Friday, May 25, 2007

A Tragedy Waiting To Happen

Penny Campbell: a victim of the Department of Health

"Penny Campbell, a 41-year-old journalist, died in March 2005 despite six telephone calls and two face-to-face meetings over the course of the four-day Easter weekend with doctors working for an out-of-hours GP service.

An investigation into her death has found that she was not offered appropriate care as a result of the the actions of a GP and because of problems in how the out-of-hours service was run."

Of course, the blame is being directed at the out-of-hours service provider Camidoc: the GP co-op in north London that employed the doctors, apparently "had no procedures to ensure notes on patients were easily available to all GPs". But the real blame lies with the Department of Health.

We've blogged the out-of-hours (OOH) fiasco many times, how the appalling Department of Health gave away our traditional GP service without having the faintest idea how they were going to replace it (eg see here, and here).

Last year, Tyler attended the Public Accounts Committee meeting where the DoH mandarins were grilled about the whole thing (see PAC Report and evidence transcript here). As we noted at the time, it was frankly scary. The Chairman described the mandarins as being "underwhelming", and we were shocked that they were so far out of their depth.

But even more shocking was the DoH's inability to define what the OOH service was actually meant to be doing. And remember, this was a full two years after the new GPs contract was introduced in 2004. Even by the abysmal standards of government, the muddle and confusion was appalling.

Let's note some the exchanges that took place on OOH that afternoon:

Q16 Chairman: What is the actual standard of care that is supposed to be provided? Are they supposed to meet simply urgent need, or is this a 24-hour seven-day NHS provision which is available to everybody? What can we as the public expect to receive?

Sir Ian Carruthers (NHS Chief Exec): Again, I think this is an area for further action. One of the matters which we shall be looking at following the recently produced White Paper is our urgent care strategy and how we define it. Broadly speaking, the approach taken at the present time is that members of the public are able to contact the out-of-hours services. They have a choice between A&E, out-of-hours services, walk-in centres and NHSDirect.

Q17 Chairman: How are the public to know which is the right service for them when there are so many options available? Previously, they did the rather old-fashioned thing of ringing up their family doctor.

Sir Ian Carruthers: I am sure that many people actually do that now and they are put through to the services, but we want the public to be able to choose what they feel is appropriate to their circumstances.

Q18 Greg Clark: Is the out-of-hours provision supposed to be an urgent or unscheduled care service?

Sir Ian Carruthers: As I said before, there is a view which says that the Department of Health should define it.

Q19 Greg Clark: What is your view?

Sir Ian Carruthers: I can express only a personal view. I have said that this is one of the issues on which we shall take action.

Q20 Greg Clark: To be clear, the Department does not have a view as to whether the out-of-hours service is urgent or unscheduled provision?

Sir Ian Carruthers: At this stage we have not defined whether it is “urgent”. Generally, people understand “urgent” to mean care and treatment given there and then with an appointment maybe the next day.

Q21 Greg Clark: How could you negotiate a contract with GPs when you were not even aware whether or not this was a service dealing with urgent or unscheduled care, since clearly one will be used far more than the other?

Sir Ian Carruthers: The contract was based on a broader range of issues, which was to say that when people needed out-of-hours care they could access it by a range of different routes. The precise definitions of those two areas were not undertaken.

Q22 Greg Clark: You are the Accounting officer of the Department and I know that you had
predecessors, but if the Department was about to negotiate a contract why did it not decide that issue then rather than start to think about it now?

Sir Ian Carruthers: What we are saying is that we now recognise that it is an issue.

Q23 Greg Clark: But the specific question is: why did the Department not decide this before negotiating the contract?

Sir Ian Carruthers: I cannot answer that. What we are saying is that we recognise this is an issue to be addressed.

Q24 Greg Clark: Do you concede that it was wrong and you should have settled it before?

Sir Ian Carruthers: I am not saying it was wrong or right. The out-of-hours service was about replicating what was there previously. We have now got into definitional issues which we have indicated will be taken forward as part of the White Paper.

I think that's more than enough. Just imagine how Tescos would be if Sir Terry worked like that.

The bottom line is that the DoH bumbled their way into the GP pay negotiations without having the faintest clue how the OOH service was going to be handled. Indeed, it's pretty clear they fondly imagined that GPs would just keep going with their traditional service. There was no plan as such. Just a dim and distant hoping for the best.

And now someone has died.

You have to guess there are many more such cases.

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