into email exchanges concerning how complaints against public bodies are dealt with. I have no personal stake in any of the specific sources of concern (which include patient care in the NHS and responses by Police Scotland, the Scottish Government and the Crown Office and Procurator Fiscal Service (COPFS) to requests for formal investigations). I do, however, have a long-standing interest in issues of public accountability and am familiar with the various techniques used by bureaucratic organisations to avoid responsibility when things go wrong: these include silence, delay, evasion, buck-passing and attempts to discredit complainants.”

Prof Humes went on to say:

“Those who hold high office in public bodies are very adept at defending their own interests. They may claim to support openness and transparency but those principles are not always translated into practice. Bureaucratic Scotland often falls short of the democratic ideals which are said to underpin civic life”

 

To seek balance in the appreciation of where expertise rests: my submission on PE01651

Submission on PE01651: Prescribed drug dependence and withdrawal

Made by Dr Peter J Gordon

Date of submission: 3rd June 2017.

Submission made in a personal capacity.

I am writing in support of this petition. I am an NHS Consultant Psychiatrist who has worked in this specialty in Scotland for almost 25 years now. My wife has worked as a General Practitioner in Scotland over the same period. I have an interest in ethics, human rights and the medical humanities generally. One of the areas I have taken much interest in is informed consent.

I would argue that this backdrop may mean that I can add some thoughts and reflections that might help the Committee in the consideration of this particular petition.

I should make it clear that as an NHS psychiatrist I do prescribe antidepressants and other psychotropic medications. I try to do so following the best available evidence as considered as relevant or not to my professional understanding of each unique patient and their life circumstances.

I wish to keep this summary short as I am aware that the Committee receives a great deal of evidence. So I offer a few points of evidence that I would be willing at a future date to expand upon if that were felt to be helpful:

• Antidepressant prescribing In Scotland (ISD figures) has been rising year-on-year in Scotland for at least the last ten years (this is also true of all other prescribed psychotropic medications). It is estimated that 1 in 7 Scots are now taking antidepressants and many of these in the long-term.

• At a recent Parliamentary Cross Party Meeting on Mental Health and older adults an invited speaker stated that: “depression is under-recognised across all age groups” and that “maintenance treatment has a good risk-benefit ratio.”

• A key opinion leader and Government advisor has previously argued that prescribing of antidepressants in Scotland is “conservative” and “appropriate”.

• Many of the key opinion leaders “educating” doctors prescribing antidepressants in Scotland appear to have significant financial interests with the makers of these medications. Across the UK, £340 million was paid by the pharmaceutical industry in the last recorded year to healthcare workers and academics for such “promotional activities”.

• “Informed Consent” will not be possible if the information that doctors base prescribing on follows such promotion rather than independent, and more objective, continuing medical education. This issue is now at the fore of the Mesh Inquiry.

A few questions that need to be considered:

  • When patients are prescribed antidepressants are they informed that as many as 1 in 2 will be taking antidepressants long-term?
  • Are patients informed that there may be a significant risk of pharmacological dependence on antidepressants?
  • Do patients know that their experience of antidepressants may be considered less valid than the experts (who may have been paid by the pharmaceutical industry) who educate other doctors (who may be unaware of this potential financial bias)?

Summary:

My view is that antidepressants are over-prescribed in Scotland.

My view is that patients have not been properly informed of benefits and risks.

My view is that appropriate prescribing has not been realised due to a number of factors: the lack of access to psychological therapies or other meaningful supports; the wide promotion of antidepressants where marketing is routinely conflated with education; and a culture of increasing medicalisation generally.

I would suggest that this petition might be considered in light of the Chief Medical Officer’s Realistic Medicine campaign. It is time for balance to be re-established between “medical paternalism” and the valued, vital and real-world experiences of patients who are taking medications like antidepressants. I am particularly disappointed in my own College, the Royal College of Psychiatrists for not making greater effort to facilitate such balance. Without such, I fear more harm will result from inappropriate and costly prescribing in NHS Scotland.

Finally, due to widespread “off-label” promotion of antidepressants in Scotland, patients may experience withdrawal syndromes which can be most severe and precipitate mental states far more serious than the mental state for which they may have originally been prescribed.

I would urge the committee to consider this petition most carefully and to seek balance in their appreciation of where expertise rests.

Submission on PE1517: Polypropylene Mesh Medical Devices

Submission on PE1517 on Polypropylene Mesh Medical Devices

Made by Dr Peter J Gordon

Date of submission: 17th May 2017
Submission made in a personal capacity.

The Agenda for the Public Petitions Committee meeting of the 18th May 2017 includes a most helpful summary “Note by the Clerk” on PE1517: Polypropylene Mesh Medical Devices (Document PPC/S5/17/10/1). Having read this carefully, and in accordance with the first suggested “Action” (point 45, page 8), I would like to offer evidence. Before doing so I have listed below the most relevant sections of PPC/S5/17/10/1 in relation to the points of evidence that I wish to make.

In Annexe B of PPC/S5/17/10/1 the Interim and Final Conclusions of the Independent Review are listed side-by-side.

Conclusion 1, both Interim and Final, was that “Robust clinical governance must surround treatment”

Conclusion 3, both Interim and Final, was that “Informed consent is a fundamental principle underlying all healthcare”

In  Annexe C: Parliamentary Action (page 21 of PPC/S5/17/10/1) the Cabinet Minister for Health, Shona Robison answered question S5W-07749 by Neil Findlay, MSP on the 17 March 2017, by stating:

“Informed consent and shared decision making are expected prior to any procedure being carried out. The Chief Medical Officer goes into this in more detail in her Realistic Medicine report.”

The Clerk, in point 7, (page 2 of PPC/S5/17/10/1) confirms that:

“The Scottish Government does not have the power to regulate what medical devices are licensed for use in the UK. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medical devices in the UK”

The Clerk, in point 12 (page 3 of PPC/S5/17/10/1) includes quotations from the Preface of the Review’s Independent Report:

“We found some concerning features about how new techniques are introduced into routine practice”  and that

“We are aware that some of our conclusions have wider implications and see the need to embed this in patient Safety and Clinical Governance strands of the NHS”

Points of Evidence by Dr Peter J Gordon  (GMC number 3468861)

• HDL62:  the Scottish Government has acknowledged that this 
Guidance is not being followed by NHS Boards

• There have been media reports that NHS professionals working in 
Scotland, who are involved in educating NHS staff about Mesh
procedures, have been paid by commercial sectors who have 
financial interest in Mesh products. 

• PE1493, A Sunshine Act for Scotland, was closed in February 2016 

• A Public Consultation on PE1493 was undertaken by the Scottish 
Health Council. The Scottish  public, in majority, were of the view 
that it should be mandatory for  all financial payments made to 
healthcare workers and academics to be declared in a publically 
accessible form 

• No meaningful update has been provided by the Scottish Government 
since this Public Consultation was published more than a year ago.

• I  fully support the Chief Medical Officer’s “Realistic Medicine” 
initiative and I have suggested that Sunshine legislation should be 
considered an essential part of this development  

• I agree with the Independent Review that “robust clinical 
governance must surround treatment”. I am concerned that if the 
current situation continues, where “education” of health 
professionals may be significantly based on marketing, further 
examples of iatrogenic harm may occur in NHS Scotland.

• The Independent Review concluded that “informed consent is a 
fundamental principle underlying all healthcare”. If the advice 
given to patients is based on marketing, either partially or wholly, 
then informed consent may be denied patients. Further examples of 
Iatrogenic harm may then  unfortunately occur and healthcare 
in Scotland may risk being considered as  unrealistic 
rather than “realistic”.

 

Update, 22 May 2017:

Public Petitions Committee – Scottish Parliament: 18 May 2017 (click on image below to watch the full meeting)

The official report of the Public Petitions Committee of 18 May 2017

Sunday Post, 21 May 2017: ‘Probe to examine possible conflicts of interest in troubled mesh implant inquiry’