With careful thought, and backed with full supporting evidence, I sent the following letter of the 2nd February 2016 to support my petition for a Sunshine Act for Scotland.
The Senior Clerk of the Parliamentary Committee was of the view that this letter did not comply with the Scottish Parliament’s policy on the treatment of written evidence. I was therefore asked to redact significant sections of the letter.
After considerable communications to and fro, I replied as per this e-mail of the 3rd March 2016:
I fully respect the right of the Scottish Parliament to determine what it publishes. I feel very strongly that my letter without the highlighted text merely reiterates what I have already said, and fails to provide the evidence that I have repeatedly been asked for. So my position is that I do not wish to amend my letter of the 1st February on PE1493.
My petition has since been closed. I therefore have decided to publish my letter to the Scottish Parliament in full along with supporting evidence. I have had professional advice that what is contained in this letter is not defamatory as it is based on veritas and has full supporting evidence:
Dear Mr McMahon
Petition PE01493: A Sunshine Act for Scotland
I realise that the Committee must receive a great amount of correspondence however I hope that the committee might agree that what follows is extremely important when considering PE1493.
Since I last wrote to the committee I attended, for accredited continuing medical education, the Royal College of Psychiatrists in Scotland Winter Meeting held on the 29th January 2016. It is this that has compelled me to write this update as it demonstrates beyond doubt that lack of transparency around financial conflicts of interest remains a serious issue. An issue with implications for both patient safety and healthcare budgets. It also demonstrates that Government action is the only way to address this.
The full powerpoint presentations of this Accredited meeting for Continuing Professional Development can be accessed here - but only for members of the Royal College of Psychiatrists. I am a member of the Royal College of Psychiatrists and I am of the view, as a scientist, that these lectures should be available to all and not just to members.
One speaker highlighted the increase in prescribing costs in her health board area which was due to the high prescribing rate of a new antipsychotic injection, palperidone depot (XEPLION®). The next speaker demonstrated both the inferior effectiveness of this drug when compared to existing (far cheaper) depot medications and the perception amongst Scottish psychiatrists that it was more effective. Below you will see the flyer sent to mental health professionals in Scotland when this drug was launched:
I have highlighted one of the paid speakers, Dr Mark Taylor, because he also spoke at this week’s meeting where he reminded us that he was Chair of SIGN Guideline 131: The Management of Schizophrenia, which was published in March 2013.
At this week’s meeting Dr Taylor presented his declarations as follows: “Fees/hospitality: Lundbeck; Janssen, Otsuka; Roche; Sunovion”.
Dr Taylor commented on these declarations with the statement that “you are either abstinent or promiscuous when it comes to industry. Well you can see which side I am on”. Audience laughter followed.
The general question that arises is whether an influential professional such as a Chair of National Guidelines might earn more from the pharmaceutical industry than in his or her role as a healthcare professional? At present it is impossible for anyone to establish the scale of competing financial interests. To remind the committee the following avenues are not illuminating:
1. Royal College of Psychiatrists. This week’s meeting did not appear on the college database. In any case this database is neither searchable nor does it include specific details of payments and dates
2. NHS Boards. The committee has already established that, across Scotland, HDL62 is not being followed.
3. SIGN guidelines. The committee is aware of significant governance failings particularly in comparison with NICE which includes details of financial sums paid and associated dates.
4. Discussions with Senior Managers in NHS Scotland relating to the General Medical Council’s expected level of transparency has brought forth written responses describing my interest as “highly unusual” and “offensive and unprofessional”
5. The forthcoming ABPI register allows any professional to opt out of inclusion.
It is also worth repeating that the information provided to the public consultation on this petition failed to highlight most of the issues identified in points 1 to 5 above.
In terms of cost both to the public purse and the individual patient the Government’s stated wish for a “robust, transparent and proportionate” response would be fulfilled if a single, searchable, open register of financial conflicts of interest that has a statutory basis were to be introduced
There were a number of reasons why I left NHS Forth Valley. One of those reasons was a concern that patients, often elderly, were being harmed through the misdiagnosis of dementia.
Shortly after I left I wrote to senior management seeking the following reassurance:
- that any patients that have been harmed are acknowledged and where appropriate supported in coming to terms with their mis-diagnosis,
- that practice in NHS Forth Valley now follows Scottish, UK and International guidelines on Dementia.
- that NHS Forth Valley has, as an organisation, reflected on this matter
Following a reminder I received a reply suggesting that examining comparative data would be helpful but would take some time:
Following another reminder I have now received what I take to be the final position of NHS Forth Valley on the matter. My understanding of this is that NHS Forth Valley cannot provide the reassurance that I was seeking:
I have sent the following letter to NHS Forth Valley which reiterates my ongoing concerns:
"I remain concerned about the potential for harm relating to the over-diagnosis of dementia. I understand that you are not in a position to reassure me on this in terms of patients referred to NHS Forth Valley. I would welcome it if this “could potentially be explored in the future.” I note and understand your general comments about reflection. The book “Intelligent Kindness” considers the importance of reflection not just at an individual level but also at an organisational one. I feel that it is now time to conclude our correspondence on this matter."
If anybody would wish to see the full context of the letters please contact me.
I have reluctantly decided that I am no longer going to write any posts about NHS Scotland on Hole Ousia. I will however still continue to discuss health and wellbeing in the context of the “two cultures”.
My reason is that I no longer feel safe to speak out individually as an employee of NHS Scotland.
I will continue to advocate for transparency and accountability.
I feel very lucky to be a doctor. The NHS is so important to me. I have so many wonderful colleagues and I never cease to learn from the Scottish folk that I try to help when in a time of need.
I will always try my best to put patients first. That is the way I am. I do not agree with those who suggest that such a determination might be considered as a sign of illness.
Dr Peter J. Gordon
After sending an update of my petition for a Sunshine Act to the Chief Executive Officer of NHS Forth Valley I received this reply. Whilst I was employed by NHS Forth Valley I raised concerns that HDL 62, the Scottish Government Circular sent to all Chief Executives in NHS Scotland, was not being followed.
Two aspects of this letter from the Chief Executive Officer for NHS Forth Valley are worth further consideration:
When I was an employee of NHS Forth Valley I was formally written to by Dr Rhona Morrison, Associate Medical Director. In this letter from the Associate Medical Director, which was both unsigned and undated, I was described as “unprofessional” and “offensive” for raising concerns that NHS Forth Valley was not following extant Scottish Government guidance on transparency regarding declarations of interest.
This letter confirmed that I would be “invited” to an “informal” meeting by the Associate Medical Director’s immediate peers.
My experience of this “informal” meeting was that my character, reputation and probity were robustly questioned by the Medical Director, Dr Peter Murdoch, and the General Manager, Mrs Kathy O’Neill. This meeting was not minuted. This meeting left me distressed.
A number of weeks after this meeting I resigned from NHS Forth Valley. On my resignation I had this feedback from those who I had cared for and worked with
(2) Freedom to Speak Up:
The Chief Executive Officer reinforces in her letter the “importance of a culture of openness and candour”. However, Jane Grant, the Chief Executive Officer for NHS Forth Valley then goes on to give qualifications: that any concerns raised should be “appropriate” and “correct”.
To conclude: it appears to me that there are still significant barriers to raising concerns in NHS Scotland. If you click on the image below you can read the full review by Sir Robert Francis. I have selected one particular recommendation which I think will require a different mindset to that suggested in the letter from Jane Grant, Chief Executive Officer for NHS Forth Valley:
Update: November 2016: On the 22 March 2016 the following petition was lodged by Pete Gregson with the Scottish Parliament: PE01605: Whistleblowing in the NHS - a safer way to report mismanagement and bullying. On the 24th November 2016 the Public Petitions Committee considered all the submissions requested as part of evidence gathering. This included a letter from the Chief Executive Officer for NHS Forth Valley. This letter was commented on in particular by Angus MacDonald, MSP:
This report was published recently:
I was particularly interested in the following excerpt:
I was a Consultant in one NHS Board for 13 years until I resigned in the summer of 2014. I then applied for a post in another Board. I was the only candidate but was unsuccessful. The same post has now been readvertised:
Written submission by Dr Peter J Gordon to the Scottish Parliament on NHS Governance
I had several envelopes like this delivered through my letter-box.
Immediately recognisable, even before opening, I felt my heart (‘hairt’ in Scottish) beat much faster.
I shall try and explain why.
This is another pattern that I wish to present.
Alexander McCall Smith, as an admirer of my films, wrote to me about our shared interest in patterns. He recommended this book “A pattern language” which has inspired some of my recent posts:
Here is an example from a letter from the Medical Director of NHS Forth Valley, Dr Peter Murdoch, to me dated 21st May 2014. It was part of a wider letter. The letter made references to my “behaviour”. The letter summoned me to an “informal” meeting with the Medical Director and General Manager for NHS Forth Valley:
When I was off sick, due to work stress, the Locum Consultant who covered for me, had the following experience:
The Locum Consultant concluded that this demonstrated:
This was the Locum Consultant’s experience of the Medical Director, Dr Peter Murdoch. There was no action taken here.
I have many interests: interests which remind me how little I know. One of my interests is in ethics.
In my 13 years with NHS Forth Valley my ethical interests were in three broad areas.
In my time with NHS Forth Valley there was no forum to discuss ethics.
It is fully accurate to say that not one of my consultant medical colleagues in NHS Forth Valley shared my advocacy for a timely approach to the diagnosis of dementia. Today it is the basis to the diagnosis of dementia across Europe
I share the view of most ethicists and many in academia that education and research should be free of marketing. Free of any distortion created by financial incentives. I have petitioned for a Sunshine Act (or clause) for Scotland. I believe that a central, open-access register would be straightforward and not at all costly to set up.
My view is that we need to consider more fully the importance of consent. Any intervention, be it a test, or a “tool”, or a treatment can have potential benefits and potential harms. These need to be shared as best as we can.
The Former Cabinet Minister for Health and Wellbeing, October 2014:
This week, the General Medical Council published:
This report confirmed that 54% of those doctors who committed suicide had been referred by their employers.
One response to this GMC investigation remarked:
“There is a parallel with whistleblowing here. The stress of the situation caused mental health difficulties and the person concerned is therefore dismissed as being unwell. Which comes first?”
My experience in raising ethical considerations, and thus trying to put patients first, was very difficult indeed.
I do hope other healthcare professionals, if they raise genuine concerns, will not face what I have faced for raising ethical considerations.
I see a pattern here. So did a senior NHS doctor who wrote to me recently:
“No wonder NHS doctors live in fear when threatened with the GMC for raising ethical concerns in the workplace.”
In the previous post I outlined my experience of seeking transparency in the Health Board in which I was employed.
I was asked by senior managers to reflect on my “behaviour” for seeking transparency. From the senior managers perspective I had not followed the social media policy issued by my Health Board. I was thus invited to meet with senior managers about this. It was eventually concluded that I had not breached any of my employers’ policies.
More than a year on I still feel the angst that this meeting caused me. A meeting where I had been summoned, was told I could “bring” a union representative, and where I ended up having to defend my professional character. This meeting was designated by my employers as an “informal meeting” (I assume in terms of employment law). The result is that any such “informal” meetings do not need to be recorded by the Health Board. My concern over such an arrangement is that it risks facilitating an imbalance of power that favours the employer. I am aware of health professionals who have resigned from health boards following such “informal meetings”.
In my particular case, the senior managers focussed on one policy in particular. This was the Social Media policy of the Health Board. Actually to be factually correct, the NHS Board in which I was employed had two social media policies: one for “personal use” and another for “business use”. To me it felt like these policies were being used to stop me seeking transparency. Furthermore it was very much as if the Health Board’s priority was not the same as mine. I was trying to put patients first.
I have no expertise in developing policies for Health Boards. However, it is clear that there are significant differences between different Scottish Health Boards in terms of their approach to employees use of social media.
For example, employees of Healthcare Improvement Scotland are encouraged to use social media at work. Many staff, including senior staff have what would appear to be professional social media accounts. It is most surprising then that Healthcare Improvement Scotland have no social media policy for their staff. [FOI request: reply from Healthcare Improvement Scotland, dated 18 June 2014 “We do not hold a formal policy on employee use of social media”]. It has recently been clarified that Healthcare Improvement Scotland staff are guided by” a “code of conduct policy” and a “Social Media Guidance” document.
NHS Ayrshire and Arran has a social media policy (now 4 months beyond review date) that is publicly accessible. It is a clearly written 6 page policy that is strikingly different in approach to that of NHS Forth Valley
NHS Highland takes a similar approach to NHS Ayrshire and Arran and both would appear to be of the view that social media can bring benefits to continuing education of healthcare staff when used with careful guidance but not exhaustive restrictions.
Views on use of social media will naturally vary. Social media have the potential for both good and harm. Rev Eli Jenkins in “Under Milkwood” would likely agree.
“We are not wholly bad or good
Who live our lives under Milk Wood,
And Thou, I know, wilt be the first
To see our best side, not our worst.”
My view is that having no policy, such as Healthcare Improvement Scotland, risks loss of reasonable professional boundaries. The other problem is that if Healthcare Improvement Scotland wishes to use social media to support improvement work and education across Scotland, social media policies in some areas will prevent this.
I would like to see greater consistency across NHS Scotland in terms of extant policies in the use of social media.
Personally I would support the approach taken by NHS Ayrshire and Arran where there is a clear policy in place which allows the use of social media as long as this is consistent with good professional practice for all healthcare workers.
This post is about medical education in NHS healthcare: this is called “Continuing Professional Development” (“CPD”).
In this post I will explore the current relationship between medical education with commerce.
The title of this post is taken from a quote by the current Director of Medical Education for NHS Forth Valley in a communication to me on this matter. The Director of Medical Education was scolding me for asking about transparency.
As I get older I find that I see more patterns.
How we “see” such patterns will differ for us all! My previous post was about a pattern that I had noticed regarding ageing and memory: The parabolic pattern
The pattern in this post is not one of light. It is a dark pattern. A pattern not easily seen.
Before trying to shed some light on this pattern, I want you to know that I am a scientist (as well as an artist) who supports innovation, scientific realism and progression. This is why the Scottish physicist, and poet, James Clerk Maxwell has long been my guide.
The pattern of images that follow (where I will try to keep my words spare) represent my very real concern that science today (and not just “in the past”) has rather too readily become the pocket of industry.
It was Alexander McCall Smith who wrote to me recommending this book:
This week I faced a repeating pattern with this “educational” circular from my new NHS employers:
Professor David Taylor is an Academic Pharmacist and so not registered with the General Medical Council. Prof Taylor has had significant input into the development of UK-wide guidelines on prescribing in mental health. He has been open about his significant financial conflicts of interest
Professor David Taylor, paid by the Pharmaceutical Company Janssen, had earlier this year, given an “educational” talk to CPD teaching with my former employers:
I refused to go to this. Why? Well through much of the previous 6 months, my NHS e-mail in-box had received e-mails (not at my request) from the makers of Asenapine. Several “key opinion leaders” featured in these promotions, including Professor Alan Young (whom more of later) and Prof David Taylor. The following slide comes from this online powerpoint:
The next in this slide demonstrates good practice as in it Professor David Taylor outlines his comprehensive, and well-spread, financial conflicts of interest:
Even though not a doctor, after I wrote to him, Prof David Taylor submitted his declarations to whopaysthisdoctor.com . We should commend this openness, as here Professor Taylor is a leading example of necessary transparency. It is important however that we consider that in “offering” “education” Professor Taylor has significant financial under-writing. Professor Taylor has had a significant role in the development of UK-wide guidelines on prescribing in mental health.
Three years back: On the 17th May 2011 I wrote to NHS Forth Valley to say that I found that the link to the “Hospitality Register” was non-functioning. It took two years of polite inquiry for NHS Forth Valley to finally confirm that as an NHS Board it had NO register of interests for ALL staff. I was later to discover (through Freedom of Information requests) that this was a pattern spread across ALL twenty-two of NHS Boards in Scotland:
Eleven years back: in circular HDL(2003) 62 The Scottish Government stated that “Chief Executives are asked to establish a register of interest for ALL NHS employees and primary care contractors”:
This year: The Director of Medical Education for NHS Forth Valley, said (25 February 2014) “Traditionally we have not registered the various meetings on the list as it was not required of us”.
I will post some recent examples of sponsored education involving NHS Forth Valley employees. I do so without wishing to focus on any individual. It is important that what I present is understood only as part of a wider pattern.
It may be my error, but I cannot find any declarations made, by those involved in these sponsored educational meetings in any NHS Forth Valley Register. I wrote to the CHP General Manager of NHS Forth Valley on the 20th March 2014, where I included ALL the following examples of employees involved in what would appear to be sponsored meetings.
[the coloured highlights in the following promotions are mine (they are only part of my much wider effort to bring transparency). My endeavour is not to single any individual out.]
[I recognise that the sample I present (based on my much wider pinterest page) is simply the promotions for “education” which have come my way.]
Patterns appear at all levels and not just “local”. For the governance of conflicts of interest, at a UK level, we follow the General Medical Council. At annual appraisal and at five-yearly revalidation all doctors are asked to sign a probity section where each individual doctor confirms (or not) the following (this screenshot is from my recent Revalidation):
Before closing: the following example of an “educational” “CPD” event reveals a pattern that does not just involve those employed by the NHS such as charities and third-sector organisations:
The pattern is broad. I have no doubt. I recently debated with Professor Clive Ballard at a Royal College of Psychiatry Conference in Durham. I suggested to the organisers, well in advance of the conference, that all those involved might consider that they declared any financial interests in the programme. The organisers agreed that this was a good suggestion. As it turned out I was the only one to declare.
Professor Clive Ballard chose not to reveal in the RCPsych programme, or in his presentation, any potential financial conflicts of interest.
Another speaker at this RCPsych Conference was Professor Allan Young. Like Professor David Taylor he had given hearty support to the promotion of Asenapine (my NHS email in-box was frequent witness to all of the promotions).
At the RCPsych conference, where I was a fellow speaker, Professor Allan Young started out by mocking any need for transparency: “for those of you who watch panorama, I do not give my consent for you to film this”. Professor Allan Young then presented his “Conflict of Interest Statement”. He did not talk his interests through (unlike the rest of his presentation) and my image is thus blurry. Professor Allan Young presented his multiple financial interests in a blink of an eye but also fortunately in a camera click.
In my camera click, I resisted Professor Allan Young’s wishes. Light is important to all patterns.
Following my advocacy, NHS Forth Valley, would seem to be the only NHS Board, out of Scotland’s twenty-two NHS Boards to have an open access register for all employees.
From the evidence I have gathered it seems clear to me that Scottish Health Boards continue to fall very far short of complying with HDL 62. Yet this guidance delivered to ALL NHS Board Chief Executives is now 11 years old!
I am not legally minded. Senior Health Board Managers in Scotland are signing off annual Appraisals and five yearly Revalidation that staff are individually following their employers Guidance (including Scottish Government HDL 62 guidance: guidance issued to all Chief Executives in 2003) . The GMC are clear on what is expected regarding “probity”
It is for this reason that I submitted a petition to the Scottish Parliament suggesting that they might consider a Sunshine Act. Other countries have instituted such legislation. Like John Betjeman, I do not welcome bureaucracy, however a central, open access register, enshrined-in-law, should be neither difficult nor burdensome to implement.
On the 30th October I received this most helpful reply from Alex Neil, MSP, Cabinet Minister for Health and Wellbeing for the Scottish Government.
The full letter is as follows and my full response below that. My view is that the lesson Scotland has for NHS England as to regards our approach to the diagnosis of dementia is important. My view is that it is not the lesson as portrayed by the Scottish Government. Please read my letter and see what you think?
My reply as posted to Alex Neil:
It is not always easy to read image files, so below is an html version with a few added photographs that were taken at the Alzheimer’s Europe Conference held in Glasgow between 20th and 23rd November 2014.
Friday, 31st October 2014
To Alex Neil,
Cabinet Secretary for Health & Wellbeing,
The Scottish Government.
Your ref: 2014/0032642
Dear Cabinet Secretary for Health & Wellbeing,
I wanted to write and thank you for your letter dated 31st October 2014 which actually arrived by e-mail on the 30th October. It was very helpful for you to outline so clearly the Scottish Government’s position on the diagnosis of dementia. I thought it might be helpful if I replied to some of the points you made in this letter but first I wanted to say that I thought your speech to the Alzheimer’s Europe Conference held in Glasgow was very good.
I was delighted to hear about the “Glasgow Agreement” based on rights & dignity of individuals and to see this signed by representatives of all walks of life. I think to have Scotland lead the way here is a matter in which we can take much pride. The level of inclusion at the conference of those living with dementia was inspirational. The value of experience in terms of shaping policy should never be lost. My only concern is that many of the patients I see with cognitive changes are very elderly and frail and with multiple health problems. So we must be careful to include this group’s very quiet voice. They tend not to have straightforward “Alzheimer’s”.
I have many interests and so I am an advocate for scientific pluralism when it comes to the subject of wellbeing. As a general point I would like to reflect on my experience in the last four years or so where I have not found it easy to raise ethical considerations. I refer both to my experience as an employee of NHS Scotland and indeed my “engagement” with Healthcare Improvement Scotland. I would hope you might investigate how ethical matters can have a routine place in healthcare in Scotland. It is also my view that scientific methodology requires to include critical voices. History reminds us time and again that well-intentioned policies can have unforeseen consequences. I am hugely impressed at your personal determination to see that concerns can be raised without what has happened to me and others: isolation and mischaracterization. I want to thank you for this.
Above newspaper extract is from the Sunday Herald, 12 October 2014
My experience in NHS Forth Valley for raising ethical considerations and trying to be a voice for those most vulnerable (generally our very elderly) was far from easy. I had the same experience for raising transparency and following HDL 62 which has been extant for over 10 years.
The incentivised approach to the “early diagnosis of dementia” as set out explicitly in HEAT Target 4 first raised concerns for me in day-to-day practice. This target was pursued by senior Scottish Government officials most rigorously. Here it is worth looking at the evidence presented to Westminster’s All Party Parliamentary Group by senior Scottish Officials (Government and Clinical). Phrases used included “being careful to take out saboteurs” and an approach suggested that Senior Managers and Clinicians should be taken around the “back of the bike shed” if they disagreed with policy. I am of the view that such approaches are unhelpful and unethical.
HEAT Target 4 and the first Dementia Strategy (covering a combined period of 5 years – 2008-2013) were based on early diagnosis. It was only following my meeting with a senior Government official raising ethical concerns that a “timely” approach to diagnosis was included in 2013 for the second Dementia Strategy. It is welcome to see this now as the basis of a rights based approach as advocated across Europe in the “Glasgow Agreement”. The Keynote address to the Alzheimer’s Europe Conference I felt misrepresented the truth. The audience were given the impression that “timely diagnosis” had been a founding principle of the Scotland’s Dementia Strategy when in fact it was only introduced last year.
You are correct that I am concerned about the over-diagnosis of dementia. Dementia diagnosis is a complex matter and must not be simplified or rushed in my opinion. I am equally concerned about mis-diagnosis. When I left NHS Forth Valley this summer I had a series of patients who had been given an ”early diagnosis” of “early Alzheimer’s disease” even though clinically they did not fulfil International criteria for Dementia. Five years on (or more) these individuals still have no signs or features of dementia. Our elderly are generally deferential folk who respect medical authority. We owe it to them to take better care.
It is my view that HEAT Target 4 and the first Dementia Strategy encouraged loosened diagnostic boundaries to become accepted practice. I wrote to the Scottish Government about this but received no written reply. Then I found that my NHS Board, who had initially supported my concerns, no longer agreed with me and the Medical Director at the time concluded I was “the main concern”. Following this an “External Review” was held with the two senior doctors mentioned this month in the Dementia in Europe magazine (see below).
In private the former Chief Executive of the Mental Welfare Commission acknowledged that he agreed with timely diagnosis. But in public discourse about policy, strategies and targets he endorsed early diagnosis. I have looked at all the online Scottish Government minutes of meetings about the first Dementia Strategy and HEAT Target 4. All involved with these policy meetings endorsed early diagnosis and wished to “educate” other doctors, especially GPs, about this. There was no mention of a timely approach anywhere.
The summary that you mention was a fair reflection of my conversation with a senior Government official until it stated that ”the Scottish Government’s shift from early to timely diagnosis between the first and second National Dementia Strategy has been quite a subtle and nuanced one reflecting the balance of clinical and other opinion in favour of the latter” [bolding mine]. It is my opinion that, far from being “subtle and nuanced”, this is a significant change in emphasis. I welcome it whole heartedly as it addressed the potentially harmful consequences of a focus on early diagnosis. The current debate in England would have been better informed had the Scottish Government acknowledged the significance of this change.
I hope this letter helps you understand a little better where my concerns come from. I want to help policy makers and to find it easier in the future for my voice or the voices of those far less able to be heard.
Dr Peter J Gordon
Update: November 2016:
Such a statement seems back-to-front.
It was Geoff Huggins who addressed Westminster Parliament in person to say that any “saboteurs” to HEAT Target 4 would be addressed by taking them “behind the bike shed”.
November 2016: Sir Harry Burns, former Chief Medical Officer for Scotland has agreed to lead a review into Targets: [the full transcript of his initial thoughts to the Scottish Parliament can be read here]: