Doctors, patients and privacy

The Healthcare Commission aims to improve health care

The doctor patient relationship is one based on confidentiality and privacy.

But pause for a moment and imagine how you'd feel if a total stranger could read and photocopy your medical records.

What's more, they don't even need your permission.

Inside Out investigates the work of the Healthcare Commission.

Healthcare Commission

The Healthcare Commission is the government agency causing quite a stir in the medical world.

It was established two years ago in the wake of the inquiry into the Harold Shipman affair.

Its brief was to clean up and regulate the NHS and private medical sectors.

The Healthcare Commission has a statutory duty to assess the performance of healthcare organisations, award annual performance ratings for the NHS and co-ordinate reviews of healthcare by others.

But Inside Out has been investigating a serious falling out, between the usually discreet world of private medicine and the Government's Healthcare Commission.

The list of complaints against the commission goes on and on - unannounced visits, patients being upset in waiting rooms, medical records being photocopied and taken away.

But, to protect the public from dodgy doctors, there's also a strong argument saying the commission should be proactive and act tough.

So should the government be able to pry into our medical records?

To find out what was going on between the private doctors and the Healthcare Commission, we decided to investigate further.

Work on the ground

Dr Michael Sheill is one of the South East's most successful cosmetic doctors.

He does botox, facial peels, and similar cosmetic treatments.

He knows that his type of medicine is frowned upon by many, but he has no shortage of patients.

Up until 2004 Dr Sheill's surgeries were going well, until he got a visit from the Healthcare Commission.

Dr Michael Sheill says the Healthcare Commission came in unannounced and looked at his patients' records and made comments about them.

They tried to photocopy them but he wouldn't let them.

He says that the Health Commission has extraordinary powers but they don't even tell you what they are doing, causing distress to patients and doctors.

Dr Sheill says that he shredded a document of a judge who'd come in for an HIV test to protect his confidentiality.

If it got out into the wrong hands it could have been embarrassing for the judiciary.

Dr Sheill in his surgery

Patients of Dr Sheill, who were in the surgery at the time, were unhappy about what they felt was a breach of the confidential contract between patient and doctor.

Just after Christmas 2005 Dr Sheill was suspended from practising as a doctor, after a GMC panel found that he had "inappropriate practice arrangements".

According to the panel, there were "prescribing and dispensing irregularities".

And he was in a "contravention of the requirements of the Healthcare Commission".

He says the allegations against him are untrue - like seeing a patient he never saw.

Dr Sheill is now taking issue with the Commission over confidentiality issues, and some of his concerns are also being voiced by other doctors.

In response Simon Gillespie from the Health Commission says that they have the power to enter buildings without announcement at any time of the day or night, and can report individuals to the police who obstruct them.

Inspecting health

Inside Out decided to visit the the Healthcare Commission, and spoke to a number of its staff.

Simon Gillespie is in control of a network of 200 inspectors - his brief to police the NHS and private health business.

Julie Inggs is one of those inspectors. Her beat is the South East of England.

Julie started her career as a nurse and has worked in both the NHS and private sector.

Simon Gillespie controls a network of inspectors

Julie and Simon are guardians of the health service , but putting patients first has sent some doctors' blood pressure sky high.

They say they are patients guardians and that patients want to know someone's looking after their interests. They insist they are preserving patients' confidentiality

Although the Healthcare Commission is playing a vital role actually, issues of confidentiality are causing concern.

The Commission is trying to do an essential job - regulate the medical profession.

But many doctors and patients believe our medical records should be kept confidential.

Perhaps the solution is to get both sides around the table?

Links relating to this story:

• Healthcare Commission
• NHS Direct
• Department of Health
• Patients Association

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Making of the Weald

Iconic landscape - Dover's White Cliffs

The High Weald is one of the South East's natural wonders.

Inside Out looks at how it came to look the way it does, and investigates its link with greedy pigs and heavy metal.

The Weald is designated an Area of Outstanding Natural Beauty. And with good reason.

The area is sandwiched between the North and South Downs, stretching across Kent, Sussex and part of Surrey.

So how did the Weald get here in the first place?

"Fifty million years ago Italy crashed into Europe and it buckled the whole of southern England into the shape of a dome," explains Dr Ed ?.

"This dome emerged from the sea as a huge mountain of chalk. Then the rain eroded away the top leaving chalk hills to the North and South - what's now the North and South Downs.

"In between is the High and Low Weald. High and Low because there tends to be harder sandstone in the high bits and softer clay in the low bits."

Nature in action

But it wasn't just geology which shaped the Weald of today.

Take the sunken lanes, for example.

You'll often see roads which pass through steep banks on each side, and yet there is no river or stream which could explain the little valley shape.

So what is responsible for sunken lanes?

It's a surprising fact that sunken lanes were made by pigs.

Greedy guzzlers - pigs helped create the landscape

In medieval times people used to drive pigs into the woods in the autumn to feed them on acorns.

On their way the greedy pigs ate everything in their path.

The isolated woodland pastures for pigs were called dens, hence
the concentration in one area of places like Smarden, Biddenden, Bethersden, High Halden, and Tenterden.

Today many types of pig live at the Rare Breed Centre near Tenterden.

The people who look after them say that sunken lanes would have been made by pigs like Tamworth wild boar crosses which they rear at the centre.

These animals will eat anything in their path.

Ancient woodland

The name Weald comes from the Germanic word meaning forest.

Geology of The Weald uncovered

We know from the Domesday Book in 1086 that the High Weald remained the most densely wooded area in England.

Today it still has highest proportion of ancient woodland in the country.

Much of the woodland is coppice wood.

A side effect of coppicing is that more light in let in through he thinned-out trees, so plants can grow on the woodland floor.

As a result the Weald is famous for its bluebell woods.

Heavy metal

Historically the Weald's woodland was important for iron smelting.

The Weald boasted all the raw materials that allowed iron to be smelted for over 2,000 years.

Iron ore, clay and trees were found in abundance.

For two periods - in the first two centuries of the Roman occupation, and during Tudor and early-Stuart times, the Weald was the main iron-producing region in Britain.

Sunken lanes - created partly by foraging pigs

By the late 16th century there were 100 furnaces and forges.

All over the Weald, the iron industry was making an impact, with large numbers of people employed in digging ore, cutting wood and transporting both raw materials and products.

The Weald has numerous small streams and valleys which were dammed for water power for the bellows and hammers of the forges and furnaces.

This created what are called 'hammer ponds'.

Inside Out meets Jeremy Hodgkinson from the Wealden Iron Research Group.

He takes Inside Out to a special place in the High Weald which boasts one of the best preserved iron works in the area.

Links relating to this story:

• BBC Radio 4 Open Country
• High Weald
• Weald and Downland Open Air Museum

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Bustards

Rare sighting - the Great Bustard is making a comeback

Dave Waters is on a quest. In fact, you might say he’s a man obsessed.

He dreams of watching a rather special bird fly over Salisbury Plain – a bird that died out in this country over 170 years ago.

The Great Bustard is the heaviest flying bird in the world and became extinct in Britain in 1832.

Although changes in farming played a major part, ironically it was the bird watchers of the day who finished the UK population off,

If you were a “twitcher” then, you had to produce the carcass to prove you had actually seen the bird.

Sadly the last British Great Bustards were only viewed down the barrel of a gun.

But Dave has made it his aim in life to bring the Bustard back.

He’s given up his job as a policeman, sold his beloved motorbike collection, forgone holidays - all in attempt to try to establish a self-sustaining Great Bustard population back on the plains.

And the RSPB is hoping that if the bird's reintroduction is successful on Salisbury Plain, then they will also spread to Sussex.

Sussex used to be a mecca for the birds before they died out.

Spectacular birds

In fact, it’s been Dave’s dream to see Bustards back on Salisbury Plain since he was a young lad.

In the 1970s, Dave saw a captive flock from Portugal being reared at Porton Down.

The birds appealed to Dave’s boyish sense of humour… there’s obviously something in a name!

The Bustards are also known for their spectacular mating display - the adult males inflate special throat pouches and twist their feathers, turning from their normal brown colouring to almost totally white.

Thirty years on, Dave’s quest has taken him all the way to Russia, where the Great Bustard still survives on the plains of Saratov.

The Russian authorities have allowed Dave to collect eggs that are abandoned by the female birds and would otherwise perish.

This is the project’s second year and back in the summer, Dave hatched out 37 chicks.

Then came the tricky job of transporting the chicks back to Salisbury Plain. After a month in quarantine, the chicks were ready to be released.

The birds were released into an open topped pen to give them some initial protection until they were happy to fend for themselves.

Of course, it’s still early days – Dave expects that it will take up to ten years to establish the Great Bustard properly and for us to be rewarded with the wonderful breeding spectacle.

But so far so good, and the latest news from Dave is that there is now a big flock of Great Bustards happily flying over Salisbury Plain – so keep your eyes peeled!

Links relating to this story:

• Great Bustard
• Great Bustard Project
  RSPB

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