Australian bushfire smoke drifts to South America

From SciDevNet

By Daniela Hirschfeld, Martín de Ambrosio, Pablo Correa

Smoke particles from the fires ravaging Australia have traveled more than 12,000 km, crossed an ocean and a mountain range and arrived in South America, meteorological institutions confirmed, after smoke was detected in Chile, Argentina, Brazil and Uruguay.

“From the afternoon of 6 January, a grey cloud and redder sunrises and sunsets could be seen in the sky [in Uruguay] due to the presence of small particles in suspension, more than 6,000 meters high, of smoke generated by the great fires in Australia,” said a statement from the Uruguayan Institute of Meteorology (Inumet).

Lucia Chiponelli, technical manager at Inumet, told SciDev.Net that despite the annual “bushfire season” in Australia, this was the first time smoke had been recorded arriving in Latin America in recent decades.

Fires raging in Australia since September have killed 24 people, destroyed more than 1,500 homes, and razed 6 million hectares of land, leaving more than 500 million animals dead. The bushfires, which are among the worst in the country’s history, have been fuelled by record temperatures — 41.9 °C on 17 December — and several months of intense droughts.

It comes after record fires in the Brazilian Amazon last year burned around 1 million hectares of forest between July and September, according to official statistics, while environmental organisations put the figure at more than double that.


NASA video shows the movement towards South America of a huge cloud of smoke from the Australian fires.
One of the consequences of such fires is that when air is heated it rises to the upper layers of the atmosphere, dragging particles from the burned materials along with carbon monoxide and other compounds derived from combustion.

This hot air reaches a height of up to 6,000 meters and from there joins the air currents of the Southern Hemisphere, Chiponelli explained. Smoke from Australia entered Latin America through Chile “because air circulation [in the Southern Hemisphere] always goes from west to east,” Soledad Osores, of the National Meteorological Service of Argentina, told SciDev.Net.

From Chile to Uruguay

On 6 January, the Chilean Meteorological Directorate announced the presence of smoke whose “effect was seen in the sun with red tones (…) the product of a cloud of smoke coming from the [Australian] fires”.
In Argentina, the smoke was visible to the naked eye from Patagonia, in the south of the country, to Santiago del Estero, in the north. The greatest concentrations were found at about 5,000 metres high, and therefore had no impact on surface visibility, according to the meteorological service. “It’s just smoke, without ash, that will dim sunlight during daylight hours,” Osores added.
In Uruguay, smoke arrived 6 January, as was the case in southern Brazil. “The sky was grey in several cities west and south of Rio Grande do Sul [Brazil’s southernmost state]. In the cities of the northern half of the state, including Porto Alegre, smoke was not noticed due to the large number of clouds,” a spokesman for the Brazilian meteorological company MetSul told SciDev.Net.
MetSul added that with smoke remaining in the Pacific, more particles could be expected to arrive in Brazil in the weeks ahead, depending on wind currents.

However, the situation depends on many factors. Even if Australia’s fires persist at their current rate, the concentration of particles can be lessened by local circumstances. The smoke reached Latin America more than a month after the fires started in Australia, for example, after being dispersed by Pacific Ocean winds in its path.

Australia night fire

Forest fires raging in Australia since September have destroyed homes, land and wildlife. Credit: Sascha Grant (CC BY-NC-ND 2.0). This photo has been cropped.

Other factors, such as storms, may stop the smoke in its tracks. “The clouds that generate storms have a vertical development that can reach 6,000 meters high. If the particles enter those storm clouds they will precipitate with the rain. Then, if storms form on the road over the ocean or when entering Chile, the particles do not arrive,” said Chiponelli.

According to Osores, the rains forecast for Wednesday [8 January] and Thursday in Patagonia, in the central area of Argentina, will reduce the particle load towards the end of this week.

Health and airplanes

Daniel San Vicente, cardiologist and president of the Montevideo regional council of the Medical College of Uruguay, said the current concentration of particles in the air was not enough to have an impact on health. But he said the episode should alert doctors to the possible health effects of events related to climate change.
Another sector potentially affected by such events is aviation, since smoke clouds are found at the same altitude at which aeroplanes fly and particles can reduce visibility. However, both Inumet and MetSul agreed that visibility has not been affected so far.
“It is not worrisome [for health or aviation] but you have to be alert. Public and media interest is well-founded, especially since Australia is far away and the arrival of smoke particles helps people to understand the magnitude of the fires that affect that country,” said Chiponelli.

How can we predict fires?

The severity of the fires has shone a spotlight on strategies to prevent further outbreaks and deal with the growing climate threat.
Scientists from Medellin, Colombia, gathered at the American Geophysical Union conference in December in San Francisco, to share the results of a fire prediction model that could be expanded to other locations.
Experts from SIATA, a science and technology project focused on risk analysis of natural hazards, joined citizens to build an air monitoring network, installing more than 100 low-cost sensors in homes and workplaces. The Medellin region records between 500 and 700 fires every year.
Other technologies used by the team included laser sensors to test air quality, a pyrometer to measure solar radiation reaching the earth’s surface, and a radiometer that measures atmospheric temperature and humidity.
Nicolás Velásquez, one of the members of the project linked to the University of Iowa, explained that these tools enabled scientists to build a model that generates hourly vulnerability and risk maps of each area to share with firefighters in the region.

Results showed that the areas of greatest risk are within a radius of 2,000 metres of urban areas, a sign that many of the fires are started by local people.

 

This article was originally published on SciDev.Net. Read the original article.

The Magic Money Tree

(first published 21/12/19: Wee Ginger Dug)
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A few miles north of Bridge of Orchy, as the A82 skirts Loch Tulla and climbs steadily over the Blackmount towards Rannoch Moor and Glencoe, a lone rowan tree grows atop an enormous boulder, just a few yards from the road. It is an improbable place for a tree; its roots taking support and nourishment from the shallowest crack in a rock in the most inhospitable environment.

Yet every September, it produces an impressive harvest of berries and does so year after year, despite its exposure on a seemingly barren piece of rhyolite. In 1970, it was almost six feet high – as tall as my Dad – who climbed up the rock one day to cut a small branch to bring home to Lochgelly for our garden. Within a few years, it too was heavy with berries at the end of each summer.

Throughout my childhood, the rowan would invariably be cited in parental lessons about money. Unlike berries, money didn’t grow on trees – it had to be earned and saved before it could be spent – a mantra reinforced repeatedly over the years by my elders and politicians like Theresa May, who claimed ad nauseam, that government has no Magic Money Tree. It was her particular way of defending her policies of austerity.

It is not true.

On 8 October 2008, the then PM, Gordon Brown, announced his package to rescue the British banking system and immediately made available £400 billion to eight banks and building societies. Few asked, “Where’s the money coming from?” or, “How are we going to pay for it?” but the bankers and politicians knew the source and understood precisely how the Government was going to ‘pay’ for it.

The Government  (or currency issuer) was the source – and it was ‘paid’ for by imputing numbers into a bank account. The money was not transferred from government deposits or by raising funds through bonds, gilts or taxes: it was created out of thin air by pressing a few keys on a computer. It is that simple.

De La Rue, the printers, did not go into overdrive – nor was there hyperinflation – and the bankers were naturally delighted that the consequences of their greed and dishonesty were rewarded by the UK Government’s very own Magic Money Tree. One day, they were broke and facing penury; next morning they were celebrating with champagne, pay rises and bonuses. Quelle surprise !

‘Quantitative Easing’ was just the Bank of England buying bonds, shares and other assets in exchange for deposits made by the central bank in the commercial banking sector, by crediting their reserve accounts through a digital transaction. The purpose was to create excess reserves that could be loaned to chase a positive rate of return, which in turn would provide greater liquidity and stability. All well and good, but the ‘money’ was no more than an accounting adjustment in the respective accounts to reflect the asset exchange.

The secrecy of the global banking system and the deliberate lack of transparency in government fiscal reporting conceal the true nature of these financial exchanges and capital creation. However, due to a small group of economists and academics, a new economic paradigm has evolved that provides a greater understanding of these financial mechanisms and how they may be harnessed by governments to fund their operations and policy objectives.

Modern Monetary Theory (MMT) outlines the principles for a progressive, sustainable society which has no funding constraints. It is, in effect, the Magic Money Tree – and if used responsibly, could transform society across the planet.

At this point in history, our civilisation faces enormous challenges. Pollution of our atmosphere and oceans threaten our very existence, primarily as a result of uncontrolled population growth and all the attendant waste that humanity produces. The impact of pollutants on the climate and weather systems is well known, but the deterioration in air quality in particular poses a far more immediate and deadly threat than extreme weather and rising sea levels.

We will all have to change the way we live if humanity is to survive – and that level of readjustment, together with all the environmental restoration that is urgently required, cannot be funded sustainably (or desirably) by borrowing from the banks and markets. But for currency issuing countries like the UK, that isn’t a problem.

MMT is best explained as a macroeconomic framework that says monetarily sovereign countries like the U.S., U.K., Japan, Russia and Canada are not operationally constrained by revenues when it comes to government spending. In other words, such governments do not need taxes or borrowing for spending since they can print as much as they need and are the monopoly issuers of the currency.

“The United States can pay any debt it has because we can always print money to do that. So there is zero probability of default.”

Alan Greenspan. 2011

 MMT challenges conventional beliefs about the way government interacts with the economy, the nature of money, the use of taxes and the importance of budget deficits. These beliefs, in part reinforced by our well-intentioned parents and grandparents, are really no longer accurate, useful or necessary.

You may ask if that is the case, why do we have such horrific levels of poverty and homelessness in the UK? Why the cuts to public services and infrastructure if government spending is not constrained by revenues? Why do we have Universal Credit instead of a universal income? Why is Holyrood’s budget restricted? How could Gordon Brown magic up £400,000,000,000 from thin air and gift it to the wealthiest in society whilst child poverty reminiscent of Victorian times rose during his tenure of No10?

Why – if not to preserve the status quo? I suppose those responsible for these policy decisions have their reasons but at least they can count on being suitably rewarded for their loyalty once their time in office comes to an end. But at what cost to the rest of us?

Scotland, therefore, can do something quite remarkable should it choose independence. It already retains the rights to issue the Scottish pound and can legally establish its own currency issuer or central bank, through which its government can credit the commercial banks’ reserves to provide sufficient money for the economy and all its policy objectives without reliance on raising taxes, issuing bonds or borrowing from the private sector and markets.

“Too wee, too poor and too stupid”, really is no longer applicable (if it ever was).  Everything Scotland needs to be an economically sustainable, progressive sovereign country is within its grasp – providing it adopts and exploits the MMT paradigm to create its currency reserves then applies transparency and good housekeeping principles to all of its transactions.

Is there a risk? The reality is that governments across the world have been using their own Magic Money Tree to create any amount of cash for many years. The USA printed billions of dollars and shipped them out in crates to Iraq and Afghanistan to fund day-to-day military and security operations during the ‘war on terror’. The money wasn’t taken from the American people through taxation; if it is recorded anywhere; it is merely as an accounting entry on a Federal Reserve ledger.

Japan embarked on a course of fiscal stimulus, money creation and increased government spending following the asset collapse and economic crash of 1992. It runs a substantial deficit and will continue to do so but that does not constrain or limit its spending in any way whatsoever.  Its economy is stable and its citizens enjoy a high standard of living, despite the enormous impact of the tsunami and the ongoing operation to recover and isolate the nuclear corium from the Fukushima power plant.

And the UK – which has gifted some £535,000,000,000 to the commercial banks since 2008. Where did it all go? Can it all be accounted for? How much ended up off-shore in secretive banking networks? I would not like to guess but it also raises the question that if the UK Government utilised these arrangements to create over half a trillion pounds for the banks, has it done so to fund other commitments and expenditure? And what might they be for?

One of the founding proponents of MMT, Professor Bill Mitchell gave a lecture at the Labour Party Conference on the 23 September this year where he outlined the potential for sovereign nations to adequately fund the Green New Deal. I am certain a Scottish audience would be extremely receptive to his suggestions.

Scotland’s reputation for building a progressive and inclusive society was gained in no small part through the wisdom of its famous sons and daughters during the Enlightenment.  In ‘The Wealth of Nations’, Adam Smith observed:

“What improves the circumstances of the greater part can never be regarded as an inconvenience to the whole. No society can surely be flourishing and happy [when] the far greater part of the members are poor and miserable.”

 Smith could never imagine a Magic Money Tree when he wrote his book in Kirkcaldy during 1775 and would probably be incredulous at the suggestion. Yet today, a few miles along the coast in North Queensferry, sits a Fifer of lesser repute who certainly knows otherwise.

Scotland has an incredible opportunity to take a completely different path with the ability to fund itself fully without impoverishing its citizens – indeed, quite the opposite. Its Magic Money Tree is in Holyrood, not atop a boulder on the Blackmount but its harvest could be just as productive and as beautiful as the rowan.

Use it responsibly. Use it now. Before it is too late.

 

 

 

The Gaia Prospectus

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It will be obvious to all, that our system of governance has failed and whatever the outcome of the General Election tomorrow, none of the proposed policies from any of the established political parties will address the significant challenges facing the people within these islands at this point in history.

To understand why, go back to basis.

We are the latest and possibly last civilisation to populate this planet. We are characterised by our creativity and ingenuity, exemplified in many areas – arts, music, industry and technology – and achieved much, even in our lifetimes, that our forefathers could never dream of.

But it has come at an enormous cost. The focus on environmental issues is welcome, but climate change is only part of the problem; there are far more imminent threats to our survival than severe weather and rising sea levels – as catastrophic as that may eventually prove.

From space, this place we call home is spectacularly beautiful; the deep hues of the oceans and brilliant white of clouds – all under the very thin blue line of our atmosphere. There’s nothing else like it out there in the void, but there is plenty evidence that some of our closer neighbours had something similar to Earth once upon a time – but not now. They are spectacular too – but only in their desolation and emptiness.  And absence of life.

A fluid and a gas. Water and air.  The basis of all life on this planet. Yet in just two centuries, human activity has contaminated and polluted both of these essential substances to such a degree that we now imperil the future prospects of not only humanity itself, but most living species that we have been so fortunate to share this place with.

The only thing we had to do was to look after it and preserve the delicate balance in nature that provides us with everything so that future generations could experience the same as ourselves; to wonder at the incredible miracle that we exist at all and to marvel at the abundance, wealth and beauty around us. We should be overjoyed every day and be having the most ridiculous amount of fun – and sharing these experiences with each other, wherever we happen to find ourselves.

The decline in air quality is accelerating with the destruction of the rainforests and global wildfires rapidly contributing to the increasing volume of toxic gasses, particularly CO2 in the air we breathe. It doesn’t evaporate out into space, it remains in the atmosphere.  Two centuries ago, we numbered a billion people. A century later, the population had grown to 1.8 billion. Now we are approaching 7 billion. All consuming, all polluting.

That’s a lot of cars, trucks, factories, houses, airplanes and any other number of sources pumping out vast quantities of gas that is poisonous and will suffocate us – not in decades to come, but much sooner. We are all aware of the recent deaths in Delhi and other cities. Saturation of our atmosphere with gas that is incompatible with life is simply stupid and must cease immediately, however inconvenient that may be. We need clean air again. Anything that impairs that goal must stop.

The pollution in our seas and fresh water supplies is also grave. Aside from the plastics and toxic chemicals we’ve dumped in the oceans, we now face the horrific prospect that the highly radioactive corium from the three nuclear reactors at Fukushima may never be recovered and will continue emitting high levels of isotopes directly into the Pacific. The corium will also require constant cooling for decades to come – and Japan is rapidly running out of space to store the contaminated waste already. Eight years have been wasted through corruption and cover-up. We are rapidly running out if time.

Our waste is rapidly destroying the entire marine habitat. Large areas of the oceans are now devoid of oxygen from the build up of algae that follows agri-chem discharges. Witness the beaching’s and decline in migratory fish stocks. If we kill the seas, we die too.

Even our fresh water is unclean. Britain has some of the highest levels of antibiotics in its waterways – from the way we farm our livestock. Resistance to infection from the conventional misuse of these drugs is already well established. That we add to the problem from food production methodology is insane and may well be a contributory factor in the exponential rise in sepsis cases in the last few years.

For these reasons, the restoration of Earth’s environment should be our principle objective. But Britain cannot achieve this alone. No country can, whilst we all remain shackled to the present economic model. We urgently need to change the way we live, but none of the politicians anywhere in the world can offer a solution. How can it be done? How can we afford it?

How can we not?

To appreciate the challenge we all face, go back to basics again and consider human nature and our own behaviour.  Think of the chronic smoker who’s had a leg amputated and told they will lose the other – if not their life – within a year, unless they quit. Few will manage it. Most will head outside in their wheelchair desperate for another smoke. We know it’s stupid, but that’s just addiction. We all suffer from it to one degree or another. Drugs and alcohol are even more difficult to quit because of the pleasurable feelings.

But substance addiction is relatively harmless – except to the individuals and those around them – when compared to the consequences and impact of our greatest addiction. Money. Our one invention that was supposed to benefit all humanity has been corrupted in every sense. The obscene wealth inequality and resulting poverty is commonplace in every country, destabilising societies across the globe. Money and wealth has become the sole prerogative of humanity for so long that it has obscured everything else

If we aspire to achieve only monetary wealth, then it is not only the financial elites who perpetuate the status quo; it is all of us.  We have to break the cycle. We have to beat this addiction. Everyone. But money will also be vital to our recovery, if we ever chose a different road.

That choice will not be offered by any political party. Our governments are part of the problem – they are committed to the geopolitical and neoliberal economic model that endangers us all, not least because of the personal and financial rewards their subservience provides. Their motives, ideologies and tribalism are no longer fit for purpose – and it should be abundantly clear by now that trust and honesty are qualities long disappeared from political and public life.

** UPDATED 9.1.20 **

Since writing the foregoing, Australia burns.

The following is taken from Bill Mitchell’s excellent blog. Click on text for full article.

“It is hard to feel any further shame about my nationality than I already do given the way that we have allowed successive Australian governments to indefinitely imprison innocent refugees on Pacific Islands over many years now.

These people were seeking shelter from oppression and turmoil, much of it sourced, initially, by the fact that our governments decided to play ball with the disgusting and illegal invasions of various nations (Afghanistan, Iraq, etc) by the Americans.

There is a deep cultural insecurity in Australia where we seem to think that anything American is to be celebrated and prioritised over our own identity and capacities.

That ‘cultural cringe’ cuts across all areas of our lives – political, cultural and educational. We need to grow up.

****************

Life on this planet should be very simple. Enjoy the miracle and keep the place in good health for other generations to do the same, otherwise, this may well be our lasting legacy.

 

solar-system-mercury-planet-wallpapers

Links:

Fukushima March 2019: March 16 version (2)

Modern Monetary Theory: Bill Mitchell.

 

 

 

 

 

 

Whistleblowing and the lies of Jeremy Hunt

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Thirty-five years ago, during the summer of 1984, my grandmother, Agnes MacDonald became unwell and after several hospital visits for blood transfusions, she passed away at the start of October aged 68 years.  She died from acute myeloid leukaemia (AML) – an aggressive cancer of the bone marrow that results in a fatal abnormality of the white blood cells.

However, the true cause of death was a negligent mistake by the NHS. Over a decade before, she undergone a hysterectomy for ovarian cancer and been prescribed a course of cyclophosphamide – an immunosuppressant used in cancer care. The recommended course was 12-18 months, however a simple administrative error meant that course completion dates were not recorded or flagged and she remained on the drug for the next twelve years, unbeknown to her consultant and GP.

The overexposure to cyclophosphamide destroyed her bone marrow and was the cause of the AML – however, this was not reported to the family at the time and would have remained undiscovered, had it not been for another mistake by a hospital medical records department a few years later.

I’d only been qualified for a year when she died and worked at the same hospital as her consultant. When a patient sharing the same name of Agnes MacDonald came in for treatment one afternoon a few years later, the notes in the bundle of records I’d been sent were my grandmother’s; therein lay the truth of the matter.

It was clear from the consultant’s final entries and letter to the GP, that the cause of death was overexposure to the drug. But there was no explanation why this had happened, any admission of negligence or suggestions to prevent any similar cases happening again in the future.

At the time, there were few options to pursue enquiries regarding NHS treatment and care of relatives. Complaints managers or liaison services for patients didn’t exist back then and medical negligence litigation was extremely rare, not that any of these would have been a consideration anyway. Not in our family at least.

My grandmother’s view would have been quite simple. Everyone makes mistakes, the important thing is to learn and not cover them up for fear of punishment.  That only compounds the problem. She had always been thankful and gracious with all the doctors and nurses that had looked after her over the years – and any notion of a complaint or legal action for negligence would not be something she would have wished for in any circumstance. But I still needed some answers.

I wrote about these events in an earlier essay, but it was not until relatively recently that I realised just how much of an impression they had made – and why the lessons they offered at the time are equally important today as they were back then.

Whistleblowing was unheard of in 1984 – unless you were familiar with the adventures of Winston Smith – and in the NHS particularly, the idea that an employee would seek to publicise through the media, mistakes made in patient care, would primarily be regarded as a betrayal and breach of trust of colleagues; a powerful inhibitor in any consideration. In practical terms, it may also prove counter-productive – negative publicity, loss of trust and respect, blame and punishment – rarely act as a prelude to a satisfactory outcome.

But that was thirty-five years ago and in the interim, the NHS has been politicised and weaponised by successive governments and an increasing number of external agencies with powerful vested interests. Professional bodies, private hospitals & commerce – such as the pharmaceutical industry, medical regulators and the legal profession – each one pursuing a different agenda – are all part of today’s working environment in the NHS.

Ostensibly, these agencies should compliment and enhance the function and performance within the NHS – and improve patient outcomes. In many aspects they do just that. But they also complicate and threaten professional responsibilities for health professionals within the NHS who raise concerns regarding risks to the general public.

When dangerous practice is created by the function or actions of one of these agencies, the risk to the health professional raising concerns becomes substantial. Sadly, over the last two decades, we have witnessed the persecution and victimisation of many individuals in the NHS – and other sectors – who have had their careers ended and reputations tarnished when their concerns implicate the very agencies and institutions whose principal responsibility is to ‘protect the public’.

Raj Mattu, David Drew, Narinder Kapur and Shamila Chowdry all had the misfortune of losing their careers after raising concerns about patient safety in the NHS. The conduct of the agencies involved in persecution of Dr Mattu and Dr Drew led directly to the Public Inquiry headed by Sir Robert Francis, whose condemnation of the conduct by the NHS Trusts and regulators involved in the cover-up of the scandal at Mid Staffs, compelled the Health Secretary, Jeremy Hunt, to make a formal apology in Parliament on 11 February 2015 in response to the publication of the Francis Report.

“Sir Robert confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed because they tried to do the right thing for patients: people losing their jobs; being financially ruined; brought to the brink of suicide; and family lives being shattered. Eminent and respected clinicians had their reputations maligned.

There are stories of fear, bullying, ostracisation, marginalisation as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny” with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers” and then blacklisted from future employment in the NHS as the system closed ranks.

But the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if doctors and nurses who have given their lives to patient care always feel listened to if they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which has no place in our NHS.”

Jeremy Hunt 11/2/2015

Whilst he was making this statement, I was standing in the dock at Hammersmith Magistrate’s Court being prosecuted for the second time by a health regulator. Hunt was aware of the case – my MP had written several times by then – but the Health Secretary remained silent and refused to intervene. Even after it became known that one of the UK’s worst paedophiles had exploited the loopholes in the legislation and had been practising as an unregistered podiatrist for over a decade until his arrest and conviction in 2016 – Jeremy Hunt refused to acknowledge the regulatory failings at the HPC.

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Blatant hypocrisy from a Health Secretary who presided over a regime at the Department of Health that created its own ‘hostile environment’ in the NHS and Social Care with its continued persecution of whistleblowers. Dr Chris Day, the nurses at Gossport and Shrewsbury continue to have their lives blighted by malicious and sustained victimisation by the Department and its partners in the regulatory and legal agencies.

Earlier this month, Norman Lamb MP tabled a debate in the Commons regarding whistleblowing and highlighted the experience of Chris Day.

 

In recent months, medical and health regulators issued their own guidance on whistleblowing for their registrants. This included the Health Professions Council (HPC) and the Nursing and Midwifery Council (NMC), who jointly regulate over a million health professionals in the UK.

Readers of this blog will recall my own experience at the hands of the HPC after I raised concerns about public safety caused by deficiencies in their primary legislation regarding “protected titles”. Following two criminal prosecutions and fifteen separate hearings over four years – with legal costs for the HPC exceeding £300,000 – I am sadly unsurprised by Norman Lamb’s remarks in Parliament.

I suspect in due course, he will share a similar sentiment when he reads the following.

I am now in a position to advise readers that the legal proceeding have now concluded in my case with this regulator. In January last year, I submitted an application to the Criminal Cases Review Commission after my conviction was upheld by a perverse judgement at Preston Crown Court in June 2016.

The application to the CCRC was based on evidence that the HPC and Department of Health, wilfully and knowingly conspired to conceal the actual provisions governing use of title, thus compelling individuals to register with them when the legislation gave no such authority in law. The HPC – and NMC – fraudulently misrepresented the conditions for registration when they became statutory regulators in 2004 – and their failure to properly disclose the provisions formed the basis of my application to the Commission.

When submitting this in January 2018, I asked the CCRC to obtain the transcript of evidence heard at my Crown Appeal – together with the prosecution and defence papers. The Judge had contradicted herself a number of times in her summary judgement – whilst the prosecuting counsel for the HPC had misled the court regarding disclosure during my evidence. I provided new evidence that the regulator had deliberately concealed essential information from the professions, public and myself as a defendant in a criminal prosecution that had only one purpose: To silence an individual whose persistent defiance threatened to expose yet another scandal in the agencies associated with the NHS.

The CCRC agreed to obtain this material and estimated a conclusion by May 2018. In February 2019, they issued their provisional review – and upheld and reinforced the Appeal Judge’s findings. It was quickly apparent that the Commission had not examined the transcript evidence from the hearing – a fact confirmed in an email exchange on the day the review was received.

Hello Andrew

When I made my application to the CCRC last January, I asked whether the Commission would have access to the court transcripts of my hearings – particularly the Crown appeal. I was assured they would be available for consideration, if required.

From the Commission’s response, I suspect the transcript of the appeal was not considered. Can you confirm that is the case, please?

Hello Mr Russell,

I can confirm that you are correct – the Commission did not obtain a full transcript of the appeal proceedings, but instead relied upon the detailed judgment of the court that you provided to us in support of your application.

Regards,

I invited the CCRC to reconsider their decision and set out why their decision and that of the Appeal Court was fatally flawed. I asked them once again to obtain the transcript of the hearing and consider this in context with my submissions.

In May, I received a final decision from the CCRC not to refer the case to the Court of Appeal. They refused to obtain and consider the Appeal hearing transcript and then compounded matters by offering their own interpretation of the legislation, directly contradicting the findings of all the courts during this bizarre case. It was perhaps, given all that had gone before, a fitting conclusion – but not one, I suspect, the CCRC will be especially comfortable with in the very near future.

For transparency, I have uploaded the application and all other papers referred to here:

Application for review Jan 18     CCRC Provisional Review

Request to reconsider    CCRC Final decision  Closing correspondence

I had really hoped that there would at last, be a satisfactory outcome in this sorry saga – not least to provide some reassurance all the other health professionals who may, in future, be faced with a similar dilemma that I had a decade ago. Regrettably, I am unable to do that, but what I can do it to offer some advice for all registrant health professionals, doctors, nurses and dentists – who might consider voicing a concern regarding safeguarding but is worried about the implications and impact it may have, professionally and personally.

  • Document everything; every meeting, conversation and all correspondence.
  • Be honest, objective, accurate and truthful at all times. Don’t exaggerate any claims. Be concise.
  • If your initial concerns are rejected or ignored, think carefully whether you wish to pursue the matter further. Consider what other interests might be affected by your claim and how that may impact in future action against you.
  • Do not trust anyone in authority. Do not trust the institutions you expect to be honest, transparent and forthright – as if we didn’t know that by now.
  • Do not expect any assistance from your professional body or any other agency you are affiliated with, particularly when they are implicated in the safeguarding issue you raise.
  • Do expect to lose your livelihood, future career, reputation, home, savings and pension. Your relationships, with loved ones and friends, health, sanity, self-respect and dignity will also suffer detrimentally. At some stage, suicide will seem an attractive solution.
  • Anticipate little satisfaction from political quarters. Pursuing whistleblowing concerns directly with government Ministers through constituency MPs is a complete waste of time and energy. Particularly when they are in the governing party.
  • Do not assume any support from the media, unless your claim is sensational and can be summarised in just one sentence. The vast majority of journalists and editors in the media – and their readers – don’t understand complex cases where victimisation, cover-ups and NDAs all form part of the game.
  • Confide only with close friends and seek the assistance and guidance of others who have experienced similar matters.
  • Provide an account of your experience with documented evidence for the public and your colleagues to consider.
  • Be resolute, determined and most of all, believe in yourself, particularly when all seems lost.

As the political chaos with Brexit engulfs Parliament and the country, I watch with a mixture of horror and disdain at the choices facing us for the future Prime Minister. On the one hand we have a fantasist buffoon who can barely string a sentence without contradicting himself – and on the other, a consummate liar; a Machiavellian character who has inflicted immeasurable damage on the NHS and many of the dedicated professionals who work in that sector. A Hobson’s Choice, if ever.

I’ve never considered myself a whistleblower before – just a podiatrist who raised a safeguarding concern through the appropriate channels – and discovered, to my cost, a quagmire of dishonesty, deceit and corruption. Never again. As another matter has exquisitely reinforced, no-one is listening.

The Health Professions Council spent over £300K prosecuting me to cover-up their dishonesty and fraudulent misrepresentation. I was fined £200. My costs including loss of earnings now amount to over £700K. I am now unemployed and in receipt of Universal Credit which provides me with a generous £3.85 per month to live on.

The pendulum always swings back, Mr Hunt. This time it carries more weight than you can ever imagine.

 

Sepsis and Limb Loss – an avoidable tragedy.

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Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. In other words, it’s your body’s overactive and toxic response to an infection.

It is the third largest cause of death in the UK and kills more people than bowel, breast and prostate cancer combined.

There were over 250,000 cases of sepsis in 2018 according to the UK Sepsis Trust and at least 46,000 people die every year as a result of the condition.

Some people are at higher risk of developing sepsis because they are at higher risk of contracting an infection. These include the very young, the very old, those with chronic illnesses, and those with a weakened or impaired immune system.

But it can affect anyone at any age, even those in good health – and recovery can be a long and difficult journey for those fortunate to survive.

In severe cases of septic shock, the most common cause of death is multi-organ failure due to a loss of blood pressure. To combat this, a range of drugs called vasopressors are administered. These have the effect of constricting the blood vessels in the arms and legs, redirecting the flow to the major organs. Approximately 40% of critical care patients with septicaemia require vasopressor administration. Unfortunately, this necessary regime has serious complications with life changing consequences for many patients.

The primary complication is a condition called disseminated intravascular coagulation (DIC), which occurs when trapped blood in the constricted arteries in the arms and legs, coagulates (or clots) and blocks the vessel. When the drug regime is discontinued and the blood flow returns to the limbs, these clots impair the re-vascularisation and gangrene occurs. Many of these patients then undergo limb salvage and amputation, often in multiple limbs – with mid-calf and above-wrist level amputations not uncommon.

Currently there is no NHS treatment for DIC induced ischaemic and gangrenous limbs other than salvage surgery.

In 1999, Tom and Nicola Ray were newly married and expecting their second child when, almost overnight, their lives were thrown into turmoil. Tom developed sepsis following a dental procedure and within a day of onset, he slipped into a coma. He was 38 years old.

When he woke up five months later, Tom discovered he had undergone quadruple amputations to both hands and feet, with additional facial amputations as a result of sepsis. He couldn’t remember who he was and didn’t recognise his family. During his coma, Nicola gave birth to their second child, but their difficulties were far from over.

Tom and Nicola lost the business they were running together and had to sell their house and move out. There followed several years of reconstructive surgery..

“I had to go through several years of extremely painful facial reconstruction operations to get a cosmetic nose and to make me look not so ugly. But the surgeon at the London Hospital gave up in the end – he is the best in the world but he said there was nothing more they could do about my face. I never understood why but apparently it was too difficult.”

Last year, an extremely moving film detailing Tom’s journey to recovery was released at the Edinburgh Film Festival. It should be seen by everyone.

When Scottish businesswoman Corinne Hutton from Lochwinnoch, fell ill at age 43 in June 2013 after suffering acute pneumonia and sepsis, surgeons were forced to amputate both her hands and her legs below the knee. Prior to her illness, Corinne was a busy small business owner, devoted Mum and regular fitness fanatic, setting herself challenges like running marathons, cycle rides and climbing expeditions to raise money for worthy causes. Earlier this year, Corrine underwent a double hand transplant and is presently recuperating, but like Tom and Nicola, she has since devoted herself to raising awareness of sepsis and its devastating complications and helping those who have lost limbs. Brave and amazing people all.

Five months ago, I wrote about the experience of a friend, Alan Bowell, from Blackpool who contracted sepsis last September and was gravely ill on admission to hospital. Alan had recently started taking medication for Crohn’s Disease – an immunosuppressant called Azathioprine – and was nine days into the course when he became disorientated and shivering uncontrollably.

He wasn’t made aware that immunosuppressant therapy can be a contributory factor in sepsis cases – and consequently, remained ignorant of the clinical signs and symptoms of the disease. Alan thought he was coming down with the flu and didn’t seek any medical help until the following morning when his condition deteriorated significantly. His last memory before he fell unconscious was being helped into the ambulance at home.

Ten days later, when he regained consciousness he discovered gangrene was already established in both feet and the fingers of his right hand and the prognosis was poor. Alan had undergone a colon resection a few days after admission and had a stoma fitted, but a surgeon advised he would require further operations to the gangrenous limbs, before a stoma reversal could be considered.

In cases of vascular insufficiency, with accompanying tissue necrosis and gangrene, a demarcation line is often found encircling the affected limb. This represents the boundary between the truly viable and dead or dying tissue. In limb salvage the level of amputation is determined by the demarcation line to ensure healing takes place.

Three weeks after regaining consciousness, the demarcation line in both Alan’s legs was mid-calf and in his right arm, just above the wrist.

From the previous post you will have read that Alan started a course of hyperbaric oxygen treatment when he was discharged home the following week. I wasn’t aware that he was ill until six weeks after he was admitted – and a month after he regained consciousness. When I visited him on 24 October, I was shocked by his appearance. We’d played guitar together late August and enjoyed a meal and drink. He was in great form.

Within just two months he looked dreadful, lost over two stones and dwarfed in the standard issue NHS high backed chair. It took a bit of time to adjust – just thinking about what he had gone through and what he was now facing. I’m not sure if I was in that position – the very real prospect of losing hands and feet – if I could even face it for a day. But here he was. Knackered, confused, frightened, angry but very determined. At that point, I’m not that sure I understood why.

As he told me what he knew had happened – falling ill, coma, abdominal surgery with bowel resection and stoma – and gangrenous fingers and toes (with established demarcation), I remembered something vaguely similar in the past and mentioned it to Alan.

When the ward doctor called in, we asked him about the possibility of starting hyperbaric oxygen treatment, but he hadn’t heard of it. Nor had any of Alan’s other doctors he was to subsequently see. The vascular and plastic surgeon he was referred to told us there was no evidence that HBOT helped limbs affected by vasopressor administration, but nor did they think it would do any harm.

So, the following week, when he was discharged from hospital, Alan started a seven-day course of HBOT at ‘A Breath for Life’ near Lancaster. After the first one-hour session, he reported feeling ‘tingling and pins and needles’ in both feet and his right hand. By the end of the course the demarcation lines in all three limbs had disappeared and pulses were present again in both feet.

Over the following three months, some recovery of necrotic and gangrenous tissue was established and new skin has since formed. Alan finally underwent salvage surgery in March this year to remove the putrefied tissue of his right forefoot, the apex of three toes on the left – and the tips of two fingers on his right hand.

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He is making a good recovery and is hoping the stoma reversal will be scheduled in the very near future. Two weeks ago, he played his first gig since last August and it was a privilege to watch him perform.

I’m not a sepsis or vascular specialist, simply a podiatrist that recalled a similar case a few decades ago and assumed – wrongly, as it turned out – that  pressurised oxygen treatment was already playing an important role to play in restoring circulation to limbs affected by vasopressor administration in sepsis management.

To discover that this is not the case in the NHS was astonishing. It certainly worked with Alan, which we are all grateful for – although I can’t help wonder how much more of his limbs could have been saved had the HBOT been started much earlier. Time is the critical factor – once the tissues and blood vessels degrade past a certain point, they are unrecoverable.

But when one considers just how many other patients are facing a similar prospect and prognosis currently, it seems inconceivable that they should be left with no other option than the surgeon’s knife.

Until very recently, I had no idea how HBOT worked in these cases. When I searched for articles online, I discovered no published articles reporting or supporting its use in preventing limb loss in sepsis recovery patients.

However, there were numerous articles on limb loss from vasopressor induced ischaemia following septic shock – and these explain the mechanisms that cause the loss of blood supply and tissue necrosis. The blockage of arteries by clots of coagulated blood – DIC – resonated with me when I read the first article. It is the same mechanism of injury that occurs in severe frostbite – and I’ve known a few people over the years climbers and patients that have lost fingers, toes and limbs from prolonged exposure to the cold.

When searching for DIC in frostbite gangrene – I found several prominent articles citing the use of HBOT for the treatment of frostbite, which explained in detail how pressurised oxygen helped re- vascularise limbs affected by cold induced DIC – even with established high level demarcation and gangrene.

It appears that the mechanism of injury – the coagulated clots in the blood vessels that impair the return of the blood flow – and subsequent tissue death – are the same in severe frostbite and those recovering sepsis patients. In the former, it is extreme cold that closes down the circulation – in the latter it is the drugs used to combat the loss of BP and multi-organ failure in severe septic shock management.

Subsequent searches on different medical and scientific databases have revealed numerous articles citing the use of HBOT for frostbite – many as the ‘gold standard’. Pressure chambers are now installed in most scientific stations in the Artic and Antarctic – as well as various sites in the Himalaya – specifically for that purpose.

Scientists and medics from Norway, Denmark, Russia and Canada use the HBOT chambers in the Artic – and all reports/papers demonstrate favourable outcomes and a considerable reduction in limb/tissue loss.

Recent papers cite a combined regime of HBOT, thrombolytics and manual physiotherapy/massage initiated as soon as possible following injury provide the best outcomes. If this works for frostbite, it may prove beneficial in sepsis care to prevent limb loss.

As Alan remarked, “It seemed like a good positive thing – and what did I have to lose, except the obvious?”

So, although I am no longer in practice, I thought it might be a good idea to report it to someone, especially as it seemed no-one in the NHS had even heard of HBOT, never mind its use for these patients. In January, I wrote to my MP and asked him to notify somebody in the Department of Health and two months later they replied saying following a recent review, HBOT was only now commissioned for decompression sickness in diving injuries and before they’d consider it further, they’d need a detailed proposal from a relevant specialist.

There are no HBOT facilities in the NHS and most of the private/charitable centres use multi-person chambers we are all familiar with. However, single use units for intensive care are used in many other countries. They are inexpensive and simple to operate and take up no more space than a hospital bed.

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I’ve since written 98 emails to various people I think might be vaguely interested – the editors and presenters of news programs every time sepsis is mentioned, which is fairly regular these days. Same with newspaper health and medical correspondents who write regularly about tragic cases like Tom and Corinne – and other sepsis patients. To Ministers, shadow Ministers and other politicians – and even places like the Sepsis Trust and other charities.

Unfortunately, I have yet to receive an acknowledgement never mind a response from any one. You’d think I would know better by now….

I’m publishing this now in the hope it gets shared through social media, text or word of mouth – so that those of you who may one day find yourself in a similar predicament and told, like Alan, that nothing that can be done – might now be able to offer a suggestion to the medical team that could be very worthwhile.

You will encounter scepticism if not opposition; the majority of NHS doctors will search internet and find no evidence – and that’s what forms their opinion today – but if you are the victim or relative or friend, please persist and cite this post and the attached articles as evidence.

Hopefully someone else will join up the dots very soon. Of the 200,000 plus survivors of sepsis every year in the UK, a not insignificant number of people will require salvage surgery and amputations as a direct result of the drugs given to save their lives. It really shouldn’t be one or the other.

This may well prove to be a low-cost, simple, safe and evidenced solution for a tragic, horrific condition that the NHS is simply ignoring and leaving to deteriorate without intervention.

Please share if you think it useful or appropriate, thank you.

Metro Article

Blackpool Gazette

Septicaemia, Systemic Peripheral Gangrene and HBOT

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A 65-year-old man develops systemic peripheral gangrene (SPG) following hospitalisation for acute septicaemia and pneumonia. On admission, it was established that he was ten days into a course of Azathioprine, an immunosuppressant used in the management of Crohns Disease. Ischaemic changes to all limbs were noted one day after admission, consistent with disseminated intravascular coagulation (DIC).

He is kept in an induced coma for ten days, but on recovery, discovers necrotic and gangrenous changes to all hands and feet. At an initial a surgical consult, he is advised that it is likely he will require both feet and hands to be removed. He remains in hospital under observation for a further three weeks, at which point, the demarcation line is mid calf and above wrist in the respective limbs. A further surgical consult confirms bilateral BK and above wrist amputations, but surgery is delayed until he makes a full recovery from the sepsis.

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On discharge from hospital, he commences a seven-day one-hour course of Hyperbaric Oxygen Treatment (HBOT) at 2.2 atmospheres of pressure with 100% oxygen.

At the conclusion of the seven-day course, re-vascularisation of all limbs was achieved and over the following month, there was rapid sloughing and granulation to many areas of gangrenous and necrotic skin.

Three months after discharge, there remains dry gangrene to the right forefoot, and the end of the three middle toes on the left foot. The terminal phalanx of two fingers on the right hand are also unrecoverable. His surgical prognosis, is however, substantially improved, with only the right foot requiring salvage beyond the toes.

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There isn’t any published literature that details the use of HBOT for SPG following acute systemic infection like sepsis or meningitis, but I recall being told of a similar case over four decades ago following an abdominal puncture wound to a diver during sub-sea installations in the North Sea. Subsequently he developed septicaemia with resulting ischaemia and SPG in all limbs.

He remained in decompression during his treatment and rapidly made a full recovery with no limb or even tissue loss.

Over the last four decades, the use of HBOT in a variety of medical conditions is becoming more widespread, particularly with ischaemic conditions such as cerebral palsy, strokes, diabetic and neurovascular foot and leg ulcers, where increased blood flow and oxygen perfusion can improve outcomes significantly.

Whilst I appreciate that n=1 is no basis to claim vascular recovery can be achieved in all cases of SPG by commencing a course of HBOT at the earliest opportunity, it is surely worthy of consideration.

Limb loss following septicaemia and meningitis is a life changing experience for the survivors – and a huge cost to the NHS in continuing care.

The gentleman referred to in this post was not a patient, but a friend of mine – a very good blues guitarist from Blackpool, who thankfully will be able to play again sometime soon – and drive himself to gigs. For others, the road is much more daunting.

So, to any vascular or sepsis specialists out there with responsibility for managing someone with SPG following septicaemia or meningitis, it may be worthwhile considering HBOT as a preferred option for limb recovery in these tragic cases.

John Russell 1937-2018

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Dad was born in the mining village of Cardenden on 15th October 1937, the first of two children to Jack and Mary Russell His father was a miner at the local pit and it’s reasonable to assume that Dad’s early childhood was not one characterised by luxury, not least because of the hardships that were to follow during and after the second world war, which started a month before his second birthday.

He spent many days during his formative years with his maternal grandfather, who introduced him to the art of fly-fishing, but only after he had learnt to tie his own flies and to cast properly, which he practised on the football pitch at the side of the River Ore. He knew of all the good pools on the river – and on the Fitty, down the ‘Meedies’ and every other bit of water in Fife – treasured information passed down from generations – something he put to good use.

I was with him many years later, in a reversible role, when he hooked an enormous brown trout at the ‘meetings’ – where the Fitty joins the Ore at Glencraig and it took nearly ten minutes to land. It was a monster, almost 5lbs, dark brown with big hooked jaw and I was too scared to go near it. I was only nine or ten at the time, but I remember him telling me about the pool and that his granddad once told him about the fish that were to be had under the branches of the trees on the opposite bank.

He was a creature of habit and kept to a fairly rigorous routine, something that was evident from an early age. His little sister, Irene, remembers Dad taking her to the village cinema where they used to sit in the same two seats every week. Woe betide anyone having the temerity (or stupidity) to sit in them before they arrived. There would be no reasoning with him. Thrawn wasn’t the word for it!

As a teenager, Dad attended Auchterderran High, where his prowess on the sport’s field outshone his academic achievements by a margin. That is not to say he was lacking in the classroom – far from it – but it was his athleticism and skills on the football field that were to combine into something truly remarkable. He made his first appearance for Dundonald Bluebell – the local Junior team – when he just turned fifteen and soon gained a reputation for being a fearsome tackler with a great turn of speed on the wing.

It was 1953. In March, he was selected to play for East of Scotland -v- Sunderland in the senior schools competition at his favourite position of right back. The inside right for Sunderland was Robert Charlton, better known, of course, as Bobby – and the pair were to meet again a few months later at Filbert Street in Leicester in the Schools Home Internationals. Bobby went on to be one of football’s greatest ever players – and whose goals will live on in the memory of everyone that ever loves the game, far beyond Manchester. But he didn’t score in either match back then. “I didnae let him” was the only boast I ever recall Dad making.

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Dad played against Wales the following week and the young Scots went on to win 2:1 – then went on for trials with Liverpool and Hearts but a change in circumstances at home following his parents’ divorce took him in a different direction. A career in football then didn’t provide the security in the game today. Bobby (Charlton) trained as an electrician and Tom Finney (who was a patient of mine many years later) as a plumber – something to fall back on if they didn’t make it or were injured. As the new breadwinner at home, Dad didn’t have this latitude – so he gave up football and instead started a sales job in the Cooperative Shoe Shop in neighbouring Lochgelly, where a young girl by the name of Anna MacDonald worked in the ladies section. They were soon an ‘item’ in today’s parlance and one that was to endure.

The following year saw Dad enlist in the army as part of his National Service, which he served with 2 Para in the Middle East – first in Egypt during the Suez Crisis and then in Palestine. During his ‘square bashing’ at Aldershot, he was ‘volunteered’ as the Foot Orderly for his troop – an essential role to combat the crippling damage inflicted on squaddies feet during route marches from the army issue boots.

Blisters were soon his forte. It was, in hindsight, an unlikely apprenticeship and the start of another journey – one that would last for many years and lead him into a career, where he would continue to provide relief and comfort to many others that sought his skills and care.

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In September 1960, John and Anna were married at St Andrews Church in Lochgelly and the following year, he opened his first chiropody surgery in the Main Street next to the Cross. I made my appearance a few months later and was a regular visitor in the practice by all accounts and some of my earliest memories are of Dad sitting in front of an old lady’s feet, the black Bakelite telephone with the two buttons and an overpowering smell of Dettol and TCP.

In 1966 the local Council introduced a chiropody scheme for old folk and Dad was asked to join the team, which was headed by Jim Ivers, a chiropodist from Northern Ireland. The following year, the NHS took over the service and Dad started work at the newly built Rosewell Clinic in Lochore and closed the Main Street surgery. But he kept his private practice running in the evenings, doing home visits most days after work and on Saturday mornings too. His services were always in great demand. Football would have been a gamble, but chiropody provided Dad with everything he needed and ever wanted – security, respect and the satisfaction of doing a good job.

We were all fortunate as a result. In April 1965, Mum arrived back from Kirkcaldy one afternoon carrying a tightly wrapped bundle with a shock of blonde curls at one end and suddenly I had a wee sister to entertain and play with for a year before I started school. A few months after Susan was born, we moved from a shared rented cottage in David Street to a brand new council house in Stewart Crescent, where we grew up and where Mum and Dad would spend the rest of their lives.

Our childhood was idyllic – a strange thing to say all things considered. Lochgelly was different back then – a working-class mining village for sure, but proud, ambitious and hopeful too. Dad’s job provided us with not only the staples, but also many of the luxuries he could only dream of as a child – holidays all over Scotland and everything we needed at home. His first car was a Hillman Minx followed by a run of Austin Maxi’s, which he loved. This was mostly down to the fact they could accommodate everything Mum would take on holiday with us – which was most of the house bar the furniture.

Oban was a favourite destination and became a regular haunt twice a year during the summer and autumn holidays. Dad had a patient that owned the caravan site in Benderloch and we spent many enjoyable weeks there. During the really hot summer in 1976, Dad took a notion to climbing Ben Cruachan after a day trip to the hydro scheme at Loch Awe. A few days later, we were sitting on the summit looking down on Loch Etive under clear blue skies.

It was a special day – the first of many in the mountains for both of us. The next few years would tick off many Munro’s all over the Highlands and what started as a holiday adventure, soon became a regular weekend feature.

Dad joined Lochgelly Bowling Club in 1960 and with both Mum’s parents they soon became regular names on trophies and club championships. He played at Lochgelly for 48 years until Mum’s death in 2008 and was regularly selected to play for the county team over the years. But he was modest and an intensely private man too. He didn’t like a fuss and certainly didn’t crave the limelight.

I only found out about his football history when I was a teenager and went rooting one Saturday afternoon in the attic and opened an old suitcase I hadn’t seen before. The first thing I saw was his Scottish Cap – then a pair of leather-studded football boots and horsehair shinguards – and not for the last time thought, “who is this man that’s called, Dad?”

When I played football for the school team, he would come to every game and stand quietly on the touchline and only make comment afterwards, if at all, but when he did, it seemed to make sense. But I had no idea. He was a season ticket holder at Dunfermline for a few years and used to take me to the home games on the supporter’s bus. It was the era of Willie Callaghan, Alex Edwards, Jock Stein – we watched many great games at East End Park and internationals at Hampden and he’d dissect the game on the way back home in the car or on the bus and I just used to sit and smile. What the heck did he know about football, after all?

That’s just how he was. After nearly two decades at Rosewell Clinic, Dad was promoted to District Chiropodist in Dunfermline where he worked in Carnegie Clinic managing the chiropody team in West Fife, until his retirement from the NHS in 1997. He kept his private practice running for another decade though and continued to ‘do the feet’ of many in Lochgelly, including some that first visited him in the Main Street shop almost half a century before.

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With Anna, Dad found his perfect partner – they really were a beautiful couple in so many ways – and they complimented each other in every respect. It was an enduring romance but like all good relationships, the ending was always going to be hard to bear. When Mum was diagnosed with MND in 2007, Dad found it hugely difficult to accept, which is not in the least surprising. When she passed a year later, a big part of Dad left too – and that set the scene for the remainder of his journey.

Dad liked Soor Plooms and Barley Sugars. He whistled tunes that sounded like the Clangers and clucked his tongue like Skippy the Kangaroo. He loved music though, especially The Corries and he was a life-long Nationalist, long before it became fashionable. A brilliant smile and an avid reader throughout his life. His favourite story was Geordie – about the young boy who won a Gold Medal at the Commonwealth Games in New York.

I wonder why?

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Q.E.D.

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On Tuesday 15 May 2016, Philip Ralph Batten was found guilty at Guilford Crown Court of 42 offences including gross indecency, child cruelty, serious sexual assault and indecent assault on a child. Batten had been a teacher at the Royal Alexandra and Albert School in Surrey where the offences occurred during the 1970s and 1980s.

He was sentenced to seventeen years imprisonment. In his summing up the trial judge, HH Neill Stewart remarked:

 

“There is no sentence I can pass that can reflect the impact this has had on the victims.

“Your victims were particularly vulnerable because of the age disparity. Some were children of service personnel stationed overseas, and others had troubled backgrounds.

“Your entering their dormitory was akin to entering the child’s home. On occasion you acted with other adults, and you used alcohol and drugs on occasion.

“We have heard that there was also filming involved on some occasions.

“This was an exceptionally grave breach of a high degree of trust which was placed in you. You had the responsibility of a parent to safeguard and nurture these children. Instead, you groomed and manipulated them.

“You truly were a sexual predator, and for 30 years or more you tried to get away with it. The court cannot undo the grotesque harm you have caused.”

These offences went unreported at the time and Batten moved to other schools where the assaults continued. He was eventually dismissed and convicted of sexual abuse to children on 21 April 1989. A decade later, on 5 March 1999, Batten was found again guilty of nine charges of indecent assault and sentenced to three years imprisonment. He was placed on the Sex Offenders Register for life.

It appears that during his incarceration, Batten enrolled in the Prison Service education programme and undertook a correspondence/distance learning course in chiropody and was sent a certificate on completion. After release in 2001, Batten and his wife moved to the small village of Stogumber near Taunton in Somerset and despite being on the SOR, he commenced a visiting practice from his home in Wood Lane.

In 2001, health regulation was in flux – the old regulator, the CPSM, still had statutory responsibilities until the HPC emerged in 2003, but Batten would not have been compelled to apply for registration anyway.

It seems that Batten never joined any professional bodies or associations and didn’t apply for grandparenting onto the statutory register when the newly formed Health Professions Council opened the scheme in 2004. Had he done either, his previous conviction and SOR entry would have been discovered and the authorities could have liaised with the Police to restrict and monitor his activities. That didn’t happen.

According to press reports, the Battens quickly became a fixture in the local community. He immersed himself in the local church – and his new business as a chiropodist – which he ran as a visiting practice from his home in Wood Lane. Batten didn’t have a practice website and probably didn’t have to advertise much save for few business cards in the local shop to get him started. However, there are a few business directory entries online, where he promotes himself as a podiatrist and specialist in sports medicine, which presumably brought him into contact with children from time to time.

Philip Batten remained in practice as a chiropodist until his arrest in 2015.

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Readers of this website will recall that it is now ten years since I first wrote to Marc Seale, the Registrar of the HCPC – and reported a deficiency in their legislation that could allow something like this to happen. I was concerned that an individual could use an unprotected title like “Foot Health Specialist” and practice without any vetting or scrutiny – posing a real predatory risk to the public if they were so inclined.

Batten didn’t use an unprotected title. He called himself a chiropodist and podiatrist and did so quite openly, even though he never registered with the HCPC or any professional organisation. On the face of it, he was breaking the law and given his history, he should have been prosecuted and warning notices issued.

However, as we now know from the evidence heard during both my prosecutions, that might not have been the case after all. Batten’s “qualification” in chiropody predates the legislation and providing he made it absolutely clear to the public and his patients that he was not registered, then he would be lawfully permitted to use either title. Even with his previous conviction.

The discovery that one of Britain’s most prolific paedophiles had been practising as an unregistered chiropodist, completely invisible to regulatory scrutiny, for fourteen years up until his arrest in 2015, is shocking enough. But when you think that the regulator responsible for public safety had been repeatedly warned that such a scenario could occur – then prosecuted the individual raising the concerns in an attempt to conceal the regulatory failings, the whole matter takes on a different hue.

Why would the HCPC spend up to £400,000 to prosecute someone who was simply highlighting a glaring and serious weakness that allowed someone like Batten to practise as a chiropodist with impunity?

We are about to find out.

Over the last eighteen months, with the help of my constituency MP, Mark Menzies, we have established a number of astonishing facts about the HCPC and Department of Health that shines a new light on this affair.

As a result, my conviction has now been referred to the Criminal Cases Review Commission, who will review the prosecution and papers over the coming weeks, before making a submission to the commissioners by the end of May. With the new evidence provided, I hope that justice will finally prevail in the near future – and when it does, the government and Health Secretary in particular, will face some difficult questions indeed.

Separately from the above and following advice from the Crown Prosecution Service in January, a formal complaint was lodged with Lancashire Police who will now investigate the circumstances of my prosecution to determine whether any offences occurred, specifically in regard to:

• deliberate non-disclosure of evidence in a criminal trial
• misconduct in public office
• fraudulent misrepresentation.

I had intended to update readers to this blog when some progress had been made in the concurrent investigations, however the fact that someone like Batten has indeed exploited this deficient legislation changes matters significantly.

The Prison Service is one of the largest purchasers of online and distance learning courses as part of their educational programme for inmates. Batten secured a certificate in chiropody during his incarceration in 1999, but now courses offer certificates in “Foot Health” where prisoners can legally call themselves a Foot Health Professional on release – and join the growing ranks of unregistered and unregulated ‘practitioners’, who remain completely invisible to the authorities.

A review of health regulation is urgently required together with an assessment whether any other ex-convict has access to vulnerable adults and children as a result of a qualification gained whilst serving a custodial sentence for offences against either group.

A separate inquiry should also be established to determine whether Batten re-offended during his 14 years in practice as a chiropodist to provide some reassurance to the people of Somerset who may have been exposed to this monster, in the belief he was someone they could trust. Those of you familiar with an earlier essay will appreciate why this is important to me.

I have written today to the Chair of the Health Committee, Dr Sarah Wollaston MP, to alert her to this matter. I have also written to the Health Secretary (again) via my MP.

Recent correspondence is attached below.

If you feel strongly enough that individuals like Batten should not be able to work in a health/caring capacity without any form of vetting or scrutiny, please share this post with your friends and MP and ask them to make some noise, please.

After ten years, my voice is getting just a little hoarse.

Mark Russell response from DoH

Phillip Dunne

Mark Russell letter January 18

Mark Russell response from minister March 6 2018

Mark Menzies:Barclay

Mark Russell CCRC letter

Chair to Mark Russell 05.03.18

Chair to Mark Russell 11.04.18 (NEW)

**UPDATE** 1.4.18

Well, well. Just like buses – you wait ages for one coming then all of a sudden, half a dozen appear at the same time! I’ve just been passed another case involving an “unregistered chiropodist” – this time in Liverpool.

Yvonne Thomas called herself a chiropodist to gain entry to old folk’s homes where she assaulted, injured and stole money from her “patients”.

Jailing her, Judge Alan Conrad, QC told Thomas: “You are a persistent and predatory burglar. You have previously served custodial sentences for house burglaries.

“In this case you have targeted victims who are extremely vulnerable due to their age and or their disability.”

Yvonne Thomas Conviction

 

First Impressions

(First published 7 October 2015)

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I was nine years old the first time I remember visiting a hospital. It was late 1970 and my maternal grandmother just had an operation on her right foot to remove a painful bunion, something my father explained, was a lump on the side of her foot. She had the procedure carried out at the Bridge of Earn Orthopaedic Hospital, a familiar landmark to many, its wartime single storey buildings situated just east of the M90 motorway as it crosses the River Earn, just south of Perth. The hospital was constructed at the beginning of the Second World War to deal with the expected casualties from the fighting and opened in 1940 with space for 1,020 patients. Early admissions came mainly from neighbouring military camps, and the lack of expected air raids led to beds being used by three British General Hospitals, patients with tuberculosis and prisoners of war. The busiest time for the hospital came in 1944, initially from casualties of the V1 and V2 bombing of London, and then the Normandy invasion. Following the war in 1947, an orthopaedic unit from Larbert was transferred to Bridge of Earn and it was predominately for this discipline that the hospital gained its reputation until it finally closed in 1992.

My grandmother had a part time job as a home help and was a fit, healthy woman in her early fifties at the time of the procedure. Her foot had been troublesome for a number of years and it was becoming increasingly painful, especially during her sporting activity, lawn bowls, for which she held a great passion. My father, a chiropodist with the NHS, had spoken to the family doctor, and he arranged an appointment with the surgeon and the bunion was duly removed as an in-patient procedure some time later. I cannot recall much of the visit to see her recovering from the operation other than the smell on the ward of antiseptic, which was quite different to that in my father’s surgery or even the local dentist – and the nurses, who looked pristine in their starched white uniforms. My grandmother was sporting a below-knee plaster cast on her right leg and only her toes were visible and I remember being asked to count them in case any were missing. None were, but she had gained something extra! The operation was a simple arthrodesis; a procedure that corrects the position of the great toe and involves having part of the joint removed and a steel pin or wire inserted through the end of the toe down into the long metatarsal. This pin and the plaster cast would hold the toe in the correct position until the surgery healed in around six weeks and where the pin protruded from the end of the toe, it was capped by a small cork and it was this that held my attention for the duration of the visit. She remained in hospital for a week then returned home to convalesce until the pin and plaster cast were removed around a month later. The operation was deemed a success and a few months later she resumed her bowling with renewed enthusiasm, going on to win a number of championships and trophies in the following years. The operation was carried out on her leading foot as she was right-handed, and as such, the toe joint remained straight with the foot flat on the ground when she released her bowl. By contrast, the great toe on her trailing, left-foot was fully bent back or extended when she released and had the problem occurred on this foot and she had undergone the same procedure, then it would have been much more difficult for her to be able to return to the game she loved so much and in that respect, on this occasion, she was fortunate.

Four years later she was back in hospital for another operation. This time she was in the relatively new Victoria Hospital in Kirkcaldy – a general hospital encompassing the whole gambit of medical specialisms, but this time it was not for a minor joint problem but something altogether more serious. What she would not be aware of at the time was that this episode of ill-health would herald the circumstances of her death a dozen or so years later through a number of simple but completely avoidable mistakes by those she entrusted with her care.

Agnes Wilson was born on 2 October 1916 in the small mining village of Lochgelly in central Fife, midway between Dunfermline and Kirkcaldy. It is a date that would have some significance in my own life some ninety nine years later and is just one of a number of quite remarkable coincidences you will learn about in due course. It was a time of turmoil and slaughter in the middle of the Great War; the Somme Offensive in northern France was entering its bloodiest phase with many casualties from fighting in the Battle of Thiepval. In the collieries and pits of central Fife the outlook was just as grim. Desperate working conditions and real hardship with a dark sense of foreboding saw thousands of young men heading south to help the war effort, leaving behind families struggling to put the basics on the table – a task made even more difficult with the loss of their sons to the battlefield rather than the coalface. The coming decade at the end of the war saw little improvement in their prospects and with so many sons and fathers killed in action the future must have seemed devoid of hope for those left behind. By the time she was thirteen, Agnes had left school and was in work at the Jenny Grey Pit washing and separating coals and rubble at the pit-head where she worked for three years. She was one of five children; two sisters and two brothers and perhaps the only remarkable thing about their formative years was that they survived through into adulthood during times of high infant and child mortality arising from the poor sanitation, not to mention malnutrition and work related injuries down the pits, which were often horrific. By sixteen she had left the pits and went to work ‘in service’ in Edinburgh – cleaning mostly in some of the grand Georgian houses in the New Town where she lived in servant’s quarters before returning home to Lochgelly on her days off. Sometime during the next few years, she met my grandfather, Tom MacDonald, an apprentice blacksmith and a romance started and they were married soon after in 1938 and moved into a ground floor two-roomed tenement next door to the West School in the town. Two years later their first child appeared – my mother, followed two years later with another girl, both born at home with the doctor in attendance.

It is difficult to imagine today what living conditions were like in this working class mining village during either War when both my parents and grandparents were born. From the stories I have heard over the years it must have been unrelentingly arduous; outside toilets, food rations, freezing winters without any heating other than the coal fire – and yet these times are remembered in good terms and with fond memories. The family lived in these sparse conditions throughout the war and beyond until the incredibly harsh winter of 1947 when they moved into a brand new prefab on the edge of the village opposite the golf club. Perhaps unsurprisingly, they endured the usual childhood illnesses of the time – chicken pox, scarlet fever, mumps, influenza were all unwelcome visitors at some time or another, yet I cannot recall my grandmother or grandfather telling me of a time when they were struck down with anything that required a visit to the doctor, never mind a hospital. Until the bunion started to hurt.

I had just started secondary school in neighbouring Cowdenbeath when she started to feel unwell. It was 1973 and we had just returned from a family holiday near Oban where she had experienced several bouts of abdominal pain over the fortnight. I suspect she consulted the family doctor on her return as her first appointment with the hospital consultant coincided with my first day at Beath Junior High. It was ‘woman’s troubles’, my father explained later. And she was to have another operation.

It was over a decade later before I discovered she had ovarian cancer and that the operation was, of course, a hysterectomy, but at the time it was just another mysterious illness attributed to the fairer sex under the guise of ‘woman’s troubles’. Whispered quietly, it was a subject that was to be acknowledged but not discussed and therefore completely misconstrued. An approach that my father took quite regularly whenever a topic came up that he was uncomfortable with. A few days after her operation, I went to visit her again with my mother and father. This time she was on the seventh floor of the new tower block at Kirkcaldy’s Victoria Hospital, which seemed quite a contrast from the wartime buildings at the Bridge of Earn where she was four years previously. I can recall spending most of the visiting time looking out of the window with its panoramic views over the town rather than speaking with my grandmother, but then what thirteen-year-old boy would do otherwise? Besides, she looked in great health and not unwell in the slightest, sitting up in bed and castigating my mother for making a fuss of her. I cannot say I had any worries for her.

There were a number of follow-up appointments at the hospital; check-ups every now and then, but she made a remarkably quick recovery and by the time the following Easter arrived, she was back on the bowling green and as bright and enthusiastic as ever. There wasn’t anything to warrant any concern as far as I knew. In the years following her hysterectomy she attended the outpatient department at the hospital perhaps once or twice a year. Occasionally, I would accompany her, taking the bus down from Lochgelly through Cardenden to arrive at the hospital forty minutes later for the appointment with the doctor. She was always the epitome of great health, always smiling and always unfailingly respectful and grateful with every doctor that she consulted. And they were always content with her, with good reason, as her progress back to full health was excellent and there didn’t appear to be any recurrence of whatever ‘trouble’ she had that required the operation in the first place. On each visit to the hospital she saw a different doctor, whoever was on rotation at the time in the out-patient department she attended, but the result was always the same – “very happy with your progress and we’ll check you again in six or twelve moths time” – and off she would go until the next visit.

Eleven years pass and the operation was a distant memory. I had left school then taken a year out before starting Podiatry College in Edinburgh, graduating in 1983. My first post was based at the same Victoria Hospital in Kirkcaldy where my grandmother had undergone her hysterectomy and where she still visited very occasionally for her ‘check-up’. She was sixty-seven years old now but still full of the energy and vitality she always exhibited – and still winning competitions at the bowling green. Life was good.

Shortly after I started to work in the September I took her down one evening and showed her my new surgery in a wing of the hospital that had been recently built. The Whyteman’s Brae complex consisted of five specialist wards for psychiatric, psychogeriatric and geriatric patients and several clinics for physiotherapy, podiatry and the other professions allied to medicine that were applicable in such a unit, such as speech and language and occupational therapy. I had been very fortunate as my surgery was pristine and fitted out with the latest equipment and I remember the look of pride not to say amazement when my grandmother walked through the door.

“You’re in a lovely place” she remarked “and if you can look after your patients they way I’ve been looked after here, then you will do very well indeed.” Six months later she started to feel “off colour” and by the time the bowling season resumed that Easter she barely had the energy to play the opening tie. But there was other trouble on the horizon. A week or so before the Bowling Green opened the National Union of Mineworkers called a National Strike and the miners’ walked out of the pits and collieries in protest at the proposed closure program by the NCB under Ian MacGregor. My grandfather, had been retired for five years, but had been through the previous National Strike in 1974, which had been quite traumatic. He was, strictly speaking, not a miner but a blacksmith on the surface and responsible for, amongst other things, the heavy steel cables that raised and lowered the pit cages down the shaft and as such he was permitted to undertake essential maintenance work by the Union, but it was not a comfortable situation for him crossing the picket line every day, albeit with his fellow miners grudging consent. If they were fighting for their jobs, some would have to ensure they had a safe pit to return. Ten years later, these bitter memories were reignited against a different background.

A few days after the bowling season started properly in early May, Agnes visited her GP as she was becoming increasingly tired and exhausted by the slightest effort. A blood test was done and a few days later she was in another hospital for a transfusion. Milesmark Hospital in Dunfermline had a couple of medical wards similar to the geriatric unit at Whytemans Brae and it was here she had her first units of blood. I was unaware of these events at the time and only discovered she had been in hospital a few weeks after the transfusion after I returned from a holiday in Ireland. “It was nothing to worry about”, she said, dismissing my questions. “Just needed a little top-up”.

I don’t know if she knew what was really wrong or whether a diagnosis had been made at that stage, but should that have been the case, it would have been so characteristic of her to play things down. I don’t recall hearing any complaints about her health, ever. Even over the coming months.

During the summer of 1984 and again with a backdrop of a National Strike, Agnes was in Milesmark another three times for more blood; the tiredness and exhaustion returning increasingly and more obvious as the weeks passed. More worryingly, just before her final admission, she began to bruise quite readily and in addition, there were several areas of what looked like pin-prick sized spots on her arms and legs. I had assumed, until then, that her malaise was simply because she was anaemic, but I was wrong. The day after she was admitted at the beginning of October, my father telephoned to say that the consultant had requested a meeting with my mother, aunt and grandfather and the news was not good. She had developed acute myeloid leukaemia and it was unlikely that she would make a recovery this time. By the time I reached the hospital that evening she was already heavily sedated and barely able to speak, but still managed to smile. The following morning she slipped into a deep sleep and four days later, she died.

It was the first close relative to me that had died. Both my maternal grandparents were a huge influence in my life, but my grandmother – or Nana – especially. They lived in Gordon Street a hundred yards from our house and I spent much of my childhood with them. I was the eldest grandchild; my sister four years later then our cousin two years after her. My grandfather, being an engineer and blacksmith, had a fabulous wooden garage he built himself, stuffed full of every imaginable tool and implement for all sorts of jobs; a workbench made from railway sleepers and shelves overflowing with jam jars full of screws, nails and three-in-one oil in copper pourers. I used to stay over most Friday nights and on the Saturday morning I helped wash and polish his car – an Austin 1300 – before we started on a job in this magic den of his. He made me my first ice axe from a miners pick welded on to a tubular metal shaft with a bicycle-handle grip to protect bare skin. He was a short, stocky man with a head of bright, thick, white hair lightly bisected with a nicotine-orange streak in his later years. I can still see him standing at his bench in dungarees – an Embassy Red with two inches of quivering, curving ash hanging impossibly above the heavy vice before him. He managed a full cigarette once, the whole ashy length hanging in flaccid surrender whilst he planed some wood. I doubt he even noticed. He was everything you imagine a miner would be; tough as nails, strong as an ox with a dour Fife personality through and through. There is a photograph of the two of us at the stile in the path above the east sands in St Andrews when I was three years old. It provokes both morbid and sobering thoughts when you realise that after the passage of half a century, you have become the same age as your grandparents in faded family photographs.

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But if my grandfather gave me my love of taking things apart and finding out how they worked – a practical influence – it was my grandmother’s inspiration in so many other ways that I still treasure to this day. She was a calm, sagacious woman and although she only travelled out of Scotland on a handful of occasions and never further than York or Blackpool, her outlook was anything but parochial. She was the one person I could tell anything to; an absolute confidante and on the one occasion I did run away from home aged eight (my father first giving me a hand to pack my suitcase) I made it no further than her back door. As I write this, it is thirty years since she died and there is rarely a day that I don’t still think of her, but at the time of her death I felt strangely unemotional and disconnected. Perhaps it was the relative suddenness of it all – I had just a few days to prepare for the inevitability yet it still didn’t seem to sink in even on the day she died. It was a surreal feeling and not uncommon, as I discovered subsequently with surviving relatives who experience sudden death of a loved one. In the blink of an eye she was gone and you are thrown into the aftermath of things to organize and people to call so that the time to allow grief to have the time to form properly is deferred. That is how it seemed in hindsight, but at the time it was as though I had become a spectator in a drama witnessing the incomprehension of my grandfather to the inconsolability of my mother and aunt and realizing immediately that the guiding insipration that was needed at this time was not there anymore.

Four months later, on a Friday afternoon, I had an out-patient clinic running at Whyteman’s Brae in Kirkcaldy when I noticed my penultimate patient of the afternoon had the same name as my grandmother, however her address was in one of the small fishing villages in the Neuk of Fife. But when I collected the patient notes from the front office, I discovered that the records office had sent the wrong notes and had inadvertently sent those of my grandmother instead. Thirty-years ago it took some months to close patient records, especially where care was spread over different hospitals and all the correspondence and ward notes were gathered and filed manually – and it wasn’t uncommon to receive a number of wrong records in any clinic, but it still came as something of a shock when I noticed the address on the front label. I took it back to my room with the rest of the bundle and sat down and began to read.

The first set of notes were from the Bridge of Earn Hospital about her foot surgery fourteen years earlier including the referral letter from her General Practitioner in Lochgelly, Dr Roy Blues, his illegible handwriting immediately recognisable. I could just make out ‘bunion’ and the name of the surgeon, but that was about it. The surgical and nursing notes followed, then the paperwork changed to the Victoria Hospital and her operation for her ‘woman’s troubles’ – the ovarian cancer. This was my first surprise. Even after the passing of the years and her death, I still hadn’t known that her hysterectomy had been performed for underlying pathology so the notes from her gynecologist, Dr Hill were a revelation of sorts. There was a letter to Dr Blues shortly after her hysterectomy informing him that the operation was a success and that she would be put on a maintenance regime of cyclophosphamide and reviewed in six and twelve months time. This was followed by a series of out-patient records that coincided with her annual or bi-annual check-ups before the final tranche of records from Milesmark leading up to her death. But it was the final piece of correspondence that really stopped me in my tracks. It was a letter from a Consultant Haematologist to the doctor in charge of her care at Milesmark during her final weeks. It was a single piece of A5 white hospital notepaper, neatly typed with two short paragraphs; the first, thanking the doctor for asking him to review my grandmother’s case and the second, informed him that she had “developed acute myeloid leukaemia which will be refractory due to the prolonged exposure to cyclophosphamide.”

I hadn’t heard the term ‘refractory’ before, but could easily make an informed guess as to what it meant, given the eventual outcome. Nor had I heard of cyclophosphamide and why she was on such a regime in the first place. There was no internet and no quick answers then, so it had to wait until the end of the clinic and a visit over the road to the hospital library before I found what I was looking for.

Cyclophosphamide is a drug that was commonly used as an adjunct therapy in the treatment of some cancers, including ovarian tumours. One of its actions is as a bone marrow suppressant in particular to the formation of T lymphocytes, a form of white blood cell that are thought to increase the risk of further cancer developing. The literature went on to state:

“Cyclophosphamide is used for the treatment of numerous malignant processes and certain autoimmune diseases. Goals of therapy are prompt control of the underlying pathological process and discontinuation or replacement of cyclophosphamide with less toxic, alternative medication as soon as possible in order to minimize associated morbidity. Regular and frequent laboratory evaluations are required to monitor renal function, avoid drug-induced bladder complications, and screen for bone marrow toxicity. Cyclophosphamide has severe and life-threatening adverse effects, including acute myeloid leukemia, bladder cancer, hemorrhagic cystitis, and permanent infertility, especially at higher doses.”

I re-read her notes again and couldn’t locate a specific entry for the proposed length of the course she had been recommended after her hysterectomy. The letter from her gynaecologist to Dr Blues was the only mention of the drug and that she was due to be reviewed in six and twelve months time, but that was it. Even on her subsequent out-patient reviews there was never mention of the drug again – most of the entries simply noting that she looked fine and had no problems before suggesting a review at some future point, usually twelve or eighteen months time. I then read through her later notes from Milesmark and found a hand-written entry from her first visit the previous year when she received her initial transfusion, made by a ward doctor following a telephone call with the haematologist. Underlined, it read simply, “discontinue cyclophosphamide immediately”. At the time she had been on the drug continuously for eleven years, but I couldn’t find any information regarding recommended treatment courses so I had no way of determining if this was normal or otherwise, but the ‘prolonged exposure’ was sitting uncomfortably in the back of my mind by that stage and I had an inkling that something was not quite right.

I took her records home with me that evening, in contravention of hospital policy, of course, but I needed to find out whether anyone else I the family was aware of this. They weren’t; at least according to my father. Nor did he know anything about cyclophosphamide or its ability to cause AML or what her recommended course was. Rather he was dismissive. “What do you want to know that for?” he asked, with not a little menace in his voice.

It is worth remembering that the issue of medical malpractice was very much under the radar until a relatively short time ago. In the early 1980s, it was generally accepted that mistakes could sometimes happen, but the apportionment of blame and liability for such a concept was entirely foreign in the National Health Service. I have heard my grandmother say on many a time that accidents occur for any number of reasons but providing there was no intent to harm, there should be no blame or recriminations (most usually when waiting for a confession and explanation of any number of misdemeanors by myself) – and so it seemed a likewise philosophy was similarly adopted by my father as he contemplated what to say. He was by then, a district chiropodist, employed by the same NHS Board in Fife as I was and any thought about raising any concern over an incident like this would not have even entered his head. The Health Service was very much regarded as a big family; a close knit organization with a proud tradition in Scotland but with a definite hierarchical structure and it would, with hindsight, have been a formidable prospect for someone even in his position to challenge established medical practice, especially over something he would have little, if any, authoritative knowledge about. “How do you know she was on it for too long?” he asked. And of course, he was right. I didn’t know that for certain. Perhaps she needed to be on a maintenance regime of the drug for that eleven years and it was just an unfortunate consequence that she went on to develop AML, but it was the prolonged exposure that still sat firmly in my thoughts later that night as I pondered what to do.

On the Monday morning I looked through the hospital directory until I found the number for the Consultant Haematologist, Dr John MacCallum, whose office was located in the main hospital block. I wasn’t at all sure what I would say to him or what his reaction might be. I was twenty-three years old and only been graduated for around eighteen months and I remember being extremely nervous when I eventually dialed his extension. His secretary answered and I asked her if it would be possible to see him about a patient later that day. She suggested after his ward round at 11.30am.

Dr MacCallum was a quietly spoken and extremely courteous man who had taken up his consultant’s post a year earlier and welcomed me into his office with typical grace. “How can I help you?” he asked. My hands were shaking as I passed him my grandmother’s records and opened them at his letter.
“I was wondering if you could tell me what this means?” I said, pointing to his second paragraph. He read the letter then looked back at the previous pages then said, “This patient died last year. What is your interest in this exactly?”
“She was my grandmother.” I went on to explain the circumstances of my discovery, courtesy of the patient record department.
“I see.” He said, before he filled in the gaps. He informed me that he had asked to review my grandmother’s records the previous year, shortly after she had her first blood test in the weeks after the opening of the Bowling Green when she started to feel unwell. Her blood test showed abnormally low numbers of both platelets and white blood cells and he had flagged the result up for further clinical investigation. The transfusion she had was not for haemoglobin for anaemia as I suspected, but for platelets. She had a bone marrow aspiration carried out, which again I knew nothing about at the time, and this fuelled his suspicions that she was starting to develop a form of leukaemia. It was at that point he recommended discontinuing the cyclophosphamide. Later, when she began to exhibit the bruising and the pin-prick haemorrhages on her arms and torso, which he called thrombocytopenia, he made the final diagnosis of AML.
“How long should she have been on it?” I asked, acutely aware I was on difficult ground.
“I would think between six and eighteen months.” He replied. “But that would depend on the diagnosis at the time. I’m not sure what happened here with your grandmother, it was possibly an oversight or a mix-up with her prescription, but she had been exposed to this for quite some time and that wouldn’t have helped.”

I tried to take in what he was saying and thinking how to reply when he said; “I’m sorry you had to find out like that and I’m really sorry for your loss.” And I could tell that he was genuine with it. He handed me back the notes and suggested I return them to the medical record department and that was that. I didn’t find out any more. There was no investigation to determine who knew what or why. I’ve no idea if my grandmother was even aware that it had been the chemotherapeutic drug she had been prescribed all those years that was the likely cause of her death. She may have been informed, I forgot to ask, but if she had, it was probable that she would have kept the information to herself anyway, that being the measure of the woman she was. She certainly wouldn’t countenance a fuss.

Trying to determine what might have happened is simply conjecture. The failure, if that is the correct term, could have been in several areas. There was no computerisation then and medical notes were anything but contemporaneous and standard clinical practice was more of a verbal art form handed down from senior consultants to their protégées than in published guidelines and protocols. Certainly someone should have realised that she had been taking the drug for much longer than usual, but who and when? The environment wouldn’t have helped; the continual merry-go-round of registrars, house officers and trainee doctors through the various specialisms in the hospital set-up provides an obvious impediment to continuity of care where records may not be as detailed as they could be. There was no forward review of her medication written up in the notes for guidance in future consultations, just a record of how she presented and how she felt. It was, in all probability, a simple administrative error; an oversight, as the consultant had suggested; an unfortunate error but one with significant and avoidable consequences.

I returned her notes to the records department later that day and filed the slip with the other Agnes MacDonald’s podiatry treatment from before the weekend in the correct patient file. That was the end of the matter. There was nothing else I could have done and even if there was I don’t know if I had the capacity to take it any further and whether it would have done any good. The philosophy was different then and it was generally accepted that the Health Service, as with most of the institutions of the State always acted in the best interests of the individual and where the outcome was not as expected and someone went on to suffer loss, injury or life, it was seen, from my perspective at the time as a tragic mistake; something to acknowledge and learn from rather than apportion blame or liability. Hospital management was simply administrative and supported clinical practice whose principal oversight was through the various consultant committees. However, changes were on the horizon with the recent publication of Roy Griffith’s report on general management in the NHS but his recommendations would take time to filter through, but even then it is doubtful if they would identify simple failings of the kind that compromised my grandmother’s care.

I am being careful with my words as I do not seek to apportion any blame; I do not find the concept helpful in the slightest as we understand in its current lexicon and I think I still share my grandmother’s philosophy too in that providing there is no intent to harm there should be understanding and a learning rather than retribution and punishment, but I am only too well aware such a view is not in fashion much these days. The pendulum has very much swung in the other direction since my grandmother’s death and after the likes of Shipman, Alder-Hey and the countless other ‘scandals’ in our State Health Service, there is an entire industry devoted to medical malpractice with enormous attendant costs. Countless Public Inquiries with armies of barristers, solicitors and traumatised relatives pouring over endless evidence of failings in care has achieved little more than promoting a defensive culture riven with fear and intimidation, not least because of the enormous liabilities the NHS is accruing from an equally expanding battery of claimants. Such are the times we are in, but it would have seemed absurd, even wrong to seek financial compensation or bring someone to task for a simple oversight that had inadvertently contributed to someone like my grandmother’s death, even though such an approach would not be out of the norm today and probably even encouraged. Especially by the industry geared up to profit the most out of it – our legal profession and in particular those concerned with regulation and compliance.

Thirty years ago I was a new entrant into our National Health Service – a lowly foot soldier, as it were, but nonetheless very enthusiastic about my profession and its prospects. It seemed a time of great promise and hope as I was instilled into a great institution founded on tremendous principles – and there was another more personal connection closer to home. The wife of Aneurin Bevan, the architect of the NHS, was Jennie Lee, later Baroness Lee of Asheridge, was born in Lochgelly and very much one of my grandfather’s favourite people and the subject of many a tale. She was ten years his senior and he could well remember her firebrand style supporting the miners through their various struggles in the years before she became a prominent Member of Parliament in her own right. The prospect of a career in the Health Service was something really I looked forward to. It seemed worthwhile and exciting. It was also set in a time of great innocence and naivety, for me at least. But the coming years were about to change all that.

It would take decades and a completely different set of circumstances before my views about ‘great’ institutions of State and their responsibilities and functions were challenged again and another two decades after that before that any lingering confidence in them finally dispelled.