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Dear Mrs Beecroft, You may be aware that in February I wrote to Mr Anderson and Mr Killip following the publication of the Robert Francis report I urged them to take full responsibility for the current state of Noble's Hospital, which at present bears many similarities to Mid Staffs, particularly regarding the style of management This is aided and abetted by some senior clinicians (medical/non medical) who deliver at best, clinical care that is not current and who are happy for Nobles Hospital to remain in a time warp because it suits their level of clinical competence and their extremely comfortable lifestyles.

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I was interested to hear the letter prompted a written response from Mr Anderson to all MHK's,but to my surprise all remained quiet other than this. His correspondence acknowledged my concerns but frankly amounted to nothing more than I had questioned in the letter, unfortunately confirming my fears that both Mr Anderson and Mr Killip are completely complicit in the propaganda and fabrications that are regularly generated about the quality, standards of care and reviews undertaken at Nobles Hospital.

V' Since the original 10 Consultants put their concerns into writing to senior Hospital Management 6 months ago, there have been many meetings, much talking and significant pen pushingjkey board typing, but absolutely no meaningful or definitive action taken by Management or the DOH. This is despite the fact that many of the very busy, dedicated clinicians tasked with the specific areas of concern, have already returned robust evidence based reviews and action plans at a recent 'Patient Safety Forum'. In effect I believe the Hospital Management Team/DOH have attempted to 'tie up' the progress of these projects in bureaucracy and red tape whilst they 'regroup' and endeavor to organize a plan to save face, money and effectively, their own jobs. I appreciate it is difficult to act upon an anonymous letter, but I clearly stated my reasons for remaining anonymous and those reasons have not changed. To give an example of why I need to remain anonymous, apart from already being threatened with my own job last year, a senior manager this week threatened their staff with 'downgrading' because they refused to work in a clinical area they are not trained to. The request was due to staff shortages, which are a regular occurrence, putting patients in danger and professional registration at risk because staff would be working outsidestheir 'scope of practice'. I feel that if perhaps just a few specific issues are identified, this will enable you, as representatives of the 10Mpublic, to ask the important questions that provoke the debate and action required to significantly improve standards. It would be impossible to list every single issue and concern; however I have begun below with what I believe are top of the list Would you be shocked to discover?

Staffing, medical and nursing at Noble's Hospital is so poor that patient safety is regularly put at risk with care ultimately being comPromised. Wards are regularly staffed unsafely with even the basic care requirements of patients becoming unachievable. Numerous staff have been d~rbed enough to actually put their concerns into writing to the managers. Recognised British standards and recommendations regarding staffing and cover, in particular out of hours and emergency care are systematically dismissed and ignored with the main obstacle often being that 'things are differe,¢here'. Does this mean that suboptimal standards of care are acceptable to the public because they choose to live on an island?


In March 2013 15 registered nurse vacancies were advertised from just one division (medicine). On 20/04/13 there were adverts for 10 speciality doctors across medicine/paediatrics/anaesthetics with 5 registered nurse posts in surgery/medicine. I am reliably informed that there are also currently at least 6 registered practitioner vacancies that remain unfilled within the theatre department, and 4+ within the intensive care unit This is of considerable concern, as the recruitment process in the 10M is incredibly long and drawn out, sometimes taking 6 months OT more for a registered healthcare professional to take up their new post My question would be, why have so many vacancies been left to accrue and who has allowed this to happen?

• Despite evidence-based national guidance regarding the treatment of trauma ../ patients, Noble's Hospital currently does not have a dedicated Consultant led trauma team with Consultant Orthopaedic/Surgical cover available to be activated if required. Statistics/evidence/research demonstrates that patients have a significantly higher chance of survival and better future outcomes when treated at regional trauma centres as soon as possible. Noble's is not part of a trauma network and does not have a robust, immediate consultation system with off island neuro/cardiothoracic specialists and no direct referral and transfer pathways in place to refer and transfer patients as quickly as possible to a regional trauma centre in UKor Ireland.

• There are very clear recommendations by the College of Emergency Medicine, regarding the staffing of the Accident & Emergency Department Noble's Hospital currently only has ~Consu]tant (Associate Specialists are not Consultants). One Consultant is not even close to the current recommendations for a department of its size. This impacts on the quality of patient care that can be provided and a knock on effect to a patients pathway throughout the hospital. Consultants are essential for their knowledge, clinical expertise and experience.

There is currently an extremely outd~d model for critical care and admissions to the intensive care unit due to the lack of dedicated doctors specifically qualified and experienced in treating patients requiring intensive care. Patients then experience unintentional 'substandard' care when Consultants with specialist intensive care skills are not on duty, leading to patients being cared for by clinicians who are not experienced and current with modern intensive care treatments and practice.

The Air Ambulance service is in complete disarray, there is always difficulty staffing the transfer of patients with suiyz6'1y qualified staff and I am aware of at least 2 recent complaints by receiving UKConsultants regarding inappropriate treatment of patients prior to their transfer. The Healthcare Commission report in 2006 identified issues with this service, which appear not to have been taken seriously or addressed since this report.

• Staff are being active~scouraged

from completing adverse clinical incident reports when staffing levels/events are unsafe and putting patients as risk/danger. Incident reporting is for the individuals concerned to complete, in certain areas mangers insist that staff go through them, thus dissuading them from highlighting concerns. A senior manager in medicine recently told staff that the incident reporting system was not to be used when staffing levels were unsafe. If it's not been reported, technically it hasn't happened and there is no record. This was an area that the Francis report specifically focused on, staff


expressing their concerns to management bullied into remaining quiet. •

but continually

being ignored or

In the 10M there isn't a legislation to ensure that patients are discharged from the acute care of Noble's Hospital when deemed 'medically fit for discharge'. In 2003 the UK introduced the Community Care (Delayed Discharges etc.) Act to -address this very problem. Presently there are many patients occupying expensive acute hospital beds at Noble's Hospital when they are medically fit to be discharged, some for~ years. This then creates bed shortages for new patient admissions, the danger is that other patients are then discharged too early to free up a bed but are then require readmission due to being sent home inappropriately.

Are you horrified to learn? ./

Despite endless campaigning by the Anaesthetists, Obstetricians, Theatre Staff and more recently the Hospital Management at Noble's Hospital, Mr Anderson and Mr Killip have failed to provide the 'heads' required to supply qualified anaesthetic assistance available on site 24/7 for expectant mothers and emergency patients throughout the hospital. This is a grave cause for concern and evidence suggests this has the potential to cause the death of a mother and her unborn child The 7th Annual Report of the Confidential Enquiry into Stillbirths and Deaths in Infancy, identified 11 anaesthetic-related deaths due to delays in getting appropriate staff, of which four were attributed to the absence of a skilled anaesthetic assistant (CESDI, 2000). This service is not a luxury, but an absolute necessity. The General Medical Council (GMC) have clearly stated that this could result in and Anaesthetist being formally disciplined or struck off the GMC register should they anaesthetise patients without a qualified Anaesthetic Practitioner being present. It would be be unheard of in a UK hospital not to have this service available immediately for an obstetric emergency or in fact any situation which required an anaesthetist to administer an anaesthetic. This issue has been ludicrously debated for at least 6-8yrs, with hospital management, Health Minister and Chief Executive now agreeing it is a 'good' idea, however they have not been forthcoming with the 'heads' to provide this service. Ultimately mothers, babies and emergency patients remain at risk of death or harm due to their inactions.

Are you aware? In the recent years there have been numerous senior medical staff investigated, suspended, dismissed or have resigned. The list is extensive considering the size of Nobles's Hospital. These include: Mr Dirk Hohman, Consultant ENT Surgeon - convicted of criminal offences in Germany which were subsequently not discovered by police checks (dismissed and extradited back to Germanv and subseauently struck off the GMC register) - investigated for poor surgical technique and sent on full pay for 'refresher training' on at least 2 occasions. Elective colorectal surgery is currently suspended at Noble's pending the review of spvpraJ rases bu an PYDPrt snnman and anesthetist from the UK. plaints regarding surgical technique and patient complications. Questions regarding poor eyesight (locum


contract was not renewed allegedly due to the increase in complaints/pressure _rro_m_cOD_c_e_r_ne_dsta~[O~ _ _ suspended for investigation of long NHSlists and excessive private practice. Also investigated for the harassment of a locum Consultant Opthalmologist employed to undertake surgical procedures in the absence of OPhthalmic surgeons (currently practicing ophthalmic surgery) - suspended for investigation Of Tong NHSlists and excessive private practice. Also investigated for.the harassment'of a locum Consultant Opthalmologist employed to undertake surgical procedures in the absence of ophthalmic s~nsl_currently practicing ophthalmic surgery) loglst - employed by DOHto reduce waiting lists for eye surgery. Successfully achieved amidst controversy. Since been struck off the GMCregister. suspended for attitude and behavior. Gagging order successfully gained 2011 by DOHwhen he threatened to whistle blow regarding poor patient care (dism issed) --- 3 month prison sentence suspended for 2 years and suspended from practice for harassment of a ~ague -~ ic Registrar - charged with inappropriately administering treatment to patients without seeking advice and making adequate records. Unprofessional and aggressive towards colleagues. No la.n qpr reoistered to practice. v" - - . -msivist - resigned with immediate effect following frustration and inaction of management regarding poor standards of patient care and practices, particularly critical care/Tl'U. It would be the easy option of course to remain silent, as many of my colleagues presently do. I am in the fortunate position of being 'in the know' and can ensure that my family and I receive the best care possible available on the island at the time. However; this would be immoral, unethical and also against my professional codes of conduct I have sent a copy of this letter (and the one sent previously) to the UKDepartment of Health and intend to discuss matters in person with them; they may be interested being one party in the reciprocal healthcare agreement currently in place with the Isle of Man. r suspect they assume that the same levels/standards of care are applied and provided on the island to those in the UK.I also plan on contacting Julie Bailey who formed the campaign group 'Cure our NHS' and played a key role in exposing the Mid Staffs scandal. Some questions to begin the process could include:

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How has Noble's Hospital become so far behind clinically, essentially meaning that it will require significant investment to bring the hospital and services even close to our UK counterparts? In the interests of openness and transparency the findings and any recommendations of the recent colorectal review and report should be made public and ifnot why? Particularly when Mr Killip clearly stated in January's Hansard transcript that following the review "all cases were appropriately treated and that the surgical procedures adopted were acceptable" with all outcomes "to be expected" with "nothing in the report to give cause for concern". What are the future plans of the DOH to ensure national standards and recommendations are met and if this is not possible due to geographical


location, logistics and resources, what detailed measures and protocols will put in place to address this? As pubJically elected politicians I sincerely hope you will feel compelled to ask serious questions of the Government, Health Minister, Chief Executive and the Hospital Management regarding the quality of the health care provided to the people of the Isle of Man.

Kindest Regards A Concerned Clinician

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CC: Nursing and Midwifery Council General Medical Council UKDepartment of Health


Anonymous letter redacted