Whistle-blowers say Sir Robert Francis’s report fails to offer enough protection to staff to who speak out and will not encourage others to come forward
Whistle-blowers have warned more needs to be done to protect them and encourage others in the NHS to speak out, despite the recommendations in Sir Robert Francis’s report.
Amanda Pollard, a senior inspector with the Care Quality Commission (CQC) watchdog who resigned after saying that the organisation “would not spot another Stafford” – the hospital where failings led to hundreds of “excess deaths” – said Sir Robert’s recommendations would have done little to protect her at the time.
She told The Telegraph: “The legal protection he recommends seems to be aimed at people who are looking for work after being forced out of their job for whistleblowing, rather than protecting whistle blowers in their organisation.”
Mrs Pollard said several of the principles put forward by Sir Robert to protect whistle-blowers depended on the good will of NHS trusts and bodies to implement them.
“Saying that the culture needs to be more open relies on that organisation wanting to be more open. Where is the incentive for them to do that? And where are the sanctions if they don’t? There don’t appear to be any” she said.
Mrs Pollard, who had worked in the NHS for 20 years, left the CQC in 2013 after growing increasingly frustrated with the behaviour of management as she tried to alert them to her concerns.
She complained to her managers after the CQC disbanded its infection control teams – which advised hospitals on the crucial task reducing the risk to patients of ‘superbug’ infections such as MRSA, C. diff and E-coli – and transferred the inspectors to regional teams.
The result was that Mrs Pollard and her colleagues found themselves inspecting care homes and nursing homes, in which they had no expertise or knowledge. She told Mid-Staffs inquiry: “I could not believe that something so effective could be thrown away.”
Mrs Pollard said on Wednesday: “If all of Sir Robert’s recommendations were in place now I would still be hesitant about coming forward with my concerns.
“I just don’t see how his recommendations would have helped my case or changed what happened to me.”
Mrs Pollard, who has found it impossible to get work elsewhere in the NHS since speaking out over her fears, also questioned how effective Sir Robert’s proposal for ‘whistle-blower guardians’ would be if they were recruited from the ranks of NHS managers.
“For them to be fully effective they need to be at board level. If they were trust managers they could easily be accused of not being independent,” she said.
Robert Rose, a medical negligence lawyer with Lime Solicitors, said other pledges this week to introduce financial sanctions for hospitals that fail to be honest about clinical mistakes were “likely to make little difference” if NHS whistle-blowers remained unprotected.
He said: “Potential whistleblowers must be able to voice their concerns safe in the knowledge that this will not negatively impact on their careers. Until this is addressed, and a watertight process is put in place where staff can safely raise concerns, the culture within the NHS will not change.”
David Drew, a consultant paediatrician who claimed he was sacked after raising the alarm over a toddler who died after being discharged from Walsall Manor Hospital, said the Francis review underlined existing problems but that the failure to help those whose lives had been crushed remained an “open sore” on the NHS.
He added: “We will be back campaigning for reopening of cases of sacked whistle-blowers.”
In April 2012 an employment tribunal rejected Mr Drew’s claims of unfair dismissal, religious discrimination and victimisation against Walsall Hospitals NHS Trust.
Gary Walker, the former chief executive of United Lincolnshire Hospitals Trust, said Sir Robert’s recommendations would prove to be “completely ineffective”.
He said: “The focus should have been on dealing with the individuals who victimise whistle-blowers, and these are usually trust board members. Sir Robert seems to be saying that no one is to blame and that’s absolutely ridiculous.”
Mr Walker claimed his warning to senior NHS figures about patient safety were ignored for years until he was eventually sacked by the trust in 2010, ostensively for swearing in meetings.
Raj Mattu, a cardiologist who publicly exposed overcrowding at Walsgrave Hospital in Coventry in 2001, claiming it might have led to avoidable deaths, said there still a lack of “sufficient protection” for potential whistle-blowers.
Dr Mattu said earlier that Sir Robert’s recommendations were “of no value if they are not going to be enforced”.
He added: “As of today, I don’t believe there are sufficient protections in place that are of any value. I couldn’t possibly recommend anybody else whistle blow at this moment and go through the sort of ordeal I and others have gone through.”
Hundreds of senior doctors and nurses gave evidence to Sir Robert about how their careers came to a standstill after they tried to alert NHS managers of unsafe practices and cost-cutting risking lives.
Sir Robert told The Telegraph the NHS should exploit the idealism of its doctors and nurses and not crush those who put patients first.
Dr Mattu welcomed Sir Robert’s report, but added: “It’s frustrating and depressing to hear that whilst there is often and periodically noises made about … protecting whistle-blowers, the reality is there are very few palpable, material changes that take place.
“Today even, the culture is very unsafe. There is still ongoing persecution of whistle-blowers on a grand scale.”
Dr Mattu said: “Large numbers of managers in the NHS are in there for a different reason to the nurses and doctors. Most of us come in because we want to care for people. Managers largely come from a background of wanting a career in management.
“Many of us who are whistle-blowers feel compelled and a moral obligation to speak up. I saw practices in my hospital that were putting patient safety and lives at risk.”
Some whistle-blowers were more enthusiastic about the report.
Roger Davidson, currently Head of Media and Public Affairs at NHS England, said: “A culture of denial has absolutely no place in our NHS – there should be no ifs or buts. The fact this report has been produced is a powerful first step. It sets the direction and provides a yardstick against which we can measure. But it’s behaviours that will make a difference. I hope the NHS roots out poor behaviour and drives strong values-based leadership to every corner of the health service.”
Mr Davidson lost his job as head of media and public affairs for the CQC just before the 2010 general election, after telling how a quarter of NHS trusts had failed to meet basic hygiene standards.
He also warned that the CQC had stopped telling the public how to find reports on infections in their local hospitals in order to limit publicity damaging to the NHS.
Mr Davidson was forced to sign a gagging order when he left, but his testimony emerged during the Francis inquiry into the failings at Mid-Staffs.
Sir Robert’s proposal to station “freedom to speak up guardians” in hospitals to help staff in coming forward was based on an idea by Helene Donnelly, a nurse who raised the alarm at Stafford Hospital.
Ms Donnelly, who advised Sir Robert on how whistle-blowers could be helped and now works as ambassador for cultural change at Stafford, suggested the guardians would be able to go over the head of hospital boards who failed to act appropriately.
“(In the) worst case scenario, if the board fails to act and there is serious patient or staff safety risk, they can then take it externally to an external guardian and all the other regulators as well to ensure the problem is dealt with,” she said.
The campaign group Patients First said: “We believe that those staff who are brave enough to raise patient safety concerns should be treasured, not bullied, and look to Jeremy Hunt to decisively act to help change the prevailing culture in large parts of the NHS and protect such staff.”
But Chris Hopson, chief executive of NHS Providers, the association of NHS foundation trusts and trusts, said that while “there is a significant minority of trusts where whistle-blowers are not being treated appropriately”, the NHS had been ranked as the safest health care system in the world.
Mr Hopson said out that only 0.06% of NHS interactions with patients ended in complaints and that more that 80% of patients were satisfied with the care they received.