Are things looking up for doctors?
Who won the war of Rose's head? Both Tory and Labour politicians feel that they have scored vital points in what has perhaps been the most crucial recent battle over the most crucial public service in electoral terms. The war of Rose's head is the new war of Jennifer's ear—which erupted in 1992 when a Labour election broadcast used the case of a five year old girl who had waited months for an ear operation to highlight problems in the health service. Although Jennifer Bennett was not named in the broadcast, her case notes were leaked, and Labour stood accused of sacrificing patient confidentiality for party political purposes. The Tories went on to win the general election.
The war of Rose's head concerns the case of 94 year old Rose Addis. Under the headline “Abandoned in casualty,” London's Evening Standard reported on 21 January that Mrs Addis had waited three days at the Whittington Hospital “caked in blood” after “gashing her head in a fall at home.” In many ways this was a straightforward human interest scoop—another example of a failing NHS—by a right wing local paper which goes in for NHS shock horror stories (BMJ 2001;322:562 and BMJ 2000;321:1538). The report appeared complete with a picture of a confused looking Mrs Addis, which had been taken by her grandson, freelance photographer Jason Gold.
Mrs Addis's family had contacted the paper to complain about her treatment. In deciding to go to the press, had they forfeited Mrs Addis's right to confidentiality? The government clearly thought so. When Conservative leader Iain Duncan Smith raised the case at prime minister's question time last week (he is Mrs Addis's daughter's MP) without first having checked his facts with the hospital, prime minister Tony Blair was ready, with a letter from the Whittington, to refute the complaints. Their debate sparked off a tangled web of claims and counterclaims about the facts.
The Whittington's medical director, James Malone-Lee—who, to the delight of the right wing press, was revealed to be a Labour activist—took exception to Mr Duncan Smith's remark that Mrs Addis would have received better treatment “if she was a dog.” He demanded an apology from Mr Duncan Smith for “kicking us around the floor of the Houses of Parliament.”
And in saying that he touched on one of the real difficulties for doctors in cases of this kind: how to answer public criticism without being accused of breaching patient confidentiality? In the war of Rose's head, Downing Street decided it had to state its position. After its publicity machine briefed journalists that Mrs Addis was “confused” and also raised confidential medical details about two other patients whose cases had been raised by the Evening Standard, Mr Blair went on Jimmy Young's show on Radio 2 to defend his actions. He said: “We did not release any information that wasn't already in the public domain, either through the relatives who had spoken to the media or in the public statements from the hospital.” He added: “I am afraid we are not going to have a situation where doctors and nurses are abused in this way without the other side of the story being given.”
The Guardian believed that the government and the hospital acted appropriately. Its editorial of 25 January said: “If a patient runs to the media with allegations against a hospital, NHS guidance issued in 1996 rightly allows medics and managers to correct any misleading comment.”
The Daily Telegraph wasn't having any of this. “The lesson of this case seems to be that any patient who now dares go public in complaining about treatment received at the hands of the NHS may be trashed by the hospital and government in combination.”
The Daily Mail went one further. Its columnist Stephen Glover wrote a stinging criticism of the government, in an article headlined: “Stalinist stifling of the truth.”
The right wing press has been attacking the NHS for months. Mr Blair clearly decided that the war of Rose's head had given him an opportunity to hit back. On Friday, he made a speech spelling out Labour's commitment to doctors and nurses.
And this is one of the most striking aspects of this case—how it has forced the government into a volte-face over its public attitudes to doctors. Instead of openly attacking them in a bid to appear the champion of the consumer, Labour is now cosying up to them. Daily Mail columnist Melanie Phillips didn't miss this trick: “Until last week's uproar over the Whittington Hospital, the government had identified the medical profession as public enemy number one in New Labour's version of the class war.”
Maybe, then, in the long run it will be doctors who will emerge the victors in the war of Rose's head. Perhaps they will cease to be Labour's whipping boys and last week's bitter row over patient confidentiality will increase public understanding of the difficulties doctors face whenever there is a complaint about a patient's treatment, and they cannot answer back.
Figure.
How the Standard first reported the case