What NHS Fife's FOI fight tells us about transparency
NHS Fife cited Section 38 of the Freedom of Information (Scotland) Act 2002 — the personal data exemption.
When The Herald appealed, arguing that the data was not personal, the board stood by its decision. So we took the case to the Commissioner.
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Curiously, NHS Fife tweaked its position during the investigation. It claimed the exemption extended not only to personal information but also to commercial interests under Section 33(1).
In essence, the board argued that disclosing the costs could assist Sandie Peggie's legal team, or offer other law firms insight into billing expectations for future NHS work.
NHS Fife also invoked Section 39(1) — the health and safety exemption — suggesting that releasing the information could endanger staff.
The Herald disputed all of these claims.
We argued the information sought was financial — legal fees, tribunal expenses and so on — not personal data relating to Ms Peggie, Dr Beth Upton or the board's legal team.
We pointed out that the costs do not reveal anything personal about the people involved beyond the fact that a tribunal is occurring, which is already public knowledge.
We also challenged the commercial interest exemption, given that public bodies routinely disclose legal expenditure.
The cost of the employment tribunal so far, we said, will likely consist of payments for legal service. These are sunk costs – funds already spent.
Precedent supports this: government departments and public bodies regularly publish similar disclosures.
Furthermore, law firms routinely have their public sector earnings disclosed via FOI without issue.
As for the health and safety exemption, we argued it was wholly unwarranted.
It was unclear, and the health board never quite explained, how publishing a cost breakdown could reasonably be expected to endanger anyone.
NHS Fife had suggested this exemption, presumably on the theory that making the costs public could lead to harassment of staff or other individuals involved.
There is no evidence for this. The identities and roles of the key individuals in the tribuna are already matters of public record.
If there were any risk of harassment or threats related to this case, that risk already exists independently of the cost details.
This matters. Invoking 'health and safety' in this way sets a dangerous precedent — allowing contentious costs to be concealed on the basis of hypothetical public backlash.
In the end, the Commissioner agreed.
FOISA exemptions serve important purposes — but, as NHS Fife has discovered, they are not tools to obstruct financial transparency in public bodies.
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Pembrokeshire Herald
35 minutes ago
- Pembrokeshire Herald
Concern grows over future of Withybush Hospital as services face review
Prince Philip Hospital whistleblower warns of regional impact as Glangwili faces ICU overflow A SPECIALIST nurse has spoken out as critical care services at Prince Philip Hospital in Llanelli are quietly scaled back ahead of a public consultation — with direct implications for Pembrokeshire patients who rely on Glangwili Hospital for intensive care. Hywel Dda University Health Board is preparing to launch a consultation on its Clinical Services Plan, which includes a proposal to formally downgrade the Intensive Care Unit (ICU) at Prince Philip Hospital and replace it with an Enhanced Care Unit (ECU). However, the transition has already begun. The Herald understands that ICU staff are being reassigned, and patients requiring high-level intensive care are being routinely transferred to Glangwili Hospital in Carmarthen — nearly 24 miles away — despite no final decision having been made. One senior nurse at the hospital told The Herald: 'Staff are being moved off the unit. There are people who need ICU beds but have to wait, as there are none now here. Everyone who needs one has to be transferred to Glangwili.' The ICU at Glangwili is under significant pressure (Image: File) She continued: 'They could have bleeds, they are not stable. Not only that, but if they need to be transferred between hospitals, that is done by a specialist NHS service based in Cardiff – the Adult Critical Care Transfer Service (ACCTS), part of EMRTS Cymru. We call them ACCTS. When we sign the paperwork, we can see the Health Board is paying around £6,000 per patient for each transfer. The transport is carried out in a specialist ambulance, including an anaesthetist, doctor, and critical care team, to ensure patient stability during transfer. It's not cheap.' The nurse also claimed that there are enough skilled staff locally to continue providing intensive care, but the team is being broken up. 'We are a specialised team, and we are being dispersed. The people of Llanelli are being put at risk. For what? To save money.' She said patients from Llanelli were now overwhelming beds in Carmarthen, leaving Glangwili Hospital with little capacity for new cases. 'Everyone now down at Glangwili are people with Llanelli area postcodes. They should be being treated here near their family, loved ones. And now down in Carmarthen they are chocker – no room to accept new patients, which is going to impact on patients further west into Pembrokeshire.' This concern is echoed in Pembrokeshire, where Withybush General Hospital still technically retains seven ICU beds. However, ongoing staff shortages and the discovery of unsafe RAAC concrete have meant that many patients requiring critical care from Pembrokeshire are already being transferred to Glangwili. Now, with Llanelli patients added to the demand, access to critical care is under further pressure across the region. Costly specialist ambulances from Cardiff are used to transport ICU patients between Llanelli and Carmarthen hospitals (Image: NHS) Hywel Dda University Health Board is expected to launch a 12-week public consultation on its Clinical Services Plan this week, with options that could lead to permanent reconfiguration of hospital services across Carmarthenshire, Pembrokeshire, and Ceredigion. However, documents seen by The Herald confirm that changes such as the ICU downgrade may proceed before consultation results are finalised. Appendix 7.55 of the Clinical Services Plan states: 'We recognise that the need to respond to service fragility may mean some service change and investment decisions are required ahead of any final reconfiguration, and these will be developed with service, operational and executive leadership.' Another section of the Plan notes: 'Due to the nature of service provision across Mid and West Wales, it is recognised that a wide range of services have some fragilities. This was a key driver behind the development of the Health Board's strategy which seeks to reduce, if not eliminate, the risks to sustainable service provision.' Hywel Dda University Health Board's Medical Director: Mark Henwood (Image: HDUHB) Commenting directly, Hywel Dda University Health Board's Medical Director, Mark Henwood, said: 'There has been a temporary change in place for critical care services at Prince Philip Hospital since July 2022. This was approved by the Board because of an inability to safely staff two critical care units with Consultant staff in Carmarthenshire providing care to the most unwell patients. This has meant that the sickest patients have been stabilised and transferred mostly to the Critical Care Unit at Glangwili Hospital. 'The temporary change was needed to improve our ability to safely deliver our critical care services in Carmarthenshire with the staffing available. 'We launched our Clinical Services Plan consultation at our Board Meeting today and Critical Care is one of the services which we will be looking at. 'In the consultation, options A and B propose having fewer intensive care units, and Option C proposes maintaining the current temporary arrangement at Prince Philip Hospital, where the sickest patients are transferred to Glangwili intensive care unit. 'In all options, bringing specialist critical care consultants together onto fewer sites would make the service more sustainable, improve safety, and help meet quality standards for our patients.' However, critics argue that the Health Board's response amounts to a technocratic justification that fails to meaningfully address community impact, consultation integrity, or patient safety. Lee Waters MS: 'You can't run a consultation while services are being stripped away' Lee Waters MS: The people of Llanelli deserve proper, local access to intensive care Commenting, Llanelli's Member of the Senedd, Lee Waters, told The Herald: 'It looks very much like decisions about critical care at Prince Philip Hospital are being made before the public's had a real say—just like we saw with the overnight closure of the Minor Injuries Unit. That's not how you build trust. The people of Llanelli deserve proper, local access to intensive care, and I'm not convinced the Health Board has a credible plan to deliver that. I've always tried to be reasonable about change, but in this case the case simply hasn't been made. You can't run a meaningful consultation while services are being quietly stripped away.' Dame Nia Griffith MP: 'This erosion of services by the backdoor has got to stop' Commenting, Llanelli's MP, Dame Nia Griffith, said: 'I am extremely concerned to hear reports of intensive care services at Prince Philip Hospital being scaled back, because people in Llanelli should be able to access this care here, and not see loved ones taken all the way to Glangwili for services that have hitherto been provided in Llanelli. 'Moreover, the fact that this is happening without there having been any consultation, or even any mention of this, completely undermines trust in the Health Board. I will be seeking an urgent meeting with Hywel Dda health board bosses to seek clarification, and make it absolutely clear to them that they must recognise the need for these services in Llanelli and design their staffing model accordingly, with full teams of appropriately qualified staff based here. 'Everyone knows that they are already struggling for space in Glangwili so it makes no sense to be sending more Llanelli patients up there, and on top of that, there is the cost of transporting patients, the discomfort for the patients and the anxiety and inconvenience for the family. This erosion of services by the backdoor has got to stop.' Welsh Conservatives: 'Declare a health emergency' Commenting, a Welsh Conservative spokesperson said: 'The downgrading of ICU services at Prince Philip Hospital before public consultation is unacceptable and undermines trust in the health system. 'The Welsh NHS is in crisis under Labour, with over 10,000 patients waiting more than 12 hours in A&E and two-year waits still unacceptably high, the Welsh Labour Government continues to fail our communities. 'The Welsh Conservatives would declare a health emergency, directing the resources and the entire apparatus of government at the health service, ensuring timely access to care and restoring faith in our Welsh NHS.' Sam Kurtz, Senedd Member for Carmarthen West and South Pembrokeshire added: 'If any decisions are taken before the consultation has concluded, then both the Health Board and the Welsh Labour Government must be prepared to justify them to a deeply concerned public. 'Recruitment has long been a challenge, one that has only worsened under the shadow cast by ongoing uncertainty over the future of healthcare in West Wales. 'That uncertainty stems from the Welsh Labour Government's continued drive to centralise services, often to the detriment of rural communities.' Kurtz added: 'Access to critical healthcare should never be a postcode lottery.' Campaigners: 'Not acceptable – and a shock' Shocked: Hospital campaigner Cllr Deryk Cundy was not consulted, he said (Image: BBC) Chair of the SOSPPAN campaign group, Councillor Deryk Cundy, told The Herald that they had raised concerns with Hywel Dda over 'rumours from a separate source' suggesting changes to intensive care were already under way — before any formal decision by the Health Board. 'We have not been directly contacted about these changes,' he said. 'SOSPPAN has been working closely with Hywel Dda trying to find a way forward — recommending a merger of the Minor Injuries Unit and Same Day Emergency Care, operating 16 hours per day, with increased mental health cover available in Llanelli 24/7.' He said that when combined with the existing 24-hour Acute Medical Assessment Unit, this could improve service delivery in Llanelli and reduce pressure on Glangwili Hospital. However, he described the ICU downgrade as 'a shock' and 'not acceptable'. 'For too long, Hywel Dda management have said departments are unsafe and instead of making them safe, they shut them down — only to reopen them 20 miles away. We will be asking for an early meeting with the Health Board, and if these proposals are confirmed, we will express our determination to prevent any further reductions in service at Prince Philip Hospital.'
The Guardian
2 hours ago
- The Guardian
What is the most common mental health misinformation on TikTok?
Thousands of influencers peddle mental health misinformation on social media platforms – some out of a naive belief that their personal experience will help people, others because they want to boost their following or sell products. As part of a Guardian investigation, experts established clear themes to the misinformation contained in videos posted with a #mentalhealthtips hashtag on TikTok. Several videos about borderline personality disorder suggest symptoms that are everyday experiences – such as feeling anxiety when people change plans, experiencing mood swings, a fear of abandonment and mirroring people's behaviour to be liked. Another video purports to show how depression manifests in the workplace as a lack of concentration, feeling tired, having low energy levels, a loss of appetite and irritability. 'While some of the 'symptoms' overlap with depression, these can be attributed to a range of afflictions and struggles,' said Liam Modlin, a therapist and psychology researcher at King's College London. One video said that people with bipolar disorder experience mood swings because their emotional pendulum swings more widely and rapidly than most. However this is a misunderstanding, since people experience extended mood changes over periods of weeks rather than rapid 'mood swings'. 'This is an example of misappropriating a mental health diagnosis to wrongly explain or justify behaviour,' said Dan Poulter, a former health minister and NHS psychiatrist. 'A person with bipolar disorder may find this trivialising of their experience of living with a debilitating and serious mental illness.' Another popular video suggests that when someone is about to die by suicide they become 'almost bipolar' – 'language [that] can further stigmatise mental health', said Prof Rina Dutta, a consultant psychiatrist and psychiatry professor at King's College London. Another video claims signs of abuse are constantly apologising; breaking down during small disagreements; needing reassurance; struggling to be open; being hypersensitive to criticism, and hiding feelings. 'The behaviours it describes, while potentially present in abusive dynamics, are not exclusive to abuse and may occur in a variety of other contexts,' said Modlin. 'By presenting these signs without sufficient context or diagnostic nuance, the video risks encouraging viewers to self-diagnose or mislabel complex relational struggles as abuse.' This was the most common form of misinformation contained in the videos. One video promotes a method it said was cheaper than therapy and had fewer side effects than antidepressants that could enable people 'to heal from trauma in an hour' and involved writing about the traumatic experiences for 15 minutes non-stop. 'No research suggests this is sufficient for cure, definitely not in an hour, and there is risk of independently forcing oneself back into this traumatic mindset without the support of an experienced therapist,' said Amber Johnston, an accredited psychotherapist. Another clip suggests that crying is self-soothing and good for processing emotions, including by stimulating the release of cortisol. 'Cortisol changes related to crying are complex and cannot be distilled down in this way,' said Amy Durden, a psychotherapist. 'Crying can bring relief but not always. It can be self-soothing but if the person crying judges their crying negatively, they do not experience this benefit and may feel acute shame.' Several videos featured glib quotations that the experts viewed as unhelpful such as: 'If you're not changing, you're choosing', while another popular quotation said: 'When you feel like everyone hates you, sleep. When you feel like you hate everyone, eat. When you feel like you hate yourself, shower. And when you feel like everyone hates everyone, go outside.' 'This is a huge oversimplification of how to address complex emotional states,' said Durden. 'It seems to be pulling from behavioural activation in CBT, but without any context or individualisation.' A specific breathing technique for treating anxiety was promoted in another video. 'There is no single, universally effective breathing technique that is helpful in all cases,' said David Okai, a consultant neuropsychiatrist. 'If performed incorrectly, the exercises can be the equivalent of hyperventilation, which can be extremely unpleasant and exacerbate anxiety.' Another video suggests depression is caused by alcohol, tobacco, MSG, caffeine, sugar and hydrolysed wheat. Modlin said that although lifestyle factors can contribute, 'this framing is overly simplistic and potentially misleading', since there are complex interwoven factors, including genetics and neurobiology, psychosocial stressors, childhood adversity, medical conditions and personality styles. Other clips promote supplements including saffron, magnesium glycinate and holy basil extract to ease anxiety. Although the psychiatrist Famia Askari said there are some studies showing benefits to some of these, there is not sufficient consensus for these to have become part of clinical practice – they are also manufactured supplements, in contrast to the 'natural' claims that featured. Two videos recommend admission to psychiatric units based on personal experience, including one suggesting someone had considerably improved after six days, and another offering a template for children to ask their parents to have them admitted. Poulter said this was 'misleading' and can 'create misconceptions' about the benefits of inpatient admission. 'Inpatient admission can in fact create and reinforce maladaptive coping mechanisms,' he said. 'It is also very rare that someone would be driving themselves into mental health hospital in the way depicted by the video.' Another video depicts someone in a hospital gown in what appears to be a psychiatric ward stating: 'I was too honest with my psychiatrist.' This could be harmful as it is 'potentially encouraging people to not be honest and open with healthcare professionals about their mental health', said Poulter. In another clip, a woman gives her strategies for managing anxiety, including eating an orange in the shower. 'There is no evidence-base for eating citrus in the shower as a means to reducing anxiety, and I would worry that this would lead on to an ever-increasing spiral of unusual behaviours,' said Okai.
The Independent
2 hours ago
- The Independent
Denying joint operations to obese patients is counterproductive
We fear that there are going to be many more stories such as this about the National Health Service before the wounds of a decade of underfunding followed by the coronavirus pandemic start to heal. Rebecca Thomas, our award-winning health correspondent, reports today that obese patients are being denied life-changing hip and knee replacements, and being left in pain as the NHS attempts to cut costs. One-third of NHS areas in England and some health boards in Wales are refusing joint replacement operations to patients who exceed a given body mass index. This is contrary to guidance from the National Institute for Health and Care Excellence (NICE), the body responsible for deciding whether treatments are value for money. Of course, as long as healthcare is rationed, difficult choices will have to be made. And the blunt truth is that all expensive treatments on the NHS are rationed, as they have to be in a system of limited resources. Instead of being rationed by ability to pay, the usual mechanism for rationing in the NHS is queueing. At the same time, however, treatments are also rationed by need, and it is the role of NICE to help to decide which groups of patients should be prioritised over others. We can understand why some parts of the NHS might de-prioritise obese patients for hip and knee replacements. It might be argued that obesity is the cause of joint problems and that therefore treatment should focus on weight loss, or else the problems are likely to recur with the artificial joints. But the NICE guidelines recognise that causation may not be all one way and that for many patients joint problems contribute to obesity rather than the other way round. In which case, joint replacement is the key to reducing weight, allowing patients to exercise more. This is a field of healthcare undergoing rapid transition, as the availability of weight-loss drugs such as Ozempic has changed the options available to patients, offering hope of treatment without surgery. But it remains important that overweight patients do not face a sweeping ban on joint replacement operations on the basis of arbitrary body mass index counts – especially as these BMI limits vary from area to area across the NHS. It is devoutly to be wished that this new government is beginning to turn the NHS round. Rachel Reeves, the chancellor, will confirm at the spending review on 11 June that the health service will be allocated substantial increases in resources over the next four years. Wes Streeting, the health secretary, has already taken the risk of overclaiming the improvement that has been made in just 11 months since the election. He claimed that waiting lists had fallen for six months in a row, only for the latest figure, for month seven, to show a small increase. His claim of having met his target for the number of new appointments 'seven months early' was undermined by figures obtained by Full Fact, the fact-checking charity, suggesting the rate of increase has in fact been slower than last year. We hope that resident doctors will vote against strike action, in order to allow these early, if overstated, signs of improvement to turn into real progress. In the meantime, difficult choices about whom to treat, and whom to treat first, will continue to beset the health service. In making those decisions, doctors must avoid unfair and discriminatory blanket bans based on arbitrary weight limits.
