Why doctors must be made accountable

medical care we deserve?

MOST people wouldn't book their car into a garage without first checking that the mechanics were reasonably competent, says Val Stangoe. But when it comes to our own bodies, we're prepared to put our health in the hands of people about whom we know almost nothing.

That has certainly been the case in the past. But after recent high-profile cases such as the Bristol heart surgeons, gynaecologist Rodney Ledward and, now, former Northallerton gynaecologist Richard Neale, things may be changing.

Today the Government announced plans for an "early warning system" to root out incompetent and negligent doctors. A register of medical incidents will log serious cases.

The news came on the day when another scandal rocked the NHS. More than 200 patients were found to have been wrongly diagnosed for cancer and other diseases by pathologist Dr James Ellwood, 78.

Val Stangoe, chief officer of the Northallerton and District branch of health watchdog the Community Health Council, says change can't come too soon. Patients need to adopt a much more questioning approach to their own treatment, she says - and health professionals need to be much more open about their own track record in providing treatment.

"There needs to be a long-term change of culture so that people are being encouraged to ask for information, encouraged to want to know and have the right to know about the track record of the department they're being treated by," she said.

Few would argue with that. Following the Rodney Ledward case in particular, the newspapers were full of stories about the 'consultant is king' culture - a culture where junior staff were afraid and colleagues reluctant to criticise fellow consultants, so that their incompetence could go unchecked for years.

Of course, not all consultants should be tarred with the same brush as Rodney Ledward. Most health professionals are doing the job they do because they believe in it, and are genuinely striving to provide the best possible treatment.

It would be impossible to count the number of British people who owe their lives and health to the dedicated care of doctors, nurses and other health professionals in the NHS.

"A few high-profile cases, that no-one would attempt to defend, should not be allowed to get in the way of what we know to be the case, that the vast majority of doctors are doing a good job, often under very difficult circumstances," says Dr Tony Sweeney, York GP and local spokesman for the British Medical Association.

Nevertheless, there is a recognition that we can no longer simply take it for granted when we seek medical attention that the treatment we get will always be the best.

It is accepted that standards vary from hospital to hospital, doctor to doctor - and that more needs to be done to ensure that best practice is identified and problem areas recognised and dealt with.

Most doctors, stresses York MP and junior social security minister Hugh Bayley, provide a good standard of care.

"But it is no longer acceptable to expect the public to take that on trust," he says.

The time has come for more openness and accountability in the NHS about the quality and level of treatment being offered. And it is not only patients and health pressure groups saying this - it is senior health managers themselves.

Professor Mark Baker, medical director of North Yorkshire Health Authority, today admitted that complaints procedures within the NHS are 'dire' and bogged down in bureaucracy.

And he said it is vital that information about the outcome and success of treatments by particular doctors and departments is used to monitor their effectiveness.

It is 'extraordinary', he says, that it is not already being done.

The NHS is beginning to get its act together. The Government has introduced a number of new guidelines and programmes over the last couple of years designed to make health outcomes more measurable.

They include setting up the new National Institute for Clinical Excellence to promote better and more consistent standards, and a system of 'clinical governance' to gather information about outcomes on a hospital-by-hospital basis.

The General Medical Council, which regulates the medical profession, has also made moves to put its own house in order - including relaxing the rules on the hearing of complaints to encourage more people to come forward.

Local health trusts are also trying to improve accountability.

In York, every consultant will from this year be subject to an annual review of their performance.

The problem, says Professor Baker, is that while certain medical specialities are easy to monitor - such as surgery - others are more difficult.

"There is not, yet, systematic, high quality data on the performance of clinical services across the board," he says. "This needs improving. We need to be far more rigorous than simply responding to complaints. There are a lot of people who have grounds for complaint but don't actually complain. It is getting at that information that is important."

Statistics on clinical outcomes is one way of trying to get at that information. Another is by encouraging doctors to come forward when they fear a colleague's performance is not up to scratch. One of the main concerns about the Rodney Ledward case was that it appeared not to have been happening.

Nobody likes 'blowing the whistle' on a colleague.

But where there is an area of real concern a doctor has to ask him or herself where their real loyalties lie: to a colleague or to members of the public.

Val Stangoe stresses that any response to concerns about a doctors performance must be handled constructively. Retraining rather than public disgrace would the better course in the vast majority of cases, she says.

Any sense that a colleague was being 'witch-hunted' would only make other doctors more reluctant to come forward - and could also create a climate where staff found it difficult to do their work properly.

"If you're trying to encourage someone to come forward and say there is a problem (with a colleague) and then all hell breaks loose, then they are not going to want to do it, especially if you're a junior doctor who is vulnerable," she says. "Having a situation where people are thrown to the wolves doesn't help."

It is also important that the person 'blowing the whistle' doesn't feel their career could be threatened by it.

Hugh Bayley says doctors who do raise concerns about a colleague's performance have to be sure their own careers won't be jeopardised as a result: something which has not always been the case in the past.

"Doctors should not be afraid to speak out and they should be protected by the medical profession and by NHS managers when they do," he says.

"Doctors who do that are acting in the interests of patients and the public."

PICTURE: Dr Iain Barclay of the Medical Protection Society faces the media after reading a a statement from surgeon Richard Neale