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Thursday, 22 February, 2001, 09:02 GMT
Standards in the NHS
Recent scandals have placed greater emphasis on how the NHS and its workers are regulated.
Health is a devolved matter dealt with domestically by the Scottish Parliament, and the Welsh and Northern Ireland assemblies. Westminster retains UK-wide powers over medical regulation and safety.
In the past doctors and nurses were beyond reproach.
Patients, politicians and the press would not have dreamt of questioning the way the health service and its staff worked.
But the mystique has faded and the spotlight has been turned on how well the NHS and its staff do their job.
The paternalistic attitude of the medical profession, according to its leaders, is dead, and doctors now have to listen to their patients.
The cases of the GP serial killer Harold Shipman and disgraced gynaecologists Rodney Ledward and Richard Neale headed a roll call of mistakes and malpractice which has led to a revamp of professional regulation.
The scandals at Bristol and Alder Hey hospitals and recent high profile cases where drugs have fatally been injected into the wrong part of the body have also raised public fears about the NHS.
Health professionals have, just, managed to retain powers of self-regulation.
But the government is keeping a very close eye on how they deal with cases of staff who are not up to scratch.
In February this year, the Redfern report into the retention of children's organs without consent at Alder Hey Children's Hospital in Liverpool was published.
It found the pathologist at the centre of the scandal, Professor Dick van Velzen, had removed organs and whole body parts without permission and had lied on his application form to the hospital. He also falsified records and post-mortem results.
But it also found the management at the hospital was at fault for not picking up on problems earlier.
Bristol Royal Infirmary was also hit by scandal in 1998. Two doctors were struck off after it emerged that the hospital had unusually high death rates in paediatric heart surgery.
An independent inquiry is due to report later this year.
The Hyde GP Harold Shipman was sentenced to life last January for murdering 15 patients. He is suspected of killing up to 300 patients during his medical career.
Critics of self-regulation say the General Medical Council - the body that polices doctors - failed to act in the 1970s when Dr Shipman's methadone habit was discovered after he falsified prescriptions.
There is to be a public inquiry following his conviction to examine how Shipman was able to have access to the large quantities of diamorphine with which he killed patients.
Questions have also been raised over why no one queried the number of death certificates he signed, something critics say should have been picked up.
Rodney Ledward, the self-styled "fastest gynaecologist in the South East", was struck off in 1998 after he was found guilty of bungling 13 operations on women.
And in 2000, a second gynaecologist, Richard Neale, faced 35 charges of clinical incompetence, professional negligence and extreme rudeness. He was found guilty of all but one.
The government, late in 1999, showed it was already growing impatient with the GMC and professional regulation.
And at its annual conference in June 2000, the British Medical Association passed an overwhelming vote of no confidence in the GMC.
Last year, Chief Medical Officer Liam Donaldson proposed a system of annual appraisals and assessment centres where they can upgrade their skills. This was accepted by the government in the NHS Plan.
The medical profession itself has also drawn up plans for a system of revalidation, where doctors have to show they are still fit to practice on a regular basis, probably every five years.
The GMC is reinventing itself and is set to increase the proportion of lay members on its council.
In January this year, Donaldson said the GMC was making "very considerable progress" in sorting out its problems.
The government said last year that a new mandatory reporting system for all errors and "near-misses" would be in place by the end of 2000, but it is likely it will be the end of 2001 before the system is introduced.
Nurses have fared better. The UK Central Council for Nursing, Midwifery and Health Visiting regulated 635,000 members of nursing profession, and has done since 1983. In January, the UKCC received a record number of 144 complaints.
But the government drew up plans for a new Nursing and Midwifery Council to take over from the UKCC later this year.
It too will have more lay members on its council. Under the government's proposals, professionals will outnumber lay members by just 12 to 11.
In the NHS Plan, the government proposed an umbrella body, to oversee all the other single-profession regulators. But if those bodies fail in the future, the UK Council of Health Regulators, could take over their responsibilities. Its initial remit, though, is to co-ordinate how the various bodies work.
Under proposals made by Labour in government, a new Health Professions Council would take over regulation of professions allied to medicine, such as speech and physiotherapists, dieticians and paramedics. It would take over from the Council for Professions Allied to Medicine.
Other health professionals, including psychologists, chiropractors, opticians, osteopaths and pharmacists also have their own regulatory bodies.
The Care Standards Act sets out how both the private and voluntary sector and social services will be regulated.
The National Care Standards Commission would police the private and voluntary sector, including care homes for children, the elderly, and the disabled. Care provided in the home, and adoption services will also be covered.
Private and voluntary hospitals will also be regulated.
The Bill also sets out plans to regulate social workers. From October this year, they will be policed by the General Social Care Council.
Many social workers belong to the British Association of Social Workers, and are therefore required to adhere to its code of ethics, but all social workers will have to register with the GSCC.
Set up under the 1999 Health Act, the Commission for Health Improvement (CHI) will review clinical services in NHS trusts and GP practices across England and Wales, and will assess how national standards such as National Service Frameworks are being implemented.
But CHI's most high-profile role is to investigate failing hospitals.
In November 2000, it published a report into North Lakeland NHS Trust in Cumbria which cared for the elderly and mentally ill patients, where it found a culture it described as "unprofessional" "degrading" and "cruel".
It also published a critical report into Carmarthenshire NHS Trust in Wales, after the high-profile case of 70-year-old Graham Reeves who died in February after surgeons at the Prince Philip Hospital in Llanelli removed a healthy kidney instead of a diseased kidney by mistake.
From April, all GPs, whether they work in practices or as locums, will have to be on the local health authorities list and will be governed by clinical governance arrangements.
A National Clinical Assessment Authority will be set up to deal with local concerns about individual doctors' performance.
The NHS tribunal system will be abolished and health authorities will have the power to suspend or remove GPs.
Community health councils will be replaced by Patient Advocacy and Liaison Services (PALS) and patients forums.
From next year, if an operation is cancelled for 'non-clinical' reasons, the hospital will have to offer the patient another date within 28 days, or pay for it to be done at a hospital of their choice.
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