Annex A > Chapter 27 - Concerns 1992 > Concerns > The October article in `Private Eye'
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The October article in `Private Eye'
134 On 9 October 1992 `Private Eye' published the following:
`The sorry state of paediatric cardiac surgery at the United Bristol Healthcare Trust has been confirmed by an internal audit over the last two years' operations. The results of procedures to correct two congenital heart abnormalities (Tetralogy of Fallot and transposition of the arteries) were especially poor.
`James Wisheart, chairman of the hospital management committee and medical advisor to the trust board, is required to maintain standards of medical practice at UBHT. Curiously he has not felt it necessary to inform the trust board or the trust's purchasers of these findings. Could it be because he is also associate director of cardiac surgery?' [168]
135 Dr Hammond gave evidence about this article during an exchange with Counsel to the Inquiry on a further article in `Private Eye' he had written in 1995 based on earlier information.
136 He agreed that the figures quoted in 1995 were those which he had quoted earlier in 1992. He said that he had not followed up the story after 1992 because he had been assured that the DoH and the RCSE : `... had been made aware of the problem and we were looking into it, and ... I mistakenly trusted that they would act'. [169] He said that he had been given this assurance either by Dr Bolsin or his other source: he was unsure which of them.
137 The sources of information which Dr Hammond quoted in his 1995 article were, he said, those whom he had relied upon in 1992. He described how the points in his later article had been based upon the earlier material, as well as information by which `Through ... cabarets [170] and ... letters sent to "Private Eye" and various things ... I managed to ascertain that around the country other units were doing better...' [171]
138 Dr Hammond referred to anonymous circulars that he was receiving, to the effect that parents at Bristol were being told that they were in the best hands and in the best unit. He said that he had therefore asked his sources what precisely the parents were being told:
`I was always very interested about what are the parents being told. If a unit is not as good as another unit, it does not necessarily matter provided the parents are being told "We do not have particularly good figures here but we are trying to improve our numbers, to get them up". I wanted to know what the parents were told ... .' [172]
139 Dr Hammond agreed that the information he had received from what he described in the later article as `an expert opinion from the sources within the Trust' was second-hand, anecdotal, and that he had chosen to rely upon it. He noted further that Dr Bolsin had told him that he should attempt to alter the referral pattern of GPs.
140 In his May 1995 article Dr Hammond had written that persons working within the Unit `probably would not send their own children for heart surgery in Bristol'. This led to the following exchange:
`Q. How many people working in Bristol told you that?
`A. It was a report of a discussion that one of my sources was having with various doctors of the unit. I believe that it was fairly well known that there were problems.
`Q. So the answer is, no doctor at Bristol told you that?
`A. I would have asked Dr Bolsin, certainly, whether he would have considered sending his own children there. He very clearly said "No". But I was told that the discussion that happened around the Unit was that was the conclusion that was reached ... I have to say actually on that point, some of the junior staff I spoke to would have reached that conclusion as well, I think.'
141 A number of witnesses who gave evidence about what had appeared in `Private Eye' told the Inquiry that they regarded it as a satirical magazine, not to be taken seriously.
142 Dr Trevor Thomas, Chairman of the District Audit Committee, thought `Private Eye' was `invariably scurrilous' and had `... no currency in proper information for much of the time'. [173] He said that the articles about paediatric cardiac surgery at Bristol were not discussed at any Audit Committee meetings. [174]
143 Miss Catherine Hawkins, Regional General Manager of the SWRHA from August 1984 to December 1992, commented that `Private Eye' was `not known for its accuracy'. [175] Dr Joffe said that `Private Eye' was `the last paper around that should be believed in terms of its data'. [176]
144 Dr Roylance said that, when he read the articles, some of the information contained within them occurred to him as being obviously incorrect. For that reason, he said, he thought the remainder of the information was likely to be incorrect. [177] He also said that `Private Eye' was recognised as representing a sustained attempt to denigrate and undermine newly created NHS trusts by a series of satirical articles. [178]
145 Mrs Helen Vegoda, Counsellor in Paediatric Cardiology at UBH/T from January 1988 to September 1996, told the Inquiry that it was her impression at the time that the `Private Eye' articles wrongly discredited the paediatric cardiac surgery Unit rather than raising a legitimate concern that results were unacceptable. [179] She was not able to tell the Inquiry specifically who gave her that impression save to say that it was a `general impression'. [180]
146 Mr Alan Bryan, a Senior Lecturer in Cardiac Surgery at the University of Bristol, and consultant cardiac surgeon at the BRI since July 1993, on the other hand, thought that `Private Eye' did not publish information unless there was some element of truth to it. [181]
147 Dr Jordan recalled Mr Wisheart's drawing his attention to the articles in `Private Eye'. Mr Wisheart, according to Dr Jordan, was concerned that there had been a leak of information, [182] but seemed more upset by the fact that there was a criticism of the Unit. Dr Jordan said his impression was that Mr Wisheart felt it was a resurgence of the `Welsh nonsense from a few years ago', although he said that he did not sense that Mr Wisheart displayed an undue intolerance to criticism. [183]
148 Professor Jeremy Berry, Professor of Paediatric Pathology at the University of Bristol, and a consultant paediatric pathologist at BRHSC since November 1983, said that the medical staff were advised by Dr Roylance at a meeting of the Hospital Medical Committee to ignore the allegations in `Private Eye'. [184] He said that Dr Roylance said that the allegations were nothing to worry about. [185] Professor Berry was not able to recall the date of this meeting.
149 Professor Gordon Stirrat, Professor of Obstetrics and Gynaecology at the University of Bristol, gave evidence that one of the `Private Eye' articles had been raised at a meeting and that those attending were reassured by Dr Roylance and Mr Wisheart that audit was being carried out and that steps were being taken to rectify problems. Professor Stirrat said that he could not recollect at which meeting this had taken place or when. [186]
150 While a number of witnesses expressed the view that the 1992 articles as a whole were widely discussed within the UBHT, and that `everyone knew' about the adverse publicity, [187] there was a lack of specificity as to the dates or the content of the discussions. [188]
151 Mr Peter Durie, the first Chairman of the UBHT, stated in his written evidence to the Inquiry that some informal discussion took place at Trust Board level:
`I remember talking informally with other Board members about the articles. We concluded that as the authors were believed to be one or more junior doctors working at the BRI, it was understandable that their articles were more than likely to be about Bristol than about hospitals further afield. As we the Board had not received any adverse comment from the Department of Health or from the Royal Colleges or from the UBHT Medical Audit Committee, or any other source, we saw no reason to call for an investigation.' [189]
152 Sir Michael Carlisle was surprised when he was shown the `Private Eye' articles in the course of his oral evidence to the Inquiry. He said:
`A. Forgive me, but it is very interesting and I have only seen this now, an eminent cardiac surgeon in Southampton says "everyone knows about Bristol".
`A. Absolutely not.' [190]
153 Mr Alan Angilley, Administrative Secretary to the SRSAG from early 1987 until January 1992, said that he held the view that `Private Eye' in general was not to be believed. [191]
154 In relation to the allegation in the May 1992 article that the DoH was aware of Bristol's `problems' and yet did nothing, Sir Graham Hart, Permanent Secretary at the DoH between March 1992 and November 1997, said:
`I have absolutely no knowledge of that. In so far as I understand what "cover-up" means, I think it is a pretty scandalous allegation and I would be very surprised if it was true.' [192]
155 Dr Roger Moore, a Branch Head in the NHS Executive, stated in his written evidence to the Inquiry that he understood from the Librarian at the DoH that records showed that the Department first took out a subscription to `Private Eye' from 1 October 1993. He stated there was no record of a subscription before that date. [193]
156 Dr Moore stated that the reaction of Ministers and officials to any journalism was: `... dependent on its authority and accuracy and the influence which it might be expected to have in presenting or influencing public opinion.' [194]
157 Miss Hawkins indicated that Dr Alastair Mason, the Regional Medical Officer, had shown her the July article. Miss Hawkins told the Inquiry that, until she saw that article, she had not heard of the alleged problems at Bristol and that Alastair Mason had said that he had not known either. [195]
158 Miss Hawkins said the follow-up action that was taken was that `... the RMO was, I believe, going to investigate ... and visit the Unit and talk to the department [of Health].' [196]
159 Dr Mason told the Inquiry that he saw the `Private Eye' articles in May and July 1992. He confirmed that he brought the latter to the attention of Miss Hawkins. He explained:
`Having no formal role in relation to this service, I made discreet inquiries of colleagues ... to ascertain whether there was any truth in the allegations. I was reassured by those to whom I spoke that they were not aware that the clinical performance of this service was poor and reported back accordingly to [Miss Hawkins].' [197]
160 Dr Moore added that in his view `Private Eye' was `... not an automatic choice for authoritative journalism on NHS or clinical audit.' [198]
161 Sir Terence told the Inquiry that before the contact from Dr Zorab, neither he nor the RCSE had known about the adverse publicity in `Private Eye' (or elsewhere) concerning the UBHT. He said:
`... the cardiac surgeons ... are a small specialty within the whole discipline of surgery, and I do not know that anybody would have picked up the "Private Eye" piece at all, other than some cardiac surgeons may have noticed and mentioned it to others. ... I had no such inkling [that there may have been problems at Bristol] until I received Dr Zorab's letter.' [199]
`The "Private Eye" piece meant nothing to me. The letter from Dr Zorab did. "Private Eye" had run a campaign against perhaps the most distinguished cardiac surgeon of my generation, Sir Donald Ross, some years earlier and, quite honestly, I do not think anybody paid a lot of attention ... But I did pay attention to Dr Zorab's letter.' [200]
163 Sir Donald Irvine, President of the General Medical Council (GMC), gave evidence that the GMC only acts in its disciplinary capacity on the basis of a complaint. [201] He said the GMC does scan the press but `did not scan "Private Eye"'. [202]
164 Dr Christopher Monk, a consultant anaesthetist at the BRI, and Clinical Director of Anaesthesia from January 1993 to December 1995, told the Inquiry that in his opinion `Private Eye' was an inappropriate vehicle through which to bring to light serious concerns about performance. [203] Dr Hammond agreed that it was `not ideal' for confidential audit details to be published in `Private Eye'. He stated that he did so at the time because he felt so strongly about the issue that he was `... willing to risk a charge of breach of confidentiality from the General Medical Council'. [204] Professor Stirrat told the Inquiry that the articles were `prime examples of lack of confidentiality'. [205]
165 Dr Hammond reported that he had subsequently changed his approach in responding to confidential audit information sent to `Private Eye'. He stated:
`I now fax it back immediately to the chief executive of the Trust, the President of the relevant Royal College and the chief executive of the General Medical Council. I ask for the matter to be looked into urgently, ask to see the results of any inquiry and reserve the right to investigate and publish if I do not believe action has been taken to protect patients. Inquiries using external assessors into the quality of surgical care in two UK trusts are currently underway because of this approach.' [206]
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Footnotes
[168] SLD 0002 0006 ;`Private Eye' , 9 October 1992
[170] Dr Hammond appeared on television programmes and in theatres as a stand-up comedian
[178] WIT 0108 0124 Dr Roylance
[184] T55 p.143 Professor Berry
[185] T55 p.143 Professor Berry
[186] T69 p.39 Professor Stirrat
[187] Dr Thomas T62 p.136; Professor Vann Jones T69 p.146; Dr Thorne T35 p.116
[188] WIT 0086 0036 Mr Durie; T81 p.87 Dr Bolsin; T47 p.168 Mrs Vegoda; T46 p.126 Miss Stratton; T79 p.99 Dr Jordan; WIT 0169 0032 Mr Downes; T55 p.142 Professor Berry; T69 p.38 Professor Stirrat
[189] WIT 0086 0036 - 0037 Mr Durie
[190] T15 p.77 Sir Michael Carlisle
[192] T52 p.66 Sir Graham Hart
[193] WIT 0482 0002 Dr Moore
[194] WIT 0482 0002 Dr Moore
[197] WIT 0399 0004 Dr Mason
[198] WIT 0482 0002 Dr Moore
[199] T18 p.136-7 Sir Terence English
[200] T18 p.137 Sir Terence English
[201] T48 p.114 Sir Donald Irvine
[202] T48 p.132 Sir Donald Irvine
[204] WIT 0283 0003 Dr Hammond
[205] WIT 0245 0006 - 0007 Professor Stirrat
[206] WIT 0283 0010 Dr Hammond