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of everyone affected by epilepsy

Hospital trust criticised over epilepsy doctor

21 October, 2003

An
independent report into how a local hospital Trust handled complaints
about a paediatrician has been critical of the Trust's management.

Dr Andrew Holton was suspended in July 2001 by University
Hospitals of Leicester NHS Trust
following concerns about his clinical practice
and diagnosis of children with epilepsy. A review of the 1,948 children
seen by Dr Holton, issued earlier this year, showed that 31 per cent
had their diagnosis of epilepsy changed or re-categorised following the
review.

The latest
report
, the Department of Health's Independent Review of
Leicester's Paediatric Neurology Services, states that the problem could and should have been
identified earlier and acted on more robustly and concludes that there
was an apparent failure on the part of the Trust to plan effectively
for the controlled release of information relating to Dr Holton's suspension.

The report suggests that the
Trust was guilty of "a serious error
of judgment" in not undertaking an external review of Dr Holton's
clinical practice during 2000. A review by the Royal
College of Paediatrics and Child Health
did not proceed after Dr
Holton persuaded the hospital's Medical Director to seek local resolution
of the perceived difficulties,
rather than be subject to an external review.

However, it concludes
that the management of the issue by the Trust was well intentioned
and undertaken by staff committed to the well-being of patients, parents
and carers.

A number of recommendations are made in the report, both directly to
the Trust and across the NHS as a whole. These include:

  • Consultants'
    additional training needs should be clearly defined and agreed
  • the Consultant appraisal process should assess whether Consultants are
    trained and practising to accepted modern standards
  • clinical networking, incorporating peer review, should underpin appraisal
    and particularly in respect of single-handed medical staff
  • the appropriate authorities should clarify training requirements and
    qualifications for Consultants in specialty areas, particularly paediatric
    neurology
  • a mechanism should be established whereby community pharmacists can
    register/pursue concerns

The Chief
Executive of the Trust, Peter Reading, welcomed and fully accepted
the recommendations of the
panel:

"Mistakes
were made in handling some aspects of the problems associated with Dr
Andrew Holton
before and after his suspension. The Trust deeply
regrets the distress this has caused to patients, families and carers.
It also regrets the loss of confidence and trust amongst many during
this long and complex process.

"The report
points to a range of factors which affected the handling of the problems
associated with Dr Holton. Nonetheless, we fully accept
that we could and should have done more in several important respects."

Chief executive of the charity Epilepsy Action, Philip Lee, said:

"This report
confirms many of our concerns regarding the diagnosis and misdiagnosis
of epilepsy in the UK. While we welcome the focus on consultant
training and appraisals, we are on the whole disappointed in the Department
of Health's response. We would have liked to see a much greater commitment
towards improving epilepsy services at both a national and a local
level, in order to ensure that the situation in Leicester could not
happen again
elsewhere.

"While there
are some excellent epilepsy services, there are still too many children
and
adults receiving inadequate care. Epilepsy misdiagnosis
rates for children could be as high as 40 per cent and this is totally
unacceptable. Inadequate epilepsy care will continue unless there is
more funding,
more epilepsy specialists and national targets to improve epilepsy services
in the UK. It is vital that lessons are learnt from this review, not
just in Leicester, but across the country."