Chapter 3: The experience of patients and families on the wards
How patients were treated: the roles and responsibilities of the consultants
Each patient, unless in a GP bed, would have been under the care of a named, designated consultant; this is a requirement of NHS practice. The available records for 1988 refer to two consultants in post who were responsible for patients at the hospital: Dr John Grunstein, the consultant physician for elderly services, who received Dr Barton’s application; and Dr PS Wilkins.
Dr David Jarrett was described as the Lead Consultant for Elderly Medicine in 1998 (HCO109815, pp1–5).
Dr Bob Logan was a consultant geriatrician in the Portsmouth area, responsible for supervising the care of a wide range of elderly people. He subsequently described his responsibilities as including consultant cover for Redclyffe Annexe until 1992 or 1993, but not for other wards at the hospital. Dr Logan described visiting Redclyffe Annexe once every two weeks and being available for consultation between ward rounds. He was clear that the clinical assistant had day-to-day clinical responsibility for the medical care of the patients (HCO006896, pp1–3).
Dr Althea Lord worked as a consultant geriatrician for elderly medicine in Portsmouth from March 1992 until June 2004. This role extended to Gosport War Memorial Hospital (including Daedalus and Dryad wards) as well as other hospitals in the area (MDU000001, pp2–3). When Dr Jane Tandy was on maternity leave in the period until February 1999, Dr Lord covered her duties on Dryad Ward (HCO110482, p1). Dr Lord described her involvement in these terms:
“… re-building took place at the hospital in about 1994 or so with the construction of new facilities including Daedalus and Dryad wards at the hospital. I then became the Consultant responsible for the patients on Daedalus and Dryad wards and would carry out a ward round on each ward every other week.” (MDU000001, p2)
Dr Tandy worked as a consultant geriatrician from 1994, including overall medical responsibility for Dryad Ward until 1996. Dr Tandy confirmed that her responsibilities included a ward round on Dryad Ward once a fortnight. She would normally be accompanied by a senior member of the nursing staff as well as Dr Barton. Dr Tandy’s usual routine, when conducting a ward round, would be to see all the patients. She described discussing the care of the patients with the ward team, talking to patients and examining them if appropriate (HCO110808, p2).
In her statement to Hampshire Constabulary in 2004, Dr Tandy said:
“… one of my responsibilities was to review the prescription of drugs on Dryad ward at Gosport War Memorial Hospital. The majority of drugs can only be prescribed by a doctor. The day-to-day administration of drugs would be by qualified nursing staff … Drugs can only be prescribed by a doctor. Drugs could be modified, current drugs stopped or new drugs added depending on the patient’s condition. The drug regime would be reviewed by the consultant on the ward round as appropriate during the week by the general practitioner (GP) where necessary. There was no requirement to notify me of every change to drugs prescribed to the patient by the GP during his or her ward round unless the GP sought my advice. From my experience it was very infrequent that the doctor would phone me for advice.” (HCO110808, p2)
In referring to her respective responsibilities and those of the clinical assistant, Dr Tandy said: “At this time in 1996 there was not a resident doctor for these patients on Dryad Ward. Day to day cover was provided by the local GP. In the case of Dryad Ward this was Dr BARTON and possibly others from her practice” (HCO110808, p2).
Dr Richard Ian Reid was appointed in April 1998 to a role which combined working as a consultant in geriatric medicine with the post of Medical Director of Portsmouth HealthCare NHS Trust. In his statement to the police in 2006, Dr Reid said that while, in theory, the two parts of his role were evenly spread, in practice his work as medical director amounted to two-thirds of his time (HCO109815, pp1–5).
Dr Reid was concerned to clarify that his appointment as medical director related to the Trust and did not make him the medical director for Gosport War Memorial Hospital. At the hospital, Dr Reid was consultant for Dryad Ward, on his account for about a year from the spring of 1999. He said that he also provided cover for Dr Lord on Daedalus Ward but did not conduct her weekly ward rounds, instead operating on the basis of being available in an emergency (HCO109815).
Dr Reid indicated that he would spend around three hours in the afternoon on the ward round before seeing relatives and writing up notes (HCO109815).
When questioned by the police about his contact with Dr Barton, Dr Reid said that if she was on the ward round “she would clearly ask me about problems”. He added: “I was always available in terms of certainly telephone contact if she wanted to discuss something” (HCO006981, p34). In her statement, Dr Barton described Dr Reid as “nominally in charge of Dryad” while emphasising his other commitments away from the hospital (HCO110482, p1). Dr Reid did not appear to appreciate the risks of the prescribing practice and overuse of diamorphine affecting his own patients. He was in an ideal position to investigate this further and would have had a major responsibility for clinical governance within the Trust.
The Panel has seen accounts explaining how the consultants worked in relation to the clinical assistant. Nurse Collins, for example, said:
“I anticipate that the Consultants had 100% trust in Dr Barton and they did not feel the need to oversee a lot of her work. Their main input would be in the next step in the patient’s care, in terms of deciding whether the patient should be transferred to a nursing home, or kept on the Ward, if the patient should go to rehabilitation or should go home for a period.” (MDU100001, p3)
“In my view, Dr Barton did not have sufficient consultant input, not in the sense that she did not know what to do, but simply in terms of demands on her time. These demands were very high … It seemed to me that no sooner had a consultant found their feet than they then moved on.” (MDU100001, p5)
“The Consultants responsible for Dryad Ward must have been aware of the practice of prescribing drugs in this [anticipatory] way. It was there for everyone to see on the medical records, which would be reviewed when the Consultants carried out their Ward Rounds each week. However, I never heard any expression of disquiet or concern from Consultants about the operation of this policy. I think the Consultants may also have operated this system of prescribing on occasion.” (MDU100001, p8)
The descriptions of their responsibilities confirm the statutory position that the consultants, though not present and involved on a daily basis, retained responsibility for patients on the wards. The nature of their involvement in practice is revealed by the case studies examined by the Panel. These case studies include Case Study 5, which is published here in its summary form, with the fuller version at Appendix 2.