What Data Can The Hospital Withhold?

[Sali]

I have recently requested my (deceased) mum's medical data from the hospital. I questioned many times the competency of the medical staff during her stay. I believe a capsule endoscopy was not carried out correctly because, as the doctor told me at the time, he was not trained to use the equipment. On the day of the procedure I visited in the evening and the belt that is worn during this process was absent, although the nursing notes that I now have say that the belt was removed during the time when I visited! I was so concerned at the time that I wrote to my mum's GP requesting a second test be done at another hospital. They failed to do this. The procedure notes (now in my possession) written by the nurses are incomplete, there are only three images in the data I have received for a process that takes upwards of 6 hours. I want to see all of the video footage that this procedure would have gathered. The response from the hospital is that 'the video images are not accessible.'

Does anyone know my rights in the situation?

 

Many thanks.

[poppynurse]

It is not uncommon for test images to be withheld, they may be difficult to copy and the average man in the street would find them meaningless - the expert report on the test should be documented within the notes.

 

Can I ask what you think you will gain by viewing this test?

[Sali]

Hi

 

Thanks for your response. In the interim I have written again to the hospital and they are now figuring out a way of supplying the video images. These I will have reviewed by a specialist, independent of the the NHS if possible.

 

You are right, the report of the procedure should have been written up, but it is incomplete and was, by admission, carried out by a consultant that was not trained to use the equipment.

[Sali]

How much information is available on specific doctors. I don't want to know personal details like dob, home address etc, but where they trained, what qualifcation(s) they have, their work history to date. I see that there is a register of doctors, but it seems that I can only find out when they became MRCS or LRCP and when they were provisionally and fully registered with the GMC.

Many thanks.

[poppynurse]

Can I ask why you want this info?

[Sali]

Empowerment.

[ScarletPimpernel]

Your local public library will have a copy of the Medical Directory, which has details of where a doctor trained, their qualifications and work history - providing they've kept their entry up to date.

[Sali]

Thank you. I wasn't aware of this source. However, it does sound as if the onus is on the doctor to publish and update, which cynical as I am, will be only if there is something in it for him like a private practice. Why this lack of transparency? If I had any faith in the GMC to do the right thing, I wouldn't be so bothered. Compare this with the NMC who recently struck off the nurse who allowed herself to be involved in the Panorama filming, which exposed the horrific treatment of elderly patients. I know she broke her contract, but her colleagues who seemingly allowed these practices to go unreported continue to work in the profession. What does this say about the hospital, our NHS? Presumably the Chief Exec continues to pick up his/her big fat pay cheque. What a topsy, turvy world.

[Sali]

Although I did not make use of their services, my understanding is that the Healthcare Commission existed so that issues surrounding poor healthcare service could be investigated thoroughly and measures taken to prevent recurrences. If you were unhappy with the HCC's findings, you could then escalate your complaint to the Ombudsman.

 

The abolishment of the HCC leaves consumers, ie. patients, with only one path of escalation and that is to the Parliamentary and Health Service Omudsman. However, it seems that they perceive their role (although this is not at all explained on their current website) to assess whether the healthcare provider has responded to a complaint in a 'reasonable' way. If the Ombudsman considers (in fact two 'advisers' seem to make this judgement), the healthcare services's response 'reasonable' they will not investigate any further. There is no appeal against the Ombudsman's decision, unless you wish to seek legal advice for a judicial review, which I would think is pretty scary to the average man on the street.

 

This appears to me to be a very narrow remit for the Ombudsman - a remit that seems to have narrowed after the dissolution of the HCC, when I would have thought the opposite would have been more appropriate.

 

It seems to me that the healthcare provider only has to become adept at responding to complaints - something which they already excel at without admitting liability - and that will be the end of it. There will be no spotlight on their gross failings or poor standards and thus no incentive to improve. There could be many Mid-Staffs.

 

The odds are stacked against the complainant from the outset. Many of those wounded and wearied by their NHS treatment and not practised in the art of complaining will fall at the first hurdle.

 

I know that the CQC has been created. However, how do they become aware of issues (and we certainly cannot rely on medical staff or hospital management to alert them) if the Ombudsman filters the complaints in this way?

 

I wasn't particlarly impressed with the HCC who seemed to award commendations willy-nilly and without cause, but the new system seems to me much, much worse. I'm sure that the only goal of this awful government is to save money and stymie individual's rights.

[Sali]

On a ward's Drug Prescription and Admin Record with the patient details at the top, why is the page often crossed through with the words (handwritten) 'rewritten [date]' and then again 'rewritten [different date]' at the top of the page?

 

Thanks.

[Night Owl]

Hello Sali,

 

this may be different in different areas but in my area medication that is prescribed on a drug prescription chart may be handwritten by the medical staff (some medication can be prescribed by trained nurse prescribers) or using pre printed prescrition stickers with the drug name on and any information regarding it's administration.

 

Each prescription if hand written or stickers should clearly state the medication to be given, the dose to be given, the route to be given, the start, and stop date if known (ie short course to stop after so many days), the doctors signature and we have bleep numbers too.

 

Any changes to this prescription must either be made by, ideally, by re writting the prescription for that specific medication or the changes made are striked through with the date and the doctors signature by the sides.

 

Some dose changes have to be made when certain medication requires theraputic levels to be monitored through blood tests. These levels will be either written on the drug chart, as we do, or in the medical notes.

 

The staff administering the medication should sign each medication as it is given and write the time given and dose amount if it has been changed.

 

We and our pharmacy team do have a zero tolerance on badly prescribed drug charts. Prescription charts are legal documents as is most of the documentation that we use and must be clearly written. Some doctors have very bad writting! but then so do some nurses!

 

Hope I have been of some help?

 

Night Owl

[Sali]

Thank you for that.

 

However on the Drug Prescription and Admin Record I am looking at, it is blank, except for patient details and the big cross through the page and the two 'rewritten' dates, which are different.

[Night Owl]

Hi Sali,

 

maybe the chart was not used.

If it was blank apart from the patient details it can either be shredded or filed in the medical notes.

 

We strike across each page when the chart is full and there is nowhere to add more medication or space to sign administration then the chart is re written by the medical staff.

When individual medications are re written then each individual entry is crossed out and date and signed by the medical staff.

[Erovanproach]

I have experienced the NHS complaints system and it's a waste of time the first stage was to compain to the local trust I did that and they supported the doctors decisions and not mine because I was'nt in a position to comment on medical matters.Any evidence from medical experts in my favour was ignored.The was no access to legal funding without my own financial imput.The advocacy services were confined to guidlines which were fine tuned in favour of medical experts who were heavily sheilded by the pompus medical protention regulations.It may have well been like the days of Robin Hood and and the Sheriff of Nottingham they were just the same.Without the violence though.But the Health Care Commission were just the same when they were in place now without them the Ombudsman is just as bad they are a bunchh of total arseholes they don't a **** about anyone.They don't take any notice all they do is support the people the complaint is against.I'm not an idiot I wrote an extensive report of the details regarding my experiences with the NHS and they just kept getting it all wrong and twisted and the doctors could play it however they liked and they would always be in their favour because of their doctors badge that says they know better than me because I'm not as medically correct as them because I have'nt received their training.I just said Heil Hitler and **** off to them thats about all you can say.

[Erovanproach]

Although I did not make use of their services, my understanding is that the Healthcare Commission existed so that issues surrounding poor healthcare service could be investigated thoroughly and measures taken to prevent recurrences. If you were unhappy with the HCC's findings, you could then escalate your complaint to the Ombudsman.

 

The abolishment of the HCC leaves consumers, ie. patients, with only one path of escalation and that is to the Parliamentary and Health Service Omudsman. However, it seems that they perceive their role (although this is not at all explained on their current website) to assess whether the healthcare provider has responded to a complaint in a 'reasonable' way. If the Ombudsman considers (in fact two 'advisers' seem to make this judgement), the healthcare services's response 'reasonable' they will not investigate any further. There is no appeal against the Ombudsman's decision, unless you wish to seek legal advice for a judicial review, which I would think is pretty scary to the average man on the street.

 

This appears to me to be a very narrow remit for the Ombudsman - a remit that seems to have narrowed after the dissolution of the HCC, when I would have thought the opposite would have been more appropriate.

 

It seems to me that the healthcare provider only has to become adept at responding to complaints - something which they already excel at without admitting liability - and that will be the end of it. There will be no spotlight on their gross failings or poor standards and thus no incentive to improve. There could be many Mid-Staffs.

 

The odds are stacked against the complainant from the outset. Many of those wounded and wearied by their NHS treatment and not practised in the art of complaining will fall at the first hurdle.

 

I know that the CQC has been created. However, how do they become aware of issues (and we certainly cannot rely on medical staff or hospital management to alert them) if the Ombudsman filters the complaints in this way?

 

I wasn't particlarly impressed with the HCC who seemed to award commendations willy-nilly and without cause, but the new system seems to me much, much worse. I'm sure that the only goal of this awful government is to save money and stymie individual's rights.

 

 

 

 

Futhermore in response to your post here,You mention the art of complaining. How many ways are there to skin a cat? I mean at the end of the day I can't see how anyone can acheive a result with the Ombusman.

Its all geared in their favour they are all the same family if you like they are going to back each other up no matter how well presented a complaint is regardless of the contents.They get their own way.

I don't see why government has this meaninglesss organization installed anyway because it serves no purpose other than a facimile, a front, a nice cosmetic ornimental meaningless institution which makes it look as though they are there to care about the NHS not being up to scratch even on larger scales I think councils petitions would struggle to get any action and addmission of guilt say for instance hygenge standards are not up to expectation I'm sure they'd put up a huge fight.

The individual complaint is only kind of dealt with in terms of was it handled correctly ie did they investigate it and do all their bits that would be on their song sheet and of course they would have done all that.But its the standards of care the quality that is deliberately engineered by them to be not considered. All they care about is did some prat examine breifly and skimm through and say nothings wrong I aggree with these people even though I have'nt really had time read it all but they are doctors so they should know what they're on about and so Ill sign it.

So as far as they're concerned everything was handled correctly.They are pathetic.What ever happened to the NHS that I grew up with they used to care?

[Sali]

Erovanproach

 

I totally agree.

 

However, I feel that I must do something, so will petition my MP to try to change this. I know...it's probably hopeless.

 

The remit of the Ombudsman is just too narrow.

 

The focus is now for better resolution at local level. It will never happen. There is not an NHS manager on the planet who will admit error or failure - it might effect their status or paycheque. The onus will be on the damaged patient or their relatives, already wearied by the fight, to take it further and justice has a big price tag.

 

The NHS will become increasingly complacent as they are less likely to be challenged on their standards and competence. Complacency will inevitably lead to further failure.

 

Is it any wonder that the ordinary citizen feels more and more disengaged from the democratic process.

[zippygbr]

On a ward's Drug Prescription and Admin Record with the patient details at the top, why is the page often crossed through with the words (handwritten) 'rewritten [date]' and then again 'rewritten [different date]' at the top of the page?

 

Thanks.

 

does this involve a relatively long hospital stay ? or one with lots of changes of medication ?

 

i currently work in an acute inpatient setting where we may have patient stays of several months ( specialist rehab setting) and even the 'long term' prescription charts only last for 4 weeks ... so once a month the junior doctors have to write out a new prescription chart which they annotate with the date of admission and the date this chart was written / re written .... they then 'cross out' the front of the 'old' chart with a single pen line X across the whole front of the chart - which is then filed in the notes by the ward clerk.

 

equally if we change a lot of medications you can easily fill the spaces for prescriptions before filling the spaces for recording the drugs being given ...

 

the same would happen there - junior doctors / nurse prescriber would write out a new chart

[NurseAnne]

The drug chart has each drug prescribed on it with the time to be given. There are 31 horizontal boxes next to each drug because their are 31 one days in each month.

 

On the 1st of the month I show that I gave the drug at the correct time by putting my initials in the first box. On the second day of the month I put my initials in the second box, to the right of the first. And so on and so forth. When we get to the last day of the month we are probably on the far right of the chart and there are probably no more boxes to put my initials in. Therefore I cannot give the drug until the chart is re -written because I cannot sign for them properly.

 

When that happens, the junior doc will put a big giant x over last months chart and write "rewritten" on it. Then he rewrites the drugs onto a new chart and the old one gets filed.

 

It is a very antiquated system of doing things.

[NurseAnne]

Or maybe the doc made a spelling error or something or didn't like the way he prescribed it so he just crossed it off and grabbed a new chart. Different charts for different areas as well.

[Feebee_71]

We often have charts re-written because there are no more spaces to add new medications and other medications have been crossed off - very frequently when going from hourly medications (take up 4 prescription spaces on one chart) to 2 then 3 or 4 hourly. Also prescription has to be re-written when doses are changed otherwise you don't know the effective date of the new dose - up or down.

 

Finally, if adding new medications and there are lots of previous crossings out then a new chart may be written to stop medications being missed.

 

As an aside, our drug charts only have sufficient boxes for 3 weeks of prescriptions so need re-writing more often if a patient is with us for longer than that.

 

Feebee_71

[Sali]

Are other people being forced to make an appointment with their registered doctor under some new rule?

 

In truth I haven't been near or by a GP in quite a few years, but I wanted to make an appointment for a particular afternoon. As my own GP was not available I said I was quite happy to see anyone qualified. No, now it seems all patients HAVE to see their own doctor. I pointed out that although some patients may wish to see their own GP for continuity purposes, I really was not bothered and surely it was my prerogative as a customer to make that choice.

 

The poor receptionist could not give me any definitive reason why this decision had been made. She said I could complain by letter and was not at liberty to say if others had also complained.

 

I can only think that there is some financial incentive for the GPs - such cynicism!

 

Is this Andrew Lansley's Brave New Health Service?

[cobee33]

My surgery is first rate to be honest, if your own GP is in you will see him but otherwise another GP ( I don't mind, they are all friendly and good GP's ). Same day appointment ? No problem, just phone around 8am and they will always fit you in. I believe surgeries are essentially independent ( ?) so if you find a good one be thankful.

[Sali]

Let's hope that your GP practice continues as is. I've a feeling though, if there's lolly in it for the GPs, other surgeries will go the same way.

[zippygbr]

nothing i'm aware of

 

i suspect it may be that practice especially if there are issues with a minority of the GPs being over popular, certainly my 'list' GP has told me to make appointments with other partners before because of the other partner's GPwSI interest ( ditto with women's health stuff for female patients - there's only a couple of the GPs that insert coils, not for any ideological reason but becasue gynae is their special interest)), the registrars and some of the =junior salaried docs in the practice are no one's list GP

[Nystagmite]

I generally see any doctor. According to the receptionist, I'm not registered with a particular GP. I'm registered at the surgery; but not to a particular GP.