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HomeCulture Wars‘It’s not about blaming the NHS’. Why not?

‘It’s not about blaming the NHS’. Why not?

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A GERMAN doctor saved my life when I was just over a year old. A joyous first family Christmas in Germany ended in my catching an infection from my cousin, sepsis and ICU. The doctor gave me the best possible chance, and I owe him much. Sadly many of my subsequent encounters with doctors and nurses in the NHS have been the opposite. I was assaulted by an NHS doctor when I was 14 and desperately unwell with a complex mental illness. However it’s never been as ‘straightforward’ as dealing with the one horrific incident. Many months of bullying and threats preceded that assault. Subsequently I have survived more often despite and not because of NHS medical ‘care’. It is a great source of pain to me that I now approach all medical professionals with distrust, even fear.

The prevailing British view of ‘our NHS heroes’ and ‘our amazing NHS’ could not be further from mine. The reverence of many Brits for their healers knows no bounds. This even extends to when their health or that of a loved one has been mishandled and damaged, sometimes even resulting in death. Just recently I read a report of the cancellation of vital scans, due to NHS Covid policy, for a boy of 15 with a brain tumour. The mother did not blame the NHS or doctors for missing his clear symptoms earlier on. Heartbreakingly this poor lady blamed herself for not being ‘pushy’ enough! My mother encounters this regularly in her job as a vicar looking after eight rural parishes. Even when an avoidable death has occurred, people are reluctant to complain about their medical treatment. ‘I’m sure they did their best,’ is the predictable response. I am often contacted privately on social media by those who want to tell me their stories of awful medical experiences. Telling me is safe because they know I will accept and empathise rather than judge or dismiss their NHS heresy. A Twitter follower shared a link to the Oliver McGowan Mandatory Training in Learning Disability and Autism video. Oliver’s brave mother tells the heartbreaking story of a catalogue of errors and mistreatment that led to her son’s death. It shocked me that even in a case where clear blame could be ascribed to individual physicians, she said: ‘It’s not about pointing fingers, it’s not about blame.’ But isn’t it?

It’s actually quite rare for people to make an official complaint against the NHS, even if they do feel wronged. The intrepid who do embark on the official complaints process find their path beset with obstacles that can feel designed to make you give up.

‘Scandalous and shameful. If you’re looking for an outcome and you’re emotionally stressed, don’t waste your time with these corrupt individuals.’

This is a Trustpilot review of the Parliamentary and Health Service Ombudsman (PHSO), the final arbitrator of complaints against the NHS and its employees. It is typical of pretty much every review. Undeniably, people who have had bad experiences are more likely to leave online feedback. However this near-universal fury and distress suggests a fundamental problem.

In 2016, after a scandal provoked a change of Ombudsman, Patients Association chief executive Katherine Murphy said patients had ‘been failed by the PHSO for too long’. Yet the statistics, as well as patient feedback, suggest nothing has improved. In 2018/19 it was found that the PHSO upheld just 2.4 per cent of all the complaints submitted. (If resolution without investigation is taken into account this figure rises to 20 per cent. However that ‘resolution’ is most often no more than a simple apology.) This is a decline from the already paltry 3 per cent in 2016/17 and even further from 4.7 per cent in 2015/16. The Ombudsman is theoretically held to account and monitored through the submission of annual reports to the Public Administration and Constitutional Affairs Committee (PACAC), a parliamentary committee made up of cross-party members. However PACAC can’t review individual complainants cases and the Ombudsman’s verdicts can’t be challenged. Therefore the Ombudsman is not accountable in any meaningful sense. The only recourse available to a complainant is judicial review, a path that precious few citizens have the means to make use of. One rare example of a successful High Court challenge in the High Court was brought by two GPs in 2018. In the ‘Miller & Another v Health Service Commissioner for England’, the judgement criticised all aspects of the investigation process including failure to consider all the evidence and an inadequate review process. Importantly, it highlighted the ‘lottery’ of the ‘clinical adviser’ selected for each case. When the PHSO investigates and scrutinises a case it uses but a single clinical adviser whose words are Holy Writ. Therefore one person’s opinion is basically all that matters and it is an NHS doctor reviewing one of his or her fellows. The NHS acts as its own judge and jury.

‘It doesn’t matter what I say or what evidence I present you will simply stick to your narrative that bears no relation to the truth. I am powerless.’

These are my own words, taken from my response to the PHSO’s final report on one of two complaints I submitted in late 2018. I had already gone through a long draining process to get to that stage of despair. This involved first complaining to the hospital, then the NHS Trusts, several labyrinthine forms and some rather interrogatory face-to-face meetings. That smorgasbord was completed by an intimidating phone call from someone at the relevant NHS Trust trying to dissuade me from taking things further. Both complaints centred around the absence of psychiatric assessment and serious negligence in both psychiatric and physical healthcare. My wounds from the medical malpractice I suffered were actually deepened by the complaints process which I had hoped would bring some healing and justice. The fact that my records were lost, my complaints muddled up, resulting in huge delay, and that my caseworker frequently went AWOL feels inconsequential now because the whole process was a whitewash anyway. The first question asked of the PSHO’s clinical adviser assigned to my case was: 

‘Is there any evidence that Ms Cerratti should have been assessed by a psychiatrist during her admission/time as an inpatient?’

The Ombudsman actually questioned whether it is essential for someone with severe psychiatric problems to be assessed by a psychiatrist whilst in hospital! This gives a fair impression of the whole tortuous cover-up of an ‘investigation’. I was left staring at a page of my medical records, on which were a few notes of my medical history dictated by my mother, but which the PHSO insisted was a psychiatric assessment. One by one family members stared at the same page and we all started to wonder whether we’d fallen ‘through the looking glass’. Indeed my whole encounter with the PHSO had the bewildering feel of being in a shape-shifting bonkers Wonderland in which, as Humpty Dumpty says, a word means ‘just what I choose it to mean’. They were in control and could weave whatever fiction they chose.

The Shrewsbury and Telford maternity scandal has brought the reality of NHS failings and above all the cover-up culture into horrifically sharp focus. Twenty years of avoidable deaths, injury, suffering and of course cover-up. Surely this must be a wake-up call both for those worshipping the institution and those who work in it. I heard one of the victims interviewed on the radio describe how she was left in agony for 45 minutes whilst nurses chatted and drank tea. Certainly in Shrewsbury there were policy and managerial failures, as well as stretched resources. That is the case in the NHS nationwide. But these do not explain lack of basic care and compassion. It does not explain the concealment of errors and a whitewash culture. It has recently become almost acceptable to criticise NHS management but criticism of front-line workers remains heresy. They are the new saints in a society that has drifted away from its Christian roots. My sister recently told me that her neurosurgeon husband is swamped with work as an expert in court cases against NHS doctors. I asked if many get prosecuted or struck off. Her answer was ‘none’.

There must be total, all-encompassing and urgent reform of our broken NHS, all its staff and its culture. That means we must lose our false religion.

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Romy Cerratti
Romy Cerratti
Romy Cerratti is half German, a quarter Italian and a quarter Peruvian but is proud to be British. She has a masters degree in medieval history from Oxford and is a passionate campaigner on issues of mental health and NHS reform.

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