Friday 30 June 2017

Data Protection: Another Jeremy Hunt Failure

"Completely unacceptable", Jeremy Hunt described the data leek (1). He said patients needed to feel confident the NHS would look after their personal data. "If we are going to win that trust we need to strengthen the independent oversight of data security within the NHS to a level that we don't have at the moment." (1)

Hunt wasn’t speaking about the patient data leak that came to light this week (2), he was talking about a patient data leak that happened in 2015 (1). 56 Dean Street, a sexual health clinic in Central London, ran a regular email newsletter sent out to its patients, many of whom are HIV positive. At the beginning September 2015 they sent out an email to 780 patients but the person sending out the email newsletter forgot to hide the recipients email addresses. Everyone who received the email could see all the email addresses of everyone else it was sent to (3). Jeremy Hunt was very quick to condemn it and in very harsh language.

Having your health status outed to 779 other people is certainly traumatic and I won’t want it to happen to anyone, but ultimately no one’s health was damaged by it. I cannot say the same for data leak that was revealed on Tuesday.

On 27th June the National Audit Office published a damming report into the NHS Shared Business Services (SBS) disgustingly poor handling of confidential patient documents (4). Jeremy Hunt was forced to answer questions in parliament about this sorry affair (5). It has all made a mockery of his claims, back in 2015 (1), for patients to be able to trust data protection in the NHS.

In 2008 NHS Shared Business Services (SBS), a private company, was created as a joint venture between the Department of Health and Sopra Steria (4). Though a private company NHS SBS is 49.99% owned by the NHS and the Department of Health had three places on the company’s board, though them only took up one of them, Jeremy Hunt himself took that place (5). NHS SBS’s website boasts that the company will save the NHS £1 billion by 2020 (6).

NHS SBS was contracted to deliver medical paperwork from hospitals to patients’ GPs in many areas across the country. First they had contracts with PCTs and then, after PCTs were abolished in 2010, with NHS England (4).

In 2011 NHS SBS’s own internal audit found that they had 8,146 items of undelivered correspondence (4), yet they seemed to do little or nothing about it. In June and July 2015 an NHS SBS administer raised concerns internally about a large back log in undelivered correspondence (4). They raised concerns, in August 2015, that the backlog was now being destroyed (4). As far back as January 2014 Senior Managers at NHS SBS knew about the clinical risk this backlog of correspondence posed but they didn’t have any plans to deal with it (4). In November 2015 the backlog of correspondence was escalated to NHS SBS’s Chief Executive (4).

NHS SBS told NHS England, their employer, about the backlog on 16 March 2016 and the Department of Health (49.99% owner of the company) the next day (4). NHS SBS’s
Chief Executive told the company’s board about the problem on 24 March 2016 (4), a board Jeremy Hunt himself sits on. In April 2016 the Department of Health decided not to tell Parliament or the public about NHS SBS’s failure to deliver patient correspondence (4). They argued that they didn’t want to “worry” patients and the public, and publicising this would have lead to questions they could not answer (4). The subtext being that the Department of Health didn’t want to be embarrassed by this, they were one of the majority owners of NHS SBS.

The DoH did inform parliament on 21 July 2016 about NHS SBS’s failure but only as a written statement (4), if Hunt had done so in person it would surely have generated a lot more publicity. In the written statement Hunt called it “an issue with a mail redirection service” (4). It not mention the potential harm to patients, which NHS England was concerned about, that this backlog of correspondence could cause.

As of 31 May 2017, NHS England has found 709,000 items of unprocessed correspondence and 1,788 cases of potential harm to patients have been identified, so far (4). They have still not finished checking all the undelivered patient correspondence, and do not expect to do so until December 2017, so far they have only checked a third of the documents (7). The undelivered correspondence included cancer test results, child protection details, patients’ medical records, treatment plans which included changes to patients’ medication and forms registering patients with GP practices (4). NHS England estimates that it will all cost at least £6.6 million in administration alone to resolve (4), they haven’t said how much the clinical follow up of the patients involved will cost, and so NHS SBS has borne £2.26 million of these costs (4). Will this be counted against the £1 billion NHS SBS claims to be able to “save” the NHS? (6)

The National Audit Office’s report into all this was very scathing (4). They criticised NHS SBS for its poor response to the backlog, poor management and low prioritising of the backlog and for being “obstructive and unhelpful” to the NHS England investigation (4). They also criticised Jeremy Hunt for a conflict of interest, he was both Secretary of State for Health and had a seat on NHS SBS’s board, he was in charge of the Department of Health who are responsible for NHS England who were the organisation who employed NHS SBS and he was on the board of NHS SBS.

NHS SBS has now lost the contract to deliver medical correspondence (5).

Jeremy Hunt was forced to answer questions in parliament on Tuesday about this scandal (5). He didn’t go willing to parliament, instead he had to be forced to answer questions by the Shadow Health Secretary, Jonathan Ashworth, had petitioned the Speaker of the Commons to hold urgent questions on this (5). Hunt was accused, during these questions, of being “asleep at the wheel” by Labour MP Clive Efford (5).

Answering questions Hunt justified not originally telling parliament and the public about this scandal because he said if he did GP practices would have been “overwhelmed” by calls from worried patients (5). This is the opposite of what he called for after the 56 Dean Street email breech (1). Hunt did admit that the Department of Health’s oversight of NHS SBS was not good enough (5), but this should fall directly on his shoulders because he was the only Department of Health person sitting on NHS SBS’s board. Will he be held directly responsible for this complete failure? Who will he answer to for this?

Hunt also told MPs the investigation had not found any patient harmed by this paperwork backlog (5), but how could he claim this? NHS England’s investigation into this disgusting scandal will not be completed until the end of the end, and correspondence not sent to GPs included cancer test results and treatment plans that included changes to patients’ medication. Again Hunt has made claims that the evidence does not support.

When I first heard about this scandal I can’t say I was surprised, but I was deeply sickened. Again this was a scandal were a private company, contracted to work for the NHS, was putting profit before patient care, and exercising the most disgustingly low clinical governance. What sickened me most was how deeply Jeremy Hunt was involved in this and how he tried to cover it up. Yet again Hunt has shown poor judgement and even poorer leadership.

This isn’t the first time Hunt has failed and failed to such a high degree. I have worked for the NHS for nearly 30 years (I worked in the NHS several years before I started my nurse training) and I have watched a large number of extremely poor Secretaries of State for Health bungle their way through the NHS but Hunt seems to be the worst in my living memory. Whenever there’s a problem or scandal in the NHS Hunt’s leadership repeatedly fails whatever is needed. His reactions show that he just doesn’t understand the problem (8), or he ignores the problem (9), or his actions make the situation worse (10), or he is very quick to pass the blame (11), or worst of all he spills forth untruths (12).

Why is this completely incompetent man still in such an important job?

The answer is simple, the NHS is such a low priority to Theresa May. Her actions since becoming Prime Minister attest to this, starting by not sacking Hunt from his post.

Our Secretary of State for Health is incompetent and one of the worst in living memory, but his repeated failure in the role only bares testament to the poor quality of the leadership of the Prime Minister who keeps him in this post.

Drew Payne

P.S. NHS SBS’s twitter address is @NHS_SBS, why not tweet them with your feelings on how they managed this scandal? I did.

Wednesday 21 June 2017

Silent Prayers

Bert (not his real name) was a patient on my District Nurse team’s caseload, he needed daily visits to help him take his medication, and he was one of my favourite patients, even though we’re not supposed to have favourites. He and I could talk for far longer than the time I was allocated to his care. Bert was a great believer in capital punishment, not just for murder but for a whole range of different crimes. Every fibre of my being is opposed to capital punishment; no matter how severe the crime the state does not have the right to enact vengeance to such a degree, because capital punishment is no more than vengeance. Yet Bert and I never argued about it. Every time he started talking about capital punishment I’d just quietly change the subject.

My job there was to provide Bert’s nursing care needs, not to argue with his options or to try and change them. I have many patients with whose views I do not agree, I am a very opinionated person (Just read some of my previous blogs to see that) but when I am working as a nurse it is not my place to be forcing my opinions onto my patients; I am there to be their nurse not someone to challenge their views and to even call their views wrong. I would like to do that, so many times I would like to do that, but I just cannot.

This isn’t just my opinion, it is also part of my professional code of conduct (1). Section 1.5 says I must “respect and uphold people’s human rights” (1). The Human Rights Act 1998 lists 18 articles that make up our human rights (2), Article 9 is Freedom of Thought, Conscience and Religion and Article 10 is Freedom of Expression. How can you say you respect someone’s human rights and in the next breath tell a person that their views and beliefs are wrong?

Last year Sarah Kuteh, a nurse at Dartford and Gravesham NHS Trust, was dismissed for what appeared to be expressing her Christian believes (3). She quickly took to You Tube to defend herself (4), saying that she had “discussions” with patients when she asked them what their religious beliefs were. The tabloids were quick to pick up her story. The Daily Mail called it a “persecution of Christians” (5), the Telegraph claimed she was sacked for “offering prayers” (6), “How could telling anyone about Jesus be harmful?” the Mirror asked (7), and the Daily Express claimed she was sacked for offering to pray with fellow Christians before surgery (8). She even appeared on This Morning television program defending herself (9).

Not unsurprisingly Sarah Kuteh took her case to an Industrial Tribunal (10), backed by the organisation Christian Concern (11). Her tribunal was earlier this year and out of it came some very uncomfortable truths.

Sarah Kuteh was open about the fact she’d been working in a pre-admission clinic, and part of her role was to fill out a pre-admission questionnaire with patients. What she wasn’t honest about was when the patient said they had no religious beliefs, in answer to only one question in the questionnaire, then she would preach at them about her own beliefs (12). She told one patient his chance of surviving cancer was better if he prayed (13). She questioned another patient so intently that he was left feeling shaken (14), she had constantly questioned him about his beliefs, offered him a bible and wanted him to join her in singing a psalm. He felt patients shouldn’t have had to face such religious preaching when they were in such a vulnerable position. Another patient felt very awkward after she quizzed him about what he thought Christianity was (14). She implied to another patient that they would be cured if they believed in God (15). Yet another patient complained that she spent more time talking about Christianity than she did on the pre-admission questionnaire (13). None of these patients had said that they asked her about religion, all of them complained that she had preached at them, forcing her beliefs onto them.

Dartford and Gravesham NHS Trust had received eight complaints about Sarah Kuteh, all complaining that she’d preached her beliefs at them (14). After the first five complains Sarah Kuteh was disciplined for her behaviour, this was chaired by the Trust’s General Manager of Medicine and Sarah Kuteh received a Formal Warning (14). This was not the story she implied in her You Tube video (4). She didn’t heed this warning because there were three more complaints about her behaviour after she received it. This behaviour lead to her dismissal, after a formal disciplinary hearing chaired by the Trust’s Executive Director of Nursing and Quality (14). The seniority of the people chairing her hearings is testament to how serious the Trust took her behaviour. Anyone who works in healthcare knows that patients are reluctant to complain, for these eight complaints about her how many other patients did Sarah Kuteh leave upset or distressed by her behaviour?

The Industrial Tribunal did not find in her favour, they found for her employer and that she had been fairly dismissed (15). With the weight of evidence against her how could they have found in her favour?

If Sarah Kuteh had been preaching a far right or far left wing message at patients, if she’d been preaching hard line atheistic views would there have been the media circus around her dismissal as there was? A very well oiled Christian propaganda machine kicked in with her case, getting out her message that she had been dismissed solely for standing up for her beliefs, the media coverage of this case is the evidence of this. But this case isn’t about Christianity or religion or even beliefs.

This case was never about religion. It related to professional nursing responsibilities, behaviour and conduct in a public facing role and position of trust.  Dartford and Gravesham NHS Trust Spokesperson (15).

This case was always about someone forcing their views on other people, people at very vulnerable times in their lives. This case is about someone forcing their views on other people and ignoring those people’s own views and wishes, discrimination of the worse type. This is about a nurse ignoring her responsibility to nurse her patients so that she could preach her views at them. People facing surgery can be very vulnerable, add to that all the worries and concerns that come with a cancer diagnosis and you have extremely vulnerable patients.  Sarah Kuteh seemed more interested in promoting her own views than meeting her patients’ needs. At times her behaviour seemed to border on bullying.

As nurses we are required to deliver non-judgemental care for our patients (1), how can we do that when we tell our patients their beliefs are wrong and our beliefs are the right ones? This is the opposite of non-judgemental.

Drew Payne

 This was the Dartford and Gravesham NHS Trust full response to Sarah Kuteh's dismissal

Update (17/08/2018):

Following her dismissal, Sarah Kuteh was referred to the Nursing and Midwifery Council (NMC), the nursing regulators, over her actions (16). The NMC tribunal imposed a four-month conditions of practice order on her, which meant that she could only practice as a nurse when under the close supervision of a senior nurse (16). This might not sound much but in reality this was a tough sanction. She could not perform the simplest of nursing tasks unless a senior nurse was observing her. As nurses we are independent practitioners, we are responsible for our own actions and work within the scope of our practice. As a qualified nurse, to have to return to the status of a student nurse were all our actions are supervised will feel stifling and restrictive. But Ms Kuteh behaved extremely unprofessionally, acting in a very discriminatory way and forcing her views on patients and ignoring the patient’s own views.

What was worrying was that Ms Kuteh was supported by the right-wing Christian organisation Christian Concern at her tribunal (16). This was the same organisation that was supporting her after her dismissal, with all the propaganda that painted her as a “victim” and spreading so many untruths about really happened leading up her dismissal. In a statement, Christian Concern told the panel Ms Kuteh conceded that giving her own Bible to a patient had been “going too far”, and that she should have used a Bible from the hospital chaplaincy instead (16). If this Sarah Kuteh’s insight into her behaviour then I am very disappointed that she has not learnt anything from what happened to her. But this was a statement from Christian Concern on her behalf so I am not certain how reliable and true full it is, does it even represent her views?

What was really surprising was the professional attitude of the NMC to her actions. They took seriously her actions and how she had acted unprofessionally, and then they imposed an appropriate section on her. They didn’t strike her off the register of nurses, which would have been completely over the top, and neither did they ignore her actions. For once the NMC has behaved appropriately. Is this a new trend with the NMC? I am not sure, my latest blog is about another nurse treated very shamefully by the NMC (17).

Drew Payne