”Are you the first comedian ever to give evidence at a public inquiry?” Trust a journalist to throw you off-kilter as you’re about to take the stand. Some comedians would give their best lines to be taken this seriously, some even argue that comedy can be an agent of social change. But what if you joked about the appalling death rates at a heart surgery unit and changed absolutely nothing? And then had to account for your actions to a shit-hot QC seven years down the line? “When you referred to the Bristol unit as ‘the killing fields’ and the departure lounge . . . that’s medical humour is it?” So who’s funny now?
Not much to laugh about at the Bristol hospital inquiry. The largest ever public inquiry into systematic failure in the NHS, chaired by Professor Ian Kennedy, has just been published. It centred on the poor results for child heart surgery in Bristol between 1984 and 1995, and how the surgeons were allowed to continue unchecked for years. But concerns about Bristol were first made public nine years ago, in a satirical magazine and at an Edinburgh fringe show.
Back in 1990, when Tony Gardner and I first went to Edinburgh as Struck Off and Die, we were angry young doctors crippled emotionally and irreparably by medical training. The first patient I met was a dead one. Without any attempt at moral guidance, we cut her into increasingly small pieces, roughly in line with the textbook. Some students fainted, a few juggled with the kidneys or skipped with the intestines.
When the Bristol inquiry chairman spoke of the tribalism and emotional indifference of doctors in his interim report on organ retention, I tried to take myself back to the dissection room. We really didn’t care that much about dead people’s parts, because we never met anyone who did.
This attitude is still very prevalent in medicine. Many doctors have labelled the whole organ retention scandal as a hysterical overreaction, but too many doctors spend their lives cocooned by other doctors and have very little notion of what real people think.
Many of the stories we told at the Edinburgh fringe focused on the inadequacies of medical training and supervision, and the disasters that resulted. A colleague had taken his health authority to court over his inhumanly long hours that led to him fall asleep at the wheel. He was doing an obstetrics job at the time and wore a brain-wave monitor during a particularly onerous shift. He was found to be firing off sleep waves while repairing women after childbirth. So, inside of vagina got stitched to outside of anus. I don’t know why people laughed at this, but they did.
After the show, doctors would meet in the bar and have group therapy sessions, where they would exchange their best stories. One had given a patient too much diamorphine and she stopped breathing. He asked the nurse for the antidote, Naloxone, and she misheard him and handed him Lanoxin, a heart drug, which didn’t help at all. Without realising the error, he administered ampoule after ampoule of the drug, not understanding why it wasn’t working. The patient died, the cock-up was covered up, and he shrugged it off in the mess.
A characteristic of all these stories was that no one was ever held to account. Errors occur every day in the NHS and pass unnoticed because there is neither the mechanism nor the will to pick them up. The NHS was founded on the unshakeable belief that doctors are jolly good chaps and the nurses are angels, and so there was no need for quality control. Given the lack of manpower and resources, everyone was thrown in at the deep end and expected to take on tasks they didn’t have the competence to do. So if it went wrong, you could hardly blame them.
By 1992, I started taking my anger out in Private Eye. When a friend told me that the child heart surgery unit at Bristol was dubbed the killing fields, I began asking around. I could find no one who would send his or her own baby there for heart surgery, but neither could I find anyone who knew what to do about it. Heart surgery in Bristol was just known to be not very good, and hadn’t been for some while.
When I had gathered enough information to make the story stand up, the magazine ran it four times in 1992. When I reread the columns before giving evidence, I was struck by how stark, obvious and brutal the warnings were. But these were anonymous columns in a satirical magazine and, although the inquiry found they were widely read, they were just as widely ignored.
Since the Bristol story broke in the mainstream media in 1995, I have hardly done any new comedy shows, aside from turning out old jokes for cushy corporates. I felt so guilty and angry about my inability to stop it that I threw my energy into BBC2’s Trust Me, I’m a Doctor, which in five series exposed similar Bristol-type scandals in a whole range of medical specialties – and may even have improved a few. The cat is well and truly out of the bag now – it really does matter where you’re treated.
However, I think that, if anything, the Bristol inquiry has been too thorough: if it took three years to report on the failings of a single speciality in a single hospital dating back 17 years, what chance does new Labour have of turning round the whole NHS in a single term?
What is pretty clear is that doctors can’t be trusted to regulate themselves in secret, and it amazes me that any sane society lets us cut open babies’ hearts without proving that we’re any good at it. In Bristol, at least they now publish their excellent results on the web – oh, and I’ve even allowed my dad to have heart surgery there.
Dr Phil Hammond is a GP and clinical assistant in sexual health in Bristol
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