Scape-goating Dr Hadiza Bawa-Garba

I referred to the NHS Newsday post on the left in a comment on my post of Carillion. It should give us all pause for thought and check any enthusiasm for contracting out even minor services. Here it is.

It’s not often I find myself agreeing with Jeremy Hunt, whom I suspect of being the smiling face of NHS privatisation – and it appears I’m not alone (Stephen Hawking and others accuse Jeremy Hunt of backdoor NHS privatisation) -, but I agreed with him when he tweeted that he was “concerned” about the implications of the case of Dr Hadiza Bawa-Garba. The General Medical Council may have been technically correct in upholding the rulings of the court, but if the original court did not hear all the evidence surrounding the tragic death of Jack Adcock, particularly about the systemic failures in the Royal Leicester Infirmary and the health trust then the question is whether justice was done in the first place.

I understand the boy’s mother wanting someone to be held responsible, but it seems unlikely that the right person was found guilty. The fact that Dr Bawa-Garba’s fellow doctors have crowd-funded over £200,000 to remedy what they fear is a miscarriage of justice which could affect them all is telling. An orthopaedic registrar explained their feelings on their Facebook page.

“The Orthopaedic Registrar

26 January at 22:17 ·

“So yesterday, a highly regarded junior doctor was struck off the GMC register after the GMC successfully appealed against the judgement of the Medical Practitioners' Tribunal Service.

“She was struck off because a child died. And that is a terrible thing. But as a tribe, we junior doctors are horrified. Why? Because this junior registrar, just back at work after more than a year off for maternity leave, has been scapegoated for system failings.

She was doing the job of two registrars, and the consultant who was supposed to be supervising her was in another city. So she was covering six wards and dealing with medical issues on the surgical wards, plus taking referrals and calls, with one FY1 (foundation year 1 doctor) and one SHO (senior house officer), both of whom were new to paediatrics. She was moving as quickly as she could, and working as hard as she could. She was no doubt anxious to make a good impression in her new post. She had had no trust induction. The blood reporting system was broken. She had missed handover because of a cardiac arrest. She mixed up two children and confused one DNAR (do not attempt resuscitation) child with another who was not - note the nurses had swapped the two patients beds around, and not told her. Concerns about the child deteriorating were also not raised to her by the nursing team. The child was given a medication for blood pressure, the last thing you would want for an unwell, dehydrated child, which she had quite rightly not prescribed, and then they arrested. How is this manslaughter? How she was then treated by her senior colleague and by the police when they arrested her 18 months later (it's not polite or reasonable to keep a breastfeeding mother away from her two-week old baby for seven hours while questioning her and any statement she signed at that time must be considered under duress) is another, horrifying issue.

“So why are we horrified? We have all been here. We have all been that doctor who is doing the job of more than one person, where our boss is not helping, and we are hours behind in what we need to do, everyone is annoyed with us, and we are annoyed with ourselves because we know our patients are not getting the care they should have. We have all been desperate to eat, and go to the toilet, and just sit down and do nothing for five minutes. We have all mixed patients up. So all of us look at this and think: 'This could me'.”

There’s an impressive professional assessment of the affair by a number of paediatric consultants: Account of GMC action against Dr Bawa-Garba.

As a mere layman, it seems that the hospital administration which permitted such pressure to be placed on a comparatively junior doctor’s shoulders have some answering to do. It appears to me that the sad sad death of a precious boy with Down’s Syndrome was caused by something more than one doctor’s human error. It involves poor management within the hospital, the irresponsible stretching of resources and, ultimately, the restricting of those resources by central government for its own socio-political purposes. That the individual doctor at the fulcrum of the system which caused her to make a mistake which proved fatal should bear the whole blame is a reprehensible example of scape-goating – a habit which it seems is becoming increasingly popular. There was once a time when the man at the top would accept responsibility for things which went wrong on his watch.

In the words of a searing article from the right-wing Bow Group,

“The outcome is to inflict a penalty on a single individual; to destroy an otherwise flawless career on this chain of events should chill every professional and indeed any member of the public. We all have a right to know our accuser and in this case it was clearly not the GMC as a whole. It has put back accountability of healthcare at least a decade by returning to the culture of shame the system by blaming the doctor. It was this refusal to see systemic failures that led to so many deaths in Mid Staffs and Morecambe Bay among others and has led in a much less publicised manner to a cruel and needless assault on the mental health and financial viability of many doctors, for some of whom it was too much to survive.” 

Finally I recommend an excellent post by Dr Rachel Clarke, a palliative care doctor who knows the pressures of being a junior hospital doctor in the NHS. She expresses the dangers of the case far more clearly than me. The Hadija Bawa-Garba case is a watershed for patient safety.

Bat and bird norms

This morning before dawn I woke up to hear our nocturnal robin singing quite energetically. I guess it’s not perversity that makes him or her tweet away in the night. I’ve always assumed it was the result of his/her territory being over the road from one of those orange sodium street lights. However I believe that this habit predates cars and electric lights. He's not abnormal. He may not, after all, have been corrupted by our modern culture.

It put me in mind of a story I’ve just come across in a blog article, Turning a Unicorn into a Bat: the post in which we announce the end of our marriage. It's a long and moving article about a gay husband and straight wife divorcing after a long and happy marriage held together by their shared faith. Lolly, wife to Josh, summarises the story like this. “Stellaluna by Janell Cannon. It’s a charming story with beautiful illustrations.

“Stellaluna was a tiny baby fruit bat. One day, Stellaluna’s mother was out flying with Stellaluna, when suddenly an owl attacked them. The owl knocked Stellaluna out of her mother’s grasp, but luckily she ended up safely in a bird’s nest. Stellaluna was allowed to stay in the bird’s nest as long as she acted like a bird. She ended up giving up all of her bat ways—she slept at night, ate bugs, and never hung upside down because Mama Bird told her that those things were wrong. Stellaluna tried very hard to be a good bird, even when it was very difficult.

“One night, Stellaluna ended up finding her bat family who convinced her that her bat ways were not wrong for her—that they were part of who she was. Maybe they were wrong for a bird, but not for a bat. They fed her delicious mango and taught her to fly at night and she realized she never had to eat bugs again. When she finally accepted her identity as a bat, she found happiness she never knew.”

If you want to hear the whole story being read, you can hear it here: Stellaluna read. Full life must include being the way you were made, mustn't it? When we dictate that someone should be like us, we run the danger of killing the real them.

For whom the bells toll

Courcieux (Wikipedia fr)

I’m really annoyed at Carillion. I don’t know where they got their name from, but it’s very close to the sound I first heard camping with our family in the pretty village of Courcieux in the Vosges Mountains. From the campsite we could hear the “carillon” of bells from St Mary of the Assumption’s church, playing a hymn. That was a great holiday.

However, my annoyance can be as nothing to the desperation of those tens of thousands affected by the collapse of Carillion, the second biggest construction and services company in the country – not only those employed directly but also those working for its subcontractors. Small and medium-sized companies face bankruptcy. Workers are likely to lose jobs and pensions, facing insecurity for themselves and their families. Meanwhile the bosses of Carillion, perhaps seeing the writing on the wall as far back as 2016, tried to ring-fence their bonuses and their pay, so that despite the collapse of the huge firm they ran they would continue to receive their 6-figure salaries for another nine months. Carillion bosses rewards (The Week)

And it appears that the function of the company (and others like it) was merely to tender for government contracts, at the lowest possible price to undercut other bidders, and then to subcontract the work to smaller companies which they squeezed in one way or another such as delaying payments. On the way they bought up potential competition such as the old family construction firms, McAlpines and Laings, thus reducing the field of those available for tendering. So what in effect did they do? To my amateur eye it seems they acted as middle men between public authorities and private contractors, a role once carried out in-house by central and local government – and of course they creamed off profits for the directors, management and shareholders. A prodigal waste of public money.

Photo: The Week

I watched Prime Minister’s Questions today, hoping to see some depth of sympathy at the impending flood of human misery which the Carillion collapse is about to unleash and some real anger at malpractice that led to it. But not at all! I appreciate that the government did not “manage” Carillion, as Mrs May pointed out, but their due diligence must be up for question. But what I saw as she talked about it was precious little genuine concern from the front bench, just nods – but of course they are not about to lose their livelihoods. And there was no recognition that the Carillion affair is a stress-test for the Private Finance Initiative (PFI) and it has revealed its fatal flaw. Private profit is no partner for public works.

It’s to be hoped that this Carillion carillon is tolling the death knell of the whole ill-conceived PFI project, and ringing in a new dawn for the tens of thousands of our neighbours whose future is now so uncertain.

Books of grief

I’ve just finished an excellent short book which we were lent. It’s One for Sorrow by Alan Hargrave, who is now retired as a vicar.

It “relates the story of the loss of 21-year-old Tom to cancer, and how his family lived through the aftermath. When Alan began writing the memoir, he believed it would be about his son’s illness and death. He soon realized, however, that he was recording his own painful journey through the ‘valley of the shadow’, as a father and as someone responsible for ministering to others in similar situations. His core beliefs were challenged and his perspective on life changed.

“Now retired, Alan is passionate about the capacity we all have to grow through adversity and, like our crucified God, rise up from pain and death to live and love and laugh again.

Inspired by the classic poem, and beautifully and poignantly written, this memoir is destined to become a classic.” So goes the publisher’s (SPCK) blurb.

My reaction was relief that Mr Hargrave is searingly honest – about the pain, the despair and his doubt, and indeed his loss of faith during bereavement. It’s refreshing to hear a vicar reacting to a verse often trotted out as comfort to the suffering: “It’s a load of bullshit.” None of the usual anodyne platitudes cut through the pain of losing a son. In the end we are reminded that in Christian thought we have a God who has been there too.

What took me by surprise was the incident that reduced me to tears. It wasn’t Tom’s death, harrowing though that is; it was Mr Hargrave’s farewell to the church where he’d been vicar to become a canon at Ely Cathedral. On reflection, I suppose it was a sign of how affected I was by my enforced retirement, though I didn’t feel it at the time. The writer describes how three years after Tom’s death, in the Ryder Cup, Europe “creamed” the USA. “Yet, the following week I feel terrible, plunged into a deep, dark place of depression and anger. I cannot understand why. Then I remember why. What happens the week after you win the Ryder Cup? Answer: your son dies.” Tickets to see the Ryder Cup at the Belfry were Tom’s last present to his father, who loves playing and watching golf. Maybe I miss being a vicar more than I admit.

This is the second book I’ve read recently by a parent who lost a son to cancer. The first was ‘End to End’ – with love by Lorraine George, about her son Rob. That was a similarly harrowing account of an equally painful dying. They are quite different books about individual families’ experience; what they have in common is ruthless honesty. And, I suppose the truth is that no two deaths are the same. However, it may be comforting for others going through similar bereavements to know that they are not alone.

A Happy New Year

Well, my nightmare hasn’t actually happened. We’re still here, stuck in to 2018.

A new year! I’m not a great one for New Year’s resolutions, mainly because I’m so rotten at keeping them. However, I think this year I might have a try. My resolution is to “but no buts” – of course, the spelling is important! To butt a butt is entirely different, and something I have no intention of doing that either, even if I could.

I guess you’d recognise the sort of thing I’m talking about. Someone says, “I’m not a racist, BUT…” Or “I’ve nothing against her – I’m sure she’s a nice enough person – BUT…” And the bit that comes after the BUT always contradicts the bit before. It’s prejudice disguised as politeness. In fact it’s sheer dishonesty.  

An uncomfortable test is to reverse the sentences. Some B&B owners in the 1960s put signs in their windows reading, “No blacks, no Irish, no dogs”. They might have claimed they weren’t discriminating. However, put it the other way round and the truth is clear: “I don’t want any of them in my B&B; therefore, I AM a racist.” Or, “You know, she’s one of those immigrants who take all our jobs; so I DO have a lot against her.” We shouldn’t kid ourselves with the “I’ve nothing against” lie. But me no buts!

Shakespeare never said, “but me no buts”, as prime minister, Jim Hacker, wrongly thought. It came much later. However much earlier Jesus did say, “Let your ‘yes’ be ‘yes’, and let your ‘no’ be’no’.” In other words, don’t dress up what you say in disguise. Say what you mean. But that isn’t an excuse for being rude or hurting others. Because he also said, "Do to others whatever you would like them to do to you.” And he said we’ll be judged by our careless words. That means, whatever we utter matters hugely. Ouch!

So in 2018 I’m going to try to follow the three gold tests my mother told us children to ask before we spoke. “Is it true? Is it kind? Is it necessary?” Happy New Year, everyone.