#followthefellows

 

Footnote:

The two quotes about industrialisation and healthcare 
come from Intelligent Kindness by Ballat and Campling.

The considerations on conferences are included in a
this BMJ perspective

This post is creative, made in my own time and intended 
to ask questions in the spirit of the Freedom to Speak Up 
recommendations by Sir Robert Francis.

My forebear, Alexander MacCallum Scott grew up in Polmont, 
Scotland. He became an MP and was Private Secretary to 
Winston Churchill. I mention this as he turned down an OBE 
for his work connected with the war (WWI)

 

 

I am a worrier and I worry for Scotland’s Minister for Health

If this headline represents the approach of the Scottish Government, well I worry.

It is doctors, not pharmacists, that are licensed to prescribe and to withdraw any prescription.

The scientific community shares the conclusion that it easier to start medications than to stop them.

Scotland’s Minister for Health would seem to be asking pharmacists (unregulated by the General Medical Council) to provide:

“stricter checks on medication involving addictive medications”.

Meantime, my profession and our regulators would seem to avoid issues such as:

  • the continuing “education” of NHS doctors (those who are licensed to prescribe) by financially vested interests
  • that withdrawal from psychotropic medications may precipitate (for some) a “relapse” with symptoms worse than those for which medication was first prescribed.
  • that long-term exposure to psychotropic medication may have unforeseen consequences.

I am a worrier and I worry.

 

I have a question about Duty of Candour

This post considers the question that  Maree Todd, MSP, asked at this Parliamentary committee.

As an NHS employee of 25 years I will close this post with a similar question.

Shona Robison Paul Gray NHS Scotland (1)

Shona Robison Paul Gray NHS Scotland (2)

Shona Robison Paul Gray NHS Scotland (3)

Shona Robison Paul Gray NHS Scotland (4)

Shona Robison Paul Gray NHS Scotland (5)

The role of prescribed persons from omphalos

Shona Robison Paul Gray NHS Scotland (6)

Shona Robison Paul Gray NHS Scotland (7)

Shona Robison Paul Gray NHS Scotland (8)

My question:
Is there any reason why Government officials (elected or otherwise) should not be included in Duty of Candour legislation?

Mesh implants and “fully informed consent”

Since my last post on PE1571, Polypropylene Mesh Medical Devices, there has been further consideration of this petition, with evidence given by Dr Wael Agur and the petitioners Elaine Holmes and Olive McIlroy:

What follows are some of my reflections on the parliamentary committee session of the 28th September 2017:

Before the committee began I suggested to interested colleagues:

“The petition on Mesh implants will start taking further evidence today. This could potentially be a watershed moment for the Scottish Government’s Department of Health?”

Dr Agur was extremely good in giving evidence. He came across to me as open, genuine, careful, scientific and reflective. Dr Agur disabuses the stereotypical notion that surgeons struggle to combine pragmatism with philosophy.

Dr Agur was entirely open about his declarations. Here he is an exemplar.

However I retain the concern that manufacturers may have had a greater share in “shared decision making” on Mesh surgery than we are currently able to determine?

The Mesh survivors spoke incredibly well, and thankfully more openly and candidly than any of those in the systems of power that surround us.

The cross-party questions to Dr Agur and the petitioners explored the issues extremely well.

I have no idea what will happen from here on – but I support all the recommendations of this Parliamentary committee.

I dislike over-simplified summaries and yet I now offer one:

We should be especially open to the consideration of what might constitute “fully informed consent”. I do hope the Chief Medical Officer follows through on Realistic Medicine including the potential for science to be distorted, and patients harmed, by vested interests.

The above statement was part of a longer statement made by the 
Chief Medical Officer for Scotland in giving  evidence on PE1571 
on the 18th May 2017.

 

Quality Improvement and Ethics

In a recent Healthcare Improvement Scotland blog, Karen Ritchie asked: “Do we need perfect evidence when making decisions?”

I posted this response on the 26th September 2017:

Dear Karen,
What a carefully considered and thoughtful blog. Thank you for sharing.

I do so agree with this approach: “our underpinning philosophy is that we need to ensure that decisions are evidence informed, rather than evidence based”.

You ask in your blog “Do we need perfect evidence when making decisions?”.

I am of the view that there is no such a thing as perfect evidence, however I do think that science requires philosophy and ethics. That is why I welcome your inclusion of philosophy in the above organisational approach to evidence.

However I am concerned, as I have explained to Dame Denise Coia, Robbie Pearson and Dr Brian Robson, that there is no consideration – or even mention of – ethics as necessary for science by Healthcare Improvement Scotland.

Ethics do not appear in the matrix/diagram that you include as representative of  the “many parts but one purpose” of Healthcare Improvement Scotland:

Some Quality Improvement (QI) proponents have suggested that to address the “perceived slowness” of science – and to “improve” science – we take shortcuts with ethics. I am afraid I could not disagree more. Especially when “pilots” are being scaled-up nationally as part of “good practice”.

I submitted this response on ethics and improvement science (QI) to the BMJ a few months ago.

If you have any thoughts on this subject it would be great if you could post them here.

Kindest wishes,

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

A film that considers how we may go about improving health and wellbeing:

By living we learn from omphalos

The role of prescribed persons

Health & Sport Committee, Scottish Parliament, 26 September 2017: NHS Governance:

Miles Briggs, MSP, asked this question of the Cabinet Secretary for Health and the Director General for NHS Scotland:

“I wondered if you could outline the role to the committee your role as a Prescribed Person within the Public Disclosure Act”

The role of prescribed persons from omphalos

Definition of Prescribed Persons:

“Prescribed persons, as prescribed under the Public Interest Disclosure Act 1998, are independent bodies or individuals that can be approached by whistleblowers, where an approach to their employers would not be appropriate.”

Full coverage of this parliamentary committee can be watched here [full minutes can also be accessed from this page]

Music credit: “Collapsing time” by Dexter Britain (under common license)

GP recruitment in NHS Scotland

There was a debate on GP recruitment in NHS Scotland held in the Scottish Parliament on Tuesday 26th September 2017.

It can be watched here.

The Cabinet Secretary for Health seems to have been unavailable, so Maureen Watt, MSP, stood in. It has been said that sometimes “a picture is worth a thousand words”. The picture above is surely an example of such an idiom.

‘Robust clinical governance must surround treatment’

According to the Sunday Post of the 23rd September 2017, the former Health Minister for the Scottish Government, Alex Neil, MSP, is:

“urging the Scottish Government to stage a summit bringing together experts from around the world as the scandal of women left badly injured by the propylene implants escalates”

I am interested in the Mesh implant scandal because of my petition to the Scottish Parliament which sought consideration of a Sunshine Act for Scotland.

On the 17th May 2017 I submitted a summary as part of further consideration of on PE1517: Polypropylene Mesh Medical Devices.

Mr Neil’s call for an international summit has cross-party support in the Scottish Parliament. He also has the backing of East Renfrewshire MP, Paul Masterton, Conservative, who is campaigning at Westminster.Paul Masterton MP states:

The Interim and Final Independent Reviews on the use of Mesh implants concluded that “robust clinical governance must surround treatment”. I have argued that for this to happen the Scottish Government need to listen to the people.

General practice is the best job in the world

In a previous post of earlier this summer I explained why I share Dr Margaret McCartney’s view that “General practice is the best job in the world”.

It is sad then to read this quote by the Chair of the Royal College of General Practioners Scotland, in one of today’s Sunday newspapers:
(24th September 2017)

For too long now the Scottish Government has failed to acknowledge how serious this matter is. We all realise that this is a most difficult problem, however I find  – when it comes to the responses of the ‘official Government spokesperson’ – that I am reminded of a sentence in Serious Sweet by A. L Kennedy: