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Wednesday 4 August 2010
Gagging of NHS doctors
Your revealing and disturbing, but wholly appropriate, report "Millions spent on doctor 'gagging orders' by NHS, investigation finds" (2 August) fails to mention one crucial point that is often omitted when matters of management of NHS hospitals are debated.
For many years consultants have been heavily involved in the management of NHS trusts through their roles as medical or clinical directors, often for financial or other personal reward. A pertinent question is this: does a doctor who is party to an arrangement whereby another doctor stays silent about matters of patient safety fulfil his/her duties and responsibilities as set out by, and required by, the General Medical Council in its guidance document Good Medical Practice?
If not, is that doctor not properly liable to sanction by the General Medical Council on the grounds that he/she is putting patients' safety at risk and bringing the profession into disrepute?
Hon Consultant Paediatric Neurosurgeon (retired), Wysall, Nottinghamshire
Nigel Morris's valuable article on the use of gagging agreements in the NHS unfortunately only touches on one part of the public services. Another is higher education, where these techniques have become widespread in the past decade or so.
The website AcademicFOI.com has documented that 5,528 university staff have signed non-disclosure agreements in the past three years alone. The use of these agreements is frequently linked to redundancy, which in many universities are now being pushed through by managerial decision with little or no real consultation.
In effect, tax-payers' money is being diverted by the managements of universities to silence criticism of often arbitrary decisions, and fend off scrutiny of a frequently lamentable performance. Academics are told they will not get the redundancy payments to which they are entitled if they say anything to criticise the administrations which have pushed them out. I fear that a broader inquiry by Mr Morris would discover that the same methods are now in use across much of the public sector.
Your cover story by Nigel Morris and comment by Andrew Bousfield about NHS trust gagging contracts contained no criticism of the 170 senior doctors who accepted substantial pay-offs to keep quiet.
The Government and media continually force NHS trusts to appear to provide a perfect service to keep the electorate happy. It is not surprising therefore that the public perceive that medical staff are above reproach and nearly always the victims of "malevolent" NHS bureaucrats.
The behaviour of these 170 doctors is reprehensible. How many of these pay-offs were as a result of pressure put on trusts by doctors and their union rather than the other way round.
The British Medical Association and other medical unions are the ones in the driving seat, not the trusts. When trusts offer money to keep quiet it is because they are terrified of the consequences, knowing that there is little chance the Government and media will support them.
What we need is real management strong enough to take decisions and a government strong enough to admit that it is ridiculous to put medical staff on a pedestal and ring-fence the NHS (which means protecting doctors and nurses salaries – 80 per cent of NHS costs) while the rest of us suffer.
More realism and less idealism is the answer.
Lib Dems put the country first
I joined the Liberal Party in the late 1960s, and became an enthusiastic and active member of the Liberal/ SDP Alliance, with all the disappointments that entailed. More recently, I gave up membership because I was not convinced that the party and the majority of members were actually seeking power. It seemed that they wanted to dedicate themselves to pointing out the problems of others, a sort of political Greenpeace.
With the forming of the Coalition, the Liberal Democrats put country before many long-cherished policies. They did a deal believing it was better to have some of what you want rather than none of it.
By so doing they will gain a proper understanding of the realities of power and make the Liberal Democrats fit to run the country on their own, something that has never happened in my lifetime. It was a bold, brave move and I salute them.
If your correspondents of 3 August have the best interests of the party at heart they would be preparing to work hard to ensure a majority Liberal Democrat administration, not whingeing about the regrettable compromises we all from time to time have to make.
During the course of the years I learned that life is about taking sensible risks. This is what the Lib Dems did on 10 May this year. The future is uncertain, but so it is with any risk until you pull it off.
Confronted by his party's poor showing in opinion polls, Chris Huhne says he remembers when their share was so low that they were "just an asterisk" ("Lib Dem poll rating halves to 12 per cent", 2 August). No wonder he's not worried. Nowadays the question "Would you vote Lib Dem again?" elicits a whole stream of asterisks.
Hull, East Yorkshire
No use bashing the boomers
I agree with Harriet Walker (Comment, 30 July) that it is scandalous to make a priority of trying to keep more older people in work when so many young people seem to have no jobs, homes, savings or future, and their expensively acquired degrees seem valueless.
But lumping together everyone over 50 to make an undifferentiated mass of "boomers" disguises the fact that those who caused this mess by endorsing Margaret Thatcher and her New Labour clones are not the same people as those who fought to sustain a health service, a state pension scheme, an excellent public educational system and so on. It is up to the "boomers" and everyone else to contribute more, through the tax system, to keep them in existence for the benefit of the whole society, young and old.
And younger people such as Harriet Walker need to get organised politically and demand a rebalancing, because it is politics that got us here and politics that will get us out of this mess (but not under this government). The present failure to address the scandal of youth unemployment is the fault of all these young coalition men in suits (I can do stereotyping too), not the boomers.
Building a political movement, not passive resentment, is the way forward.
Bashing the baby-boomers (born 1946 to 1965) is getting increasingly fashionable, but Harriet Walker and others need to remember that people do the best they can with the information available to them at the time.
In the 1970s and 1980s, helped by the mortgage tax relief then available, people bought the best houses they could so that their children would have nice homes to grow up in. They could not have foreseen that this would lead to problems in 2010. Would Ms Walker have preferred her parents' generation to have lived out their lives in rented accommodation?
Bashing baby boomers may help the young to let off steam, but is not going to change economic reality (which is, we're broke). Maybe the young could do a little more to help themselves. It seems a rite of passage for 18-year-olds to leave the family home and trek off 100 miles or more to go to university, accruing massive extra bills in travel and student accommodation. Could they not go to an equally good university nearer home and save a lot of money? They manage to do this in Italy and the USA. Why not here in the UK?
Tom Kirkwood (Letters, 2 August) says: "For most people, retirement is more of a curse than a blessing." How does he know? Has he interviewed the entire workforce?
Since retiring five years ago I have been able to do much more writing, including a translation project from German into English that I would never have had time for when I was in full-time library employment. And my drop in income has had its compensations, such as savings of about £3,500 per year on commuter train fares. I am lucky in being able still to keep in touch with and see my former colleagues. I may be exceptionally fortunate; I don't know. But I'm getting rather fed up with these "experts" on ageing who claim to speak for all of us when they clearly don't.
When experts disagree in court
Richard Ingrams (Comment, 31 July) wrote that the decision of the Crown Prosecution Service (CPS) not to prosecute the police officer who pushed Ian Tomlinson at the G20 protest because of conflicting medical evidence over the cause of Mr Tomlinson's death was "mystifying", and asked: "Isn't that the sort of issue that a jury would normally be asked to resolve?"
Not any more, is the simple answer. Angela Cannings was wrongfully convicted in 2002 of the murders of two of her children, after they suffered cot deaths. In 2003, the Court of Appeal quashed these convictions as unsafe following worries about expert medical evidence at Ms Canning's trial.
Where there is reasonable doubt about the cause of someone's death the person accused of causing that death is to be given the benefit of that doubt. That principle is more sacrosanct in English law than that of the jury's verdict, and rightly so. The then Lord Justice Judge said: "In cases like the present, if the outcome of the trial depends exclusively or almost exclusively on a serious disagreement between distinguished and reputable experts, it will often be unwise, and therefore unsafe, to proceed."
In a trial for manslaughter by an unlawful and dangerous act, the fate of the police officer would have depended exclusively upon such a disagreement. The CPS cannot be faulted for following the advice of the now Lord Chief Justice.
To be guilty of so-called unlawful-act manslaughter one need only commit a dangerous and unlawful act that causes someone's death. In particular, one need not intend that death or realise that one is putting someone at risk of death; that death need not even be a risk foreseeable by a reasonable and competent person. Surely possible life imprisonment for accidentally causing a death you didn't intend or foresee is an anachronism?
Convicting the officer of a homicide would be wrong in principle and is not founded on the available evidence.
Matthew Anthony Hodgetts
The article "Tolpuddle strike echoes history" (28 July) states that the Old Crown Court is in Tolpuddle. But it is in Dorchester town centre within the building which is now home to West Dorset District Council. The Tolpuddle Martyrs Museum is based in Tolpuddle itself, eight miles east of Dorchester. I hope the tourist guide strike is quickly resolved for the good of visitors to Dorset and the Old Crown Court.
Andy McSmith's report (31 July) on ministers and the Government art collection gives Vince Cable a painting by Victor Pasmore. But the picture shown is not by Pasmore: it is a lithograph by Eric Ravilious (1903-42), the English war artist killed in 1942. The picture you showed was from his Submarine series of lithographs commissioned in 1941 when he was an official war artist.
Professor Peter Green
Writing about the delights of squid (28 July), Sophie Morris remarked on the "misfortune" of tourists who order calamari when abroad only to be served "unbattered squid slopping round in its own indigo ink". Not everyone feels this way. I once had sepia in nero (cuttlefish cooked in its ink) in Venice and it was one of the best meals I've ever had.
Filey, North Yorkshire
Quiet courtesy of Hasidic Jews
As one of Stamford Hill's Hasidim, I can tell you that the Hasidic-owned shops in our neighbourhood employ both Jews and non-Jews, and are vibrant with different languages and cultures. In particular, the fish shop on the Hill is the most jovial of places, frequented by people of every colour and faith, all of whom are treated with equal friendship and courtesy. Anyone can go and shop there to verify this.
Not long ago a non-Jewish, atheist colleague commented to me about the model behaviour of Hasidic young people on buses; quiet, modestly dressed and always first to spring up and offer their seat to anyone more advanced in age.
What Christina Patterson ("The limits of multi-culturalism", 28 July) reviles as bad manners (and then astonishingly, stunningly, lumps together with female genital mutilation!) is probably the diffidence, reserve and different social customs of a minority culture. Of course some individual Hasidim will be rude or break the law, but surely the blanket stereotyping that she descends into tells us something about the liberal values she professes.
There are legitimate debates to be had about how far the rights of minority groups extend. While Hasidim do no harm (and arguably plenty of good) some may reasonably want to question the extent to which they socialise almost exclusively within their own cultural group. But Ms Patterson did not touch this question. She just unleashed a stream of bigotry about their manners, dress and beliefs, revealing the depth of her own prejudice and intolerance. As one of the despised, I am deeply saddened at the number of people who appear to share her views and that The Independent should choose to print them.
We need more commentators like Christina Patterson and we need them writing often on the strange and sometimes dangerous customs of Muslims and Hasidic Jews. Why do we have to be tolerant and sensitive to people who are intolerant and insensitive?
I do want people to be free to organise themselves into groups and wear their own costumes, but not to hurt young girls or to despise or fear menstrual women. One small gesture the Government could make in the current mood of cuts would be to remove state aid from all faith schools.
Keep up the good work.
Covert racism lurks behind diversity
Jerome's Taylor's article, "Manners, Multiculturalism, and the battle of Stamford Hill" (31 July) interested me because I have lived in East Ham and Plaistow for more than 30 years. It is a cliché to say the area is a "diverse, multicultural borough", which has changed since my Ghanaian parents moved into the borough of Newham in 1970 from Kilburn.
As a black female child born in this country, I still have memories of the 1970s when bricks were thrown through our living-room window and skinheads marched down our road in East Ham.
Now, predominantly Asians and, more recently, eastern Europeans, as well as people of African descent are the majority in the borough.
But there is perhaps co-existence rather than any real integration, co-operation, understanding, and fraternity between Asians and Africans. Sadly, my experiences and those of my family and friends is that in many Asian stores, which sell African foods, and the hair and beauty products that many women of African descent seem addicted to, we are treated with a covert racism and impoliteness.
They often refuse to put our change directly in our hands (so they avoid skin contact with us), and they lack even a minimum of common courtesy. Sometimes, I have experienced transactions without a word spoken, or have seen the lack of communication happening to others. Sometimes the Asian store-owners will be on their mobiles as they serve you, or will continue to engage in conversation (in their own language) with others at the same time as they serve. They will not excuse themselves to attend to you nor see this as rudeness.
Not long ago, I was sick and tired of such experiences that I spoke out. All three male Asian sales assistants tried to ignore me and did not say anything as I complained that they were not only rude and prepared to take my money but also prejudiced. Not one of them said a word in defence.
Dr Ama Biney
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