NHS Lothian has not tried to prevent doctor from raising concerns

The compromise agreement is about Dr Hamilton's employment issues and potential financial settlement, not patient safety issues. The agreement could not be any clearer that Dr Hamilton is not prevented from raising concerns about patient care. In fact, she has already done so on a number of occasions, all of which have been investigated and found to have no substance.

If Dr Hamilton has ongoing concerns regarding the unit at St John's Hospital then it is her duty to raise these. Any further issues raised in this way will be fully investigated. It is important to note that Dr Hamilton has not worked in the mother and baby unit for four years.

Patient safety is our top priority and NHS Lothian has responded professionally and robustly to concerns at all times. This is evident in the detailed investigation by the independent panel of experts that I commissioned.

Dr David Farquharson,

Medical Director, NHS Lothian,

Waverley Gate,

2-4 Waterloo Place, Edinburgh.

I NOTE with interest the letter from Dr Kim Holt and Roger Holt of Patients First (January 14). I was asked by NHS Lothian to conduct an independent external investigation into the safety and quality of care provided by the Livingston perinatal mental health team (both the mother and baby unit and community service). I chaired the investigation team and a report of the findings and recommenda­tions provided to the board.

The terms of reference of this investigation, the methods used and the scope of detail of our investigation are clearly described in the report. It can be seen that we did address those of Dr Hamilton's concerns that related to the current functioning, safety and quality of care of the Livingston service.

Our conclusion was that the Livingston service was safe and fit for purpose and that it provided a quality of care at least comparable to other UK mother and baby units. Its practices and procedures demonstrated a process of continued quality improvement and compassionate expertise in managing individual seriously ill mothers and their infants.

Dr MR Oates,

Consultant perinatal psychiatrist,

Clinical Lead, East Midlands Strategic Clinical Network for Mental Health, Dementia and Neurological Conditions,

NHS England,

Room K03, 1st floor, Duncan Macmillan House, Porchester Road, Nottingham.

NHS Lothian states in your report that I "chose not to" present my concerns with regard to the clinical safety and quality of the perinatal psychiatry service to a review in 2008. It also stated that my concerns have all been fully investigated.

I have recurrently attempted to present my concerns, including to the peer review quality network visit (led by Dr Oates) in 2008. I subsequently raised these and further concerns on numerous formal occasions, including to limited internal enquiries in 2010 and 2011. They have never been taken seriously and there has been no rigorous or independent investigation of them.

These include a series of critical incidents, two of which had near-fatal outcomes, for which there has been no formal response or action plan - as acknowledged by the medical director in writing. I also presented my concerns to the recent inquiry (again led by Dr Oates) in 2012.

I submitted written complaints to NHS Lothian detailing my concerns and evidence prior to the most recent review in April, 2012. I was reassured by NHS Lothian almost two years ago that my formal complaints would be properly investigated. This has not occurred beyond a preliminary meeting.

My principal purpose in raising these issues publicly has been to persuade the Health Secretary that he should, at the least, initiate some independent scrutiny of these formal complaints and whether there has been any adequate response to them.

I do hope he will now instigate some genuinely independently scrutiny of this situation as a matter of urgency.

Dr Jane Hamilton,

Consultant perinatal psychiatrist,

c/o NHS Lothian,

Waverley Gate, 2-4 Waterloo Place, Edinburgh.