In this post I reply to Professor Jason Leitch, whose letter of the 2nd June 2015 on Haloperidol prescribing to Scotland’s elderly can be read here:
This is the link to my summary on Delirium Screening written March 2014 at the request of one of those involved with improvement work in delirium. I shared this with Healthcare Improvement Scotland, the Scottish Delirium Association and OPAC (Older People in Acute Care Improvement programme). I had no replies.
Recently this automated e-mail arrived:
I thus contacted Professor Leitch to clarify. This is the response I received:
e-mail: 25 September 2015 Dr Gordon, I can assure you that not only did I receive and read
your email of 8th June, I still have it. I noted its content and
following our earlier correspondence didn’t feel it required a
response. I also read our correspondence which you published
on your blog. Professor Jason Leitch, National Clinical Director.
The following behind-the-scene communications were recently released as a result of a Data protection request. The communications indicate a tone of disdain for those who may write regularly to DG Health and Social care.
I had asked if Professor Jason Leitch might confirm if he is registered with the General Medical Council. Again there is clear evidence of a most disparaging tone made by two of the most senior figures in the DG Health and Social care. One has to worry for other correspondents who write with legitimate concerns about patient wellbeing and safety.
Professor Leitch chose not to answer my question about registration with the General Medical Council however he did kindly supply a most abbreviated CV which would indicate that he is not medically trained and qualified. Professor Leitch’s qualifications are in Dentistry and he is registered with the General Dental Council. This is important in that Professor Leitch gives advice as National Clinical Director for NHS Scotland yet he is governed by a regulatory body that is not for general medicine.
This paper was published in the Lancet in late last year. It is a two page article that is worth reading in full. All screenshots below are from this paper:
The authors commented that
The authors were of the view that
Scottish Government figures confirm that prescribing of antipsychotics is rising in our elderly. It thus seems important to consider why this may be. The authors continue:
There is always the risk in times of austerity, and when staffing levels are not ideal, that:
The authors state:
The promotion of off-label use of antipsychotic medication was instrumental in my petition to the Scottish parliament for a Sunshine Act:
The authors continue:
But what does the evidence have to say? The authors state:
The authors continue:
The authors ask:
The authors conclude with Dr William Osler:
I am also of the view that there is a risk that “brief screening tools” may result in “pathways” being followed that, despite good intentions, lead to greater prescribing of antipsychotics in our elderly. I am aware that currently “brief screening tools” are being promoted in Scottish NHS hospitals.
I wish to conclude with one recent example of many: an elderly woman, with terminal cancer returned to her GP after a recent period in hospital. She asked her GP “But why am I on this anti-schizophrenic drug?”