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.
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.
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.
August 21st 2018
Minister for Health,
Welsh Assembly Government
Dear Mr Gething
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…
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.
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.
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.
David Healy MD FRCPsych
cc. F Atherton, BCUHB Executives
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.
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.