If you'd like to have your say about the issues raised in the programme or were a breast cancer patient or family member of a breast cancer patient at Bradford NHS Hospitals Trust, then send us your comments using the form on the right hand side.
A very important issue which the programme touched on but didn't go into detail was the lack of a second breast cancer surgeon in Bradford until 1998. Surely this was extremely detrimental to the treatment of breast cancer and exceeds the NICE guidelines of surgeon(s) involved in the treatment and recommendations of a four week period between diagnosis and the start of the treatments. Bradford, until the appointment of a second surgeon, could not have possibly met these targets. This was reflected in my sister's case when she had to wait three weeks for a mastectomy from her diagnosis because the surgeon was going on holiday. Everyone is entitled to leave but in Bradford at this period there was no back-up plan and as such life threatening operations had to wait. Following our complaint at the time my sister was advised that the delay would not have made any difference. In all she waited from June to October 1998 from going to her doctor's to having her mastectomy, unfortunately my sister's case was probably not unique.
Jane Dunn, Baildon
As the former Chairman of Bradford Community Health Council I applaud the BBC for bringing this programme to public attention. You have touched upon the cover ups, bullying and intimidation that has existed in Bradford Health sector for years and still continues.
Mr Les Vasey, Baildon, Shipley
My view is that Panorama always presents data in a skewed fashion. The data presented cannot be believed. Furthermore, the team do not understand that data is plural. This makes bad science even worse.
John Sutherst, Liverpool, UK
I thought the issue was a very important one. However, the aggressive style of the journalist Sarah Barclay left a bitter taste in my mouth. It did not feel like I were listening to a journalist in the pursuit of truth. It felt like she was the prosecutioner and judge, and the defence were not represented fairly in this programme. It really felt like the only passion she had was the pursuit of a sensational story rather than the pursuit of truth. It is a shame, as had she handled it differently I may have found it more credible. Instead I were constantly wishing the other side were more fairly represented. Bad journalism that feels like a bad tabloid story when it could have been so much more.
Informative and alarming in portraying a typical British institution that fails to acknowledge its errors. Instead of trying to put things right for the sake of the individual they perpetuate the policy of fear and protection of the faceless bureaucrats shamefully protecting their own power.
S.Goodwin, Guisborough. UK.
As a legally qualified medical practitioner, I wish to congratulate Panorama for its highly professional investigation of 'surgeon 39' and the Trust. You have clearly demonstrated a glaring omission of their 'duty of candour' as espoused by Sir Liam Donaldson CMO. Your journalists are engaged in this very important scrutiny on behalf of the public. The trust has a statutory duty to monitor these standards pro-actively. Your team has demonstrated to the lay viewer that the trust failed to properly investigate long after it was given notice of the suspected clinical deficiencies. I want to commend the BBC and the Panorama team for this outstanding work and their determination to resists the threats of legal action against the broadcasting of this programme. You have good reason to be proud of your highly ethical investigation. All fair-minded doctors should support your work to restore confidence in the NHS - where it has been merited.
Dr. John Burton LL M, Magherafelt, Co. Derry, Northern Ireland BT45 5EF
I had breast cancer in 1993 and was treated at the BRI and I can honestly say I got the very best treatment possible. Anyone can make figures do what they want and they often lie. How many of the supposedly 150 women have since died?
Elizabeth Sykes, Bradford
Your program, as far as I'm concerned , is just about the only reason the BBC can justify their licence fee! Absolutely well done , do not let this NHS Trust off the hook, continue to pursue this situation on behalf of the patients concerned, and fully expose , and try to bring to account , the individuals and management responsible for this arrogant and negligent interpretation of National NHS Best Practice .
John Brigden, Normanby , England
I watched the transmission. Panorama just laid out the case against Bradford and Bradford Hospital NHS Trust defended it. It was a trial, a competition. The viewers were left to decide who had made the most persuasive case. But most viewers, including me, are not experts or sufficiently knowledgeable about the arguments to know who was right and who were simply airing vested interests. The BBC's vested interest was to present it as entertainment which has its own bias. Nobody represented the viewer who wanted to know 'the truth'.
Guy Parker, Braunton, Devon, England
It is my experience that anyone employee who raises concerns about treatment and standards in the NHS and expects to be able to remain in post is at the least being naive. I raised concerns about poor treatment of staff in the Accident and Emergency Department of the hospital I was employed with in early 2003 and by Jan 2004 I had been dismissed. I have also been reported to the Nursing and Midwifery Council and have been unable to work as a registered nurse since. I am in the process of taking legal action against my former employer for defamation such is the vilification I have received. My advice to anyone who witnesses poor standards in the NHS is to keep your mouth shut, something which seems to be reinforced by your programme yesterday.
John Adams-Hughes, Aveley, Essex
I am a breast cancer patient, and am being treated at the hospital featured in your programme. I have no complaints about the treatment and care I have received. I don't see how dragging up something that allegedly happened in the 80/90's is in the interests of the public in 2006. Of course, if I had received my treatment back then and felt I should have had radiotherapy I would be upset and concerned. I would also be happy that I was still alive. Was this programme helpful to someone who has just been diagnosed and is about to embark on their treatment? I think not. It is a worrying time anyway, and this programme will only add to the fears of breast cancer patients in Bradford. Finally, may I also point out that men get breast cancer too. Your programme continuously referred to women.
Jo, Bradford, UK
I had breast cancer in l992. Since then I have watched every concern raised in the media and by evidence both statistical and anecdotal. I believe that the reason why in this country we have such a poor survival rate for breast cancer is that there is not enough follow up for patients. It must be understood that cancer can reacure years after initial treatment. It is simply not good enough for a patient to present with "secondaries". After only a couple of years or so a patient is not usually seen at all on a routine basis. Well done for bringing to the attention of the public the need for statistical data to be used as a everyday occurrence.
Maxine Bancalari, Norfolk
Excellent programme. As an NHS employee it is enlightening to see doctors prepared to speak out in order to put the concerns of patient welfare first. It is not surprising to see the reaction of the Trust and the way in which "whistleblowers" were dealt with. Well done, I hope to see a change in culture in senior management in NHS Trusts to support rather than disclaim whistleblowers' concerns.
Marylyn Dickinson, Greater Manchester
Not a great programme. The transcript on the web site is good to have but there is no adequate evidence in the public domain to back up your claims. Why not publicise the evidence you say you have, as the whole issue is one of interpretation of complex statistical analyses of cancer treatments, and of 10 - 15 year old ones at that. The hard evidence must be publicised not just your interpretation of it. The Lancet has published an initial reply to your claims and an independent review of evidence released to York University and you do not come out well in claiming your science is sound. Scaring cancer patients is unforgivable unless your evidence is rock solid - what did you hope to gain for the patients, not just for yourselves?
Donal Duffin, Banbridge Down
The program showed how the hospital involved managed to remain in denial for a long time. Unfortunately this is symptomatic of England where institutions still find it more comfortable to shoot the whistleblower than fix the glaring problem. I have seen this many times before but have no faith in the system's willingness and ability to correct itself.
Dr Alfred Vella, Milton Keynes UK
I thought that the overall presentation of the programme was very poor. Considering the case revolves around some highly complicated statistical analysis, I was disappointed by the lack of actual figures until the very end of the programme, and these were presented with no statistical confidence limits. However, I was pleased that the advice of two different statisticians was sought to provide balance. Instead, there seemed to be lengthy periods of 're-enactments' which served little purpose as they simply showed generalised images of hospital staff working, and added an overly dramatic edge to an issue which appears to have affected less than 100 women over a period of nearly 20 years. This was not helped by the rather strangely lit interviews with some of the key players, which would not have seemed out of place in a documentary on Cold War espionage. I believe that this rather sensational focus detracted from the most interesting points raised, namely how far it is possible to find out the benefits of particular treatments, and whether 'patient choice' is possible in the NHS given the difficulties in determining exactly the end point of care and its overall effect. Overall, I felt the programme sensationalised what is effectively a rather small outlying case of cancer treatment, and once again focused on breast cancer - a decision which may have been influenced more by ratings than science. Would a similar length of time have been devoted to a less 'sexy' illness, such as prostate or lung cancer, where it would not have been possible to fill time with shots of a topless woman on a radiotherapy couch?
Andrew Porter, Oxford, United Kingdom
I found this programme interesting - but you need to know that this type of situation is relatively common. The medical profession works to protect itself. I am a senior pharmacist in a cancer centre and I would say that most senior members of other my profession would say off the record that doctors as a rule cover up for each other, by not commenting or providing information. They are like the free masons not prepared to on the record raise concerns about colleagues practice. Not only that, when concerns are raised they will tend to look to cover them up. That is my experience - when I have raised concerns they have never been investigated thoroughly - the first explanation that offers an acceptable answer is jumped on then you are ignored or place yourself at high risk. It would be interesting to set up a help line not to pursue issues but just to collate numbers. The problem of clinical governance within the NHS is one of culture and the power of the medical lobby. All the clinical governance processes introduced into the NHS have not affected this type of issue - Bradford and Bristols are happening and will continue to happen in the future until the culture is changed.
email identification supplied
What both the Lancet statement and the comments of all the Bradford spokesmen consistently ignore is the clear fact that clinical practice was out of line with the rest of Yorkshire, to say nothing of the rest of Britain, and remained so for many years after concerns were raised. Everything else flows from this stark and indisputable fact. In the end, I suspect these matters will be settled by the threat of litigation rather than a genuine desire on the part of the medical profession to eradicate anything falling below the highest standards of care. James Robertson Justice may be a distant memory but the 'consultant as God' is still with us.
Mike Power, Ashford Kent
Although the evidence in the programme suggests that radiotherapy is the correct follow-up treatment after surgery, and comments by Coleman, Spiegelhalter and other doctors are very interesting, I found the manner of the presenter to be very accusing. I therefore find it difficult to trust that the details were presented objectively, and that issues were not distorted by being over-simplified. There also seemed to be an expectation that the only acceptable doctors are perfect ones.
Stephen Mason, Aberdeen, Scotland
Care has to be taken when using statistical data to confirm or deny the risks to individual patients and performance of particular clinical teams. Judgement should be not whether a clinical team's performance was statistically below other teams due to the decisions they made, but whether such performance have been predicted from established state of the art knowledge at the time those decisions were made. It is all too easy to look at the facts today, and see the flaws. But were the flaws so easy to see in the past? The Panorama program, in my opinion did not show that back in 1996 that there was sufficient evidence for the trust to radically change its clinical procedures, only that its procedures were in doubt. The data from 1996 to 1999 may confirm that doubt, but that data was not available at that time. However, I think the trust is wrong to try to hide such complexity in the data, and by trying to hide this, it damages its own reputation. Good science (and medicine) is done with healthy debate, and that happens only when such debate is open. Such debate would inform the public that in unchartered areas of medicine not everything is known and therefore in hindsight not all decisions are necessarily the best ones. Also, sadly, those decisions are as important as the rest for making progress and improving the state of knowledge. The medical practice and the public need to acknowledge that before attaching blame, and before covering-up the so-called whistleblowers.
Dr David Siegwart, Eastleigh, Southampton
I would like to congratulate you on your programme and how you handled this subject sensitively. I hope now that you have put this in the public domain that the individuals concerned or any bereaved relatives who were treated during those times will start asking questions and that the BBC will now start following those individuals enquiries. Data protection of individuals would not allow NHS to discuss individuals cases, however, when a situation occurs such as this programme, then the NHS should have a responsibility to the patient. After all, through the NHS Modernisation, the NHS is supposed to be patient focused. How many more Shipman cases do we have to have before anything can be done? Health professionals have a responsibility to protect the public. Well done to the health professionals who whistleblowed. Please help health professionals to provide quality care and service delivery. Also, please help the general public to start asking questions of their care they receive. This is a two-way partnership. I hope the patients who are still alive call and that you will do a follow up programme. Thank you again, treating this sensitively and enabling individuals concerned with this programme to call. Thanks.
Amanda Harrison, London
I firmly believe that if this were men patients we were talking about this would not happen.
Vivian Taylor, Addlestone, UK
I would like to say well done on a very interesting piece of research, which, I consider, bravely raises some important issues on the openness of healthcare statistics and outcomes. In my opinion, openness can only be a good thing and the view held by some medical professionals that it only opens the gate to mis-interpretation by a non-expert public is, in my view, patronising and underestimating of public insight.
Something I notice about the response from the trust is that they are focussing on survival rates - quoting no or insignificant differences at 15 years, backed up by a Lancet article (has there been a study of the 5 year survival rates?) They fail to emphasise that the increase in recurrence rate after 5 years does, however, increase with no radiotherapy after BCS. Therefore, it implies that mastectomies have had to have been carried out to achieve the same survival rates - and surely this is what was hoped to have been avoided with BCS.
They also say that the choice of radiotherapy is ultimately with the patient and not just one consultant. Well this may be true, but do they really expect us to believe the implication that the reduced number of radiotherapy referrals was down to a general feeling among Bradford patients against the radiotherapy option. Patients overwhelmingly trust the consultants view and it is clear that if they were given the option of radiotherapy they were dissuaded from it - the probability of all those patients independently making the non-radiotherapy decision is too slim.
Stan Smith, Washington, UK
Well done for an excellent piece of investigative journalism! However, you did not answer one very important question: "Why did Surgeon 39 choose not to use radiotherapy in so many cases?" What was the motivation for his team's choice? May I suggest that you follow up your "Hospital that Failed Women" with a more general investigation as to why so much "government data" is kept "secret" and who benefits from this? I'm an MSc student at Liverpool University. I'm studying the "decision motivation" of people in public service.
Ken Evans, Stickford, UK