The FOI shows that the Department of Health has increased the number of its press officers (telling us what they department wants us to know) from 26 in 2006/7 to 31 in 2008/9. During the same period the number of FOI officers (what we actually want to know) was just 8. There is also a stark divide between resources with around £3 million spent on press relations and marking but just £300,000 on freedom of information.

A breakdown of the total publicity and advertising budget reveals:

Financial Year Actual Spend £ million)

• 2008-09 = 62.6
• 2007-08 = 50.3
• 2006-07 = 40.7

But as Tony Collins says, that’s only part of the story. That doesn’t include money spent by NHS Connecting for Health on PR firms such as Porter Novelli, Fishburn Hedges, Good Relations and its parent Bell Pottinger.

We’re not an informed electorate if we can’t access the raw information. Too much public money is being spent selling policies as if they’re products and not enough goes into giving us the information we need to make informed decisions about important (and costly) public services.

A company used the law to challenge a government policy on the best method for combatting the disease. The National Health Service recently updated its guidance to read: “the temperature control regime is the preferred strategy to maintain systems free from Legionella and other water-borne organisms”

This claim was contested by ProEconomy, a company that specialises in treatment using copper-silver ionisation, which they have effectively used to keep water systems free from the disease since 1993. Because of the word “preferred” in the guidance, customers of ProEconomy who had successfully applied their copper-silver ionisation process are moving back to a regime of temperature control after years of legionella-free water and water systems that ran at temperatures lower than those recommended in the document. ProEconomy’s future has not only been jeopardised but it is concerned that the guidance, which they state was written without taking into account research showing the inefficacy of temperature control, represents a substantial risk to the public.

They requested the scientific studies on which the new guidance was based. They asked three times but were refused each time. Finally under the freedom of information law, 31 scientific papers were produced. They were examined by a team of university graduates and legionella experts whom ProEconomy asked to assess them. They concluded that none of the 31 papers supported the temperature control regime. Three were against it, 21 did not discuss it at all and seven were in favour of copper-silver ionisation.

So what we have is a department that spent taxpayer money over a five-year period to a produce guidance that does not appear to be supported scientifically. This should give the lie to the idea that policy-making in secret is at all beneficial to the public.

These documents which I uncovered contain useful contact details for the new Ambulance Trusts.

Contact Information for New Ambulance Trusts (PDF, 44K)

Information on Reconfiguration of NHS Ambulance Trusts – implications for protocols (PDF, 60K)

St George’s Hospital in Tooting, south-west London, is already one of only a few hospitals in Britain to publish the results for individual heart surgeons, a controversial move opposed by many elsewhere. The Guardian used the Freedom of Information Act earlier this year to force hospitals to reveal these figures. See earlier posts.

The latest statistics don’t list the performance of individual surgeons and doctors but do show death rates for more than 20 specialities, from birth to geriatrics. The Guardian states the measure will increase pressure on the rest of the NHS to follow suit, and not before time. St George’s should be commended for publishing such important data that is clearly in the public interest.

Many doctors have battled against such public accountability, stating that to publish such statistics was ‘oversimplifying’ the data. Yet St George’s managed to publish the data while taking into account risk factors such as age and diagnosis. What the obstructionists fail to realise is that censorship and secrecy are not the solution to oversimplification (if indeed it is a problem). Patients have a right to know more about those people to whom they trust their health. If more hospitals published their rates, surely this would remind the public that complex medical procedures carry a risk of failure or death, and enable patients to quantify that risk sensibly.

Here’s my prescription for avoiding oversimplification – a big hearty dose of extra informative data.

• Article in the Guardian: Hospital first to publish death rates
• BBC: Death rates data hospital first

The new powers are designed to solve problems highlighted in a report on the private dentistry market in the UK by the Office of Fair Trading (OFT). Patients complained that they were not given adequate information to make informed choices about their treatment and often do not know how much their treatment is going to cost. The Parliamentary and Health Service Ombudsman has made several rulings against private dentists who have obstructively withheld information and/or improperly charged private prices for doing NHS work.

The Order, made under Section 60 of the Health Act, will allow the GDC to establish a complaints scheme for non-NHS patients to complain about their dental care. For example, dentists are expected to agree a patient’s treatment costs in advance. If the patient then finds that the costs substantially exceed this agreed amount they can complain.

Hew Mathewson, President of the General Dental Council said:

“The new powers will enable us to make significant changes to the way we regulate the dental profession – for the benefit of all UK dental patients and the dental professionals who provide their care. Next year will see us introduce a new complaints scheme for patients receiving private dental care and begin to register and regulate new members of the dental team. We have been preparing for these improvements for several years and are delighted now to have the legislation to implement them.”

• Outpatient Attendances, England: Quarter ending 31 March 2005
• Cancelled Operations, England: Quarter ending 31 March 2005

The BMA guidance, ‘Freedom of Information Act 2000 – Frequently Asked Questions’, applies to England, Wales and Northern Ireland. Separate guidance for Scotland is being prepared.

Other aspects of the FOIA are also covered in this FAQ including how to respond to requests for information, exemptions, financial issues and vexatious requests.

The guidance was issued by the BMA’s GP Committee and states that to withhold data on operation success rates (called ‘Quality of Outcomes Framework’ in BMA jargon) ‘could be seen as detrimental to the profession.’ The committee advises practices to be publicly accountable (obviously a novel concept for some).

A managed publication process is planned with the Department of Health. ‘Information will be published annually, most likely in July, by the Primary Care Organisations with the support of the Health and Social Care Information Centre,’ according to the document

E-Health Insider published an article about the new guidance on 4 May 2005.

The BMA itself is not subject to FOI requests because it is a voluntary organisation, however the General Medical Council, the regulatory body for GPs, is covered by the Act.

The exercise found:

Informed choice necessitates that patients have access to individual surgeons’ mortality data. You can read more about this in earlier posts.

Hospitals deny patients facts on death rates
Sarah Boseley, John Carvel and Rob Evans

Ten years after the Bristol babies scandal, patients are still being denied the information they need to make an informed choice about heart surgery, a Guardian investigation has discovered.

The Kennedy inquiry into the deaths of babies at the Bristol Royal Infirmary, following disciplinary action against two surgeons whose success rates were not as good as colleagues at other children’s heart units, prompted the government to demand in 2001 that adult heart surgeons make their death rates public.

The information should have been available by last year, but many hospital trusts are still not collecting adequate data.
more

Leader: The heart of the matter
Landmark step on the road to more openness
The surgeon’s view

The Consumers Union in the USA has just released this amusing animation for its ‘Prescription for Change’ campaign. The CU supports the American FACT Act, which is going through Congress at the moment. The bill would require drug companies to make public all the results of their clinical trials and create an independent office of drug safety in the Food and Drug Administration to ensure quick action is taken when safety concerns are raised.

In the UK by comparison, none of the clinical trials for drugs have been published and until last year it was actually a crime to make these details public even when they were obviously in the public interest. The Medicines and Healthcare Regulatory Agency (the UK equivalent of the American FDA) had to ask permission from pharmaceutical companies before it could make such information public.

This prohibition on disclosure (section 118 of the Medicines Act 1968) has now been amended to make it compatible with the Freedom of Information Act, though originally I was told it would be repealed altogether.

The chapter on ‘Health’ in Your Right to Know goes into greater detail about drug safety and the lack of information given to the public. A number of informative articles and suggestions for campaign action in this country can be found on the website No Free Lunch, run by a group of UK healthcare providers concerned about drug companies’ over-zealous promotional practices.

You can download a copy of the response issued by the Prime Minister’s Office from the Cabinet Office disclosure log or by clicking on the link below.

Health spending (PDF 288KB)

Getting information from the Cabinet Office is like squeezing blood from a stone as this letter makes clear. A bare minimum of information is given out and exemption 21 is used – ‘Information accesible by other means’. When this exemption is used, section 16 of the Act and good practice guidelines advise public authorities to provide detail about where the information is currently available and how to access it. The Cabinet Office has not done this.

Concurrently, the Department of Health released a document today that gives details on how, and on what, the NHS’ £33 billion budget was spent in 2004. The DoH states that the Reference Costs/Reference Costs Index publication is ‘the richest source of financial data on the NHS ever produced.’

‘The main purpose of the data is to provide a basis for comparison within (and outside) the NHS between organisations, and down to the level of individual treatments.’

• Reference Costs 2004 (PDF, 450K)
• Reference Costs 2004 – Appendix RCI1 (XLS, 372K)
• Reference Costs 2004 – Appendix SRC1 (XLS, 819K)
• Reference Costs 2004 – Appendix SRC2 (XLS, 409K)
• Reference Costs 2004 – Appendix SRC3 (XLS, 100K)
• Reference Costs 2004 – Appendix SRC4 (XLS, 826K)
• Reference Costs 2004 – Appendix SRC5 (XLS, 164K)

This is a great victory for patients and the public’s right to know. Yet many heart surgeons are still refusing to make this information.

The Guardian
Sarah Boseley, health editor
Friday March 4, 2005

Twenty-five surgeons from north-west England publish their individual mortality rates for heart operations today, setting a precedent for other doctors who are under pressure from the public to reveal their results.

The surgeons say they hope their move will promote openness and transparency within the NHS.

Read the full article on the Guardian’s website.

If heart surgeons are so concerned about the public then they should publish and be damned. The solution to ambiguous or unclear statistics is more information, not less. Where surgeons are concerned that those who operate on risky patients will be unfairly penalised then the solution is simply to include the risk factors in the survival rate statistics.

Better to make the current statistics public in whatever form they take so we can all see (public and surgeons alike) how this information is being collated across different trusts. Publication creates a powerful incentive to unify and clarify statistics. In secrecy, no such pressure exists and the results have clearly not been in the public interest as the Harold Shipman and Alder Hey scandals make clear.

2003-04 Annual Family Health Service Summary (210 kb)

2002-03 Annual Family Health Service Summary (97 kb)

2002-03 Annual Hospital and Community Services Summary (226 kb)

Privacy and public accountability may seem mutually exclusive but social care professionals must learn quickly how to straddle the divide. The Freedom of Information Act 2000 is now with us and queries from the public can no longer be refused simply by muttering something about data protection, client confidentiality or commercial confidence.

Although social services departments are used to receiving requests for information from the public or those involved in care cases, other organisations may find the transition more difficult. The act affects more than 100,000 public bodies, including local authorities, schools, the Prison Service and Youth Justice Board, as well as voluntary and private sector organisations.

“This is something that everyone knew was coming, but its true impact was not recognised until it came into force,” says a spokesperson for Voice of the Child in Care. The voluntary group plans to use the act to access information that will help its work as an advocate for children. For example, it could ask a council for its criteria for taking a child into care if the child disagreed with the decision.

Information can now only be refused if it meets an exemption outlined in law. Admittedly, there are many exemptions to choose from, 23 in all. Plus requests can also be refused on two other counts: if they are vexatious, in that the request has been answered but the individual keeps asking the same thing; or if providing the answer would cost central government more than £600 and other public bodies more than £450. Exemptions are discretionary. If they are applied, the majority have a public interest test, which means information must be disclosed if it is in the public interest.

All that a member of the public need do is submit their request in writing. The public authority has 20 working days to respond, though some extensions are allowed.

If the information is refused, an appeal can be made to the body concerned. If this is rejected the next ports of call are the information commissioner, followed by the information tribunal and finally to the High Court on a point of law. A public body’s failure to abide by a ruling to disclose could mean a charge of contempt of court and the prospect of jail or a fine.

With such an emphasis on disclosure, how will those in social care continue to meet their strict obligations to protect the confidentiality of their clients? The main exemption that applies to the information held by social care workers is section 40 that appears to exempt all “personal information”. But it’s not as easy as that. A person’s right to information about himself continues to be governed by the Data Protection Act 1998 but with new rights that extend access in public authorities to all unstructured files along with files indexed and arranged, known as structured files. This means notes on a client held on scraps of paper may be up for grabs.

However, the right to information about oneself is not absolute. Access may be denied, or limited if the person in charge of the data determines that it would cause serious harm to the physical or mental health or condition of the subject. Many service user groups dislike this system because it means the decision depends on one person’s subjective interpretation. They hope the information commissioner may act as an independent adjudicator to ensure that this exemption is not used by the data controller to hide mistakes. Additionally, it is legitimate for people to be given their records thinking they are complete, but unbeknown to them the data controller has deleted sections believing they are harmful.

If the information is about a third party, the act covers it, but its release will be governed by the data protection principles already enshrined in law.

A request might come into a social services department asking for the number of social workers and their case load for each of the previous 10 years. Someone else may want to know how many complaints the department receives and how many social workers are disciplined for misconduct.

If your department is small, then even answering an innocuous request will identify your social workers. But this alone is not grounds for refusal. The public has an interest in knowing the names and job descriptions of public officials who are working on their behalf. They also have an interest in knowing how well public employees are doing their jobs.

The line between privacy and openness is a bit murky here. The key factor in deciding what to release and what to withhold is what is reasonably considered private. The concept of privacy is itself ambiguous: an “I know it when I see it” kind of thing that is almost impossible to pin down.

The information commissioner’s guidance states: “It is often believed that the Data Protection Act prevents the disclosure of any personal data without the consent of the person concerned. This is not true. The purpose of the Data Protection Act is to protect the private lives of individuals. Where information requested is about people acting in a work or official capacity then it will normally be right to disclose.”

Ask yourself: does the information sought relate to a person’s public or private life? If it is about someone acting in an official or work capacity it should normally be provided on request unless there is a risk to the individual concerned.

The guidance document warns against using the data protection exemption “as a means of sparing officials embarrassment over poor administrative decisions”.

Several cases in 2003 highlighted the risks of grasping the Data Protection Act exemption too quickly. Police in Humberside claimed that they had deleted details of allegations against Ian Huntley, who went on to murder two schoolgirls, in order to comply with the act. British Gas believed that the act prevented the company notifying social services when it cut off the gas service to an elderly couple, both of whom subsequently died (one of hypothermia).

The ambiguity of data protection legislation is the main reason for the confusion. The European ombudsman warned in 2002 that EU data protection rules (on which UK legislation is based) were “being used to undermine the principle of openness”.

All those answering requests must find a balance between the legitimate need of privacy and the importance of openness. It will take test cases to establish precedents about what is and isn’t disclosable information. But an over-reliance on secrecy and the Data Protection Act will undermine public confidence in services that are meant to serve the people. And if people are expected to make informed choices about their health, their care and their lives bold decisions must be made to give the public the information they need.

http://www.hse.gov.uk/foi/index.htm

The full article in JAMA can be viewed here.

You can listen to the Your & Yours report at:
http://www.bbc.co.uk/radio4/youandyours/index_20041122.shtml

Dr Des Spence, spokesperson for No Free Lunch, said that the voluntary code of practice governing GPs’ acceptance of hospitality from drug sales reps is vague and not enforced. He has also written an article about the shadowy relationship between doctors and drugs reps for The Ecologist. Some figures say there is one drug rep for every doctor in the UK.

Medical Director Dr Richard Tiner, Tom Walley from Liverpool University and GP Dr Una Coales also contribute to this discussion on whether visits from drug reps really do influence the prescribing habits of doctors.

Observations on food by Heather Brooke

As a curry often follows a night on the beers, so a dodgy tummy often follows the next morning. Nobody knows precisely how many people suffer from food poisoning in Britain or which restaurants, takeaways and shops are the likely culprits; a secretive inspection regime leaves the public in complete ignorance about the quality of the places where they eat and shop.

When facts do come out, they emerge long after the event and in extreme circumstances, such as in the case of the £25,000 fine handed out to Tesco by Wimbledon magistrates earlier this month, for repeated instances of mice infestation and mouldy food in a local store. Though Tesco said the store had been undergoing a major refit “which led to some isolated problems”, a local council spokeswoman said the authority “was aware of a long history of problems at the store”.

But if the inspectors knew about those problems, the customers – who actually ate the food – did not. Though inspectors can shut down a business if they find evidence of a major public health hazard, most “minor” violations are kept hidden from the public.

This secrecy would not be tolerated in many other countries such as Denmark and America. I have just browsed the San Francisco Department of Public Health website and now know more about the hygiene of restaurants and food businesses 5,000 miles away than I do about those outside my own front door. The Alcatraz Market on 757 Beach Street, for example, was cited on 27 April this year for contaminated food, improper holding temperature (cold) and improper manual sanitising. The market quickly remedied these problems and got a clean bill of health at a follow-up inspection in June, and further full marks in September.

So what do British businesses think of such an idea? “We are opposed in principle and in detail,” said Miles Quest, communications director at the British Hospitality Association. But what the association says it most objects to is the arbitrary way that councils inspect food businesses. “We would far prefer inspections to be more consistent and tougher,” added Quest.

Making inspections public is exactly the way to do this. It would reveal inconsistencies. More importantly, it would highlight the frequency (or infrequency) of inspections. Some restaurants, it is said, are visited only once a decade.

Greenwich council already plans to issue food hygiene certificates to restaurants that pass inspections. These will be posted and searchable on the council’s website. But more needs to be done and once the Freedom of Information Act and new Environmental Information Regulations come into force in January, it will be difficult for councils to deny the public this vital information.

Don’t weep for the end of dodgy curry and kebab establishments. Most likely there will always be a place for them in the small hours, when good judgement and caution are thrown to the winds – but at least we’ll have the information to know what we’re doing.

Heather Brooke is the author of Your Right to Know (Pluto Press)

This article first appeared in the New Statesman. For the latest in current and cultural affairs subscribe to the New Statesman print edition.

You can search the list of offenders by company, hearing date, result and fine amount. Here are just a few of the highlights.

Details for Case No. F010000699
Defendant: Bristol City Council
Summary: Prosecution under the Gas Safety Regs and Management Regs following failure to maintain gas appliances in school resulting in unsafe condition of several appliances and an accident, and failure to remedy matters after the accident. Lack of monitoring by LEA resulted in poor level of compliance with statutory maintenance at other schools.
Offence Date: 06/01/2003
Total Fine: £10,000.00

P & O European Ferris (Irish Sea) Limited
Summary: Prosecution regarding fatality at the LOLOyard when employee was out of his tugmaster and a Kalmar stacker reach truck reversed over him.
Offence Date: 01/05/2001
Total Fine: £300,000.00

Defendant: Basildon & Thurrock General Hospitals NHS Trust
Summary: An investigation following confirmed case of legionnaires’ disease identified widespread failure to manage hot & cold water services leading to the proliferation of legionella bacteria in hot water system.
This case resulted from the investigation of a fatality
Offence Date: 17/10/2002
Total Fine: £25,000.00

Network Rail comes in for a hammering with several large guilty fines. Here is a list of all their breaches since 1997.

One to note: Details for Case No. F220000060
Summary: Breach of HSW Act s3(1) and Railway Safety (Misc Provs) Regs 1997 Reg 3. Child aged 4 electrocuted on live rail after gaining access to railway through open gate at Strood station yard.
Offence Date: 01/02/1997
Total Fine: £150,000.00
Related to this case: Details for Case No. F220000061
Defendant: Balfour Beatty Rail Maintenance Ltd
Summary: Breach of HSWA s3(1). Gate giving access to electrified railway was left open although company had ceased to regularly use yard which it served. Child age 4 subsequently electrocuted on live rail.
Offence Date: 01/02/1997
Total Fine: £150,000.00

An ironic case where the Environment Agency is fined £150,000 for a case that followed a fatal accident where a 9 tonne dumper rolled over into river drowning the operator. Case No. F230000315
Offence Date: 12/09/2001

The biggest fine was made against Nishimatsu Construction Co Ltd for a blowout that occurred on the Docklands Light Railway during test pressurisation of southbound running tunnel. ‘Extremely fortunate that blow-out happened at approx 4am and not during the day when school children would have been playing on the playing fields above the blow out.’
Details for Case No. F060000373
Offence Date: 23/02/1998
Total Fine: £700,000.00

However, the details of some cases, which appear to have a large affect on public health, are still unavailable:
Details for Case No. O75
Defendant: Shell UK Limited
Summary: CASE COMMENTS ARE NOT AVAILABLE FOR THIS RECORD
Offence Date: 30/12/2000
Total Fine: £150,000.00

Details for Case No. O131
Defendant: British Nuclear Fuels plc
Summary: CASE COMMENTS ARE NOT AVAILABLE FOR THIS RECORD
Offence Date: 22/03/2003
Total Fine: £30,000.00

Sharper teeth for medicines watchdog

Sarah Boseley, health editor
Friday November 12, 2004
The Guardian

The government yesterday announced sweeping changes to the medicines watchdog body after years of criticism and pressure, banning those who sit on its central licensing committee from having any personal or financial interests in pharmaceutical companies.

Lord Warner, the health minister, said those who sat on the regulatory body would in future have three months to sell their shares and end their potentially lucrative consultancy agreements with drug companies.

As the Guardian revealed last month, many of the doctors and scientists who sit on the present Committee on the Safety of Medicines (CSM), granting drug companies licences to sell medicines, also work as paid consultants to the industry. In 2001, 17 out of 36 members declared personal financial interests in drug companies, while more had indirect interests. When drugs in which they have an interest are discussed, members have to leave the room.

Lord Warner yesterday went further than expected with a root and branch excision of those with drug industry ties, not only from the main licensing committee but also from the expert groups on particular diseases that will advise it.

Even those who accept free flights, hotels and restaurant meals from drug companies to attend bona fide educational conferences will be debarred from the committees for six months. A Guardian investigation found this sponsorship was widespread in the NHS.
Read the whole article…