I Recognise these Constraints
The Perfect Killing Machine claims people in medicine’s highest echelons recognise what killed Stephen O’Neill but figure there’s little they can do about it.
This letter from Frank Atherton is the most extraordinary I’ve received from Government. To see why you need to page down to the letter to which he is responding, a letter that offers his boss, Vaughan Gething, the Health Secretary for Wales, a Martin Luther King opportunity.
Dr Atherton is a decent man. Mr Gething features in an appropriate photo above. The downloadable originals of the correspondence on headed notepaper and with signatures are here – Atherton to Healy, Healy to Gething with prior correspondence between Healy and Gething further down the page. See Stephen’s Voice and SSRIStories.org for more.
Dr Frank Atherton
Chief Medical Officer/Medical Director NHS Wales Welsh Government
Professor David Healy
Betsi Cadwaladr University Health Board
30 August 2018
Dear Prof Healy
Thank you for sending me a copy of your letter of 21 August addressed to the Cabinet Secretary for Health
I recognise some of the structural constraints that you describe – these are not easily corrected, appearing as they do in all advanced healthcare systems. My suggestion would be for you to continue to engage with others who share similar views; collective analysis and advocacy are more likely to change systems than individual efforts.
I note that you have also copied the letter to your Chief Executive and Medical Director and I will look forward to seeing their response to the service-orientated issues that you have raised.
Yours sincerely
FRANK ATHERTON
Dr Atherton is responding to a letter from me to Mr Gething a week earlier. I had prior correspondence with Mr Gething 2 years earlier, before Dr Atherton took up his post, making the same points but received a strange – possibly political – response.
Half of the letter refers to a mess that the Betsi Cadwaladr University Health Board (BCUHB) was and still is in (it has been in what in Britain is termed Special Measures for 5 years). This half has been removed … indicate the spots. Despite Dr Atherton’s interest, no BCUHB executive ever responded.
The key point is that exactly the same factors that killed Stephen O’Neill are killing healthcare and patients more widely leading to organizations like BCUHB ending up in Special Measures, seemingly unable to put things right and causing the cost of health services to balloon.
Healy to Gething
David.Healy@wales.nhs.uk
August 21st 2018
Vaughan Gething
Minister for Health,
Welsh Assembly Government
Dear Mr Gething
The situation….
The primary aim [of this letter] is to point out structural issues both BCUHB and Welsh Government should be aware of – if only to offer both of you a Get-out-of-jail-free card should something go wrong..
I will deal with the overarching structural issues first. To do so comprehensively has taken me 160,000 words in draft book form. If you, your office, or the Board want to make sure you fully understand this context to local issues, I would be happy to meet.
I will then outline local difficulties. It’s likely that you, the Board and I have differing views about what is going wrong at a local level. I see input from structural factors where you won’t…
Structural Issues
The running of a health service is a complex undertaking, at present made more difficult by problems that no-one at a political or managerial level in the services today, whether public or private, has addressed.
The structural issues outlined here should shock you. I routinely lecture about these issues, write about them, repeat them under oath in legal or coronial cases, which I shouldn’t be doing if what’s in this letter is not right – so I welcome feedback.
- Since 1990, there has effectively been no access to the data from the vast bulk of clinical trials undertaken on the treatments that consume the most resources in healthcare. Not even the regulator (MHRA) has access.
- Since 1990, close to all academic publications about on-patent drugs have been ghost or company written to the extent of portraying negative trials as positive and dangerous treatments as safe.
- As a consequence, NICE guidelines on the most commonly used treatments in mental healthcare or the conditions they treat are junk.
- NICE refuses to engage on this issue.
- In large swathes of clinical care, those keeping to guidelines or pathways put patients on less effective, riskier and costlier treatments than they should.
- This also leads to a polypharmacy, which seems a likely contributor to the recently reported dip in life expectancies in the UK and US.
- It also has economic consequences. From children’s mental health to osteoporosis services, an impression of treatment efficacy and safety has led to service developments which pour money down the drain of screening programs, auditors and managers as services fail to deliver and management respond.
A common response to these points is to concede some merit to them but assume there are checks and balances in the system. There aren’t. A failure to appreciate this means politicians and managers make the following predictable mistakes.
- You view a report like this as an insider or whistleblower account when it isn’t. Insiders blow whistles about rotten apples in a barrel. This is a rotten barrel problem. A broad light of day problem.
- You respond (as you have done) by saying it’s important for doctors to stick with guidelines and on-label treatments when it’s doctors who stick to guidelines and prescribe on-label only who now pose the greatest risk.
- You respond (as you have done) by promising money for non-drug services – counselling or therapy services in children’s mental health – unable to appreciate that this is a recipe for increasing drug use.
- You have no answer for families and coroners facing Root Cause Analyses of a death where a Trust gives themselves top marks for meeting all standards and ticking all boxes but fails to explain why a death has happened – because their processes do not contain a box for treatment induced death.
- Having the requisite boxes would bring services up against missing data and a ghostwritten literature.
- You have no ready way to solve this problem, which has been caused by doctors accepting Fake Science for 3 decades.
- On paper BCUHB and other organizations see themselves as ticking all boxes, and so when faced with structural issues like this and linked local difficulties it is easier to default into Healy is a crank mode.
- This likely underpins BCUHB failure to respond to concerns raised.
- For clinical staff and patients, the mismatch between what seems rational to a Health Board and what happens on the ground is creating a hostile environment. The Health Board can only blame staff, for whom it’s like having a weather forecast tell us the sun is shining when its clearly raining – as would happen if the forecasts were based on fake data.
Where there is decent research to support a clinical pathway and staff see patients benefit, a process driven model of care in some areas of care can be rewarding for both staff and patients, but this cannot happen where the structural factors outlined above come into play.
…
Yours sincerely
David Healy MD FRCPsych
cc. F Atherton, BCUHB Executives
Healy – Gething 2016
The problems that killed Stephen were laid out above a year before his inquest and below three years before the inquest. The response from Vaughan Gething below suggests a complete failure to comprehend or else a political calculation that the public would not understand the issues.
Gething to Healy November 2016
Healy to Gething November 2016
Shortly after the letter from Frank Atherton, I gave a talk in the Senedd Building in Cardiff Wales, where Vaughan Gething is based and posted the talk online. It covers the same points about ghost-writing and brings the risks to children into the frame – https://youtu.be/oku_8t8MLek . Mark Drakeford the Welsh First Minister was standing in the background at one point – see HERE.
A year later Vaughan Gething was dragged into the Stephen O’Neill case and his response set up another key moment – to be continued with Orders from Nowhere that Kill.
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Frank Atherton’s letter is completely bizarre. As the Chief Exec he almost gives a nudge and a wink for you to tackle the problems he actually acknowledges as serious- and is responsible for – or is he trying to be patronising? So odd. Neither of them seem to care what a terrible mess the services in N Wales are in. In other situations surely an urgent response to what you outlined would have been called for. And not the farce of ‘Special measures’.
Are they really ‘decent’ men? If they hadn’t been made aware of the issues and made mistakes maybe – but they had been clearly informed and left both patients and staff in the lurch.
Gethin shows his inability to tackle issues openly by the fury he unleashed against a member of his own party recently who was asking awkward questions instead of towing the line.https://www.bbc.co.uk/news/uk-wales-politics-52385006 He is not someone who works collaboratively https://news.sky.com/story/coronavirus-whitehall-takes-charges-of-tests-after-row-between-england-and-wales-11966406
The labour party is a close group of cronies in a small nation of people in ‘top’ positions who all know each other – it’s not a healthy situation as far as speaking out is concerned It is worrying that these two men are in charge of the Covid 19 crisis in Wales.
“My suggestion would be for you to continue to engage with others who share similar views; collective analysis and advocacy are more likely to change systems than individual efforts.
…..I note that you have also copied the letter to your Chief Executive and Medical Director and I will look forward to seeing their response to the service-orientated issues that you have raised.”
How is it when faced with overwhelming evidence of harm and a brilliant cogent listing of the facts, this same old same old offensive blithering nonsense is rolled out!
Even the little people like myself get the same short shrift response when trying to raise the alarm. Oh look you are only one (individual) person who are you to think you can change anything. Next please. Oh and by the way I have many men who are on an ssri.
What part of ‘these drugs are killing people’ don’t they understand.
Why is it people in high positions are unable to think for themselves?
It reminds me of the Abbot and Costello ‘Who’s on first’ sketch. Who is in charge? And who can do something?
Cant wait to read the next installment.
Its got me trying to guess what or how Gething will respond.
Maybe he will make the insulting and highly offensive comment that ‘these drugs have helped millions blah blah blah’.
Maybe it will be the normal doctor hubris in blame the patient blah blah blah,
Maybe he will refer to others opinions or simply respond with deafening silence.
Well if he does choose to respond one thing is for sure (just going from my own limited experience),
1. it will be with a lack of logical coherence,
2. it will contain delusional thinking, and
2. there will be a strong reliance on blither…..
but I don’t know so much so lets wait and see …….. I am on the each of my seat!
H-bombs are dropped, A-bombs are dropped. It feels like D-day …
To the ‘Letter’ … ‘on behalf of Andrew Witty’ …
Where there should have been scientific objectivity there has been voodoo medicine; patients who have sought care have had their trust abused. Seroxat has turned mild stress into suicidal despair, and in many cases a passing anxiety has become a lifelong addiction, leading to self-harm, suicide and even murder. Those who have long questioned the safety and efficacy of Seroxat were ridiculed and undermined by the pharmaceutical giant GlaxoSmithKline.
Two years ago, GlaxoSmithKline wrote me a letter that contains very little that is truthful apart from the date. We know that its spokesmen made preposterous claims on “Panorama”, and the letter states: The safety and efficacy profile of Seroxat has been confirmed through clinical trials involving thousands of individuals and the experience of tens of millions of patients over the 10 years the medicine has been available. 112 The letter does not mention the number of reports that GlaxoSmithKline has disregarded, ignored or, as happened recently, actually suppressed.
https://api.parliament.uk/historic-hansard/commons/2004/feb/23/seroxat
David Healy gave evidence to the regulatory body, when it investigated Seroxat last year, and there is a rather bizarre story to tell about what happened. About nine months before, Dr. Healy had applied for a meeting with the regulatory body. When the meeting eventually took place, he was surprised that no one questioned the evidence that he gave to the regulatory body, although he was a long-time critic. Although some agreed minutes were supposed to be prepared, they were never sent out because many of the members of that committee had financial and other interests in GlaxoSmithKline and in other selective serotonin reuptake inhibitors. That is a deplorable situation.
Reply by James Shannon (JS), GSK Chief Medical Officer, on behalf of Andrew Witty
June 14, 2013
Dear Christopher Gent, Andrew Witty, and Patrick Vallance,
Unpublished trials and misreported trials distort the public medical knowledge base and undermine the basis for rational use of healthcare interventions.
https://study329.org/correspondence-with-gsk/
‘Vaughan Gething – Senedd Cymru/Welsh Parliament drops F bomb on his colleague off mic!!’
To the letter
In adolescent mental health, the standards are pushing children toward drug treatments even though we know that pretty well every single trial has been negative. We end up with drug options because wisdom and other non-drug options are not readily evaluated through RCTs and as a result sensible options don’t make it into the standards.
The selling of antidepressants for teens promised a public health benefit – less crime, alcoholism, substance abuse, divorces, career failures, suicides. But in fact these drugs increase suicidal events, alcoholism, violence, divorce rates, and career failure.
It is not going to be you alone who can get us back to a position where there is some recognition that a significant part of the medical brief is being able, among other non-drug options, to deploy poisons to good purpose, and that to do this safely a service needs good and committed people, in an ongoing relationship with the people they poison or mutilate.
cc. Guto Bebb MP, G Doherty, Professor S Wessely, Dr C Thorpe.
H-bombs –
https://rxisk.org/welsh-and-scottish-petitions-on-antidepressant-dependence/
A-bombs –
http://www.parliament.scot/GettingInvolved/Petitions/PE01651
http://senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19952
Daily Press Briefing – Matt Hancock and Patrick Vallance – plugging Sanofi/GSK vaccine …
Speaking ‘Volumes’ …
Living in North Wales and having recent experience of ‘the system” using their own interpretation of matters raised, I wouldn’t expect too much from them in the next instalment!
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The health board that’s been failing the people of Wales for four years
Betsi Cadwaladr has been in Welsh Government special measures since 2015 and signs of improvement are scarce
ByRuth MosalskiPolitical Editor
06:15, 16 JUN 2019
On June 8, 2015, a written statement appeared on the Welsh Government website and was circulated around AMs.
In 263 words, the Welsh Government’s health minister announced that the Betsi Cadwaladr “should be placed in special measures” due to “serious and outstanding concerns…over some time”.
Four years on, the person who made that statement, Mark Drakeford, is now First Minister and the health portfolio is held by Vaughan Gething.
In a recent Senedd debate, Welsh Conservative leader Paul Davies said: “The reality on the ground is that whilst report after report criticises both the health board and the Welsh Government, real people in north Wales are simply not receiving the care they need and deserve”
Four years of interventions later, the Assembly’s public accounts committee published a report in May which said Welsh Government’s interventions have had “little practical impact”.
Just days ago, Mr Gething said that “significant progress” would be needed for the health board to be taken out of special measures.
A further report by Donna Ockenden, said there had been “insufficient change and learning at the Board to date in spite of the organisation being placed into special measures by the Welsh Government over three years ago”.
During 2012, Healthcare Inspectorate Wales (HIW) and the Wales Audit Office (WAO) said they had growing concerns in relation to the health board’s governance.
And, in June 2015, it was placed in special measures
An action plan was drawn up, and Welsh Government gave the board until April 2018 to make progress.
It failed to do so.
They are still failing to “see the improvement expected,” according to AMs.
There have been a number of changes in terms of leadership.
In a joint statement, Betsi Cadwaladr University Health Board Chairman Mark Polin and Chief Executive Gary Doherty said they welcomed Welsh Government support.138304427511
Update on Gary D.
Health board boss gone as chairman says things need to get better quicker
Gary Doherty has been chief executive of Betsi Cadwaladr University Health Board since 2016
Betsi Cadwaladr University Health Board, which runs health services in North Wales, has announced that Gary Doherty is standing down as chief executive of the board this month.
The health board has been in special measures since 2015, with Mr Doherty in charge since 2016.
In a statement, Mr Polin said: “Gary Doherty is leaving his position of chief executive this month to take up the role of director of integration at Lancashire Teaching Hospitals NH
“The board recognises that we need to accelerate the pace of change and it is now time for someone else to lead the next phase of our journey of improvement.
“I would like to thank Gary on behalf of the board and all staff for his hard work and we wish him the very best for the future.
“https://www.ombudsman.wales/wp-content/uploads/2018/03/Betsi-Cadwaladr-Annual-Letter-2016-17.pdf
Today 24.04/2020 on the BBC News – Betsi Cadwaladr has failed to give accurate information of deaths from Covid.
-betsi-cadwaladr-whistleblowing-report-must-be-shared- 19/09/2019
The investigator himself described writing the report as a mammoth task. 32 individuals contributed – many at significant risk to themselves – regarding a systemic concern about poor services to children.
“There is significant concern regarding the careless waste of staff resources as well as a blind, target-driven culture where managers’ interests trumped the interests of children and families. This is no run-of-the-mill HR concern, it is a clinical governance issue.