Who's in charge at our hospitals?

THE REDFERN Report into the organ retention scandal at Alder Hey hospital, Liverpool, has had a huge impact. People can hardly believe that every organ was kept from every child who died at the hospital for at least seven years. Worse, most of the organs were never used or even examined.

Andy Ford, MSF Blood Services Committee

Alder Hey was a national centre for paediatric heart surgery. Few would object to keeping organs to improve future treatment and surgery, but the real issue is that of parental consent.

This consent was not truly informed, sometimes obtained under false pretences, or worse, not obtained at all.

The failure to obtain consent for the removal of organs, and the subsequent revelations of their storage interfered with the bereaved parents' right to grieve for their dead child.

This caused public disgust, in particular at the behaviour of Professor Dick Van Velzen, who was in charge there.

The report reveals the paternalism at the heart of Alder Hey's medical practice and management attitudes. It was almost as if the parents had no right to a view about their child's body. The Human Tissue Act, drawn up in 1961, gave legal force to this attitude.

When removing tissue, the Act merely requires doctors to "make such reasonable enquiry as may be practicable (so that) he has no reason to believe that any surviving relatives of the deceased child object to the body being used."

The ideology of "professionalism" treats (often working-class) patients as inanimate objects to be treated by (mainly middle-class) "professionals". The Act's deliberately woolly terms let a forceful personality like Van Velzen do what he liked with "his" patients, and their bodies.

From day one, rather than electing working-class representatives to control hospitals, the NHS handed power to the consultants.

The Tories tried to place doctors under the control of managers, but both groups are determined to keep any notion of NHS democracy, the only guarantee of true scrutiny and public accountability, at bay.

The Redfern Report found that managers at Alder Hey and Liverpool University didn't resource the department or supervise Van Velzen. They failed to follow up complaints, and allowed Van Velzen to abdicate his responsibilities. They were unaware of his organ retention practices and did not even catalogue the organs retained.

The inquiry also exposed the hypocritical practice of "giving" dead children's thymus glands to a drug company, who gave a "donation" of 40p per gland.

Begging Bowl

BUT WHY was Alder Hey in the body parts market? For years it's been Liverpool's favourite cause, money being raised for incubators and CAT scanners. Years of Tory under-funding, continued under New Labour, forced the hospital to rattle begging bowls at every opportunity, and finally even to sell body parts.

Media coverage can attack science in general by drawing attention to the ghoulish details. An autopsy can never be nice. The body is cut open, the organs removed, examined and weighed, and thrown in a bucket. But it has to be done and somebody has to do it. The issue should be that of respect for patients and their relatives.

Alan Milburn has definitely sought to use the scandal to continue his attack on the medical profession. Doctors and their organisations sometimes speak out against cuts, closures and re-organisations and still enjoy greater public support than either managers or politicians. They are formidable opponents.

The Department of Health want to break medical power and hand power to the managers. Have you ever heard of NHS managers protesting over cuts?

By demonising Van Velzen, Milburn can deflect attention and blame from managers, civil servants and politicians. But organ retention was common practice in the NHS.