A senior doctor at the centre of the row about the elderly patient Rose Addis has explained why he felt duty bound to defend accident and emergency staff from political spin and name calling.
In an interview with the BMJ, Professor James Malone-Lee from the Whittington Hospital, north London, spoke of his horror at seeing the Evening Standard story last week under the headline “abandoned in casualty.” The article claimed that Mrs Addis, aged 94, had been left unwashed and “caked in blood” for almost three days because of bed shortages.
Professor Malone-Lee, who oversees the emergency department as medical director of the trust's medical directorate, said that he had investigated his legal position with trust managers before speaking out. And he was careful to stick to events already in the public domain to avoid breaching patient confidentiality.
“I interpreted this story as a gross infringement of patient confidentiality. At the same time I'm very conscious that health service staff are subject to a lot of public criticism,” said Professor Malone-Lee.
“In these circumstances I was very, very well informed of the facts, and I was extremely confident that from top to bottom the staff had behaved impeccably and performed to very high standards.”
Professor Malone-Lee complained that hospitals often take the attitude that “an apology never did any harm”—which he denounced as “cynical” and smacking of “sophistry.”
“You get trusts apologising when their staff have done absolutely nothing wrong,” he said. “We have spent the past decade working very hard on an NHS complaints procedure. We need to be far more outspoken with criticising families, the press, and politicians for hijacking that system.”
Professor Malone-Lee met the Addis family privately last Thursday to discuss the concerns raised in the Evening Standard. The trust has received no formal complaint from the family.
Although Professor Malone-Lee's history as a Labour party activist was dragged up in the row, he is unfazed by such personal flak. “A lot of health professionals have ended up a bit lickspittle under the weight of all the criticism [of the NHS],” he told the BMJ. “If health staff behave impeccably and are attacked in public, as their manager you must defend them and accept that you'll take the consequences.”
The Addis case has divided opinion over how trusts should respond when families bypass the NHS complaints procedure by going to the press. Dr Nicola Glover-Thomas, a lecturer at Liverpool Law School agrees with Professor Malone-Lee's stance in publicly protecting his staff. “The complaints system has been hijacked—it doesn't make doctors and nurses feel particularly safe—already there's a huge fear of litigation,” she said.
But Paul Barrow, researcher at the Institute of Medicine, Law and Bioethics in Manchester, believes that because hospitals are delivering a public service they should be ready to take public flak. The Whittington should have resisted pressure to talk to the media about individual cases—managers should have written to the family privately rather than direct to the newspaper, he said.
“You shouldn't ‘sink’ to their level. If they want to send the letter on to the newspaper, that's up to them,” said Mr Barrow, a former trust chief executive himself.
The NHS Confederation is also concerned that official channels have been sidelined during the row, limiting the hospital's legitimate right to defend itself and resolve the issues raised.
“The proper place for this to be dealt with is through the NHS complaints procedure,” said acting chief executive Nigel Edwards.
The Addis case has caused a political row, raising issues over patient confidentiality and a hospital's right to protect its employees' good names. Since the story broke on 21 January, Conservative leader Iain Duncan Smith has demanded a public apology from Tony Blair over the “disgusting” way the 94 year old great grandmother had been treated.
Tony Blair has backed staff throughout the row, and last Friday he signalled a more conciliatory tone towards the NHS with an emollient speech on public services.
“To the papers, a real life NHS story is today's frenzy and tomorrow's fish and chip wrapper,” he said, in what could have been an elliptical reference to the Addis case. “To the nurse and doctor it is their reputation, their integrity, their life today, tomorrow, the next day.”
Last week, the chairman of the BMA, Dr Ian Bogle, wrote to the leaders of the main political parties asking them to sign up to three ethical principles—that politicians should divulge information about a patient's treatment only if they have that patient's consent; that they should check the facts before raising an issue; and that they should make the NHS complaints system transparent and robust enough to be the first port of call for concerned families.
“We need to debate [the NHS's problems] in a mature and measured way—highly charged political knockabout cheapens the process,” said Dr Bogle. (See p 306.)
Figure.
PETER JORDAN/PA
Professor Malone-Lee criticised trusts that apologised needlessly