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This is not yesterday’s post about the NHS killing several hundred people

Today’s post about the NHS killing several hundred people is quite different from yesterday’s and should not be confused with it. They have nothing in common except both being about times when the NHS killed several hundred people.

The Guardian reports,

Fresh criminal inquiry launched over Gosport hospital deaths

Police have launched a fresh inquiry into how 450 patients died over 14 years after being given dangerously high doses of painkillers at an NHS hospital that showed “a disregard for human life”.

Relatives of the victims hope the investigation – the fourth into one of the biggest scandals in NHS history – will finally lead to criminal charges being brought against staff involved in administering the drugs unnecessarily.

An independent inquiry last year into events at Gosport War Memorial hospital in Hampshire found 456 patients had their lives shortened as a result of being given opioids without medical reason between 1987 and 2001. Their deaths are the focus of the new police investigation.

Another 200 people “probably” received excessive doses of painkillers at the hospital between 1989 and 2000, it added.

However the Guardian does not report a little detail that the Times does:

A hospital doctor faces a new police investigation into the deaths of 456 patients who were given “dangerous” levels of powerful painkillers.

Last year an official inquiry concluded that Jane Barton, who was known as Dr Opiate, headed an “institutionalised regime” of prescribing the drugs without medical justification at Gosport War Memorial Hospital.

Patients considered a “nuisance” were allegedly given drugs on syringe drivers filled with opiates which killed them within days of their arrival at the hospital in Hampshire.

(An earlier post on Gosport can be found here: “If a nurse didn’t like you, you were a goner”.)

22 comments to This is not yesterday’s post about the NHS killing several hundred people

  • Sam Duncan

    Yes, I noticed that nobody on one of this evening’s TV news bulletins (Channel 5, I think) thought it at all remarkable that the top two stories were both about the NHS killing people.

    It’s the envy of the world, you know.

  • bobby b

    Never piss off doctors before you’re discharged or waiters before you have your food.

    It’s just common sense.

    (Isn’t this result exactly what socialist healthcare administrators are incentivized to do? Big surprise.)

  • Greg

    I suggest a change of venue to ensure a fair trial and an appropriate sentence: Texas.

  • Julie near Chicago

    Also a change of venue for those needing hospital care.

  • Julie near Chicago

    I didn’t mean to sound flip. It’s dreadful news of an unconscionable situation.

  • James Strong

    I think I am as much opposed to the NHS as most people, although it is difficult to measure such a thing. I also understand that rhetorical devices and figurative speech have their place.
    But you are wrong to say in this case that the NHS has killed people. An individual doctor has killed people. To put the guilt on the NHS you woyuld have to show that the nature of the NHS, its philosophy, organisaion and structure, make the actions of the doctor foreseesble.
    You haven’t done that.
    If you were to show that it would certainly strengthen the side that I am on.

  • djc

    James.
    Read the title, read carefully: in the Guardian version this appears to be about the NHS killing people, in the Times a detail is added that suggest it may not.

  • Stonyground

    Would it be the case that if this occurred in a private hospital, it would quickly go out of business because no one would go there for treatment? With the NHS you have little choice unless you are prepared to pay twice. That the problem continued for decades is a result of socialised healthcare which made a bad situation much worse.

  • An individual doctor has killed people. To put the guilt on the NHS you would have to show that the nature of the NHS, its philosophy, organisation and structure, make the actions of the doctor foreseeable. (James Strong, May 1, 2019 at 6:52 am)

    That is indeed the point – both sides of it.

    If an evil nurse or doctor kills patients for a motive from their own dark heart, it may say nothing about the organisation. Less simply, the NHS is responsible for “the Liverpool care pathway” but did not order this earlier and more rapid form of it – rather, its culture was able not to notice at least this one instance of it for many years.

    One of the effects of single-payer is the patient’s loss of control. The NHS was designed by Labourites who saw it as an unmitigated good that control was taken wholly out of the hands of its patients and vested in a bureaucracy answerable only (insofar as such bureaucracies ever are) to government. Incidents like the two Natalie posted on demonstrate two issues (in the public domain, not to us who had already thought them).

    Firstly, there is nothing remotely unmitigated about this loss of control – nor is there anything elite, intellectually or morally, about left-wingers who do not see its problems. Patients and their families who notice something have no power to make the organisation notice – precisely because the organisation was designed by socialists to ensure they have not.

    Secondly (more controversially still), this loss of control may not be the very-mitigated good of a feature but the little-mitigated evil of a bug.

    People who recognise the first point would run the NHS better than people who refuse to. Niall ever-the-optimist Kilmartin thinks this idea, carefully presented, is reaching the level of being electorally viable in the UK.

    Awareness of the second point is growing – and needs to grow more.

  • Julie near Chicago

    Not sure if this is directly on point or not, but Niall’s comment reminds me of Charlie Gard, for which abomination it seems to me the NHS bears the ultimate responsibility.

    Even in the cases mentioned, doesn’t the principle that the Captain is always responsible for what’s done on his watch, or, as Pres. Truman put it, “The buck stops here,” apply?

    .

    In any case, one hopes that the Man on the Street will take notice, and experience a gnawing feeling around the tummy that perhaps he’d be safer picking his own doctors instead of letting the zookeepers do it.

    A question: Does Peter Singer have any name-recognition in the UK?

  • neonsnake

    Does Peter Singer have any name-recognition in the UK?

    Assuming it’s the same fellow, I associate his name with advocating loudly for veganism, whilst not sticking to strict veganism himself.

  • llamas

    When first this case was discussed here, a year or more ago, many of the same points were made.

    The case almost-exactly parallels that of Harold Shipman in its technical aspects – the swift killing of elderly patients by overdosing with diamorphine. Only the venue is different in that regard. And, just as with Shipman, lots of people had pretty well-founded suspicions about what was happening, over a period of more than a decade. Staff and family members made repeated reports to the police and to the NHS trust involved – all came to nothing.

    Shipman was only seriously investigated by law enforcement when he made crude attempts to embezzle the estates of his victims by means of amateurish forgeries. As soon as the police took an even-remotely-serious look at him, his massive and monstrous history of murder virtually ran to meet them – it took mere days to develop a vast case against him for a string of crimes spread over 20 years. But only because of the forgeries. Had he just refrained form doing that, he would have continued to murder people in plain sight for as long as he wished, and complaints and suspicions about his doings would have continued to be brushed aside.

    The same will happen here. So long as nobody connected with these deaths did anything so infra-dig as to try and profit from them, there will be no serious consequences. A pantomime slap on the wrist will be the worst that anyone will suffer. Gardening leave and/or a quiet retirement, with full pension. That’s how the NHS functions now – the sanctity of its structure and the immunity of its employees are now far-more important, socially and politically, than minor trivia like the deliberate killing of hundreds of its patients. Think I’m wrong? Look back over the last few years – there’s several cases each year where NHS agencies have caused (directly or indirectly) the needless deaths of hundreds of patients. In the aggregate, tens of thousands have died due to neglect, incompetence, indifference or ignorance on the part of the NHS. And what have been the consequences for the wrongdoers? Trivial – if any. A few low-level staff have been sacked or disciplined.

    I’ll say again what I said then:

    Some years ago, on these very pages, in response to another ghastly failure by the UK ‘caring professions’, I wrote these words:

    “I’m now firmly convinced, based on this story and prior experience, that ‘social workers’ in the UK could perform ritual Mayan child sacrifices on the steps of Westminster Abbey, twice weekly with a matinee on Bank Holidays, and not have to fear for their jobs, or indeed, for any consequences whatever. They have successfully made themselves immune from any sanction, whether it be legal or social. The Kafka-esque outer limits of their incompetence, whether by overt act or craven omission, are apparently beyond the boundaries of the known universe.”

    Pencil in ‘NHS employees’ in place of ‘social workers’ and the exact-same sentiment applies. I used to think it could be changed or (heaven forfend) improved. I no longer think that.

    llater,

    llamas

  • staghounds

    Llamas-

    I disagree. If the child sacrifices were so public they would be filmed by passers by and televised. That makes the organisation look bad, and there would be discipline.

  • Natalie Solent (Essex)

    James Strong writes,

    But you are wrong to say in this case that the NHS has killed people. An individual doctor has killed people. To put the guilt on the NHS you woyuld have to show that the nature of the NHS, its philosophy, organisaion and structure, make the actions of the doctor foreseesble.
    You haven’t done that.

    The organisation and structure of the NHS were what allowed this to continue for so long. It was not just the work of one woman. In fact it was rarely her hands that did the deed. She gave orders – openly – and they were obeyed. It also appears that she was open to suggestions from her subordinates.

    I did a post last year about Gosport here, centred around a powerful article in the Times by Dominic Lawson. Lawson stressed that concerns had been raised several times, including with the police, but nothing ever came of it because the complainers – patients, relatives of patients, and auxiliary nurses – were at the bottom of the hierarchy.

    After the local newspaper in 2001 reported the complaints by relatives of Gladys Richards, (whose life had been “shortened”), Spilka went to the police. In an interview with Detective Chief Inspector Ray Burt of the Hampshire constabulary, Spilka said: “It appeared to me then and more so now that euthanasia was practised by the nursing staff. I cannot offer an explanation as to why I did not challenge what I saw at that time . . . I feel incredibly guilty.”

    Spilka was especially troubled by the fate of an 80-year-old patient (his name is redacted) whom she described as “mentally alert and capable of long conversations . . . able to walk . . . and to wash himself”. He was, however, “difficult”. She told the policeman that this patient was “always making demands” and that “I remember having a conversation with one of the other auxiliaries [Marion] . . . we agreed that if he wasn’t careful he would ‘talk himself onto a syringe driver’.”

    So it came to pass: “One day I left work after my shift and he was his normal self. Upon returning to work the following day, I was shocked to find him on a syringe driver and unconscious. I was so shocked and angered by this that Marion and I went to confront the ward manager.” They were told to put a sock in it. Nursing auxiliaries are at the bottom of the chain, without any medical qualifications. What was their word worth, against that of the formidable (and formidably well connected) Dr Jane Barton

    As Niall Kilmartin has said “One of the effects of single-payer is the patient’s loss of control.” For a NHS hospital, the government is the one you must keep happy, not the patient or their relatives. It is to the credit of NHS staff that most of the time their sense of humanity does keep them striving to help patients, but in a situation like this one where the locally dominant ethos is that “the kindest thing to do” is to “put the patients out of their misery” all history tells us that the private qualms of ordinary people are easily squashed – like those of Auxiliary Nurse Spilka, and she did more than most.

    For the staff, too, the civil service model followed by the NHS is one that gives less power to staff than a free market model would.

    (I will add a link to that earlier post to this post.)

  • Jacob

    Here is the devil’s advocate:
    For many patients who are terminally ill and in great pain – an overdose of morphine is the best solution, especially for the patient himself.

    The decision should not be taken by one doctor alone, he needs to get the consent of relatives which would, normally, under the circumstances, grant such consent. He needs also to consult at least another, superior, doctor.

    I know, from personal experience with relatives, of at least two cases (not in the UK) which ended their lives this way.

    I don’t know if the cases described in the articles followed the procedure I outlined above, maybe they did.

  • Natalie Solent (Essex)

    Jacob,

    Doctors have been doing what you describe (giving morphine or similar drugs with the primary intention of easing pain but where it is known and accepted that the effect of the drug will be to hasten death) since such drugs became available, long before the formation of the NHS. I believe the official doctrine is that it is legal so long as the intention is not to cause death. This probably involves a certain amount of doublethink, but it would be harsh indeed to condemn people for doing the best they could to ease suffering in circumstances where there was no hope of the patient recovering.

    But that was not what was happening at Gosport. Quoting the Guardian article:

    An independent inquiry last year into events at Gosport War Memorial hospital in Hampshire found 456 patients had their lives shortened as a result of being given opioids without medical reason between 1987 and 2001.

  • Nullius in Verba

    There’s a common problem in jobs that involve very high stakes like the care industries, which is that scandals and prosecutions lead to bursts of extreme risk aversion. If doctors know they can be prosecuted if they make a mistake, they will refuse to treat people. They’ll take no risks. They’ll make no move without first exhausting every possible test and precaution. Likewise, social workers swing from taking every kid into care (after a scandal where some kid was left to be abused) to refusing to take any kid into care (after a scandal where some kid was taken from innocent parents). Incentives matter. If the worker is taking an extreme personal risk by treating you or helping you, they will only do so when they really have to. The higher the risk of litigation, the higher the payouts if you lose, the more risk averse carers will be. It’s been reported that in the US 50% of doctors would not stop at a road traffic accident, while in Canada 90% would, and it’s speculated that the reason for the difference is the perception of the US being more litigious.

    Nobody is perfect. Everyone makes errors. Especially when they’re tired or overworked. And if the least error can result in a $10m lawsuit, people are naturally going to be nervous and very cautious. That can result in more deaths – but you can’t sue someone for not treating you when they didn’t have to, or when they were just being over-cautious.

    To combat this, the law reduces the threshold for workers in high-risk professions. The US even has a ‘Good Samaritan’ law that requires off-duty doctors to aid at public incidents like traffic accidents, but with a ‘no blame’ exception in case of negligence. You can hold a doctor who treats you at the roadside to account, but the result will be that he drives past when he sees you. You can hold a personal doctor to account, but the result will be having to sit through a battery of tests for months and months for unlikely alternatives and complicating conditions before he will treat you for what you both know is the obvious.

    Holding doctors to account has a cost. And as in the case of tax incidence, an additional cost applied to a transaction is divided between the participants in proportion to their inverse elasticity of supply or demand. Which is a long-winded way of saying that the party with the fewest alternatives to trading pays most of the cost. The doctor can take it or leave it. The patient can’t. So if you hold doctors to account, the patients will pay for it. You’ll pay in higher medical insurance premiums, or higher doctor’s wages, or longer delays for tests, or refusal to provide risky treatments, or being left to die while they pass by on the other side of the street.

    Thus, the marketplace sets a price that encourages the ‘no blame’ culture in the care industry, so when somebody comes along prepared to abuse it, they can get away with it more easily there. State-provided services tend to pool both the risks and the costs. You can’t ‘pay extra for quality’ with the NHS, it’s more of a lottery. It blurs the incentives and makes things less efficient. But the tendency for doctors to be able to get away with it isn’t confined to the state-provided services. It’s inherent in the economics of the profession.

  • Gavin Longmuir

    NIV — Thanks for that very perceptive exposition of the situation. Most of us tend not to think of medical interventions as transactions — but they are.

    We are back to the near-universal solution to the problems of the West — “The first thing we do, let’s kill all the lawyers”. Or at least, rein them in. And, yes, we all know that the problems really start with the politicians who pass the laws — or maybe even with us voters who elect those damn politicians. “The fault, Dear Brutus, is not in our stars But in ourselves …”

  • pete

    It will have been a systematic failure, no individuals to blame.

    Lessons will be learned.

    That’s the standard lefty response when state employees fail in their jobs, whereas when privately run hospitals or prisons fail they demand that the operating companies are dispensed with because of their poor performance.

  • Jim

    “But you are wrong to say in this case that the NHS has killed people. An individual doctor has killed people. To put the guilt on the NHS you woyuld have to show that the nature of the NHS, its philosophy, organisaion and structure, make the actions of the doctor foreseesble.”

    Bollocks. It doesn’t matter whether ‘the NHS’ foresaw the actions of its employees in these cases, its whether it took one jot of action to a) discover what was going on, b) stop it when it was pointed out to the management, and c) make sure those responsible were prosecuted for murder. And it did nothing whatsoever on any point, despite what was happening being pointed out to senior management (and the police) on numerous occasions.

    The whole structure of the NHS is rotten to the core, and the whole thing needs razing to the ground and starting afresh with people with some morals rather than arrogant self serving despots.

  • Jacob

    “This probably involves a certain amount of doublethink”

    Nice phrase…

  • Paul Marks

    Yes this is awful – but I do not believe that is anything we can do about it.

    More people are going to die who could have been saved – more and more people are going to die who could have been saved. But the NHS is sacred – so no real reform will be made.

    Indeed if one looks at France, Germany, America (and so on) they are moving more and more to total government domination of health care.

    Every government intervention that increases health care costs in the United States is followed by demands for MORE government intervention (more subsidies and more regulations – the very things that cause costs to rise) justified by the high cost of health care.

    It is a vicious circle and I see no way out of it.

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