The Scotsman  Tuesday 30 January 2018
SCOTT MACNAB

Use of an NHS whisteblowing hotline is on the rise. Picture: TSPL

NHS staff are turning straight to a “whistleblowing” hotline because they are being ignored when they raise issues with their bosses, a new report out today has indicated.

Fewer NHS staff bother to go to managers in the health service because nothing gets done, the evaluation of the NHS Scotland Confidential Alert Line suggested.

Some staff have said they are victimised if they raise concerns over patient safety. The hotline was launched in 2013 and aimed to improve hospital safety after hundreds of incidents of concern, including more than 100 deaths, came to light.

It comes after a whistleblower recently exposed the fact that A&E staff at St John’s hospital in Livingston were wrongly recording the waits faced by patients, which made it easier to meet national NHS waiting times targets.

The latest evaluation of the hotline’s work in the six months from February and July last year indicate just 17 callers got in touch with the hotline. Although this was up slightly on the previous six months, it compares with 73 calls in the opening half-year after it was launched.

The latest report said: “In many cases individuals are contacting us because they have already raised their concern and feel it is being ignored and would like further advice on options for escalation or they feel they have experienced victimisation due to raising an issue.”

Of the total 17 public cases, seven callers had already raised their concern before contacting the Alert Line,” the report stated. “This is in keeping with general trends we have seen in previous reports and largely reflects the majority of calls we receive to the advice line generally,” the report added.

Patient safety was the “predominant concern” raised with the alert line. This has been a consistent trend across the six-month reports provided over the past three years, the report added.

A number of callers also got in touch in 2017 with concerns about abuse of a vulnerable person. But the report said there has been a “decrease in the number of staff who had reported their concerns before contacting the alert line compared with the previous report.”

“This is in keeping with general trends we have seen in previous reports and largely reflects the majority of calls we receive to the advice line generally,” the report added.

Patient safety was the “predominant concern” raised with the alert line. This has been a consistent trend across the six-month reports provided over the past three years, the report added.

A number of callers also got in touch in 2017 with concerns about abuse of a vulnerable person. But the report said there has been a “decrease in the number of staff who had reported their concerns before contacting the alert line compared with the previous report.”

Of the seven individuals who had already raised their concern before contacting with the hotline, three stated their concern had been ignored and only one said their concern had been denied.

Callers can seek advice from us even where concerns are admitted, for instance if they do not know how the concern is then resolved or if they are at risk of victimisation,” the report said.

Four of the calls from staff who worked with NHS Greater Glasgow and Clyde, while three came from other health boards in Scotland. T

he hotline was launched in 2013 after more than more than 300 reports into the most serious incidents in Scotland’s hospitals in 2011, including 105 deaths, were published by the BBC, and after the Francis Inquiry, which uncovered failings at Mid Staffordshire NHS Foundation Trust in England.

Read more at: https://www.scotsman.com/news/politics/nhs-staff-call-whistleblower-line-as-bosses-ignore-issues-1-4676704

Nurse & Whistleblower Helen Rochester: Whistleblowers are NOT protected under PIDA

WATCH VIDEO INTERVIEW

East Anglian Daily Times  20 January, 2018    Michael Steward     michael.steward@archant.co.uk    @MichaelReporter

One patient is said to have gone into cardiac arrest at Colchester General Hospital after taking themselves to A&E due to ambulance delays. Picture: LUCY TAYLOR

A damning dossier compiled by a senior whistleblower from the region’s ambulance trust has claimed at least 40 patients died or were harmed due to delays over Christmas and New Year – including one person who froze to death.

The damning dossier has been compiled by a senior whistleblower at the East of England Ambulance Service. Picture: SIMON FINLAY

The region’s NHS came under intense pressure in less than three weeks between mid-December and early January, with ambulances queuing outside A&E departments and patients reporting they were treated in corridors.

But the whistleblower, who wants to remain anonymous, revealed 19 people died in the east of England during the period and they expected the total number of patients harmed or killed due to delays to soar to around 80 when all cases had been reviewed.

A copy of the dossier seen by this newspaper included a man who waited 16 hours for an ambulance in Lowestoft on December 27.

The man was outside and no ambulance was sent when the first call was made by police.

Suffolk Police made a second call when they found the man, who apparently appeared to have frozen to death.

East of England Ambulance Trust (EEAST) said when the call was first made they were told the man was conscious and breathing and had no obvious injuries. Therefore the call was categorised as a non-emergency call.

When they received the second call a paramedic arrived within eight minutes but the man was dead.

In north Essex and Suffolk the whistleblower’s document claimed six people died and one was harmed as a result of the delays in that period.

These included:

• December 19, in Newmarket, a patient waited four hours and 20 minutes and there was evidence of harm due to the delay.

• December 25, in Maldon, it took six hours, 39 minutes for back-up to arrive to assist with a sepsis patient.

• December 26, in Stowmarket, a call for an ambulance was made on Dec 24 and no ambulance was sent. The patient died on Dec 26 after a cardiac arrest.

• December 26, in Ipswich, a sepsis patient waited four hours and 43 minutes.

• December 29, in Clacton, a patient with a serious spinal injury waited seven hours and 56 minutes.

• December 29, in Thetford, a patient died after going into cardiac arrest and waiting one hour and 12 minutes.

• December 30, in Walton on the Naze, an ambulance was called to a fractured ankle with an obvious deformity – a limb threatening injury – and took six hours 11 minutes.

• December 31, in Maldon, a patient arrested on arrival to hospital after waiting six hours and 46 minutes with asthma-related symptoms

• January 1, in Bury St Edmunds, a patient who had a seizure waited three hours and 41 minutes.

• January 2, in Tiptree, a patient died after going into cardiac arrest and waited for 47 minutes.

• January 2, in Clacton, a patient died from a cardiac arrest after waiting three hours and 45 minutes.

• January 2, in Chelmsford, a patient having a stroke waited 16 hours 49 minutes.

• January 2, in Colchester, a patient went into cardiac arrest after self-presenting at Colchester hospital A&E due to ambulance delay.

After years of missed targets EEAST changed its response programme last year, but in the most serious cases crews are expected to arrive within seven minutes.

The whistleblower also accused senior executives of being on holiday during the crisis, and said some of the trust’s £2.5m surplus should have been spent on hiring extra staff.

EEAST denied this was the case and a spokesman said: “The trust absolutely refutes claims that there were no senior managers in over the Christmas period. In line with all ambulance trusts, this trust operates a gold command system, which consists a 24/7 on-call rota of the most senior operational managers who are highly experienced and well trained.”

He added: “The trust is on the public record stating that it has a gap between funded capacity and demand. It is good financial planning to ensure that the trust is in a position to hire any additional resources that may become available across the months of January, February and March. The trust is well placed to buy such resources where available. We are aware of the claims made by MPs but note no complaints have been received from patients or their families at this time. Nor have any concerns been expressed internally through our line management, whistleblowing or freedom to speak up processes.”

Trust had ‘plans in place’

A trust spokesman added they “had plans in place however experienced extreme levels of demand over the new year period in particular.

“The trust was unable to respond to a very small number of the 50,000 calls we handled over a 15-day period as quickly as we would like. The trust is undertaking a rigorous analysis of that small proportion of calls.

“Where any suspected cases of potential harm are identified, then the trust will exercise it’s duty of candour to notify patients or their families. It is worth noting that any cause of death not certified by a doctor can only be established if there is a coroner’s case. It is best practice to always review the effectiveness of any plans and the trust will be doing that.

“Depending on any preliminary insight, the trust will invite an independent review of our decision making process. The trust has also requested a system wide review of these periods of high demand and lost capacity.”

Call for independent review

Former health minister Norman Lamb said the whistleblower had raised “very serious issues” with him.

Mr Lamb, the MP for north Norfolk, said: “It’s really shocking in my view, these are all suggestions which have been put to me but they are things which have to be fully investigated. I think there needs to be a urgent review by someone outside the trust.”

Sandy Martin, MP for Ipswich, said: “It is almost impossible to prove that anyone may or may not have died as the result as a result of an ambulance delay.

“However, it is clear that a better resourced ambulance service would lead to less unnecessary death and life-changing situations.

“It is time for the government to get to grips and to give our NHS the £30billion that the practitioners themselves say that the service needs.”

Giles Watling, MP for Clacton, said: “I shall be calling for an inquiry. If it is a question of funding then I shall be calling for more funding but I will wait for the findings of the inquiry.

“But we do need to get to the bottom of this.”

Suffolk health watchdog responds

Andy Yacoub, chief executive of Healthwatch Suffolk, said: “Healthwatch Suffolk is fully aware of the severe pressures all our health [and social care] providers have faced together this winter.

“I believe that at times the ambulance service has looked after and transported well over 4,000 patients a day, which would put a strain on any service. That said, each and every patient that requires an ambulance in an emergency, should rightly expect a service that is responsive and of a good quality.

“Planning and the best use of resources, in collaboration with hospitals and other providers, is essential, especially for the pressures that winter periods bring.

“For example, at a time when our hospital’s A&Es are as busy as they have been, ambulances can at times be held up, before their patient can be safely moved into the care of the hospital staff.

“The best use of what limited resources there are helps to respond to our region’s patients’ needs in as timely a fashion as possible.

“Communication is a key to this, because when ambulances are ‘delayed’, the patient and their carer(s) desperately need to know. The appropriate use of the amazing First Responder volunteers is also essential.

“Healthwatch Suffolk is currently asking the public to share stories about the ambulance service they have received recently, whether this is good, bad or indifferent. Your voice matters and any themes and trends we identify will be raised directly with the trust’s quality and governance committee.”

Sent via email

1 March 2015

Mr David McVitte

Chief Executive

Ealing Hospital NHS Trust

Dear Mr McVittie,

Re: Dr Sunil Ranjan Chowdhury DOB 4.9.31

My father, Dr Chowdhury, who was a retired doctor, suffering from multiple system atrophy (MSA), was taken to Ealing hospital by ambulance on Wednesday 21 January, when he suddenly became unconscious. My mother called the emergency service.

Although Central Middlesex hospital is the nearest hospital, A&E there has recently been shut down.

On arrival at A&E, mum and I were present and we advised the A&E of the medication my father was on. This included the type and dosage of insulin – he was diabetic. After several tests, the doctors advised us that his condition was OK and there was nothing that they were worried about. However, they would admit him.

On Thursday 22 January, I received a phone call from the pharmacy querying the type and dosage of insulin my father was on. I advised him.

On Saturday 24 January, when I went in to visit dad, I was advised that dad had not been fed for 2 days. They thought he may be aspirating. I was concerned and asked if that was the case why they had not fed him either intravenously or via a nasogastric tube. They did not reply, except to say that they were unable to do anything until the consultant returned to work on Monday. So, they had planned to starve a vulnerable adult for 4 days, before deciding on a feeding plan. After much fuss (from me), the senior staff decided to try and feed him with semi-solid food. Dad had this without any coughing or any problems – the nurse agreed that dad was not aspirating. So, they then commenced his feeding after 2 days of starving him.

In addition, I discovered on the same day, that he was not been given any fluids either. The drip remained unconnected. I queried this. The staff advised me that the there was a problem with the drip monitor. After complaining 3 times, staff eventually got this to work.

On Saturday 31 January, dad looked really poorly and was on oxygen. He did not have any lunch. However, his blood sugar was high at 15. We queried if he was given his insulin. The nurse couldn’t find anything regarding his insulin in his notes. It transpired that dad hadn’t been given any insulin for the last 10 days he was in the hospital.

I asked to speak to his doctor. I was advised that his consultant would not be in until Monday and that there was a locum covering. I asked to speak to her. She said there wasn’t anything she could do as his insulin was not written up in his notes.

Whilst looking through his notes, I came across another patient’s paperwork. A Chaudry with a different first name. I brought it to the attention of the ward sister, who removed and took the paperwork away.  How could this have happened? In addition, worryingly were my father’s details on insulin entered in another patients notes?

On Monday, the consultant spoke to my mum and said he did not know that dad was on insulin. This was despite the fact the doctor in A&E was advised and I had received a phone call from the hospital pharmacy. He was also worried that I would be putting in a formal complaint. One would have thought as a consultant he would be more worried how such a thing could have happened in the first place and investigate.

After discussing the matter with the consultant, mum asked me not to make a complaint while my father was still in the hospital as it could be detrimental to his ongoing treatment. She was clearly worried

His insulin started on Monday 2 February. Dad perked up on Tuesday and Wednesday. He was eating and chatting. However, sadly he passed away on Thursday 5 February.

As well as coping with his death, I had to repeatedly call the ward and patient services to get his death certificate. So that his death could then be registered and we could organise his cremation. It took 2 days and end of Friday to get this and this was only after I ended up physically in the ward to approach the team after my PET CT scan. Due to running around and dehydration, I ended up with severe haematuria and bladder infection and I ended up at Northwick Park hospital.

It is shameful that my father who had worked as a doctor for nearly 50 years and was really valued both by his patients and staff to the point that they remained in contact with him even after retiring for 15 years should have ended his days at Ealing hospital with such poor treatment.

I would like a clear explanation of how these failures occurred, and I expect that I should be properly involved in any root cause investigation

With regards

Sharmila Chowdhury

Norwich Evening News   17 January 2018    Richard Porritt

 Clive Lewis

http://www.eveningnews24.co.uk/news/politics/clive-lewis-ambulance-dead-1-5359204

10th January 2018

 Dear Prime Minister, 

 We are writing to you as Consultants in Emergency Medicine, Fellows of the Royal College of Emergency Medicine and as Clinical Leads (Consultants in charge) of our Emergency Departments, representing 68 Acute Hospitals across England and Wales.

 We note your recent apology to patients and thanks for how hard we and other NHS staff are working.

 We feel compelled to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues and for the very serious concerns we have for the safety of our patients. 

 This current level of safety compromise is at times intolerable, despite the best efforts of staff. 

 It has been stated that the NHS was better prepared for this winter than ever before. There is no question that a huge amount of effort and energy has been spent both locally and nationally on drawing up plans for coping with NHS winter pressures. Our experience at the front line is that these plans have failed to deliver anywhere near what was needed.

 We acknowledge that our Trusts and local CCGs are doing everything they can to create capacity and more beds in the short term, and we are grateful to them for their continued assistance in such a time of crisis. We also acknowledge the help and support given to the Emergency Departments by our colleagues in other specialties and disciplines across our hospitals.

 The facts remain however that the NHS is severely and chronically underfunded.

We have insufficient hospital and community beds and staff of all disciplines especially at the front door to cope with our ageing population’s health needs.

 As you will know a number of scientific publications have shown that crowded Emergency Departments are dangerous for patients. The longer that the patients stay in ED after their treatment has been completed, the greater is their morbidity and associated mortality. 

 Recent media coverage has reported numerous anecdotal accounts of how appalling the situation in an increasing number of our Emergency Departments has become. These departments are not outliers. Many of the trusts we work in are in similar positions.

 Last week’s 4 hour performance target was between 45 and 75%.

Thousands of patients are waiting in ambulances for hours as the hospitals lack adequate space. 

 Some of our own personal experiences range from

 We have known for a number of years that recruitment of staff to Emergency Departments has been challenging. The recent collaboration between the Royal College of Emergency Medicine and NHS England, Health Education England and NHS Improvement will provide a medium term solution to grow our clinical workforce as well as decrease the attrition rate.

 So as a matter of urgency we ask that you consider supporting strategies that will reduce crowding in our Emergency Departments. 

These include;

In the meantime we would like to apologise to our patients for being unable to fulfil our pledge for a safe efficient service and acknowledge the hard work and dedication of the staff.

 You will understand with the public interest in this matter that we have released this letter to the press also.

 We remain hopeful and committed to improving the care of patients in Emergency Departments throughout the UK.

 “The NHS belongs to the people….it touches our lives at times of basic human need when care and compassion are what matter most”

The NHS Constitution, 1948.   

Note: we sign this on behalf of ourselves and our departments but this does not necessarily represent the views of our individual Trusts. 

Shaz Afzal – County Durham and Darlington NHS Foundation Trust 

Shariq Ahmed- Wrightington, Wigan and Leigh NHS Foundation Trust

Vazeer Ahmed – Cambridge University Hospitals NHS Foundation Trust 

Abosede Ajayi, Charing Cross, ICHNT

Andy Ashton – St Helens and Knowsley Teaching Hospitals NHS Trust 

Ravi Ayya– West Suffolk Hospital

Ahmad Aziz – Mid Essex Hospital Services NHS Trust, Broomfield Hospital

Bill Bailey – Chesterfield Royal Hospital

Tom Blyth – Heart of England NHS Foundation Trust (Solihull) Birmingham

Dan Boden – Derby Teaching Hospitals NHS Foundation Trust

David Clarke – Royal Berkshire NHS Foundation Trust 

Jonathan Costello – Royal Free, London

Jim Crawfurd – James Paget University Hospital, NHSFT

Susan Dorrian – Heart of England NHS Foundation Trust (Heartlands) 

Birmingham 

Ola Erinfolami – Heart of England NHS Foundation Trust, Birmingham

Jane Evans – Norfolk and Norwich University Hospitals NHS Foundation Trust 

Shindo Francis – Milton Keynes University Hospital 

James Gagg – Musgrove Park Hospital, Taunton & Somerset NHSFT

Steve Haig  – Great Western Hospitals NHS Foundation Trust, Swindon

Elaine Harding – Lewisham and Greenwich NHS Trust

Miriam Harris – London North West Hospitals NHS Trust 

Ed Hartley – University Hospitals Coventry and Warwickshire NHS Trust 

Katherine Henderson – Guy’s and St Thomas’ NHS Foundation Trust

Chris Hetherington – South Warwickshire NHS Foundation Trust 

Caroline Howard – Southend University Hospital NHS Foundation Trust

Ann Hicks – Plymouth Hospitals NHS Trust 

Hywel Hughes – Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital

Nickie Jakeman

Ruchi Joshi – Walsall Healthcare NHS Trust 

Meg Kelly – United Lincolnshire Hospitals NHS Trust 

Tarek Kherbeck, The Norfolk & Norwich University Hospital

Liam Kevern – Northern Devon Healthcare NHS Trust 

Milena Kostic – The HillingdonHospitals NHS Trust

Subramanian Kumaran – Shrewsbury and Telford Hospitals NHS Trust

Nick Laundy – Countess of Chester Hospital NHS Foundation Trust 

Stuart Lloyd – Bedford Hospital NHS Trust 

Stephen Lord, York Hospital, York Teaching Hospitals NHS Foundation Trust

Andres Martin – North Middlesex University Hospital 

David Matthews – Mid Cheshire Hospitals Foundation Trust 

Nick Mathieu – Torbay and South Devon NHS Foundation Trust

Ann-Marie Morris – University Hospitals of North Midlands 

Rachel McColm – Wye Valley NHS Trust

Lisa Niklaus – Barts Health NHS Trust

Julie Norton – University Hospitals of North Midlands 

Tom O’Driscoll – Betsi Cadwaladr University Health Board, Glan Clywd

Nick Payne –Frimley Health NHS Foundation Trust 

Rob Perry – Betsi Cadwaladr University Health Board, Ysbyty Gwynedd (GwyneddHospital), Bangor, North Wales 

Shewli Rahman – Burton Hospitals NHS Foundation Trust

Junaid Rathore – Royal Liverpool and Broadgreen University Hospitals Trust

David Raven – Heart of England NHS Foundation Trust, Birmingham

Ben Rayner – Hull and East Yorkshire Hospitals NHS Trust 

Tim Rogerson – Aneurin Bevan University Healthboard, Royal Gwent Hospital, Newport

Emma Rowland

Mustafa Sajeel – Heart of England NHS Foundation Trust, Good Hope, Birmingham

Ramy Saker – Frimley Health NHS Foundation Trust, Wexham Park 

Ravi Sant – United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston

Matt Shepherd – Harrogate and District NHS Foundation Trust

Toby Slade – Royal Cornwall Hospitals NHS Trust 

Dave Snow – Southport and Ormskirk Hospital NHS Trust 

Lisa Somers – Whipps Cross University Hospital, Barts Health NHS Trust 

Sarah Spencer – Abertawe Bro Morgannwg University Health Board, Princess of Wales Hospital, Bridgend 

Jo Taylor – The Dudley Group NHS Foundation Trust 

Nam Tong – The Queen Elizabeth Hospital, Kings Lynn NHS Foundation Trust 

Will Townend – Hull and East Yorkshire Hospitals NHS Trust 

Malcolm Tunnicliff – Kings College Hospital NHS Foundation Trust 

James Williamson – Warrington and Halton NHS Foundation Trust

Libby Wilson – University Hospitals Aintree NHS Foundation Trust

Athar Yasin – North West Anglia Hospital NHS Foundation Trust, Peterborough City Hospital 

     Dr Peter Wilmshurst  MB, ChB, BSc, FRCP, FFSEM, FISM

Although healthcare workers have a responsibility to raise concerns about patient safety and unethical or illegal conduct, if they do so they are often treated badly.

 To view full article in Health Management: 

ITV News   10 January 2018   James Crichton-Smith    HEALTH REPORTER, ITV WALES
Dr Tony Rucinski says he’s experienced a culture of bullying and unfairness Credit: ITV Wales

The former chief executive of the Board of Community Health Councils in Wales says he’s experienced a culture of ‘entitlement, gagging, bullying and unfairness’ in the Welsh NHS.

Speaking exclusively to ITV Wales, Tony Rucinski says he was told at the beginning of 2016 not to speak to the media ‘on the behest of the [Health] Minister’ and that a closeness between Welsh Government and the NHS means that difficult conversations about what needs to happen in the health system are not taken forward.

The health minister at the time was Mark Drakeford AM, who is now Finance Minister.

After being suspended, Mr Rucinski was then dismissed from his position with the Board of Community Health Councils (CHC).

According to the Community Health Councils website, “CHCs represent the independent voice of patients and the public who use health service in Wales and play an important role in influencing the way services are planned and delivered.”

Mr Rucinski has spoken exclusively to ITV Wales Credit: ITV Wales

Mr Rucinski said: “The reality is that you discuss some hard topics, but then comes in what I would call the small country conundrum.”

He added: “You end up finding that there’s an awful lot of closeness [between the Welsh NHS and government] and the people who choose the people who choose the people, a lot of it seems to feel a bit locked in.

“What that means is you get to situations where you’re in meetings and you’ll come up with a discussion or viewpoint and somebody will say ‘we can’t say that because the minister wouldn’t like it’. And that’s the end of that discussion.”

Mark Drakeford AM was the health minister when Mr Rucinski was suspended Credit: ITV Wales

Mr Rucinski says he was ‘gagged’ from speaking out on issues affecting the NHS. He says he was told that this decision was made by the health minister. “I was told you’re being stopped from talking to the media on the behest of the minister,” he said.

“My boss said the minister had told her to keep me out of the media. I objected to that because in my point of view it’s A, in my job description and B, we’re an independent organisation and we shouldn’t be responding to political instructs to stay away from the media.”

The methods and tactics used by Welsh Government in order to prevent Mr Rucinski from speaking out, he says, are “just the tip of the iceberg”.

The ‘close’ relationship between government and senior figures within the Welsh NHS, says Mr Rucinski, could be seen through the frequency with which the health minister would meet with other NHS bosses and himself. “When I was in position, the chairs [of the CHCs] would meet with the minister at least every fortnight. So a very close relationship. I would see the minister on a ridiculously large number of occasions.”

Mr Rucinski says that ‘closeness’ between government and the NHS is harming progress Credit: ITV Wales