The partial suspension of consultants and medical staff is being considered as an alternative to the present suspension procedures, junior health minister Baroness Hayman announced in the House of Lords last week after peers had criticised “injustices” suffered by suspended doctors.
Rather than take away someone’s professional status and way of working completely, Lady Hayman envisaged a retraining, and specifying what sort of work was done. The government’s chief medical officer will produce proposals for consultation to address poor clinical performance, concentrating on presentation, early recognition, and problem resolution. Lady Hayman admitted that the NHS procedures had proved inadequate, and the government had initiated a review, which she hoped would be completed within a few months (BMJ 1998:317:1325). The BMA’s evidence would be particularly useful, the minister said. It was an irony that the present regulations did not always achieve the high standards and public protection that were sought. She also wanted to ensure that doctors were treated fairly, humanely, and with the minimum of delay.
Baroness Knight, the former Conservative MP who raised the issue, said that hospital doctors in Britain could be suspended from duty often on trivial charges and left on the rack for years. Their rights to justice under international human rights laws were totally ignored. Of 201 doctors suspended since 1986, only 25 were judged to have acted wrongly. Of the other 176, some had to wait years to be found innocent. The cost to the health service was estimated at £100m.
Two medical peers, Lord Rea and Lord McColl, suggested that if a consultant was criticised for the performance of only one type of operation an agreement should be reached for that particular operation to be excluded from his or her repertoire until the matter was sorted out.
Health Alert 2000 launched
The Doctor Patient Partnership (DPP) has launched Health Alert 2000 to bring together all the organisations involved in delivering health services over the millennium celebrations.
The DPP has invited health related organisations representing patients’ groups, accident and emergency, hospital, general practice, nursing, pharmaceutical, and out of hours medical services to join a task force. This will develop information for health professionals and the public on what services are available, who to call for advice, and tips on getting the best out of the services, and encourage the responsible use of health services over the extended holiday period. 
The DPP’s chairman, Dr Simon Fradd, said, “The millennium bank holiday will result in more people being away from their homes than ever before. In the event that they need medical attention, that is neither the result of an accident or emergency, they should contact a local pharmacist, NHS Direct, or a local GP. They should not go to a local hospital.”
NHS crisis caused by gradual attrition
The crisis in the health service and the reduction in morale are mainly the result of the long term attrition in the service, particularly the acute sector, Mr Rab Hide told the BMA Scottish council last week.
Mr Hide, who is a consultant neurosurgeon in Glasgow and one of the council’s deputy chairmen, said that some of the original bed closures may have been justified but “we have now crossed the divide of increased efficiency.” The position was not acute, it was chronic, and the profession and the health department had to develop a plan of action over a period of time. The situation was not new; it was a combination of reduced resources and beds and unfilled posts. Dr Robin Balfour, a GP adviser to the Western General Hospital in Edinburgh, said that last winter one of his patients, who had had a heart attack, was treated and fed for two days in the accident and emergency department and believed that that was normal. The hospital had to close a ward for three weeks; it then took three months to recruit the staff to reopen it.
Mistakes have been duplicated
“We are just seeing the reduplication of previous mistakes,” Dr Gus Ford, a consultant paediatrician in Glasgow, pointed out. The Scottish Office kept talking about an extra £22m; when were the health boards going to disburse any of this to the trusts? Another clinical director, Mr William Hadden, a consultant orthopaedic surgeon in Dundee, said that a 100% bed occupancy was a disaster; beds must be reopened as a safety measure.
Many of the speakers at the meeting emphasised that the service was only just coping. They were critical of the health minister’s reported statement in an interview that the Labour party was providing a health service where patients were in charge and would get what they wanted when they wanted. Representatives of the BMA were due to meet the minister, Mr Sam Galbraith, the following day, and the council hoped that he would be told that such remarks did not help morale.
Winter pressures impact on junior doctors
Many junior doctors are at breaking point because of the crisis in the health service, according to the BMA’s Junior Doctors Committee. It points out that the excessive workload combined with the long hours already worked by junior doctors mean that patients may be at risk.
The JDC has found examples of the increased workload in different regions. In Cheltenham two doctors in general medicine worked a 24 hour shift, admitting 35 patients, with only an hour’s sleep. They then had to continue working until 3 pm the following day to treat ward patients. At the Sunderland Royal Hospital junior doctors admitted 112 patients in 24 hours; the normal number is about 70. A junior doctor working in intensive care in a Huddersfield hospital had to turn down two patients from his own hospital and three from other hospitals and managed only 45 minutes’ sleep.