11.04.06 Look
out for later related articles
Freedom of information in health care is proving more
vital than for any other service paid for by taxpayers, writes Mark Watts.
Ordinary members of the public are demanding answers from the NHS and their
local health authorities.
The department of health, based in Richmond House in Whitehall, right,
and all health authorities are among the public bodies subject to the freedom
of information act (FOIA).
This includes everything from hospitals to other health-care providers,
including GP and dental surgeries, as well as primary care trusts and strategic
health authorities.
Officials at health public bodies report that the most common FOIA
requests are for information relating to clinical performance, such as the
success rates of consultants. Many of these are thought to come from worried
patients or relatives hoping to check the track-record of their doctors.
And this “people power” has put pressure on health authorities
to release more details about doctors’ performance.
People are also using FOIA to seek information related to complaints
about poor health care.
At the FOIA Centre, we are finding that people want more information
about an array of health issues, such as ward closures and MRSA, while companies
seek more details about publicly tendered contracts before making bids.
Information on health matters has also been un-covered from public
bodies other than health authorities, for example environmental health departments
of councils or the regulator for old people’s homes.
However, several exemptions under FOIA can prevent people from obtaining
the information they want. Most of these exemptions are not absolute, meaning
that public bodies must weigh up the public interest that favours disclosure
against withholding information.
For example, the department of health was asked for correspondence
since 2003 between the health secretary and Prince Charles. Communications
between ministers and the royal family are exempt from disclosure under FOIA,
and so this was refused.
Another request to provide reasons or background for Alan Milburn’s
resignation as health secretary also failed. The department, rather curiously,
replied: “Information not held.”
However, a lot of information on health has been disclosed under FOIA.
For example, we learn that 1,023 abortions were carried out during one year
in England and Wales on girls aged 14, and 148 for those even younger.
In an attempt to cut teenage pregnancies, 750 girls aged 14 or under
during a single year in England were given contraceptive injections on the
NHS, which prevent conception for up to 12 weeks, and another 150 girls were
given implants that make them infertile for up to three years, while the “morning-after”
pill was given to 7,920 girls aged 14 or under.
On another issue, the department of health released a survey conducted
by England’s 28 strategic health authorities showing that an estimated
eight million adults are classed as “obese”, more than one in
five of the adult population.
The highest proportion of obese adults was in the strategic health
authority area of County Durham and Tees Valley – more than one in four.
The lowest was in Avon, Gloucestershire and Wiltshire, where the proportion
was just over 17%.
We also found out that 750 clinical and medical staff in British hospitals
have been formally disciplined for offences involving alcohol or drugs at
work over the past decade.
Surgeons’
performance
Health public bodies have released the death rates for patients of cardiac
surgeons in the UK.
However, some experts say that patient death rates may be misleading
because such data does not distinguish between doctors who are incompetent
and those who are tackling more difficult cases.
Figures showing patient death rates for every surgeon in Scotland were
forced out after a ruling by the Scottish information commissioner, Kevin
Dunion.
However, Scotland's chief medical officer, Dr Harry Burns, said: “The
figures are pretty meaningless unless you know much more about the individual
cases taken on by each surgeon.”
“Many of those surgeons with the highest mortality rates
are the heroes of the health service... They are the last hope of very sick
patients. Some of our best, most experienced surgeons take on the very hardest
cases.”
Restaurant
hygiene
An array of environmental health reports on restaurants and other places serving
food around the country have been made public, revealing sometimes shocking
hygiene standards.
In addition, past breaches of health regulations have been revealed
at even some of Britain’s best known restaurants, including Gordon Ramsay’s
Petrus as well as his restaurant in Claridges Hotel in Mayfair, celebrity
favourites The Ivy and Nobu, together with the Cinnamon Club in Westminster,
which is favoured by politicians.
Hospital
finances
Many FOIA requests to health authorities relate to financial information and
contracted-out services. A lot of these undoubtedly come from companies bidding
for contracts.
Responses to FOIA requests showed, for ex-ample, that hospital and
primary care trusts had run up an estimated £1 billion debt collectively.
Thanks to FOIA, the acting chairman of one financially troubled hospital
foundation trust was discovered to be receiving £60,000 for six months’
work last year.
Peter Garland earned the sum while chairman of Bradford teaching hospitals
NHS foundation trust. This compared with an average of £20,000 for chairing
trusts, a role that typically requires three-and-a-half days’ work a
week.
Using
FOIA and other open-access laws
Anyone can make a request for material under FOIA or, as appropriate, the
environmental information regulations by writing to the relevant public body.
The only requirements to be included in such requests are that the requestor
and a contact address in the UK is identified.
However, we find that people ask us at the FOIA Centre to make and
pursue all types of open-access requests for them because they have been given
the “run around” when they tried to do it themselves.
Open-access provisions, their exemptions, and their interpretation
are complex matters to anyone thinking of using them for the first time (or,
indeed, the thousandth time). Compliance with these provisions in the UK is
regulated by the information commissioner. In addition, Scotland has its own
information commissioner.
Besides FOIA, people can obtain information held about them, including
health records, by writing to the body that holds it and asking for it under
the data protection act. Health records can include doctors’ notes,
as well as information about diagnosis and treatment.
Under the law, such data should be supplied with-in 40 working days.
This act, like FOIA, is regulated by the information commissioner, formerly
known as the data protection registrar, who deals with some complaints about
failure to comply.
However, unlike FOIA, requestors can find them-selves having to take
legal action at a county court to try to force compliance with the data protection
act.
In some circumstances, the health records of late relatives and friends
can be obtained by requesting them under the access to health records act.
You would probably have such rights if you are the immediate next of kin or
have power of attorney.
People can also obtain medical reports on themselves by a clinician,
such as a GP, for insurance or employment purposes, under the access to medical
reports act.
In each case, requests should be clearly set out in writing to the
relevant body, citing the act that applies.
The relevant body can ask for clarification of the request or, in the
case of personal information, proof of entitlement to it. The organisation
concerned can refuse to comply with the request until any clarification or
proof of entitlement required is supplied.
Under FOIA, a public body can refuse to supply information for any
one of several exemptions, but it can be asked to carry out a review of any
such refusal.
If the refusal is upheld, a complaint can be made to the information
commissioner for the UK or, if appropriate, the Scottish information commissioner.
Rulings by the information commissioner can be appealed to the information
tribunal, whose decisions can be further challenged in the courts.
For more information about FOIA and other open-access laws, contact
us at the FOIA Centre. We offer up to 50% discounts on our rates
for individuals seeking information in a non-commercial connection. The following
two cases illustrate how FOIA can be used in relation to health matters.
Case
study 1
Retired teacher Jan Gearon-Simm was worried about hygiene standards at a hospital
where her husband, Sam, caught MRSA after a hip operation.
Thanks to FOIA, she obtained a copy of the cleaning timetable and found
that the contract cleaners had not been carrying out basic duties that were
supposed to be part of the contract.
Sam, 68, a retired chartered surveyor from Brent-wood, Essex, contracted
MRSA at Basildon hospital. After he was moved to an isolation room, 64-year-old
Jan kept her own log of the cleaning there.
Her log showed that the cleaning carried out in the isolation room
failed to live up to the contractual commitments of the private cleaning company.
She said: “I just wanted to find out whether the cleaners knew
what they should be doing.”
The hospital initially refused to send her the information, she said,
claiming wrongly that disclosure would breach the data protection act.
“It was cleaned seven times in 21 days, and that was only when
I complained.” According to the timetable, it should have been cleaned
every day.
“There did not seem to be any kind of system. I would have thought
that cleaning would be something that was routine.”
“What they were supposed to be doing was noth-ing like what was
being done.”
The hospital said that it was grateful to Jan for bringing the problem
to its attention and said that cleanliness was a high priority.
Obtaining the information through FOIA “took a hell of a lot
of effort,” she said. “It’s brilliant, but you’ve
still got to keep on at them.”
Case
study 2
Pensioner Eileen Furbank uncovered evidence of abuse and neglect at the old
people’s home where her mother lived until just before her death.
Through FOIA, she obtained documents from the former regulator of care
homes, the national care standards commission, showing a catalogue of complaints
against the Eastmoor nursing home in Ilkley, West Yorkshire by relatives of
residents and whistle-blowing members of staff. The home has since closed
down.
Eileen, 73, of Addingham, near Bradford, said that she had discovered
her 93-year-old mother, Frances Hales, had a rotting pressure sore on her
back while staying at the home. She arranged for her to go to hospital, where
she died five days later.
Eileen said: “She was only there half an hour when they phoned
me about resuscitation. That tells you how ill she was.”
She wanted to know why the home had failed to tell her about the pressure
sore and to send her mother to hospital.
We are currently researching an article that will focus specifically
on FOIA disclosures about old people’s homes. Please contact
us if you have any information on this subject or if you would like us to
help you use FOIA to investigate specific homes.
Eileen’s quest for information was initially bogged down as the
authorities gave her the run around. “I was fobbed off from the hospital
right from the beginning,” she said. “‘She was 93, forget
about it, go home,’ and I just wouldn’t give up.”
She said that public bodies “bank on” people finding FOIA
too difficult to use.
According to the documents, there were com-plaints that residents were
subjected to violence, malnourishment, and that one developed a large pressure
sore on the same part of her back as Eileen’s mother.
“The more you dig, the more dirt you find,” she said. “There
were three more cases after my mother’s case and then it closed down.”
Another version of this article first appeared in the Daily Express.
Comment on this article
Medical staff reveal NHS waiting-list
fiddles
Private
health care on NHS set to rise five-fold
NHS gives contraceptive
drugs to young
girls
Comments on care homes (5)
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