Health: Too much analysis creates paralysis

Health Check

LAST WEEK I was sent a leaked letter from the chairman of an inquiry into a suspended doctor, which can only be described as a cry of anguish. The letter sets out in grim detail the extraordinary pressures imposed by the inquiry and seeks to justify the long delay to its final report. In three sweaty pages it highlights the real cost of opening up the closed ranks of the medical profession to public scrutiny.

The letter, from a barrister, Angus Nicol, is dated 25 April and was written shortly after a difficult meeting with representatives of Dr Bernard Charnley and mid-Glamorgan health authority. Dr Charnley, a consultant pathologist, was suspended by the health authority almost five years ago after doubts arose about his reading of cervical smears. He is the longest- suspended consultant in the NHS, still on full pay of at least pounds 50,000 a year, and the cost of the inquiry into his work is nearing pounds 1m.

In the letter, Mr Nicol tries to explain why his report, expected last year, has taken so long. It has involved, he says, reducing 2,000 pages of evidence and at least a further 1,000 pages of documents into a report that already runs to 175 pages - "about the length of the average novel" - not including the appendices. There have been the reports of four earlier cervical smear inquiries to read, he has had much other work to do as a barrister and judge, and there has been illness in his family. "I have given this report all the time that has been available. I do not distinguish between weekdays and weekends," he pleads. More disturbingly, he refers to a delay in the handing over of 2,000 slides which, when they finally turned up, were so damaged as to be unreadable. Supporters of Dr Charnley murmur darkly about goings on behind the scenes and fear that this may prejudice his case.

Mr Nicol concludes by promising to "use his best endeavours" to complete the report by 4 June. But that will not be the end of the matter. It will then be considered by the health authority, which will decide what action, if any, to take. If the decision goes against Dr Charnley he is expected to appeal to the Secretary of State, a process that could take a further year.

The question prompted by Mr Nicol's chapter of despair is: what will patients gain for their pounds 1m investment? An average-length novel to add to the (at least) four similar tomes on problems elsewhere with the screening service?

This is far from the only inquiry now under way in the NHS. Since the Bristol baby deaths disaster, the NHS has been gripped by a bout of self- chastisement with a record 33 consultants suspended so far this year, according to their support group. The Bristol inquiry is expected to cost pounds 15m and some critics believe that it achieved all it could before the first witness was heard. This does not include the many informal inquiries being conducted by trusts in response to allegations from patients and professional colleagues.

The growth in inquiries is partly driven by anxiety about the drain imposed on NHS coffers by the rising cost of medical negligence, estimated by the National Audit Office last week at pounds 2.8bn. But they are becoming a serious burden in themselves. The demand for greater openness from doctors is necessary, justified and long overdue. But if we dwell too long on what went wrong there will be less to invest, in human and economic terms, in getting things right.

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