Quintin Jardine's blog

Woke up this morning, got myself a gun . . .

Well, not quite, but I did go into full Tony Soprano mode when I read the lead story in today’s Herald, headed ‘Fears over “toxic” team of surgical consultants’ and realised that it referred to the Vascular Surgery Department at Edinburgh Royal Infirmary.

Here’s a sneak preview of next year’s Skinner novel, Private Investigations. It’s dedicated to a man called Dave Lewis, and his colleagues. He is a consultant surgeon in the ERI vascular unit and last year he and his team saved my wife’s life. She was under their care for a year, being monitored for a detected abdominal aortic aneurysm, a condition for which all men over 65 are now offered screening, but which also occurs in women.

Patients can live with a Triple A quite happily without needing surgery, but if they do, top level surgical skills are required. There are two possibilities in the latter circumstance. One is a keyhole procedure similar to a stent, where a tube is inserted in the ballooned artery to narrow it from within. The other is full-on intervention, highly complex life-threatening surgery, given the location of the problem.

I’m no mug. At the very start of the journey, when the condition was diagnosed and we were referred to Mr Lewis, I checked him out. I was more than happy with what I found; he’s one of the global leaders in the field. He explained the situation clearly at our first consultation and kept a close eye on Eileen throughout. Monitoring of the condition was regular and thorough, under the care of Neil Mitchard, our excellent practitioner nurse. When it did go symptomatic, and we went straight to A&E armed with a letter from our GP, Dave was there, waiting for us. He said that invasive surgery was necessary, urgently; however he would not operate that night, but wait until next day when he had his full team around him.

The operation took four to five hours; when it was over he called me from theatre, to say that it had gone as well as he had hoped, and that the patient was expected to make a full if lengthy recovery. Note: he called me, he didn’t delegate the task to a junior member of the squad.

That’s my experience of this so-called ‘toxic’ unit. But it’s not my only experience of the NHS and its internal politics.

Back in the 70s, as a civil service information officer, I had media relations responsibility for an extremely sensitive unit. In its relatively small management team, there were two senior consultants who would not speak to each other, literally. Ten years later, as an independent practitioner, I had as a client an NHS Trust. Some of the relationships between its management and its consultants would have been more suited to a primary school playground. There are rivalries within the NHS? Of course there are; they’re endemic. But are they ‘toxic’?

The Herald cites an independent report by two English consultants, which it says was commissioned by NHS Lothian. It quotes descriptions of ‘forceful and at times aggressive behaviour’. It says that consultants actively look for errors in each other’s work, taking notes and recording occurrences. To me, that is no bad thing; it demonstrates that there is no complacency in the department. But it goes on to claim that a ‘gang culture’ exists, with some of the consultants believing that one of their number is favoured by management.

It quotes a case in which a patient died. In fact routine major vascular surgery carries a fatality risk of maybe one in ten; in Triple-A emergencies, where it has ruptured, those are the survival chances.

Let’s consider the management which commissioned this report, and ask some questions. Why did NHS Lothian find it necessary to ask two men from far away to study and report on the behaviour of fellow professionals? Is its own control so inadequate?

The medical director of NHS Lothian is quoted as saying, among other things, that it did so ‘to ensure patient safety’. I’m sorry; that is an outrageous statement.

It implies that in some way patient safety was at risk, in a department which saves lives, my wife’s included, on a daily basis, and whose staff are regarded as world leaders, in a centre of excellence. During Eileen’s care we were told by a professional with no axe to grind, ‘If I had this condition there is no place I would rather be treated than in Edinburgh Royal.’

I must make it clear that I am not criticising the Herald, not for one second. It reported on a document that came into its possession, and it is entitled to call it as it sees it.

However there is one enormous elephant in the room, or in this case the operating theatre. How did such a sensitive, disturbing report ever come to be leaked?

At the beginning and end of the day it is the considered, but subjective view of two individuals, no more than that. There will be counter-arguments that have not been aired. And yet it has the protential to do far more damage to patient well-being than it could ever prevent.

At various locations across central Scotland right now, there are people who are in the care of the ERI Vascular Surgery Unit, at the same stage of their treatment that my wife was exactly one year ago. Every one of them will be alarmed by that report, yet in my experience, there is no need; they could be in no better hands.

I suggest that another enquiry is needed, far more urgently than the first, into the management that was unable to deal internally with bickering between its professional staff and which then allowed the fall-out to splash all over the public domain.