21/01/2013 Inside Out West

services are once again under the spotlight. Tonight, two years on

from a report into misdiagnoses, some of which led to deaths,

doctors and campaigners are still concerned. If they delay biopsies

on my new lungs, they messed up last time, I don't know I would be

happy for them to be reported here. Also tonight, we find out what the

biggest ever changes to the NHS will mean to you. Three for the

price of two. Did you know this health centre was run by Virgin?

And we tell the extraordinary story of a Dorset barrister, who is

completing a transformation from man to woman. I'm Alastair McKee,

It's been more than eight years since allegations about

misdiagnosis at the Bristol Royal Infirmary first emerged. An

independent inquiry was hugely critical of the hospital's

department of Pathology, describing an "unwillingness to learn from

mistakes" and "an overconfidence bordering on arrogance." Now,

campaigners have told Inside Out West they are far from satisfied by

the hospital trust's assurances that all the recommended changes

have been made. After scandal and inquiry, reform

was supposed to follow. But tonight the Bristol Trust is once again

under scrutiny. What we've have asked for is evidence have you done

what you've said you've done? Trust is severely criticized by a

leading international cancer expert. Where was management? Why wasn't

management sorting this out? And a patient whose cancer was

misdiagnosed fears returning to the same hospital. They messed up last

time so what's going to give me confidence. The problem has been in

the pathology department in the University Hospitals Bristol Trust

or UHBT. That's the part of a hospital that runs the tests that

diagnose whether you are well or whether you are ill. And whether

you need life-saving medication or an operation or not. So the

consequences if they get it wrong can be devastating. In 2010 there

was a major report into allegations that the pathology department had

been misdiagnosing patients. It found that overall it was providing

a safe service but it did make severe criticisms of the management.

May I begin by apologising without reservation? Now two years on - the

watchdog Monitor still has concerns. And has published a red/amber alert

about the Trust's governance on its website. And campaigner Daphne

Havercroft is pushing UHBT for evidence that it has improved.

Inside Out can exclusively reveal the National Audit Office has

responded to Daphne's complaint and is awaiting a report from UHBT.

Catherine Calland was one of the patients who was misdiagnosed. In

2005 doctors said her tumour was benign but the pathologist had got

it wrong. The consequences for me are that I now have cancer that I

might not have had and that can be quite painful when one can dream of

what might have been and the consequences for my family, the

pain and the trauma we've been through. Catherine's cancer is

incurable and it is spreading so surgeons may have to extract more

tissue from her in a procedure known as a biopsy. And then

pathologists would have to analyse that tissue and report their

findings. If they do biopsies on my new lumps where are they going to

be reported. I don't know whether I would be happy for them to be

reported here in Bristol. They messed up last time so what's going

to give me confidence? Catherine's case was not isolated. This woman

had to have part of a breast removed unnecessarily. I was

horrified they could make such a decision. Worries about patients

like Jane Hopes were given the all clear for breast cancer only to die

three years later. It wasn't only adults who were affected, Richard

Spicer is a retired paediatric surgeon from Bristol. He operated

on a child based on a pathologist's inaccurate report that had missed

crucial details. Sadly the child died due to that misdiagnosis.

pathologist told me that a certain part was normal. The child did go

home but subsequently became very ill because there was still disease

in the circuit and the child died as a direct consequence of that.

Where did that leave you personally? Obviously, personally

very distressed. Professionally in a position where I felt very

worried about treating further cases until we had an expert person

who knew what they were doing in the Pathology department.$$WHITE We

don't know how many patients were misdiagnosed but in August 2004

there'd been enough to make doctors to act. For the next five years

until 2009 doctors raised concerns with their managers about

pathologists' reports from UHBT but no effective action was taken. A

surgeon also emailed concerns to Daphne Havercroft - a high profile

charity worker with connections in the NHS in Bristol - and a breast

cancer survivor herself. When I started hearing about people being

harmed by aidable misdiagnosis I thought that could have been me

that's really how the campaign got started the campaign for justice

patients and a safe service. first email she received read: "We

will not have pathologists at UHBT doing our pathology because we

don't trust them! They are not specialist pathologists and they

don' t double report the specimens." We showed these emails

to the former chief executive of Cancer Research, UK Prof Gordon

McVie. There seems to be a degree of anarchy emerging from these

emails, moral issues and threats of resignation. The language here is

diagnostic of an issue that has been neglected and allowed to

fester, this would require urgent action as a manager. But the

management at UHBT weren't taking effective action. So the doctors

went public and sent their concerns to Private Eye. Soon after

publication UHBT ordered an inquiry into its own pathology department.

It had now been five years since doctors first raised the alarm. The

inquiry was a major undertaking costing three quarters of a million

pounds. The report severely criticized UHBT's management. It

confirmed doctors' concerns had not been taken sufficiently seriously

and were not properly investigated. And it heavily criticized the

pathology department itself. There were battles running with other

Pathology departments, there was lack of consultation with other

pathologists who might know a bit more about the particular

speciality. Staff were at times unwilling to acknowledge, let alone

learn from mistakes - an overconfidence bordering on

arrogance. The report recommended that pathologists should cross-

check or double report - their work more and there should be more

specialists in the department. And it recommended that the Trust merge

its pathology services with another Bristol trust. But it said overall

the Trust was providing a safe service. Some disagree. The report

says doctors were not providing a specialist service, they were not

double reporting, they were over confident and arrogant. That's not

a service that gives me confidence. We asked the Trust to take part in

this programme. In a statement Chief Executive Robert Woolley

said: "This Trust has dealt robustly with the inquiry panel's

concerns and has worked tirelessly to implement its recommendations.

Patients and the public should be reassured by the findings of the

independent inquiry, two inspections by the Care Quality

Commission and the conclusions reached by Monitor, that

histopathology services in Bristol are safe." The Trust said the

inquiry found very few cases that led to harm. The current red/amber

status from Monitor does not relate to pathology services. And it has

implemented all but one of the report's recommendations including

double reporting. But it's yet to create a single pathology service

for Bristol although it does now have one clinical lead. Doctors and

campaigners still have concerns. They publish their of progress

against these recommendations, but it is just ticking boxes. We asked

for evidence showing they are doing what they are saying. Daphne

Havercroft has also raised concerns about UHBT's regulators with

Parliament. And as a result the National Audit Office is doing some

research into her allegations. In a letter to the campaigner, Margaret

Hodge MP wrote: "I know the National Audit Office is taking

this issue seriously and we will come back to you. Thank you for

raising the issues." This needs proper sorting, the patients need

advice. They should be rattling the cages of these defensive medical

practitioners. Coming up we find out how the

reaching deals with the snow. For 65 years the National Health

Service has been here to look after us when we're ill. But in just ten

weeks' time it will undergo the biggest re-organisation in its

history. So what will that mean for patients where you live? We asked

doctor, comedian and Radio Bristol presenter Phil Hammond to

This is lovely, madam, because this inhaler would actually go with your

coat. And a free examination. Do you want to come here and cough,

sir? I can give you those half price. Plus something for your

water retention. I'm a GP. And today I'm taking healthcare into

the community, where it's needed. That is the government's plan. But

many doctors think the reforms are untested, expensive and over-

complicated - a view I shared with the former health secretary Andrew

Lansley. The difficulty with this is that it's 353 pages of wonk.

It's absolutely impossible to understand it. I choose my words

carefully. It is unreadable. What did you actually say? It's wonk.

But I've been wading through the jargon, and it's clear the reforms

will affect us all. It's vital we put politics aside and try to

understand exactly what they'll mean for patients. Until now the

NHS has been like a big supermarket chain that only sells its own

brands. It's a one stop shop where all the tricky decisions are made

for you. In theory, you should get the same high quality care whether

you live in Scunthorpe or Southend. But like any monopoly, it's far

from perfect. The Government's bringing in the market place model

instead - introducing more choice and competition, and putting GPs in

charge instead of civil servants. But will it work? So if I just

check your eyes there... I can confirm you have two eyes. We're

doing two X-rays for the price of one. And I can throw in a free

brain scan if you like. One change we're told patients should notice

is care much closer to home. Hospitals and GPs will have more

freedom to bring in innovative ideas. Technology might monitor

your health at home and routine surgery could be done at high

street clinics. Hospitals in Gloucestershire have already teamed

up with a charity to send this mobile chemotherapy unit into rural

communities. For cancer patients like Graham Freeman, it's a

lifeline. The concept is great, moving the treatment to the person.

Because it is a bit of a trauma, suffering from the chemotherapy and

the travelling. Bringing the treatment closer to the person is a

lot better. You do feel a little bit better. But could this shift

towards more localised care mean hospitals will have to close? To

find out, I've come to London, to one of the world's most respected

independent think tanks on health policy - the King's Fund. I don't

think we'll see many hospitals closing as a result of care coming

closer to home. It will mean hospitals changing their roles,

perhaps fewer A&E departments, fewer maternity services provided

in existing hospitals. But that could be to the benefit of patients

if we're able to plan that in the appropriate way and get better

outcomes by concentrating those services in fewer hospitals.

might not be keen though, if it's your A&E that's closing. The second

thing patients should notice is more choice. Three tomatoes for �1!

Anybody? Three inhalers for the price of two. Come and get them!

Two caulies, �1.50 over there! Competition in the NHS isn't new,

but the reforms step it up a notch. The NHS will become a marketplace,

with private companies competing with the NHS for business. So when

your GP says you need a scan, your options may look less like this,

and more like this. But it should be quality, not price, that will

decide which are allowed to offer care. It's already happening here

on the high street, where Specsavers are treating NHS

patients in 218 of its hearing centres. When I came to Specsavers,

they do private and NHS, which I find is better than going to the

hospital. You know, you go to the hospital, there's a lot of

travelling and I don't think you get such a personal attention. So

this is much, much better. When you press the button in, you'll hear

two beeps which will allow you to use the telephone then. The plan is

for patients like Doreen to choose their provider by looking at new

performance league tables. But companies must play by the rules

and can't encourage NHS patients to go private. Ultimately, Specsavers

want to protect the NHS work that we've managed to gain here and we

don't want to do anything to try and jeopardise that. We're not

going to try and sell a hearing aid, upsell a patient at all during that

time. More competition could drive up standards and lower costs. But

if profits slip, companies could pull out or even go under, leaving

patients in the lurch. Remember the collapse of Northern Rock? Imagine

if its customers had been queuing not for their life savings but for

life-saving surgery. If there is going to be a bigger role for

private companies in delivering care to patients, then there is

always a possibility, however remote, that that company will not

be successful, that we will see something like Northern Rock in

healthcare. The Government's anticipating that. It's putting in

place what's called a "failure regime" so that the regulator can

intervene and ensure continuity of services even if the organisations

are not providing care to the right standard. The third thing patients

may notice is a shift in their relationship with their GP. So if I

said, "Trust me, I know the best place to go to get your heart

surgery." Would you say, "Yeah, you're the doctor. Dr Phil, you

look like a ginger George Clooney. I love, I trust you."? Since the

birth of the NHS, doctors have taken the trust of patients for

granted. But as GPs offer more and more treatments, they could find

themselves referring patients to their own services. Add private

companies into the mix and there's real scope for a conflict of

interest. So just open really wide. But should we really be worried? In

Bath, Jasmine Bishop is seeing a GP on the NHS. But believe it or not,

he actually works for Virgin. Yup - they of planes, trains and super-

fast broadband fame also run this walk-in centre, along with 170

other NHS services... Although you wouldn't know it from the branding.

As Virgin takes over more of the NHS, what's to stop you referring

patients on to another Virgin service to make money for the

company, rather than in the best interests of the patient? All of

our GPs, like any GP in the country, have to offer patients a choice

when they're being referred for another service. So in the end,

it's down to the patient to choose where they go. And of course, GPs

and other clinical staff have a professional responsibility too to

make sure that they're finding the best care for their patients. That

doesn't differ because those GPs are employed by us. And you have to

ask if patients really mind who provides their care. Did you know

that this health centre was run by Virgin? No. Would it make any

difference to you as a patient whether it's run by an ordinary NHS

GP or a private company? No. So all that matters to you is what? What

do you care about in your treatment? That I get the best

treatment I possibly can get really. Which of these sample bottles would

you like, madam? We've got three on choice today. The bottom line is

that if you have a good idea to improve your care, tell your GP. If

he or she can make it happen, we know the reforms are working. It's

been a huge upheaval just to get the NHS to listen to patients. And

I hope for all our sakes it works. I can't lug all this back again.

Come on, it's got to go today. Last Last Friday, a big freeze hit the

West Country. The Met Office issued a rare amber warning and traffic

chaos was predicted. How did it all turnout? Inside Out spent the day

with Gloucestershire Constabulary to see how they traffic officers

coped. It is 7am. It has already been sold

for three hours and is forecast to continue all day. Gloucestershire's

traffic police are being briefed on the busy day ahead. Rosie and Steve,

you can be my it 1-5. We have got four 4x4s. We are following PCs

Steve Parr and Darren "Rosie" Rosewell. They will travel all over

Gloucestershire dealing with snow chaos. Make sure you wrap up warm.

Predominantly, it will be stranded motorists on the hills. Most of our

calls will be going out to assist them and getting them moving or

moving them pro place of safety. these dangerous conditions, Rosie

and Steve's help could be the difference between life and death.

Gloucestershire's emergency call centre is already taking 999 calls.

Any signs of any injuries? Any blood in the vehicle? It is looking

like a busy day. On some of the hills where the ice has had a

chance to form overnight, it is very slippery. It is now 8:15am and

Rosie and Steve are on their first call. Vehicles are getting stuck

between the air balloon roundabout and Cosworth. A lorry has had to

stop on a hill and cannot get going. I stopped at the top there and

managed to get going. But all of the traffic stopped here at the

roundabout. We will try to get you some traction. It is already

causing congestion so they need to We have just assisted a heavy goods

vehicle behind us as far as we can We are going to see whether he has

got a towbar and hopefully he will have more room to get us going.

Have you got a towbar? Nothing at all? No worries. They have not got

one. What he does have is 10 tons of grit. We find the community as a

halt comes together to help. -- as a whole. Put some salt under the

wheels to melt the snow and give it some grit. Hopefully it will get

some momentum and to get up the hill. Less than 20 minutes after

Rosie and Steve arrived on the scene, they have the lorry on his

way again. Back in the emergency call centre, they have another job

for the guys. Sera tango. Request for you to assist. Reports of a

broken-down vehicle stopping the traffic. Yes, we are just round the

corner. No problem. Somebody had got stuck and slipped and not been

able to move. They left they have their car halfway in the

carriageway. -- they left the vehicle. The problem with Crickley

Hill is that there is only one lane coming down and two coming up so it

causes a danger to oncoming motorists. If you go for it, we

will try to get the back wheels up. After three. One. Two. 3. That is

the best we are going to get it. People will have to take it steady

and we will put a marker rout. Trying to help our colleagues get

the car off the road. The problem is, the handbrake is on so we

cannot get traction. Calls are still coming in. A lot of them are

not emergencies. Could you ring one no one. This is not a life-and-

death emergency. -- 101. They have even had a prank calls. It was your

friend, was it? You will get your phone disconnected if you do not

keep your phone out of your friend's hand. For a snowy day, it

has been relatively quiet. Not too bad today. It is 11am. We still

have the rest of the day to go! Back on the road, Rosie and Steve

come across another motorist in trouble on the way to Painswick.

The car was refusing to go up the hill. He could not get any grip so

we have hitched him up to a vehicle and we will tear him up to the flat

part of the road. -- we will pull him. Thank you very much. Really

appreciate that. They have spent most of their police careers in

Gloucestershire. I started off in the Cotswolds, Stroud. Then I

joined Cirencester went we were a divisional traffic unit. Then we

merged and I came here along with everyone else. I I have been in the

police for 12 years. It is a great job. The odd cliche, you do not

know what to expect each day. -- the old cliche. The morning saw

Rosie and Steve prevent accidents by getting vehicles moving again.

Now they are on their way to a more serious road traffic collision that

has already happened in Cheltenham. We have just received a call from

the control room that there is a two vehicle collision. We are on

our way there. We are not sure whether there are injuries. We have

been dispatched to have a look and assist where we can. There are more

than two cars involved. The Mini crashed into a van forcing it to

rear end a Citroen. I try to put my foot on the break but I was not

slowing down, it was too late, I went straight into the back of them.

In a separate smash, a red car lost control. I ended up colliding with

a fan who was driving up the hill. That force may tear one side and I

have hit two cars as far -- that forced me to one side. We saw, what

are they doing? It turns up, they could not do anything. They lost

control. We saw the first Mini. Old guard. There is some one side in

there. As if Rosie and Steve did not have enough to deal with. It is

dangerously bald tyres. That has contributed hugely to what has

happened. They are below the legal limit. My back tyres are illegal

which I did not realise. It is my own fault. I cannot blame anyone

else. An hour after Rosie and Steve arrived, everyone is back on their

way. My son gentle on the accelerator. It is the end of the

day for the guys -- nice and gentle. But they have one last job. We will

debrief to the late Crusoe they know what we have done and where we

have been and the roads that are tricky -- the late crew. It was a

good day. Thoroughly enjoyed it. You can hear regular travel and

weather updates on all our BBC local radio stations. That is just

about it for tonight. Keep in touch with what we are up to on Twitter

Next week, why will young families and larger council properties be

kicked out of their homes when all the tenants are allowed to stay