It’s a pertinent question this week as debate rages in the blogosphere about Dr Jane Barton. For the uninitiated, she’s a GP in Gosport who has just been found guilty of serious professional misconduct by the GMC.

Dr Barton prescribed “potentially hazardous” levels of drugs to patients at the Gosport War Memorial Hospital in the 1990s. But, despite being found guilty of putting her patients at risk of premature death during that time, she has not been struck off. Instead she can continue to work under certain conditions, which includes a ban on injecting opiates for three years.

There’s been widespread criticism of the decision. Furthermore, a number of commentators have questioned why Dr Barton didn’t receive the same level of media attention as Dr Andrew Wakefield or Dr Daniel Ubani, the German GP at the centre of the out-of-hours storm.  

It being the web, conspiracy theories abound. Barton ‘survived’ and received less coverage because she’s white and from the right background. Others, like Ubani, haven’t fared so well because of prejudice and racism. The media is only interested in exposing minorities or outsiders because that’s what their small minded readerships want.

If you don’t like that one, there’s another. Barton ‘got off’ because she has friends and family in high places within the medical establishment. Conversations were held behind closed doors, strings were pulled. The media were scared off by the threat of libel.

Like most conspiracy theories, they’re nonsense. There is a more prosaic explanation. Let’s start with the GMC. Despite improvement, the adjudication of fitness to practise panels can be inconsistent. It explains why the GMC’s adjudication powers are being moved to the totally independent Office of the Health Professions Adjudicator next year, effectively signalling the end of self-regulation. 

In this case, the panel was clearly swayed by the outpouring of local support for Dr Barton, who appears to be a popular GP. It will be interesting to see whether the OHPA will be similarly influenced.

Fitness to practise panels make their own decisions, and the GMC itself is clearly not happy about this one. New chief executive Niall Dickson suggested she should have been struck off and has instigated a review. Furthermore, the Council for Healthcare Regulatory Excellence (CHRE), a supra-regulator if you like, is also having a look. Many forget that doctors now face double jeopardy. The CHRE has the power to refer the case to the High Court if it considers the decision to be unduly lenient.

In short, this case isn’t over yet. Norman Lamb, shadow health secretary for the Lib Dems, is calling for a public inquiry into the matter, though I doubt that will be required.

So, on to the next point, why haven’t the media covered it? Or, to be more accurate (because it has been covered by most of the nationals), why hasn’t it been on TV?

It’s simple - it just hasn’t sufficiently interested their journalists. While many health specialists might think it is an important story about competence, supervision and public protection, when you move into the mainstream media there is only so much ‘space’ for health stories. We’ve had a series of big health stories and if journalists, or more importantly their editors, decide that the Wakefield and Ubani cases have stronger news values (such as scope, relevance and topicality for their audiences) then every other health story gets squeezed. In the wider news agenda, the Iraq Inquiry has been squeezing everything.

Journalism is also a dying profession. Numbers have been slashed in recent years, which results in fewer specialists. Most reporters are now generalists, there’s a lot of churnalism, and effective PR has more sway than ever. ‘Good’ stories get missed. Partly because of this the media acts like a pack, if one credible publication or outlet runs a story, the others dive in. It helps to manage their risk.

So, it really doesn’t take a clandestine conspiracy for meaningful stories get pushed to the back of the queue, sadly just the England football captain getting caught with his pants down or Katie Price getting re-married will be enough.

Tens of thousands of pounds lie unclaimed in the Oxford Deanery alone because only around 20 out of nearly 500 SAS doctors have so far applied for the funding. Individual doctors could use the funds to support activities such as research, audit, management and clinical leadership.

Although the deanery is using part of its £250,000 allocation for group activities, such as development days, its associate dean for SAS doctors and international medical graduates John Lourie wants more SAS doctors to come forward with individual requests.

“We haven’t had as many applications from individual SAS doctors as we would like,” he said at the inaugural joint royal colleges conference for SAS doctors in London last week.

At Gloucestershire Hospitals NHS Foundation Trust there has been an even lower uptake. None of its 90 or so SAS doctors have applied for funding for external courses.

Read more at BMA News.

In September 2007, as part of the inquiry into Modernising Medical Careers, Sir John Tooke recommended that: “PMETB should be assimilated in a regulatory structure with the GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement.”

This was accepted by the government and PMETB is due to merge with the GMC in April.

Although the merger will bring regulatory responsibility for the whole of medical education and training under one roof, this consolidation of functions will not, in itself, achieve the full benefits envisaged by Sir John Tooke’s report.

To ensure that those benefits are realised the GMC invited Lord Naren Patel to lead a review of the current arrangements for the regulation of medical education and training and make recommendations that would inform future policy developments by the GMC.

The review’s draft report makes 27 recommendations to the GMC and they are currently out to consultation. Here is a summary:

1. All those involved in developing the skills and commitment of doctors must fulfil their responsibilities if the UK is to provide world class training. The GMC was urged to enhance links with other key interests, such as training providers and regulators.

2. Regulation has to reach across the different stages of doctors’ education and learning and support their transitions. Effective systems need to be developed for the transfer of information across all different stages. 

3. Medicine is both a profession and a vocation. One of the goals of undergraduate medical education is to instil a culture of professionalism, and to begin the process of induction into the profession, that will inform doctors’ practice throughout their careers. It has been argued that the current undergraduate experience does not always achieve this and that student registration could be one way of fostering professionalism and a sense of professional identity. However, the review panel was not convinced. Instead it called on the GMC to evaluate the effectiveness of its existing arrangements for engaging with students and how professionalism is fostered by medical schools.

4. Newly qualified doctors need to be able to deliver the same standard of care regardless of where they qualified. Until now the GMC has set high level standards and allowed medical schools considerable flexibility in the way those standards are met. It must evaluate the effectiveness of the new requirements in delivering outcomes that are consistent and reliable to determine whether further measures are needed to achieve these ends.

5. Anomalies with the regulation of the Foundation Programme need to be addressed. Doctors in the first year of their foundation training may be working many miles from the medical school which is formally responsible for their training. This leads to an unsatisfactory lack of clarity over responsibilities. Equally unsatisfactory is the lack of any clear regulatory outcome required from the second year of the Foundation Programme.

6. The GMC should develop a framework for the accreditation of trainers. It should also look at the case for accrediting the environments in which education and training takes place, in addition to approving posts and programmes as currently undertaken by PMETB.

7. Above all, the GMC should develop a regulatory framework for the education and training of doctors in career posts. This is not only in the interests of the doctors concerned (who are often disadvantaged by limited access to training and CPD opportunities), it will also provide reassurance that these doctors are meeting national standards overseen by the regulator.

8. The public and employers must have confidence in the medical registers, and in the fitness to practise of doctors entering those registers. One factor militating against this is the lack of equivalence between the standards required of UK and European doctors entering the specialist and GP registers. The GMC should explore how this might be addressed. It proposes that European specialists and GPs should only be eligible for inclusion on the medical registers ‘at the point of first revalidation following completion of training’. This would require the GMC to uncouple the completion of specialist and GP training from the decision to allow a doctor onto the specialist or GP register. The move, it says, ‘could provide a mechanism for continuing to meet EC requirements in relation to recognition of training while ensuring greater equivalence in standards at the point of entry to the specialist and GP registers’.

9. The GMC should also examine, with the Department of Health, the current legislative anomaly that makes it possible for doctors not on the specialist register to take up locum consultant posts.

10. At the conclusion of specialty or GP training, participation in CPD is key to maintaining and further developing competence and performance. In 2004, the GMC issued guidance on CPD, but its regulatory role to date has been largely passive. Revalidation will provide a new focus for ensuring effective and appropriate CPD for all doctors but it will require the GMC to re-examine its role in this area. At the very least, it should provide clear guidance on what doctors will be required to do to keep up to date for the purposes of revalidation and the role of CPD within that.

11. The GMC should re-examine the current focus on assuring the quality of the processes used for training doctors. Instead, it should consider placing greater emphasis on outcomes and the quality of the individual trainees produced by those processes. What matters to patients is the quality of the doctors who treat them, not the processes by which they were trained.

Commenting on the report, Niall Dickson, chief executive of the GMC, said: “We have a great opportunity now to create a system in which every stage of education and training is fit for purpose, successfully prepares the doctor for the next one, where standards are constantly rising and which treats all doctors fairly, wherever they come from and whatever stage they are at in their careers.

“I hope the consultation stimulates debate and encourages as many as possible to comment on the conclusions and recommendations of the draft report. This will help us set the way ahead and ensure a robust approach to the regulation of education and training in the years to come.”

Doctors can consult on the recommendations until 9 March. A final report will be submitted to the GMC at the end of that month. Read the full list of recommendations.

Read more on the GMC’s corporate strategy 2010 to 2013.

Prof Sir Sabaratnam Arulkumaran

1. What is the biggest challenge the profession faces?

“There are a few: increasing consultant presence in the labour wards to improve safety and quality, reducing litigation and enhancing the quality of postgraduate training.” 

2. When did you last laugh and why?

“Laughter is the best medicine - it makes you relax. I laughed whilst watching a comedy with my son recently.”

3. What are the RCOG’s priorities over the next year?

“To evaluate whether we are able to provide high quality training with the reduction of hours as a result of EWTD implementation; and to improve quality and safety whilst reducing the cost of care provided.”

4. Which person influenced you most as a doctor and why?

“There have been many over the years - my seniors and colleagues have always encouraged and inspired me to do better.”

5. When were you most in danger?

Fifteen years ago, I had a road traffic accident when my car skidded and hit a tree.

6. How will royal colleges maintain their relevance?

“Royal Colleges are key to the provision of postgraduate medical education. We develop the curriculum and run the examinations. We are also involved in the setting of clinical standards through our guidelines and scientific papers. These activities help advance the practice of medicine.

“Our members give up their time voluntarily and work both weekdays and weekends to give their best to the college. This commitment and loyalty shown by our members cannot be equalled elsewhere. Without this sense of altruism and the sharing of their knowledge and expertise, I think patient care will not be as robust as it is.”

7. What is your favourite piece of music?

“I enjoy Indian classical music, played on traditional instruments such as the sitar and nathaswaram, by musicians like Ravi Shankar.”

8. How will we improve maternity services?

“Three very basic points: the provision of one-to-one midwifery care in labour; care closer to home for antenatal and postnatal care; and increased consultant presence in hospital maternity units.”

9. What is your guiltiest pleasure?

“Relaxing with my family and close friends with a single malt whisky.”

10. What are the hallmarks of an excellent O&G team?

“Good clinical outcomes, small numbers of low-risk incidents and complaints received and the continuous monitoring of performance (through using the maternity dashboard).”

11. What was your most embarrassing professional moment?

“I received an honorary doctorate from the University of Athens. I thought I should say a few words in Greek which I prepared but failed miserably in delivering.”

12. Of what achievement are you most proud?

“Being Honoured as Knight Bachelor in the Queens Birthday Honors list, in June 2009, for services to medicine.”

Finish this half written sentence: trainees working to a 48-hour week will…need to work hard and use every clinical encounter as a learning opportunity.

What you do, is take something that someone else has written that’s a whole load of arse, and challenge it line by line. (Er…shouldn’t that be ‘Fisking’? Ed).

Anyway, I thought I’d give it a go and I had to look no further than the pinko leftist ban-everything site called Hospitably Doctored and its succinct coverage on the latest pronouncements of the Royal Society for Public Health Fascists With Nothing Better To Do.

Here goes:

“The Royal Society of Public Health and UK Faculty of Public Health want the political parties to adopt a 12-step wish list to boost the nation’s health.”

Whether the ‘nation’ wants it or not. Note: political PARTIES plural, in case in our childish ignorance we try to vote against any of this arse gravy.

“Jointly representing about 9,000 public health professionals.” 

Is it me or does that mean there are far too many of them?

“…their manifesto calls for: 1. A minimum price of 50p per unit of alcohol sold. Alcohol consumption in the UK has doubled over the last 40 years.”

Doubled!! Oh, no that sounds terrible, that means it’s as high as - save us, o wise Public Health Professionals - the level it was in 1900! You know, when the town centres were awash with vomiting Victorian Chavs beating up policemen, and everyone died of liver failure?

“Alcohol is now 69% more affordable than in 1980.”

What a load of arse. Check the Office of National Statistics. “Between 1980 and 2008, the price of alcohol increased by 283.3%. After considering inflation (at 21.3%), alcohol prices increased by 19.3% over the period”. Can you think of anything else that’s gone up by 20% in real terms, apart from the number of portentous authoritarian announcements from public health professionals? 

“Tackling price and availability are the most effective alcohol policies.”

So, if we ‘tackle availability’ all the way to zero, the problem would disappear, as in prohibition-era America, when nobody drank. And there was no crime!

“No junk food advertising in pre-watershed television. The Ofcom measures, in 2006, to ban junk food advertising between programmes where 20% of the audience were younger than 16 have been ineffectual. A complete ban is needed to effectively reduce consumption of salt, saturated fats and sugars by children and adolescents, reducing the risk of cardiovascular disease later in life.”

So if a partial ban had no effect, why would you assume a complete ban would do anything, other than make you feel butch and important?

“25% increase in the number of cycle lanes and cycle storage facilities.”

Don’t get me started. Looks like they didn’t read this. Oh, and this is a cycle storage facility and they’re everywhere.

“Introduce presumed consent for organ donation.” Your kidneys now belong to the state. So they will take them out and give them to someone so cack-handed and useless they could only get a job in transplant surgery.

“Free school meals for all children under 16. Evidence shows that cardiovascular diseases can originate in childhood, and it is important to start good dietary habits early.”

‘Good dietary habits’? BWAHAHAHAHA. Yeah, that’s why we all still eat school meals as adults! School meals is a byword for ghastly inedible 14p-per-head state-delivered swill. Also dangerous in combination with previous item. 

God helps us all. I shall leave the last word to Professor Henry Brubaker of the Institute of Studies: ”Once again [doctors are] talking about ‘public’ health as if that’s an actual thing. There is ‘my’ health, which is ‘mine’, and ‘your’ health which is ‘yours’, but there is no ‘our’ health. D’you see?”

Quite.

To this end, the trust has launched a staff competition for suggestions on how to save £15 million. Stage one is to think of a name for the new campaign - something which seamlessly combines the concepts of fantastically top-flight hospital and pathetically inadequate budget in one catchy phrase.

My suggestion of “NHS lite: we’re slimmer and even safer”, was rejected on the grounds it might upset some of our bariatric patients, which are the only cases we make a profit on.

A lot of the money-saving schemes seem to have one thing in common - they involve other people. So, for instance, the medical staff seem to have it in for nurses with clipboards, and obviously getting rid of managers is very popular. Other groups, however, have posted the following suggestions. “Abolish merit awards and discretionary points”. “Audit SPA time”. “No pay progression for three years”. “Sack all the orthopaedic surgeons” (OK, that one was me). “Stop operating on people who make themselves ill by eating too much”. And “try turning the office lights off now and again”.

I really hope the executive isn’t relying on this competition for serious ideas - otherwise we’ve got a serious problem.

All this is just tinkering round the edges. There are limits to what individual trusts can do to save this amount of money, especially those which are locked into expensive PFI contracts. What needs to happen is some policy changes from our government, and top of the list must be calling a halt to any more of these PFI deals.

Figures recently released showed that London PFI contracts amount to six times the value of the buildings they’re paying for.

Second to go must be any further expenditure on ICATs and ISTCs, which have been an incredibly expensive waste of taxpayer’s money.

Third, get a grip of the drugs budget by increasing generic prescribing and regulating pharmaceutical companies so that new drugs aren’t overpriced.

After that, they could perhaps take a look at the NHS’ legal budget - especially the non-clinical litigation bill. Every year hospitals have to pay out tens of thousands of pounds for staff, visitors and patients who’ve slipped on  wet floors, stubbed their toe on door lintels, or had polystyrene ceiling tiles fall on their head (I kid you not).   Why not put a strict cap on all this, so that we can spend the money on actually looking after patients.

Last week the CBI, whose membership might possibly include some individuals involved in private health care provision, claimed that megabucks could be saved by providing care for patients out of hospital and near their homes.

They don’t explain how using taxpayers’ money to build brand new “polyclinics”, doubtless run by the private sector, to replace existing outpatient departments, actually benefits patients or  taxpayers. Nor, unless they plan to build one on every street corner, do I see how it equates to bringing treatment “nearer to the patients’ homes”.

The truth is that the current NHS funding crisis is being seized upon by diverse groups to push their own particular ideology, without actually justifying how it would benefit patients or save money. In other words, look out for passing bandwagons.

Read another blog on how the NHS could save money.

In a speech to the King’s Fund think tank today, the PM is expected to pledge access to home treatment for every cancer patient within five years.

Labour says this would save over £2.5bn a year by reducing hospital admissions.

But shadow health secretary Andrew Lansley called on ministers to say what they would cut to pay for the move.

The proposals on cancer treatment are expected to form part of a wider plan to give more patients the option of receiving chemotherapy, dialysis and palliative care without travelling to hospital.

But the Conservatives are sceptical, arguing that while they support specialist nursing, the plan could cost £100m.

Read more at BBC Health.

Ramon Niekrash, a consultant urologist at the Queen Elizabeth Hospital in south London, told Hospital Dr he hopes his case will now act as a “big stick” to deter other trusts from bullying their critics.

He has also criticised the amount of taxpayers’ money that the trust wasted in pursuing their vendetta against him.

“Managers used substantial amounts of taxpayers’ money with no accountability to silence a critic who in actual fact was trying to defend and support the patient. The taxpayers’ money hasn’t gone towards medical care it has been spent on silencing me.”

Niekrash was branded a troublemaker and suspended for ten weeks after he repeatedly raised concerns about patient safety.

An industrial tribunal has now ruled that his treatment, specifically his exclusion from the hospital, was in breach of whistleblowing legislation.

In a series of letters from 2005 Niekrash raised concerns about the closure of a urology ward; a cut in the number of specialist urology nurses; hospital acquired infections; the health and safety of patients and the trust’s clinical governance obligations. 

He also complained about his contract and the job planning process and made allegations of widespread bullying and harassment in the surgical directorate in an attempt to achieve cost cuts.

The vast majority of letters received no response which prompted him to write further letters.

When he was suspended the medical staffing committee threatened to hold a vote of no confidence in the management which resulted in Niekrash being reinstated after ten weeks.

The tribunal ruled that letters written by the trust around the time of Niekrash’s whistleblowing were defamatory. It also found he suffered loss of reputation and private practice and injury to health and feelings as a result of his suspension. A separate hearing will decide on the level of compensation he will be awarded.

Niekrash said he had had to pursue the case in order to protect his reputation and because it was his moral duty as a doctor to protect his patients. 

“I genuinely believed there was a moral issue. I did nothing for any pecuniary interest other than that which was genuinely for the benefit of the patient,” he said.

Arpita Dutt, partner at Russell Jones & Walker, who represented Niekrash, said it was difficult for a whistleblower to win a case because the legalities were complex. This meant any successful whistleblowing case was a landmark because it exposed issues in public services that were of wider interest to the general public.

Dutt said: “This case is also is a salient warning because we are in times of public spending cuts and we are seeing A&E departments and wards threatened with closure so there is likely to be an increase in this sort of tension that gives rise to whistleblowing.

“This means we have to be on guard for employers and NHS trusts taking this sort of attitude to whistleblowers. This case certainly sends out a strong message that should resonate throughout all public services.”

A South London Healthcare NHS Trust spokesperson pointed out that the incidents took place prior to the establishment in April 2009 of South London Healthcare NHS Trust, which now manages the Queen Elizabeth Hospital.

She said: “There are lessons to be learned from this case and the new trust absolutely believes in the importance of whistleblowing and encourages any staff members with concerns about patient safety to bring them to the attention of their managers straight away. We now have an environment and the correct processes in place so staff can feel confident that they can raise concerns without any fear. We are assured that the issues which led to this case would not have occurred under the new trust management.”

He was given a fatal overdose by Dr Daniel Ubani, a German doctor flown in to provide out-of-hours GP cover in Cambridgeshire, and a coroner ruled this week that his death amounted to gross negligence and manslaughter.

The coroner William Morris issued 11 recommendations to the Department of Health to improve out-of-hours GP services.

The main one, and most people’s biggest bone of contention, is the need for a review of how EU agreements work in the UK. Morris said the government must issue guidance to all NHS trusts over checking doctors’ English, their experience of the NHS and how they acquired their GP status.

However, as the GMC is at pains to point out, they’re not allowed to test doctors from the EU. The combination of EU law and domestic legislation (the Medical Act 1983) excludes the testing of a European applicant’s language proficiency or their competence.

This is a bit of a problem when you consider that Ubani was flown in at the eleventh hour, started work immediately with no induction and was utterly incompetent. (Makes you also wonder why we booted out loads of good doctors with excellent English from the sub-continent a couple of years ago).

Without wanting to come over all UKIP, our health secretary needs to grow a spine and put our relationship with Europe on a proper footing on this issue.

Morris also demanded “robust” clinical and management measures, including training and induction for non-UK doctors, and said only the company actually running the out-of-hours GP services should recruit doctors in future. It follows the Care Quality Commission making similar demands of trusts last year.

And this is where we get to the crux of it. Of course all overseas doctors coming into the UK should be tested and we should have a clear idea of the equivalence of their training. But, the real problem is how we’ve organised our out-of-hours GP services. Crap European doctors shouldn’t be required.

This week’s apology by NHS Cambridgeshire, which employed Take Care Now to provide the services in question, is revealing.

Dr Paul Zollinger-Read, chief executive of NHS Cambridgeshire, said: “We as an organisation still have much to learn from this case. Our monitoring of contracts has already improved significantly, but we must not become complacent.

“Systems around the registering of GPs by the GMC and on Performers’ Lists need to reviewed, and the recruitment, checking and vetting of GPs by our providers is vital if we are all to prevent this happening again.”

He’s got responsibility but seemingly limited power to control events. It doesn’t take much to go wrong, in a safety critical environment, where organisations are contracting and sub-contracting to the private sector, to lose sight of the process.

The reasons why Ubani was used remain. He was cheap and available (he even paid for his own flight and accommodation). It had nothing to do with quality. More checks will help but, in our new age of austerity, PCTs are still going to be looking for cheap deals.

I think it speaks volumes that Take Care Now is still in business, regardless of whether it has improved. It lost its Cambridgeshire contract, but still provides services for two other trusts: NHS Worcestershire and NHS Great Yarmouth and Waveney.

The GP contract has been an unmitigated disaster for out-of-hours care in the community. It’s time to bring local GP practices back into the equation and if that means the GP contract has to be re-negotiated, then so be it.  

David Halpin, a retired orthopaedic surgeon, and five other doctors are taking legal action to force a coroner’s inquest into the death of Dr Kelly, the scientist who died days after being exposed as the source of a BBC story on the Iraq war.

No coroner’s inquest was ever held into Dr Kelly’s death. Instead, the official verdict that Dr Kelly committed suicide by cutting an artery in his wrist, after taking an overdose of painkillers, was provided by the Hutton Inquiry.

The doctors are applying to the Attorney General, Baroness Scotland, for permission to go to the High Court for a new inquest, or the resumption of the previous inquest.

Their case rests on section 13 of the 1988 Coroners Act, which allows the High Court to order a new inquest, or to resume a previous inquest, in special cases.

Lord Hutton had ordered that the medical reports, including the post mortem examination were to remain classified for 70 years. He recently agreed that the doctors could see the autopsy report but they say they are demanding to see the medical records as well.

Halpin has compiled a 14-page dossier prepared as the basis for the legal action.

As a former trauma and orthopaedic surgeon he says he cannot easily accept that even the deepest cut into one wrist would cause enough bleeding to result in death. The two arteries are of matchstick size and would have quickly shut down and clotted. He also argues that a man who was an expert in lethal substances was unlikely to have chosen such an uncertain method of suicide.

“There should be 3,000 surgeons agreeing with me because they know damn well you don’t die of one piddling artery being cut,” he said.

Halpin, whose campaign has consumed thousands of hours over six years, said he is disappointed that more doctors have not spoken out. “Some of my colleagues have said ‘well done’ but some have…not sniggered exactly…but they smile faintly and shrug their shoulders and say ‘well he was bumped off’. There is a cynicism among many doctors which is corrosive in the profession,” he said.

Halpin said in the early days when some media columnists were pouring scorn on his efforts to reveal the truth he was constantly “looking in the rear view mirror” while driving on the dual carriageway.

Halpin first raised his concerns about Kelly’s death in the Morning Star in December 2003. He then discovered other doctors had also been scrutinising the suicide verdict. One colleague Andrew Rouse, an epidemiologist in Birmingham, had trawled for records of deaths from laceration of the wrist. He had also investigated 271 cases of attempted suicide by slashing the wrist at a US penitentiary and found that only one of the inmates died.

Initially the campaign group comprised 11 doctors, but it’s now down to six.

Halpin is confident, however, that there will be an inquest. “It is difficult to see how concealing the details of Kelly’s death would be a threat to national security,” he said.

The other doctors in the group are Michael Powers, a QC and former coroner; surgeon Martin Birnstingl; Stephen Frost and Chris Burns-Cox.