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Una O'Brien, formally of the Bristol Inquiry, defends Cynthia Bower steadfastly in front of the Public Accounts Committee

Every public inquiry has a “secretary”.  Somebody  usually parachuted in from the civil service department under criticism to provide back office support.  This role can be very important. At the Bristol Inquiry, Una O’Brien was the secretary, and she has now risen to the Permanent Secretary, Queen of Wonk role.

So who’s holding the pencils at Mid Staffs?  At the Inquiry, the mandarin behind doors goes by the name of  Alan Robson, the eyes and the ears, and possibly the dead hand, of the Department of Health.  Who he?  Step forward none other than the Department of Health’s lead on enforcing the 18 week elective wait times.  In his first report, Robert Francis QC found that targets themselves had created the pressure which led to loss of lives:

“63. This evidence satisfies me that there was an atmosphere in which front-line staff and managers were led to believe that if the targets were not met they would
be in danger of losing their jobs. There was an atmosphere which led to decisions being made under pressure about patients, decisions that had nothing to do with patient welfare. As will be seen, the pressure to meet the waiting target was sometimes detrimental to good care in A&E.”

Another colorectal surgeon told Francis that they had not done any audit on quality of surgery as they were under immense pressure to meet “process” targets.  So the mandarin at the Inquiry, Alan Ronson, is charged with looking into the targets, that he himself was responsible for as head of the policy unit on 18 week targets at the Department of Health.

Given the Francis report has now been pushed into the long grass after the summer, Medical Harm wanted reassurance that the so-called “independent” Inquiry would not be tacitly guided by what is “appropriate” from the Department of Health, and its well-placed mandarin.  The Inquiry team found it difficult to provide straight answers to Medical Harm but we eventually arrived at the following:

·   Does Mr Robson have any role in the selection of witnesses?  No
·   Does Mr Robson have any role in the selection of evidence? No
·   Does Mr Robson has any role in the publication of evidence? Yes. He leads the team which is responsible for updating the Inquiry website with those statements that are read into the record by the Inquiry Legal team.

The “secretary” to the Inquiry is undoubtedly a powerful position in selecting appropriate witnesses.  Many whistleblowers sent evidence to the Inquiry.  Not many of them were called as witnesses.  

As Sir Ian Kennedy of the Healthcare Commission said of the Department of Health in his evidence this year, “My experience of the Department of Health is that they have a tendency to shoot the messenger rather than embrace changes that need to be made.  Their first priority is to ‘handle’ the situation, rather than consider and implement change…” Indeed.

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  1. Lucifer (the Dark Lord) says:

    The 18 week waiting time targets are my design to destroy the NHS. Please note that I simplified the NHS into 6x6x6 …. So 6 weeks to see the Hospital Consultant (or his minions) 6 weeks to be investigated and six weeks to have your “procedure” and be chucked out. Thus Foundation NHS Trust Hospitals become very efficient sausage factories. Never mind quality of care and the “most important outcome”.

    What is all this about chronic long term conditions, rehabilitation and other processes required ? Don’t be so bloody silly !

    Even more efficiently I suggest we open an industrial level gas chambers in our Hospitals and get rid of the sick and elderly as “useless eaters” !

    I am glad my agents in the DoH are still doing a pristine job !

    Mawwwh haaaa haaa haaaaaaaa !

  2. Amanda Pollard says:

    I was one of few CQC WBs at the Mid Staffs PI. I was an inspector. I spoke regularly with Alan Robson before giving evidence. If Alan Robson was tasked with the agenda to stop me giving evidence, then the DH chose the wrong bloke. I found him nothing but totally supportive and facilitive. My evidence could be considered explosive, and I refuted claims made by Bower, Williams and Sherlock. I told the Inquiry about the ‘generic’ inspector and inadequate inspection regime. I was terrified before giving evidence, but Alan Robson along with the Inquiry’s solicitors made it bearable. If he had another agenda, then he needs to give up the day job and take up acting.

  3. Dan Delion says:

    Lucifer’s comment causes me to reconsider the potential meaning of “Outcome” within the NHS, which, being interpreted in the vein of the ‘Just-so’ stories, may simply refer to the satisfactory shoe-horning of patients into the 18 week window, oh best beloved minion of DoH: nothing at all to do with any resulting benefit to the patient, of course….

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