Watch Health Selective Committee 21 July 2015 with NHS England
Author Archives: sharmilachowdhury
Jeremy Hunt: message to NHS staff about the future NHS
The Secretary of State for Health talks about his speech yesterday where he set out his vision for the NHS over the next 25 years.
Yesterday I set out my vision for the NHS over the next 25 years. I know there was a lot of news coverage, with a big focus on 7-day working, but I wanted you to hear about another part of my speech and how, with your help, we can make the NHS the safest, most patient-centric health system in the world.
From conversations with NHS staff across the country, it is clear to me that, too often in the past, you have been asked to focus your attention on targets. Many targets have worked well in improving standards – particularly the 4 hour Accident and Emergency target and the 18 week waiting time standard. But sometimes they have unintended consequences and make it harder to focus your attention on providing the best care and support possible for patients.
What I argued in my speech was that if we are prepared to be brave on transparency and be open about the standards of care in every part of the system, it isn’t necessary to have so many targets. People naturally want to do a better job if they know how they compare to their peers. And of course this transparency is a vital part of the Francis agenda to make sure we never have a tragedy like Mid Staffordshire. Get this right and we can turn the NHS into the world’s largest learning organisation – a big ambition for which there is a long way to go, but one really worth aiming for.
I announced a number of measures to help make this vision a reality. There will be a new Independent Patient Safety Investigation Service, which will be a central hub of expertise to advise trusts when they need to investigate something quickly and with a wholly independent team. This will be based at NHS Improvement, the new body that will bring Monitor and the Trust Development Authority together.
I want you all to have someone you can speak to if you have concerns that you are not being listened to or feel unable to raise with your line manager. Every trust will therefore have Freedom to Speak Up Guardians, as recommended by Sir Robert Francis, and a new Independent National Officer for whistleblowing will be based at the Care Quality Commission to keep an eye on how these processes work. To engrain this in our NHS culture, the importance of being able to raise concerns will also become part of all staff education, training, and personal development.
I want the NHS to be somewhere where you are able to focus on patient care and where you can challenge, learn and improve. I also know it has never been more pressured on the frontline and so this will not always be easy. But I hope that my announcements yesterday, combined with the financial support the government is giving to the NHS England Five Year Forward View, will help to empower you to make that happen.
Dr Lucia Gibson – campaign
Lucia needs our help
In 2007 Lucia explained to us that she raised concerns with her PCT over monies amounting to £60,000.
Imagine the shock of then finding herself of being falsely accused of so-called ‘ghost’ patients and has had her practice closed by NHS England.
In the criminal case brought against Lucia the Judge criticized the PCT & stated that he agreed with the Jury that they should not bring a similar case to his court in future.
Yet here we are again in 2015 at the high court, tax payer’s money being used to continue the persecution of an innocent Doctor, worth reminding you all this Doctor was cleared of all charges even the General Medical council stated that this Doctor had suffered a “Manifest Injustice”
NHS England are now pursuing Lucia for approx. £600,000 pounds part of the costs for running her practice after suspension on false allegations. She was later cleared of all allegations. The GMC admitted it was a “manifest injustice” yet still she is pursued.
We are looking for legal representation on a PRO BONO basis for this case – Lucia is like many of us out there cleaned out financially by NHS legal expenses.
Lucia came to us for help at short notice we advised, and as a result Lucia won a adjournment at the high court earlier this week, the case will be re listed at the high court in November.
When NHS England took over they spent considerably whilst running the practice by bringing in agency staff at at exorbitant rates for a single handed run practice, they themselves created the deficit.
OPEN LETTER
Dear Mr Hunt,
I write to you on behalf of Dr Lucia Gibson, it is my understanding that Lucia has previously approached you, that you indicated that Lucia’s case should be investigated as a matter of public interest.
This does not appear to have happened, Instead Lucia continues to be persecuted through the high court using tax payers money in order to claim £600,000 .
These costs accrued by NHS England as a result of running Dr Gibson’s practice whilst suspended. Dr Gibson was cleared fully of all allegations, lost her GP practice in the process, It appears Dr Gibson’s practice was run down by the incompetent business practices of NHS England Surrey.
In the criminal case brought against Lucia the Judge criticized the PCT & stated that he agreed with the Jury that they should not bring a similar case to his court in future.
Yet here we are again in 2015 at the high court, tax payers money being used to continue the persecution of an innocent Doctor, worth reminding you this Doctor was cleared of all charges even the General Medical council stated that this Doctor had suffered a “Manifest Injustice”
The employment tribunal hearing concluded that there was evidence of racial discrimination in this case.
So my question to you is are you going to allow the persecution of this good doctor , along with the continued waste of tax payers money being used to employ a legal team in order to continue that persecution?
It is, in short a disgrace, and one of the most appalling cases of injustice against a NHS worker that I have been asked to take a look at.
I trust in the circumstances this will be investigated independently as a matter of urgency.
Regards
Fiona Bell
Health Campaigner
Twitter @Unityportal
cc House of Commons Health Committe
House of Commons Public Accounts Committee
Sir Robert Francis CQC NED
Sir Jeremy Heywood Cabinet Secretary
Simon Stevens NHS England
Dr Lucia Gibson
Mr Martyn Halle – Health Journalist
EXCLUSIVE: Innocent GP suspended for six years over fraud allegations FIGHTS back
A GP falsely accused of claiming payments for “ghost patients” has demanded an investigation into how her case was handled.
Express Sun, Jul 6, 2014 | UPDATED: 09:39, Sun, Jul 6, 2014
After her suspension last year, Dr Gibson plans action against NHS England [NIGEL HOWARD]Dr Lucia Gibson was arrested in 2007 but after an 11-week trial costing £4.5million in 2009 she was cleared of all 37 charges.
The judge said he agreed with the jury’s verdicts and warned the NHS Counter Fraud Service to think “long and hard” before bringing a similar case to court.
I am an innocent doctor. The final blow to me was for them to take away the practice I had worked hard to build up
However, Dr Gibson, 51, a fellow of the Royal College of Obstetricians and former hospital obstetrician and gynaecologist, was still suspended by both the Surrey Primary Care Trust and the General Medical Council until last year.
A General Medical Council panel has apologised for the length of the suspension and acknowledged the way she had been treated was a “manifest injustice”.
Yesterday Dr Gibson, a mother of one from Weybridge, Surrey, said: “There needs to be an independent health service investigation of my case into how the allegations of fraud even came to court and the cost and length of my suspension.”
She said she spent £180,000 on legal fees to clear her name.
While she was suspended it is believed the Primary Care Trust racked up a bill of £3million pounds paying for two agency locum GPs to run her surgery at a cost of up to £250,000 a year per doctor.
The costs of a series of High Court cases over her right to practise and disciplinary hearings have added up to another £1million of taxpayers’ money.
Last year, just as she won back her right to practise, Dr Gibson says NHS England South took away her practice, which she had been at since 2003, and handed it to another doctor.
Dr Gibson, who is now back at work, said: “I am an innocent doctor. The final blow to me was for them to take away the practice I had worked hard to build up.
“I had loyal patients who stayed with the practice throughout my suspension even though they complained that the service from the locums wasn’t as good.”
She is now considering legal action because of the way she says her practice was “stolen”.
A spokesman for NHS England said: “Throughout this affair we have put patient safety and the need for absolute confidence in the ability of people working for the NHS at the centre of everything that we have done.”
A spokesman for NHS Protect, which has taken over the work of the NHS Counter Fraud Service, said: “This particular matter is related to very serious allegations of the falsification of large numbers of patient records for financial gain.”
Fit & Proper test – Hull
Rose Report – Better leadership for tomorrow:NHS leadership review
Independent report
From: Department of Health First published: 16 July 2015
Lord Rose’s report on leadership in the NHS.
The Secretary of State for Health asked Lord Rose to conduct a review into leadership in the NHS. The review asked:
- what might be done to attract and develop talent from inside and outside the health sector into leading positions in the NHS?
- how could strong leadership in hospital trusts might help transform the way things get done?
- how best to equip clinical commissioning groups to deliver the Five Year Forward View
The final report contains 19 recommendations, covering 4 areas:
- training
- performance management
- bureaucracy
- management support
Jeremy Hunt: Making healthcare more human-centred and not system-centred
Speech
Health Secretary Jeremy Hunt sets out the direction of reform for the future NHS.
We have just had an election – and whatever the disagreements between the parties, the NHS was most definitely on the ballot paper. Voters told the pollsters time after time that their most important issue was the future of a service that is part of our very essence as a country.
[Political content removed.]
From bureaucratic to patient-centred
Every health secretary has to deal with a crisis of some sort – and my first was not long coming. The Francis Report into the horror of what happened at Mid Staffs shocked me to the core: how could a system which claimed to put patients first allow such lapses in care to continue for 4 years without anyone putting a stop to it? Even more shocking was the rapid realisation that Mid Staffs was not isolated: hospitals up and down the country were making the same, tragic mistakes – a terrible, unintended consequence of a targets culture where system goals mattered more than the care of individual patients.
It was, quite simply, a total betrayal of what the NHS stood for – not least a betrayal of the staff who worked in those hospitals. None of them joined the NHS to be associated with poor care – and yet they found themselves trapped in a huge bureaucracy where too often the price of speaking out was to be bullied, harassed and sometimes hounded from their jobs.
Notwithstanding Mid Staffs, we have much to be proud of in our NHS: the universal access that it pioneered; progress on reducing waiting times; improving cancer survival rates, dementia and mental health care; strong primary care traditions; R&D; medical education and training and our high rating from the Commonwealth Fund.
We also have an excellent 5 year plan for the NHS developed by Simon Stevens which, as we saw from the Budget last week, this government is willing to support financially on the back of a strong economy.
But alongside a plan, we need a vision. That vision encompasses many things: the move from a narrow focus on access targets to a broader vision of what high quality care entails; the change from disjointed episodic care to holistic integrated care; the move to prevention not cure with a much bigger focus on public health and more personal responsibility for our well-being. But running through all these things is a fundamental shift in power from a bureaucratic system where power sits in the hands – ultimately – of politicians to a democratic system where the most powerful person is not the doctor, the manager or even the health secretary but the 1 million patients who use the NHS every 36 hours.
My argument today is simple: if we truly want to change from a bureaucratic to a patient-centric system, the NHS needs a profound transformation in its culture.
‘Patient-centric’ is horrible phrase. How about ‘more human’ – the title of Steve Hilton’s recent book? Because the truth is that decades of building processes around system targets and system objectives, often with the best of intentions, has demoralised staff and patients and dehumanised what should be some of the most human organisations we have.
Just look at some of the metrics we track. ‘Avoidable deaths’ is one of them. And how many are there? Around 800 every single month. That is 800 human beings who have not been treated with dignity, care and respect – with catastrophic consequences.
Another metric is ‘never events,’ the clinical mistakes that are so bad they are simply classified as things that should never, ever happen. One of them is ‘wrong site surgery.’ But how many people know that in our system twice a week on average we operate on the wrong part of someone’s body?
The NHS is by no means unique in this – and arguably it is facing up to these issues better than many other systems. But a more human system would not tolerate them at all. As Steve says, too often “patients have become outputs, their health outcomes, products; our hospitals, factories”.
Honest diagnosis
So how do we change this? As with any illness, the first step is an honest diagnosis.
I call it intelligent transparency – and as we have rolled it out in the last few years there has been fairly predictable opposition. Some worried that openness about failures would lead to an irreversible cycle of decline. Others said it would damage morale and staff retention. When I stood up in the House of Commons two years ago and said care was unsafe not just at Mid Staffs but at 11 other Keogh hospitals, political opponents called it ‘running down the NHS.’
In fact the opposite happened.
Following the Keogh Report and the work of our outstanding Chief Inspector of Hospitals, 21 Trusts – 15% of the total – have been put into special measures. And did staff drain away from them? On the contrary, between them they hired an additional 125 doctors and 871 nurses.
Seven of them have already come out of special measures and nearly all have shown dramatic signs of improvement. This can be seen in the ‘buddying’ arrangements which they adopted with more successful hospitals. George Eliot learned from the IT systems used by QE Birmingham, Buckinghamshire Healthcare is implementing the Salford Royal approach to safety and Medway is learning from the clinical leadership at Guy’s and Thomas’s. Many talk about a dramatic change in culture too – as one nurse at Basildon said to me, ‘if we have a worry about patient care, now they listen to us, before they didn’t.’
But it isn’t just about hospitals. We have pressed on with intelligent transparency for care homes and domiciliary services, where so far nearly 3,000 of 5,000 inspected have been classed as good or outstanding. We have done it for GP surgeries, where the data is less helpful so the Health Foundation is helping us understand how to get better metrics. We have even applied it to the work of individual doctors, where we have become the first country in the world to publish consultant surgery outcomes across 12 specialties, following the pioneering work done in heart surgery by Bruce Keogh and Ben Bridgewater.
And next March we will go further still, becoming the first country in the world to publish avoidable deaths by hospital trust and, with the help of the King’s Fund, publish ratings on the overall quality of care provided to different patient groups in every local health economy. Building on the success of the Friends and Family test, patient experience will be a critical element of how these ratings are constructed.
And has this wave of transparency damaged public confidence in the NHS? Quite the opposite. Last year it went up by 5 percentage points in England to its second highest ever level (compared to Wales, which has resisted transparency, where a survey found public satisfaction fell by 3%). The number of people in England who think they are treated with dignity and respect increased from 63% in 2010 to 76% last year according to Ipsos Mori. Record numbers now say their care is safe and, most encouragingly, the number who think the NHS is one of the best systems in the world has increased by 24 percentage points in the 7 years following Mid Staffs.
Nigel Lawson famously described the NHS as a national religion. The problem with religions is that when you question the prevailing orthodoxy, you can end up facing the Spanish Inquisition. NHS orthodoxy was that criticism should not be made public because it would ‘damage morale.’ We now see that was wrong. Intelligent transparency is becoming a ‘Reformation moment’ for the NHS as the public appreciate that a system with the confidence to be honest about failings is a system that does something to put them right.
And that means honesty with the public about their responsibilities too.
Not just over appropriate use of NHS resources, which is why we are going to put indicative pricing on the outside of more expensive medicines; but also the responsibility each one of us has for our own health and those of our families. Nearly half of the parents of obese children do not even know their child is overweight – even though the subsequent impact in terms of mental and physical health is beyond doubt. Intelligent transparency means an intelligent conversation with the public about the role we all need to play to make ourselves a healthier nation.
Transparency and devolution
One thing though has been a big surprise. Most of the positive changes have come not because people have been instructed, but because they want to make them happen themselves.
Self-directed improvement is the most powerful force unleashed by intelligent transparency: if you help people understand how they are doing against their peers and where they need to improve, in most cases that is exactly what they do. A combination of natural competitiveness and desire to do the best for patients mean rapid change – without a target in sight.
Transparency over outcomes also makes possible true devolution of power.
Every health secretary, of whichever party, arrives in office committed to local decision making, horrified no doubt at the prospect of Nye Bevan’s ‘bedpan from Tredegar’ reverberating around the Palace of Westminster. But then there is a flu epidemic, a care scandal or an A & E nightmare and they discover their inner Stalin as they rush to bang heads together.
But if you have independent, smart measures of performance area by area, hospital by hospital, a health secretary can relax a little. You can start to devolve power – safe on the basis not just of ‘earned autonomy’ for people delivering good quality care, but also because where there are problems, many of them will self-correct. People often say that they need to be given permission to be radical so they can do the right thing for patients. To be empowered to transform services so that they are future proofed, so that they are fit for the 21st century. Well that moment has arrived and we want to support you make those changes.
With smart metrics we can also be less prescriptive about models of care, allowing more space for local ingenuity and innovation. We need to move further and faster towards Valencia-style population-level commissioning with accountable care organisations or integrated care provision planned in Greater Manchester with DevoManc.
And as we do so, we can be officially neutral about whether one part of the country is trying a local authority-led solution just as another tries an acute-led model and another a GP-led plan. All will be assessed and held accountable through the same sensible, clear metrics, all can learn from each other, and with great relief we can consign to the dustbin the idea of continually ‘rolling out’ new models from Richmond House as local bottom-up solutions take the lead.
The world’s largest learning organisation
To power this we need to foster an inquisitive, curious and hungry learning culture. The world’s fifth largest organisation needs to become the world’s largest learning organisation.
That learning will be as much about efficiency as it is about quality, given the tight financial constraints we face. And as trusts embark on that journey, they will need all the support they can get. So today I can announce that the operating name for the new jointly-led Monitor and TDA will be NHS Improvement. I am also delighted to announce that Ed Smith is to be the new chair, supported by Ara Darzi as a new non-executive director. Ed will launch a recruitment process for the new chief executive immediately, which will be completed by the end of September. I would like to take this opportunity to thank Baroness Hanham, David Bennett, Peter Carr, David Flory and Bob Alexander for their outstanding service to the NHS over many years for which we are incredibly grateful.
Because safety and quality will be at the heart of the new organisation’s remit, Dr Mike Durkin’s safety function will move there with 2 early priorities. Firstly, to work with the Chief Nursing Officer to complete the work started by NICE on safe staffing levels. There can be no compromise on the issue of safe staffing and we need a methodology that properly assesses and publishes what appropriate levels of staffing should be, taking full account of the changes that can be made with new technology and modern multidisciplinary work practices. This will be independently reviewed by NICE, the Chief Inspector of hospitals, and Sir Robert Francis to ensure it meets the high standards of care the NHS aspires to.
And, secondly, Dr Durkin will set up a new Independent Patient Safety Investigation Service modelled on the Air Accident Investigation Branch used by the airline industry. A ‘no blame’ learning culture in that industry has led to dramatic reductions in both fatalities and cost – and we now need to do the same in healthcare.
To further strengthen a culture of continuous improvement, we have to be open to insight and expertise from across the globe. I can therefore announce today the start of an international buddying programme. Five NHS trusts – Surrey and Sussex Healthcare, Leeds Teaching Hospitals, University Hospital Coventry and Warwickshire, Barking Havering and Redbridge, and Shrewsbury and Telford – will from this year be partnered with Virginia Mason in Seattle, perhaps the safest hospital in the world. But we will not stop there: if we want to be the best we must learn from the best – whether Kaiser Permanente in California, the Mayo Clinic, Alzira in Spain, Apollo in India or anyone else – and I look forward to developing further international partnerships over the months ahead.
Game-changing innovation is not sustainable without strong leadership, as we know from the excellent Rose Report published today. In line with its recommendations, the national responsibility for nurturing and developing talented leadership in the NHS – including the NHS Leadership Academy – will be brought together and become the responsibility of Health Education England. However, as the report makes clear, every single NHS organisation will be responsible for nurturing the next generation of leaders. As we said in our manifesto, we are considering how best to recognise and reward high performance.
I am also publishing Professor Sir Bruce Keogh’s progress reviewing the professional codes of doctors and nurses. He says that while there have been some improvements, more work needs to be done on incentives so that, like the airline industry, the default option is openness and not reticence when dealing with errors. At its heart this is about rediscovering true professionalism in a clinical context, so I welcome the fact that the Professional Standards Authority will be holding a summit on this in September with Bruce, who will complete his work in October.
Taken together I want these changes to create a profound change in culture in the NHS. For too long we have assumed that the only way to tackle problems is a combination of money and targets. Both have their roles – but both, too, have unintended consequences. Our focus should be different: not top-down targets but transparency and peer review; learning and self-directed improvement that tap into the basic desire of every doctor, nurse and manager to do a better job for their patients; empowered leaders with the permission and the space to excel. In short turning our size and openness to our advantage with that bold ambition to be the world’s largest learning organisation.
And this is my offer to the NHS today: more transparency in return for fewer targets. Learning and continuous improvement at the heart of a more human system where we eliminate any conflict between organisational priorities and what is right for the patient sitting in front of you.
7-day care
One litmus test of our commitment to this is our approach to 7-day care.
This is not about increasing the total number of hours worked every week by any individual doctor. Doctors already work extremely hard, and their hours should always be within safe limits. But we will reform the consultant contract to remove the opt-out from weekend working for newly qualified hospital doctors. No doctors currently in service will be forced to move onto the new contracts, although we will end extortionate off-contract payments for those who continue to exercise their weekend opt-out. Every weekend swathes of doctors go in to the hospital to see their patients, driven by professionalism and goodwill, but in many cases with no thanks or recognition. The aim is to acknowledge that professionalism by putting their contributions on a formalised footing through a more patient and professionally orientated contract. As a result of these changes by the end of the Parliament, I expect the majority of hospital doctors to be on 7-day contracts.
Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday. No one could possibly say that this was a system built around the needs of patients – and yet when I pointed this out to the BMA they told me to ‘get real.’ I simply say to the doctors’ union that I can give them 6,000 reasons why they, not I, need to ‘get real.’
They are not remotely in touch with what their members actually believe. I have yet to meet a consultant who would be happy for their own family to be admitted on a weekend or would not prefer to get test results back more quickly for their own patients. Hospitals like Northumbria that have instituted 7-day working have seen staff morale transformed as a result. Timely consultant review when a patient is first admitted, access to key diagnostics, consultant-directed interventions, ongoing consultant review in high dependency areas, and proper assessment of mental health needs: I will not allow the BMA to be a road block to reforms that will save lives.
There will now be 6 weeks to work with BMA union negotiators before a September decision point. But be in no doubt: if we can’t negotiate, we are ready to impose a new contract.
Patient Power 2.0
Taken together, these changes are profoundly important for patients. But they are not complete because they leave untouched the essential power relationship between doctor and patient. However, thanks to technology and science, we now have the possibility to remedy this, with a radical permanent shift in power towards patients.
If intelligent transparency is Patient Power 1.0, this is Patient Power 2.0. We have the chance to make NHS patients the most powerful patients in the world – and we should leap at the opportunity.
Within the next 5 years our electronic health records will be available seamlessly in every care setting. You will be able to access them, share them, mark preferences, and shape the care that you want around them. We will be decoding individual genomes, allowing us to target personalised medicines, improve diagnosis and therapy, and reduce waste. New medical devices will mean an ambulance arrives to pick us up not after a heart attack but before it – as they receive a signal sent from a mobile phone.
With 40,000 health apps now on iTunes, these innovations are coming sooner than most people realise. The future is here, but it needs to be more evenly distributed. Heart rates and blood pressure will no longer be simply a matter for the doctor – patients will know them and monitor them too. Data sharing between doctor and patient means power sharing too. Intelligent transparency creates intelligent patients with healthier outcomes. Get this right and it is no exaggeration to say that the impact will be as profound for humanity in the next decade as the internet has been in the last.
And I want the NHS to get there first.
So last September, we launched myNHS, where patients can see information about the quality of services provided by hospitals, GPs, surgeons, and local authorities all in one place. So far there have been 244,000 visits to the site with raw data being downloaded over 5,000 times.
Last year we also increased the number of GPs offering patients access to their summary medical record online from 3% to 97%, alongside the ability to book appointments and order prescriptions – 2.5 million patients have activated this service so far.
But we need to go much further and today I want to highlight 3 areas in particular.
Firstly, I want to make sure that patients really are in a position to do something about the information they now have for the first time. Real patient power is not just about knowledge – it is being able to act on that knowledge so that those providing care feel financial, as well as operational, consequences.
So from next year as part of the new electronic booking service, which has replaced Choose and Book, all GPs will be asked to tell patients not just which hospitals they can be referred to, but the relevant CQC rating and waiting time as well. Because those ratings now include patient experience, safety and quality of care, patients will for the first time be able to make a truly informed choice about which local service is best for them. Patients also need to be able to make a meaningful choice about which GP surgery is most appropriate for their needs. Right now that is not always possible because practices get full and there is a lack of capacity. We will address this through our New Deal for General Practice which will boost GP provision in under-doctored areas, with NHS England giving particular attention to making sure that there are alternatives available when a practice has been rated ‘inadequate.’
But patient power is not just about being able to choose the right provider – it is also about being able to choose the right service within each provider.
In 3 areas in particular we still too often tell patients what service is available on a take it or leave it basis without allowing them to choose what is most appropriate for their needs. So today I can announce that before the end of this year, NHS England will come up with concrete proposals to make sure that there is meaningful choice and control over services offered in maternity and end of life care and for those with complex long term conditions.
Finally if we are to embrace the potential for technology to shift power to patients, we need patients to be willing and able to harness that technology. Digital inclusion is as vital in healthcare as everywhere else – not least because some of the greatest impacts of new technology in health is with the most vulnerable patients. I have therefore asked Martha Lane-Fox to develop some practical proposals for the NHS National Information Board before the end of the year as to how we can increase take-up of new digital innovations in health by those who will benefit from them the most.
Conclusion
The Forward View sets our course for 5 years. Over those 5 years patients can look forward to a 7-day NHS offering safer and more integrated care than ever before as we start to rise to the big challenges of the 21st century: making healthcare more human-centred and not system-centred.
But the transition to patient power will dominate healthcare for the next 25 years. We cannot resist the democratisation of healthcare any more than we can resist democracy itself. But we can choose whether we want the NHS to be the leader of the pack, turning heads across the globe, or a laggard always struggling to embrace innovation adopted earlier elsewhere.
Mid Staffs, curiously, can help us here. It was indeed a terrible shock as we looked in the mirror and saw just how far we had drifted from a truly patient-centred system. But if we learn the lessons, it could also be a decisive moment of change when we break from the past and resolve to become the first truly democratic, patient-centred healthcare system in the planet.
Starting with intelligent transparency, then using it to foster a learning culture to support and empower staff, then embracing technology to give patients real control of their own health and care – that is the journey that beckons. The world’s largest learning organisation supporting the world’s most powerful patients: time to get real to the opportunity and rush to embrace it.
Fit and Proper Persons: CQC’s movable goal posts
To Professor Sir Mike Richards, CQC Chief Inspector of Hospitals,
10 July 2015
Dear Professor Richards,
Re: CQC, whistleblowing and Regulation 5 Fit and Proper Person (FPPR)
Many thanks for your letter of 30 June, received by email on 1 July. In this response I will focus on the issue of FPPR’s retrospective scope. I will respond to other aspects under separate cover.
To recap, on 17 April, I received a letter from you about FPPR that stated:
“Directors who were unfit prior to the introduction of Regulation 5 in November 2014 are outside our remit”
This surprised me because the original FPPR guidance issued by CQC in November 2014 [1] explicitly clarified that there was no time limit for considering past failure or serious misconduct, page 24:
“While CQC will have regard to information on when convictions, bankruptcies or similar matters are to be considered ‘spent’, there is no time limit for considering serious misconduct or responsibility for failure in a previous role.”
I sought clarification of the discrepancy. This was particularly as I noticed that the above reference to FPPR’s retrospective scope seemed to have been omitted from additional FPPR guidance that CQC issued, on 27 March 2015. [2]
In your letter of 30 June you advised me that the original November 2014 CQC guidance on FPPR’s retrospective scope stands, but that:
“CQC exercises discretion about whether to consider old information which is not current”
“The application of this new regulation is not clear-cut or straightforward, and we have put systems in place to enable us to consider information on a case by case led by the most senior levels in CQC and supported by senior policy and senior legal colleagues”.
I am concerned by this. It seems to me that CQC is inconsistent in its application of FPPR, and the goal posts seem to be movable. Indeed, no one has yet been held accountable for gross whistleblower reprisal, even though parliament, Sir Robert Francis and Sir Anthony Hooper have all acknowledged that it happens and is a sign of unfit leadership. Dr Kevin Beatt’s case, despite detailed ET findings on serious detriment, has been rejected by CQC.
Nevertheless, I would be grateful if you could please clarify:
a) Whether you have advised anyone else that “Directors who were unfit prior to the introduction of Regulation 5 in November 2014 are outside our remit”?
b) Whether you will amend your advice to these individuals given that CQC now says its original guidance of 27 November 2014 (on retrospective scope) stands?
c) Will CQC revise its FPPR guidance of 27 March 2015, to include the original, crucial 27 November 2014 advice that “there is no time limit for considering serious misconduct or responsibility for failure in a previous role”?
Yours sincerely,
Dr Minh Alexander
Cc David Behan CEO CQC
Dr David Drew
House of Commons Health Committee
Sir Robert Francis CQC NED
Dr Louis Appleby CQC NED and Chair of CQC Regulatory Governance Committee
[1] Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour Guidance for NHS bodies, CQC 27 November 2014
[2] Regulation 5: Fit and proper persons: directors Information for NHS bodies, CQC 27 March 2015
Another message in a bottle to Mr Jeremy Hunt
To: Rt Hon Jeremy Hunt, Secretary of State for Health, 27 June 2015
Dear Mr Hunt,
Report on NHS management by Sir Stuart Rose, announced by the Department of Health February 2014 [1]
I write to ask for a copy of the above report by Sir Stuart Rose under the Freedom of Information Act 2000.
The findings of the report have been widely leaked for some months now. These leaks make alarming reading. For example:
“Stuart Rose has concluded that mediocre managers are allowed to move from job to job without being held to account and that success is insufficiently rewarded or celebrated, people familiar with the contents of his report say.”[2]
You will be aware that the recycling of poor NHS managers is of great relevance to whistleblowing governance. Whistleblowers frequently find that managers who have suppressed concerns and victimised them are not held accountable, or are even promoted. It is of concern that you have not authorised the release of Sir Stuart’s report despite your professed support for patient safety and transparency in the NHS, and your promise to “call time” on the mistreatment of whistleblowers. The failure to publish is a serious omission especially given that the Department of Health has been consulting on the implementation of Sir Robert Francis’ Freedom to Speak Up review. Crucial insights from Sir Stuart’s report have been withheld from this process and this will likely contribute to less effective whistleblowing measures.
The Chair of the Health Committee has criticised the failure to publish Sir Stuart’s report. [4]
It is also relevant to note that the Department of Health has suppressed important past reports that criticised NHS management and safety culture, some of which were only released after FOI requests. [3]
Moreover, I am sure that you and the Department of Health will also be aware of countless enquiries via social media by named individuals, over many months, about the publication of the report. ICO have advised public bodies to treat such enquiries as valid requests for information. [5]
Accordingly, I would be grateful if you could also advise when the Department of Health will publish Sir Stuart’s report, with reference to statements by the Department in February that it will be published “in due course”.[2]
Lastly, as I assume that this will not be the first FOI request that you have received regarding Sir Stuart’s report, please could you advise how many FOI requests that you and or the Department of Health have received
i) requesting a copy of Sir Stuart’s report
ii) requesting information about the report’s publication
Yours sincerely,
Dr Minh Alexander
cc ICO
Committee for Standards in Public Life
Lord Paul Bew
Sir Jeremy Heywood Cabinet Secretary
[2] Rose report criticising management of NHS ‘put on back burner’, Financial Times 16 February 2015
[3] When managers rule Patients may suffer, and they’re the ones who matter, Prof Brian Jarman, BMJ Editorial 19 December 2012
[4] Jeremy Hunt accused of covering critical report, Toby Helm Political Editor, Guardian 7 March 2015
[5] Recognising a request made under the Freedom of Information Act (section 8), ICO 2014 https://ico.org.uk/media/for-organisations/documents/1164/recognising-a-request-made-under-the-foia.pdf
House of Lords – whistleblowing
House o of Lords 30 June 2015
Whistleblowing – 14.45 mins into the viedo
http://parliamentlive.tv/Event/Index/730db1df-f28c-4bd4-b10a-fc9964519c54
N&N hospital chief resigns after report highlights alleged ‘bullying culture’
Eastern Daily Press
27 June 2015 Lauren Cope and Nicholas Carding
Anna Dugdale, has resigned as chief executive of Norfolk and Norwich University Hospital. Picture: DENISE BRADLEY
The chief executive of the Norfolk and Norwich University Hospital resigned last night following discontent among medical staff and a critical report which highlighted an alleged “bullying culture”.
Anna Dugdale revealed she would be stepping down after a Care Quality Commission (CQC) report, published earlier this month.
The announcement came after more than 150 consultants met hospital chairman John Fry to raise concerns about how their trust dealt with the issues raised in the report, including allegations of bullying.
The consultants gathered initially on Thursday night to discuss their concerns about the hospital leadership.
One source said staff had “lost confidence” in the chief executive after the CQC report which alleged a “bullying culture” at the trust was coming from the highest level of management.
Mrs Dugdale sent an email to staff at 6.20am today announcing that she was stepping down. The email said that the hospital was making arrangements for a handover.
On her resignation, Mrs Dugdale said: “I have worked at the Norfolk and Norwich University Hospital for many years, and as its chief executive for the last six. I love this hospital, I am so very proud of our staff and feel passionate about the care that we give our patients.
“This last year, however, has been one of the most challenging ever and two weeks ago we received a report from the CQC that raised some serious criticisms of areas of our work.
“As the chief executive I take responsibility for this and, therefore, today I have tendered my resignation.
“I believe that this is a truly great hospital and I have been so proud to serve the people of Norfolk as part of such a fantastic hospital team.”
She thanked hospital staff, patients and public for their support.
Mr Fry said Mrs Dugdale had been a “wonderful” chief executive.
“She has played a huge role in developing the hospital, its services for patients and partnerships with the UEA and Norwich Research Park,” he added.
“Her drive and commitment to the hospital, its staff and patients has been unrivalled. We owe her an enormous debt. Anna will be sorely missed and she leaves us with our very best wishes.”
A consultant at the hospital, who did not want to be named, said there was anger at the way Mrs Dugdale had informed staff about the CQC report and said that there was a “feeling the trust were trying to ignore the issues raised by the CQC”.
In a letter to staff, seen by the EDP, Ms Dugdale only referred to the trust’s NHS Staff Survey result which placed them in the bottom 20pc nationally for bullying and harassment and did not address the alleged “bullying culture” in the staff letter.
Mr Fry said: “Nobody should be bullied at work but our staff have highlighted a concern about bullying and harassment.
“This is something we take very seriously and we have been carrying out extensive work with staff members and staff representatives to develop and implement an action plan to address this issue. We are proud of our hospital and the care that we provide for our patients.
“We are introducing more frequent staff feedback surveys to monitor the effect of the measures we are taking.”
Do you have experiences of bullying in the health service? Email nicholas.carding@archant.co.uk
Critique of Francis’ model of Trust-appointed Guardians
From submission to Department of Health consultation on the implementation of the Freedom to Speak Up Review, by Minh Alexander former consultant psychiatrist, 4 June 2015
“Francis greatly emphasised the example of the Cultural Ambassador at Staffordshire and Stoke on Trent Partnership Trust (SSOTP) as supporting evidence for his proposal to introduce whisteblowing guardians nationally. He featured the SSOTP model in the Freedom to Speak Up report. At the launch of his report Francis told whistleblowers that the present incumbent had proven that such a post could work.
Few facts had been offered about the provenance or efficacy of the model, other than that a low staff uptake had prompted this arrangement, and that uptake subsequently increased “dramatically”. No other parameters were explored in Francis’ report. Details of staff contacts with the Ambassador have now been requested from the Trust and are awaited.
The Ambassador post was established two years ago in April 2013. The Trust has confirmed to me that no evaluation of this new role has yet been carried out. [1]
The Trust signals an intention for evaluative research to be carried out, but no decision has been made yet on how this will be done.
What then are the other sources of information that might shed light on the effectiveness of the model?
Local press reported that recent, significant external whistleblowing disclosures were made about the Trust. It is alleged that staff reported externally because of issues of organisational culture and because little was done to rectify safety issues despite managers being made aware of the problems. [2,3,4] If so, this raises a question of what is contributed by a Guardian-type role where there are particularly serious and knotty problems that an organisation might find threatening. For example, some of these external disclosures ultimately led to regulatory action on staffing levels, which may in turn present other challenges for a Trust seeking Foundation status.
Notwithstanding, it is recognised that external whistleblowing is often an indication of an internal blockage of some sort. The Trust’s response to press coverage of leaks was to emphasise to its staff that internal reporting was encouraged, but there was no clear acknowledgment of failure to engage with staff. [5]
Some external disclosures by SSOTP staff have been made to CQC. A full list of disclosures has been requested under FOI arrangements and is awaited. Meanwhile, remarks in a CQC inspection report of 19 March 2015 may reflect tensions inherently thrown up by an Ambassador role:
“Action the provider MUST or SHOULD take to improve
- Review the internal communication arrangements for the Ambassador for Change to ensure transparent lines of communication and staff feel reassured that the role is organisation wide, not part of the management process”
It would be understandable that any Ambassador role, irrespective of the person in post, may be viewed hesitantly if staff are wary of management commitment to transparency.
NHS Staff Surveys for SSOTP in the last 3 years, against national averages for comparator trusts, do not show major changes over the period in which an Ambassador post was established:
| Parameter | 2012 | 2013 | 2014 |
| Overall staff engagement | 3.70(average 3.69) | 3.69(average 3.71) | 3.70(average 3.75) |
| % of staff witnessing errors, near misses and incidents in the last month | 21%(average 26%) | 23%(average 26%) | 19%(average 23%) |
| Fairness and effectiveness of incident reporting procedure | 3.55(average 3.54) | 3.45(average 3.53) | 3.50(average 3.58) |
| % of staff agreeing that they would feel secure raising concerns about unsafe clinical practice | _ | _ | 70%(average 72%) |
| % of staff reporting errors, near misses and incidents witnessed in the last month | 88%(average 93%) | 92%(average 925) | 91%(average 94%) |
| % of staff reporting good communication between senior management and staff | 26%(average 28%) | 23%(average 29%) | 28%(average 33%) |
| %of staff experiencing harassment, bullying or abuse from other staff in last 12 months | 19%(average 20%) | 21%(average 20%) | 23%(average 24%) |
| Staff recommendation of the Trust as a place to work or receive treatment | 3.58(average 3.58) | 3.57(average 3.59) | 3.56(average 3.66) |
These figures give only a rough indication of some of the issues, and may be affected by factors other than the work of an Ambassador. Broadly though, they are not by any means proof that an Ambassador model clearly generates improvement around issues of raising concerns. Confidence in the fairness of incident procedures remained slightly below average. When a measure about staff’s sense of security in reporting concerns was added in 2014, this was slightly below average too.
Whistleblowers, who have seen all that the most corrupt employers can do to manipulate and pervert processes, do not have any expectations that closed organisations will be transformed by Trust-appointed whistleblowing Guardians. In such trusts, Guardians will at best be ignored, and ineffectual as a result of impassable systemic issues. More likely, the worst organisations will appoint in their own image. The role could be used to help conceal continuing whistleblower reprisal whilst falsely white washing organisational reputations. The analogy of prefects from Tom Brown’s school days comes to mind.
There is another indication that Francis’ whistleblowing Guardian experiment will fail. There is already evidence that some organisations are ignoring Francis’ recommendations that:
(i) Whistleblowng Guardians posts should be dedicated roles
(ii) The Whistleblowing Guardian role should not be on top of someone’s existing duties
(iii) Whistleblowing Guardians are ideally in a professional role, to gain the trust and confidence of colleagues.
Of concern, these are examples of whistleblowing Guardians that have been quickly appointed by NHS organisations whilst the DH consultation has been taking place:
“Formally appointing the Executive Director of Nursing, Quality and Governance as the Trust’s Freedom to Speak Up Guardian”
“…also appoint: Assistant Director, Corporate Governance as the ‘Freedom to Speak Up’ Guardian”
“The identification of one official Freedom to Speak Up Guardian, to concentrate on the assurance side, proposed to be the Director of Quality and Assurance”
“The Head of Governance, who is identified as our designated officer in the Raising Concerns Policy, to also take on the role of ‘Freedom to speak up
Guardian”
“…Director of Communications and Business Services… has also been appointed by the Audit and Governance committee as the “Freedom to Speak Up Guardian”
These appointments are clearly at odds with the Freedom to Speak Up review’s intentions. Arguably, they show corporate bias, little prioritisation of whistleblowing governance, and failure to appreciate (or care about) the nuances of staff advocacy. It is questionable that Trusts were told that they could move ahead with making arrangements before the Department of Health Speak Up consultation had taken place. However, their actions are part of the evidence that the Trust-appointed Guardian model lacks sufficient robustness and credibility.
A whistleblower contributor to the Francis review, who has worked in a established Guardian type role for some time, has very clearly advised that such a role can make a contribution but:
“… is in no way a panacea for remedy to prevent further scandals within the NHS.
And the whistleblower remains of the opinion that:
“In order to change the culture a proper whistleblowing inquiry is necessary”
This person remains conscious of the marked imbalance of power, disadvantage and stress that staff face when raising concerns. In common with the majority of whistleblowers, this person emphasises that until root causes are genuinely addressed, the overall dysfunction will continue.
Robert Francis stipulated that Trust-appointed Guardians must command the confidence of Chief Executives. Where the Chief Executive is corrupt, this is clearly nonsense, as the Guardian would have to act corruptly too, in order to command the Chief Executive’s confidence. This contortion of logic lies at the heart of Robert Francis’ fatally flawed proposal.
It is also important to note that the more robustly those in current Guardian-type posts advocate for patients, the more likely it is that they will experience retaliatory mistreatment. This has reportedly sometimes been very serious.
In summary, Trust-appointed whistleblowing Guardians are the lynchpin around which Francis’ proposals are built. Given the lack of evidence that such posts can be relied on as the key intervention to prevent whistleblower reprisal or to reduce fear, and evidence that organisations are already making inappropriate appointments, the Freedom to Speak Up review falls.”
[1] Correspondence with Stuart Poynor SSOTP Chief Executive, 1 June 2015
[2] Leaked NHS dossier: nurses log concerns over care. D Blackhurst, Staffordshire Sentinel, 2 April 2015
[3] Leaked NHS report reveals dying patients left alone and in pain, staff at breaking point, Staffordshire Sentinel, 2 April 2015
[4] NHS ordered to appoint more district nurses in North Staffordshire, Staffordshire Sentinel, 9 May 2015
[5] Health staff told ‘don’t speak to press’ after regional daily expose. David Sharman, Staffordshire Sentinel, 5 May 2015
Postscript 20 June 2015
Comments were sought from the Ambassador at SSTOP. These were received after the submission above was made to the Department of Health. I add them here for completeness. It is the Ambassador’s view that:
“The ambassador role works alongside a range of mechanisms within the Trust to support staff to raise concerns and anecdotal evidence indicates that less staff are taking sick leave or leaving the organisation because they have been listened too and supported.
The Trust is committed to openness and transparency, however changing culture across such a large organisation is a process which will undoubtedly take a significant period of time to successfully achieve and more does still need to be done.
We know there are pressures on the services and staff are working flat out to try to keep pace with growing demand and expectations and the Trust is working hard to ensure teams are able to deliver quality care.
It is encouraging staff have had the confidence to raise issues either with the CQC or with ourselves and the Trust recognised many of the themes raised by staff. Following recent press reports regarding incidents, I would have liked this person to have felt they could approach me direct but obviously felt they could not.
Staff continue to be encouraged to use existing internal mechanisms to ensure that support and appropriate action can be taken to resolve any issues as quickly as possible.
With regards to evaluation of my role, there are plans to establish when and how this will be done”.
The data from SSOTP about staff contacts with the Ambassador is awaited.
Minh Alexander
Letter to the CEO of the NHS Litigation Authority (NHSLA)
To: Helen Vernon CEO NHS Litigation Authority, 18 June 2015
Dear Ms Vernon,
Re: NCAS and implementation of Sir Anthony Hooper’s recommendations on protecting NHS whistleblowers
Thank you for your letter dated 8 May 2015, which I received by email on 23 May, and which is copied below.
It is good to hear that NCAS provides national training for case managers and case investigators on vexatious concerns. I would be very grateful if NCAS could share the details of its training guidance on vexatious concerns, as this material is of obvious interest to whistleblowers who often find themselves the subject of vexatious referrals to NCAS.
Given that NCAS accepts that concerns may be raised vexatiously against doctors, I struggle with your advice that:
“NCAS does not investigate concerns and we rely on the integrity of the information provided by both the referring organisation and practitioner in our dealings with a case.”
“As stated previously NCAS has no remit to assess or test the veracity of the information provided by either party.”
It seems to me that if NCAS accepts that vexatious complaints are made, it should not rest content with its current lack of procedural safeguards against the persecution of innocents. NCAS has great power. A referral to NCAS can be hugely stressful and also damaging to a doctor’s reputation. Yet whistleblowers who are maliciously referred to NCAS report that NCAS typically refuse to engage with them, even when provided with evidence of false allegations by employers. Instead, it is the experience of whistleblowers that NCAS will continue to approve harmful employer actions.
I have to question the value that NCAS adds if it makes no effort at all to challenge or dissociate itself from trumped up processes, even when provided with evidence. If you are correct in asserting that NCAS has no remit at all to investigate, then this seems a very serious structural flaw that should be addressed. This is especially so when NCAS continually reminds employers of the importance of accuracy, through the standard disclaimers in NCAS letters of advice. I would be grateful to know if NHSLA would be prepared to seek changes in NCAS’ remit, to enable a degree of investigation and fairer treatment of whistleblowers.
It is relevant to note here that Sir Robert Francis advised regulators to seek amendments to their regulations, if necessary, in order to protect whistleblowers more effectively. [1] I feel that a similar principle should apply to NCAS.
I should also point out that it is in fact senior doctors, acting as MHPS case managers [2], who are often key culprits in the victimisation of medical whistleblowers. Training such managers to recognise vexatious concerns misses the point. What is needed are mechanisms to hold them to account. That is what Sir Anthony sought in his proposal that registered doctors should sign referrals and attest to truth:
“68. Failure to answer the question truthfully would no doubt lead to the signing doctor’s fitness to practise being investigated and, if discovered during the course of the investigation, would be an important factor in assessing the credibility of the allegation”. [3]
I would be grateful to hear from NCAS, once it has considered GMC’s response to Sir Anthony Hooper’s recommendations, on whether it will introduce a comparable safeguard in its process.
Lastly, I must disagree with your assertion that PIDA currently protects staff who raise concerns. You say:
“Furthermore, the Public Interest Disclosure Act 1998 protects workers that disclose information about malpractice at their workplace, from suffering detriment as a result of having made a disclosure providing certain conditions are met”.
Numerous authorities, Sir Robert Francis amongst them, now acknowledge that PIDA is weak and does not protect whistleblowers from reprisal. It only provides compensation after the event.
“..the existing legislation is weak”
“..it provides remedy rather than protection against detriment” [1]
I think that unless NHSLA recognises that PIDA does not protect NHS whistleblowers, there is a risk that it will not formulate proportionate action or undertake appropriate reform of NCAS. Continuing injustices to whistleblowers place patients at risk, and they are also very wasteful.
Yours sincerely,
Dr Minh Alexander
cc Sir Jeremy Heywood, Cabinet Secretary
Health Committee
Public Accounts Committee
Sir Anthony Hooper
[1] Report of Freedom to Speak Up Review on NHS whistleblowing by Sir Robert Francis, February 2015
[2] Maintaining High Professional Standards in the Modern NHS, a framework for the handling of concerns about doctors and dentists in the NHS, DH 2005
[3] The handling by the General Medical Council of cases involving whistleblowers. Report by the Right Honourable Sir Anthony Hooper to the General Medical Council, 19th March 2015
Queen’s personal surgeon hit by ops ban: Whistleblower suspended after voicing concerns over NHS Grampian’s running of Aberdeen infirmary
Daily Record 1 JUNE 2015 BY CHARLIE GALL
PROFESSOR Zygmunt Krukowski blew the whistle on the way Aberdeen Royal Infirmary was being run and it is claimed NHS Grampian are taking ‘revenge’.
The Queen’s personal surgeon has been suspended from his duties at Aberdeen Royal Infirmary. The Queen’s personal surgeon (right) has been suspended from his duties at Aberdeen Royal Infirmary
THE Queen’s personal surgeon in Scotland has been suspended from operating after a probe into whistleblowing.
It is claimed NHS Grampian bosses took “revenge” on Professor Zygmunt Krukowski for blowing the whistle on the way Aberdeen Royal Infirmary was being run.
Krukowski heads the team on standby to care for members of the Royal Family if they require treatment while staying at Balmoral on Deeside.
The professor is understood to have highlighted serious concerns over health care in the region.
A second surgeon, Wendy Craig, who works in the same surgery department, has also been suspended for raising concerns following dignity at work reviews.
It’s understood the pair were seen as troublemakers by bosses and there is no medical reason for their suspensions.
A source said the pair had been left “devastated and angry” and felt they had been “professionally destroyed” for raising concerns.
Reuters/Russell CheyneProfessor Zygmunt Krukowski is the Queen’s personal surgeon.
They were said to feel the time had come for “a judge-led” inquiry into the management of NHS Grampian.
Yesterday, an NHS Grampian spokeswoman said: “It is our practice not to discuss
individual members of staff.
“NHS Grampian recognises that, in the main, employees do their best to achieve high standards of conduct and do not attend work with the intention of behaving inappropriately whether that is to other individuals or in the conduct of their role.
“It is inevitable, however, that some employees may, on occasions, fail to meet
acceptable standards.
“There are robust policies in place to promote the resolution of such difficulties in a supportive, fair, consistent and proactive way.”
It emerged that some operations, including cancer surgery, had been postponed because of the suspensions.
Aberdeen Royal InfirmaryAberdeen Royal Infirmary
The spokeswoman added: “We would like to apologise to any patients affected
“We have been and will continue to be in contact with affected patients.”
NHS Grampian hit the headlines last year when three separate inquiries were launched into Aberdeen Royal Infirmary and Woodend Hospital.
The situation, raised at the top of the Scottish Government and in parliament, led to the departure of board chairman Bill Howatson and chief executive Richard Carey.
A review by the Royal College of Surgeons of England found “very serious allegations” about the “behaviour, competence and probity” of medical staff in general surgery at ARI and called for fundamental reforms to the department.
A second review by Healthcare Improvement Scotland (HIS), which was ordered by the government, also lamented the conduct in general surgery and its impact on patient care.
Francis : a teacup of water to put out a house fire
Katherine Murphy, Chief Executive, Patients Association
9 May 2015
Dear Katherine,
DH consultation on the implementation of Francis’ Freedom to Speak Up review
I write as invited by the Patients Association to comment on the implementation of the Freedom to Speak Up report. I have already copied Patients Association into a summary of my concerns about Francis’ failure to address the specific issue of accountability (attached). In this letter I will summarise my general concerns, and I will focus in detail on the central issue of abuse of power and the importance of independent mechanisms for managing this.
General comments
Francis’ Speak Up review report is seriously flawed and features numerous omissions and internal consistencies. Francis admits that there is serious victimisation of whistleblowers, that occurs on a grand scale scale and is an ongoing problem. However, his report also pathologises whistleblowers and presents this as part of a range of excuses for serious management misconduct. Francis is silent as to any description of the nature and scale of matters that have been covered up, although whistleblowers have told him of many matters such as avoidable patient deaths and criminal offences, and their cover up. His report thus lacked authority in its failure to properly demonstrate the proportionality of his proposed measures.
Shockingly, Francis advised against review of past cases, even though many are very recent. Unlike the Hooper report on GMC and whistleblowing [1], Francis’ report is also unfair in the ineffectiveness of its proposed measures. This in my opinion is so serious that it amounts to a form of willful blindness. This is underlined by the fact that Francis has contradicted his own past comments on several matters, as part of reaching unsatisfactory conclusions and recommendations. Furthermore, Hooper commented on matters outside of his terms of reference where serious injustice was evident. Francis in contrast did not, and several elephants still stand in the room, such as the role of ministers and civil servants in whistleblower suppression. Evidence continues to flow freely of the DH and Health Secretary’s refusal to intervene when whistleblowers are suppressed and harmed. [2]
Abuse of Power and failure by Freedom to Speak Up to remedy this
Whistleblower suppression is abuse of power, by organisations with far superior resources, against staff who are rendered extremely vulnerable. This huge inequality of arms (a concept with which Francis as a barrister will be familiar) allows employers to neutralise perceived threat from whistleblowers with relative ease. I am sure the Patients Association will recognise the NHS tactics used against whistleblowers as very similar to those directed at complainants. [3]
NHS employers can isolate and silence staff through ostracisation, general intimidation, processes such as suspension, and other procedures that impose confidentiality or by strong arming staff into compromise agreements with confidentiality clauses. Employers can and do easily falsify evidence against whistleblowing staff to discredit them and enable their dismissal or justify malicious referrals to professional regulators. Employers often ignore and fail to investigate concerns, or defensively prolong matters. They also frequently conduct corrupt investigations into whistleblowers’ concerns in order to produce false assurance for regulators. Such investigations may be done in house, or for the appearance of impartiality, they may be outsourced, but with ultimate control remaining in the employer’s hands.
For example, in the case of Dr Hayley Dare [4] , her employer arranged an “independent” investigation into her safety concerns. However, the investigator who undertook it was in fact hired by her employer’s solicitors.
The degree of concealment can be extraordinarily intense, orchestrated and sustained. Well-known cases such as that of Raj Mattu demonstrate this. [5,6] Parliamentary Health Committee members have borne witness to many serious cases, and have openly likened the NHS to the Mafia in its treatment of whistleblowers. Many millions are wasted on improperly protecting reputations, at the expense of improving patient safety. Such waste is an unaffordable diversion of resources from patient care.
It would be self evident to most that a corrupt employer should not be allowed to mark its own homework. As such, there have been repeated calls for years by MPs, campaigners, experts, and the Health Select Committee for an independent body and or mechanism that can support, protect and if necessary, investigate NHS whistleblower’s concerns. [7] Most recently, Andy Burnham shadow health secretary also proposed an independent body. [8] Francis however, rejected the need for an independent body.
Independence in an NHS context would require a reporting line that is outside of the Department of Health’s line management (or that of any of its subordinate or arms length bodies such as CQC). There would otherwise be a clear conflict of interest between the DH as the body responsible for NHS stewardship, and the handling of concerns about the services for which it is ultimately responsible.
As you will know, the Public Administration Select Committee in its recent inquiry into NHS Complaints and Clinical Failure [9] affirmed the great importance of timely and independent investigation of serious patient safety issues. It emphasised that when safety issues are considered, the whole system should be evaluated, taking into account the actions of commissioners and regulators. In order to remove current conflicts of interest from such parties’ oversight of safety investigations, PASC recommended that a national investigative body that reports directly to Parliament is established.
Inexplicably Francis, despite all the mass of evidence that he was given about the above corrupt processes used against whistleblowers, did not make any provision for truly independent investigation or support. This was altogether unexpected, given that he had previously recommended that complaints about serious safety incidents should be independently investigated. [10] Francis also previously recognised that Boards often control whistleblower reprisal, and he recommended that CEOs who victimise whistleblowers should be sacked. [11] Further, he recommended that criminal sanctions be introduced for whistleblower reprisal. [12] The above demonstrated that Francis had a clear understanding of the need for independent process.
However, in his Freedom to Speak Up report, Francis suggested that local whistleblowing guardians should be employed by and based within NHS Trusts, and that the “independent” national guardian should operate under the combined aegis of CQC, Monitor and NHS England. In reality, these proposed arrangements are neither independent nor without conflicts of interest. Francis’ proposal has also been criticised because the bodies that he entrusts with whistleblower welfare are believed by many to be sources of the top down bullying in the NHS, and responsible for a “culture of fear and compliance”. Furthermore, whilst Francis superficially opined that “an element of independence” would be desirable in the investigation of staff concerns, he watered down the arrangements in that:
- He advised that the “independent” national guardian should not investigate whisteblowers’ concerns or have binding powers.
- He left the control of investigations in employers’ hands, and allowed them to decide which cases would require “independent” investigation
Paradoxically, Francis at the same time as recommending that precious resources should be spent on his toothless guardians, dismissed the establishment of an independent body because it was purportedly too “bureaucratic”. He also repeatedly dismissed formal processes as “too legalistic”, when in fact it is arbitrary and corrupt process that is the undoing of whistleblowers. But then, language and spin can be very powerful tools in the service of bias.
All this gives substantial comfort to rogue employers and enables suppression to continue. Without sound process, it will remain just as hard and risky for staff to speak up, and there are dangers for the interests of patients. Arguably, there is now even greater danger to patients as the current government pursues its political agenda of slashing services. It is especially regrettable that further cover ups have been enabled through such weak governance.
Moreover, the government’s consultation [13] on the implementation of Francis’ report is highly restrictive. It allows only comment on how his very flawed proposals should be enacted. As you know from correspondence into which I have copied you, the DH has confirmed that it will disregard any comments that fall outside of its very narrow consultation framework. By implication, the DH will therefore ignore Andy Burnham’s call for a properly independent whistleblowing body.
In short, Francis has surreally offered whistleblowers a teacup of water to put out a house fire, and the DH are consulting on what sort of teacup it should be.
I ask the Patients Association to reject Francis’ report and the government’s charade of consultation, and to call for a public inquiry into NHS whistle blowing to allow true learning. I also ask the Patients Association to call for urgent redress for whistleblowers who have been harmed and are seriously struggling. As you will know, the Health Committee called for whistleblowers who have been harmed to be identified, given an apology and practical redress. It is shameful that dedicated staff who have stood by patients are now consigned to long term unemployment and food banks, and face uncertain old age due to pension losses.
In order to stand by patients, I ask that the Patients Association stands by whistleblowers and helps to prevent future suppression. Until whistleblowers and complainants are fairly treated, healthcare failures and serious avoidable harm will continue.
Please let me know if any additional clarification is required.
With best wishes,
Minh
Dr Minh Alexander
Whistleblower and former consultant psychiatrist
Enc. Article on Freedom to Speak Up report and issues of accountability.
[1] The handling by the General Medical Council of cases involving whistleblowers by Sir Anthony Cooper QC, 19 March 2015
[2] Health secretary: ‘victimisation’ of Croydon NHS whistleblower not my problem. Croydon Guardian, 23 April 2015
[3] 21 ways to skin a whistleblower, Andrew Bousefield, Private Eye Special issue 2011
[4] Blow the whistle if you Dare, Dr Phil Hammond, Private Eye 1386, 2015
[5] Raj Mattu and the death of whistleblowing, Dr Phil Hammond Private Eye 1364, 2014
[6] There were hundreds of us crying out got help: the afterlife of the whistleblower, Andrew Smith, Guardian 22 November 2014
[7] House of Commons Health Committee, Patient Safety, Sixth report of session 2008-2009
[8] Labour to create NHS staff champions to protect stressed-out nurses and give an ear to whistleblower, Nigel Nelson, Daily Mirror 19 March 2015
[9] House of Commons Public Administration Committee, Investigating clinical incidents in the NHS sixth report of session 2014-2015
[10] Report of the Mid Staffordshire NHS Foundation Trust public inquiry, February 2013
[11] Oral evidence by Mr Robert Francis QC to Health Committee inquiry into Complaints and Raising Concerns, HC 1080, 11 February 2014
[12] Francis calls for new protections for whistleblowers, Shaun Lintern, Nursing Times 11 February 2013
[13] Consultation on the implementation of the recommendations, principles
and actions set out in the report of the Freedom to Speak Up review, DH March 2015
The judge delivered no justice
The judge delivered no justice; Mr Francis called for criminal sanctions, but Sir Robert only urges people to behave better.
Minh Alexander, former consultant psychiatrist
The Francis report on NHS whistleblowing was important to whistleblowers from all sectors, but proved to be a huge disappointment. I focus here on one of its most serious flaws: failure to deliver accountability.
Robert Francis has decades of experience of healthcare failures and cover ups, and the untold grief that these cause. His experience includes medical negligence cases both as a barrister and as a judge, inquiries into high profile homicides by mental health patients, representing John Roylance former Chief Executive during the Inquiry into the Bristol heart scandal, acting for the GMC in the case of Richard Neale gynaecologist, working on the organs scandal at Alderhey Children’s hospital, chairing the two Mid Staffordshire inquiries and most recently, the Freedom to Speak Up Review.
Surely all these years of experience must have crystallised key issues of justice and accountability for deliberate wrongdoing, such as recklessness and cover up. Accountability is a basic tenet of just culture. [1] The latter requires that recklessness and deliberate wrongdoing, as opposed to simple human error, are held to account.
One would think therefore, that an examination of the severe mistreatment of NHS whistleblowers and the ruthless cover up of thousands of safety concerns, would give serious attention to strengthening the means of holding wrong doers to account. This is particularly so in the light of comments that Francis made in the two years since the publication of his report of the public inquiry into the Mid Staffordshire scandal.
Firstly, in his Mid-Staffordshire report Francis recommended that cover ups of risk and harm to patients should be criminalised:
“Every provider trust must be under an obligation to tell the truth to any patient who has or may have been harmed by their care. It is not in my view sufficient to support this need by a contractual duty in commissioning arrangements. It requires a duty to patients, recognised in statute, to be truthful to them. It requires staff to be obliged by statute to make their employers aware of incidents in which harm has or may have been caused to patients so they can take the necessary action. The deliberate obstruction of the performance of these duties and the deliberate deception of patients in this regard should be criminal offences”. [2]
On a number of subsequent occasions, Francis repeated his recommendations that whistleblowers should be protected from reprisal and suppression, by the introduction of criminal sanctions against perpetrators:
“Speaking to Nursing Times, Mr Francis said: “I have called for a statutory duty of candour that trusts tell the truth to regulators and that there should be criminal sanctions if there’s willful obstruction of anyone performing their duties and informing their trusts about concerns to patients.
“That is about as rigorous protection of whistleblowers as you can imagine, and that’s what I intended,” he said”. [3]
In May 2013, Francis commented that not holding individuals to account for serious care failures, and any failure to apply appropriate criminal sanctions, would be very damaging to public confidence:
“He said: “Unless we have a criminal offence we will not be reflecting adequately the gravity of the terrible things it seems are capable of being done in our hospital wards.
“If we don’t reflect somehow the fact the public rightly think some things are terrible and there should be real accountability for them, then I believe the public confidence in the NHS will evaporate” [4]
There were critics of Francis’ own failure to hold individuals to account over MidStaffordshire. In this prophetic passage Private Eye noted that “…the judge delivered no justice”:
“Knighthood for a whitewash?
One wonders what version of his report Robert Francis was reading at the press conference on 6 February. He looked like a man held hostage. The interminable delay in publication to allow for rewrites had reportedly been because those he was minded to criticise had launched vigorous legal defences. In the end he opted for a ridiculous “no scapegoats, blame the system” approach. This was endlessly debated after the Bristol Inquiry report in 2001, when a culture of “fair blame” was proposed. Ill thought-out, untested, rushed and brutally-enforced reforms undoubtedly contribute to NHS disasters, but individuals also have to be held accountable for their actions. Patients and staff trust a system that is just. But the judge delivered no justice”. [5]
Francis nevertheless continued to maintain that corrupt NHS leaders who suppressed safety issues and victimised whistleblowers should be dealt with decisively. In his oral evidence of 11 February 2014 to the Health Committee, as part of the committee’s inquiry into Complaints and Raising Concerns [6], Francis made these comments about accountability: [7]
“In so far as whistleblowers are concerned, I am afraid my answer is very blunt about that. We now have unanimity among those who are leaders of the Government and everywhere else that suppressing whistleblowers is absolutely wrong. It seems to me that any chief executive, any board, that is found to be guilty of that should be sacked. I put that absolutely bluntly. There can be no excuse any longer. If you want culture change, if a step or two like that could be taken—and it is far from me to comment, but it may be there are some opportunities out there—then I would suggest that that ought to be done”.
In response to a question from the committee chair, Francis confirmed that it was his view that such leaders should be held to account, pour encourager les autres. Francis at the same hearing again expressed the view that enforcing accountability for misconduct was key to culture change:
“To take your example, a trust which is led by a chief executive who personally welcomes and celebrates a whistleblower or, hopefully, before even that, the raising of concerns, and at the same time comes down like a ton of bricks on anyone who has been seen to try and prevent that, will change the culture pretty rapidly, I think, in their institution”.
Last year, when hundreds of whistleblowers waited expectantly for Francis’ (by now Sir Robert) repeatedly delayed report on NHS whistleblowing, his above comments were all in our minds.
Shockingly, when Francis’ report [8] was finally published on 11 February 2015, a major U turn was evident. Criminal sanctions were not amongst his recommendations. Matters of corporate manslaughter and misconduct in public office were not mentioned, despite Francis’ acknowledgment that whistleblower suppression is a serious patient safety issue, constitutes serious misconduct, and is currently a substantial and serious matter in the NHS.
It was also despite the fact that his senior researcher on the Freedom to SpeaK Up review Professor David Lewis, Employment Law and whistleblowing expert, supports criminal sanctions for whistleblowing reprisal. David Lewis in fact went on to make several public statements about the fact that Francis had not gone far enough, and that criminal sanctions should have been recommended.
Francis glossed over the fact he himself had previously favoured criminal sanctions. There was a note of derision in his report about the fact that some contributors had “even” suggested criminal sanctions for reprisal. In fact, those who recommended criminal sanctions were amongst the most experienced campaigners and journalists, including the charity Compassion in Care [8] and Private Eye journalist Andrew Bousefield. [10]
Instead of strengthening accountability for reprisal, Francis gave inordinate focus in his report to how whistleblowers behave. He recommended that staff needed training to be tactful, he regurgitated employers’ propaganda about how whistleblowers may be “fixated” and “chronically embittered” and he repeatedly stated that staff should be held to account for the manner in which they raise concerns.
On accountability for managers, Francis painted an utterly incorrect and distorted picture of just culture, implying that accountability and just culture are incompatible:
“7.5.5 A number of the contributors suggested that if people were seen to be held to account this would send a powerful and positive message to other staff.
7.5.6 However, there is another side to this which must be considered. Managers are just as vulnerable as other staff to the effects of the culture in which they work, and the pressures which are imposed on them. As stressed by some employers and their representatives a ‘just’ culture is equally as necessary for managers and leaders as it is for staff raising concerns. The consequence of an uneven approach could be a worsening blame culture for staff and a loss of talented managers from the NHS”.
Francis further reduced the chances of corrupt leaders being held to account by refusing to support managerial regulation. He argued that CQC Regulation 5, Fit and Proper Person, [11] should be allowed to bed in. Everybody knew that FPPR was a weak instrument. Subsequently, CQC have spectacularly failed to apply it. CQC has refused to use FPPR against numerous managers complicit in serious whistleblower reprisal, even in cases such as that of Dr Kevin Beatt, who was fully vindicated by a damming Employment Tribunal judgment.
Francis also airbrushed over the ultimate source of NHS bullying: politicians and the DH. He spared many blushes by recommending that past cases remain shut, denying hundreds of whistleblowers the chance of justice, and letting managers off the hook. His stated reason for this, as the man who waded through many thousands of pages of evidence at MidStaffordshire? It would be too complicated to look at old cases. This was despite the fact that he had noted in his report that many contributors’ cases were very recent. As Private Eye noted two years ago, the judge delivered no justice.
Establishment resistance to transparency and accountability are not unique to the NHS. Commentators have noted a general rise in impunity for the powerful. [12] It is self-evident that this must change if lives are to be saved.
[1] What does just culture have to do with patient safety? A conversation with David Marx. Medscape 11 January 2010.
[2] Press release by Robert Francis upon publication of the MidStaffordshire Public Inquiry 6 February 2013
[3] Francis calls for new protection for whistleblowers, Shaun Lintern, Nursing Times 11 February 2013
[4] Francis presses government on criminal sanctions. Shaun Lintern Local Government Chronicle 17 May 2013
[5] Return to the killing fields. A chronicle of deaths foretold. Phil Hammond, Private Eye 17 March 2013
[6] House of Commons Health Committee Complaints and Raising Concerns Fourth Report of Session 2014–15, 21 January 2015
[7] Health Committee Oral evidence: Complaints and Raising Concerns, HC 1080 Tuesday 11 February 2014
[8] Freedom to Speak Up Review Report, by Sir Robert Francis QC, 11 February 2015
[9] Breaking the Silence, Compassion in Care
[10] Submission to Freedom to Speak Up review by Andrew Bousefield, 10 September 2014
[11] CQC Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour Guidance for NHS bodies November 2014 and March 2014
[12] Institutionalised corruption in Neo-liberal Britain. David Whyte and Tom Mills, New Left Project 13 April 2015
‘Don’t shoot the messenger’ : the problem of whistleblowing in general practice
The following is further evidence as to why proper support is needed to help NHS whistleblowers:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609467/
‘Don’t shoot the messenger’: the problem of whistleblowing in general practice
Br J Gen Pract. 2013 Apr; 63(609): 214–215.
Nigel Mathers, Professor of Primary Medical Care
University of Sheffield, Sheffield and Vice-Chair of RCGP, London.
Liz Sillitoe, Former Policy Officer
RCGP, London
BACKGROUND
On the 9 June 2010 the then Secretary of State for Health, Andrew Lansley, announced a full public inquiry into the role of the commissioning, supervisory, and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust. The Inquiry was chaired by Robert Francis QC, who has made recommendations to the Secretary of State based on the lessons learned from the failures of care provided by the Trust between January 2005 and March 2009.1
The Inquiry heard oral evidence from six GPs whose surgeries are situated within the Trust catchment area. This focused largely on the extent to which the GPs were aware of problems at the Trust.
The Francis Report raises a number of serious issues about NHS ’whistleblowing’ and identifies failures in the application of current whistleblowing policies. The NHS, and GPs in particular, face unique problems in whistleblowing.
A CAUTIONARY TALE
‘The GMC guidance states that GPs have a duty to raise concerns. When I contacted the GMC, they recommended that I contact the BMA. The BMA recommended that I contact my [medical defence organisation] MDO. My MDO recommended that I contact the BMA’
All doctors have a duty to act when they believe patients’ safety is at risk or that patients’ care or dignity is being compromised.2 This paper defines ‘raising a concern’ as doing so through the normal internal structures of accountability and ‘blowing the whistle’ as highlighting a concern to individuals outside of these structures, often externally, and normally after failing to successfully raise the issue through the expected internal routes.
When a GP decides to act as a ‘whistleblower’, for example because of concerns about the patient care provided by a GP colleague, he or she may have an additional challenge because in a practice partnership professional, financial, and social interdependency coincide; this is very different to the position of other doctors in a secondary care setting who have a contractual relationship with, and are normally employees of, an NHS body such as a trust. The GP contract however, is not a direct contract of employment and although under the current law, the Public Information Disclosure Act (PIDA)3 should, in principle, give protection to all ‘workers’, this protection has not yet been defined for GPs. A ‘test case’ is shortly to go before the courts but as things stand, NHS bodies can claim that whistleblowing policies only apply to employees and that they have no specified duties towards GPs. This is further complicated by the fact that GPs may be both providers of care and private employers at the same time. In the case of salaried GPs, where a GP is an employer, the situation can become even more complicated and at present the position remains unclear.
In addition, the MDOs may take the view that their duty is not to support one doctor making allegations against another and professional bodies such as the Royal Colleges do not themselves currently provide formal individual support to whistleblowing members; rather generic advice and ‘signposting’ to available websites and information.4 The whistleblowing policy of other professional organisations such as the BMA, which might have been expected to provide individual support to members, provides advice to secondary care employees or medical students and may take a similar view to that of NHS trusts towards GPs. Furthermore, local medical committees (LMCs) may find themselves with conflicts of interest if one or both doctors are members of an LMC.5–7
All of this means that a GP whistleblower may find themselves in a situation where they have little or no professional support, and this, of course, may act as a profound disincentive for a GP to ‘stick their head above the parapet’. When this is added to the current NHS ‘blame culture’ towards individuals8 and the substantive risks of whistleblowing in terms of hostility, marginalisation and the threat to a doctor’s career,9 it is quite remarkable that there have ever been any GP whistleblowers at all!
- ‘I contacted ‘Public Concern at Work’ and ‘Patient First’: both organisations gave advice and offered sympathy but gave me no practical support’
Recent changes to the NHS Constitution contain an expectation that NHS staff will raise concerns about safety, malpractice or wrong doing at work that may affect patients, the public, other staff, or the organisation itself as early as possible and will be supported in doing so.10 The Care Quality Commission (CQC) classifies GPs as ‘other workers who provide services to the registered provider’ as they are not directly employed by the NHS11 and their website guidance for providers does give a full explanation of the policies, the law, and expectations on how to raise a concern. Public Concern at Work (PCAW) is the whistleblowing charity established in 1993 which provides free confidential advice to people who are concerned about crime, danger, or wrongdoing at work.12
However, although a number of such resources are available to GP whistleblowers (such as Whistleblowing Helpline [http://wbhelpline.org.uk/] and Patients First [http://www.patientsfirst.org.uk/]), many of them are not ‘fit for purpose’, since they do not offer a great deal in the way of practical support through the specific complexities faced by GP whistleblowers. Such practical support must be the role of the professional organisations.
- ‘I did face immediate hostility, was marginalised and a campaign of retribution lost me my position and yet nobody seemed willing or able to influence this’
Although legislation was passed 14 years ago to support the rights of whistleblowers,3 there is little evidence that it has in practice provided protection to individual NHS whistleblowers: indeed the consequences for an individual whistleblower can still be devastating as the quote above from the ‘live’ case illustrates.
Hammond13 in his evidence to the Francis Inquiry stated that ‘staff that do blow the whistle are frequently marginalised, counter-smeared and suspended and many agree to a modest payoff with a gagging clause to protect themselves from personal and professional ruin’.
There are many recent examples of such denigration and ‘gagging clauses’ (compromise agreements) in the NHS.9
The widespread use of compromise agreements in the NHS is clearly contrary to the public interest, especially when it involves issues of patient safety. The recent letter from Sir David Nicholson (Chair of the National Commissioning Board) about adequate support being provided to whistleblowers in the NHS and the requirements of Health Services Circular 1999/199814 sought to discourage the use of such agreements, but this was more of a request rather than an instruction.
There is no doubt that whistleblowing can be a courageous, difficult, and detrimental thing for the individual. To report any sort of concern, let alone whistleblowing, means bringing into question the judgement of another doctor or health professional; something which is (rightly) taken very seriously. However, since patients trust their GPs more than any other professionals, they are more likely to confide in them and expect them to take action when issues about patient safety are brought to their attention.
WHAT NEEDS TO BE DONE?
The failures of care in Mid Staffordshire were quite appalling and all doctors including GPs, should and are required to raise concerns which they may have about patient safety.2 This did not happen and it is thought that up to 1200 patients received dreadful care, dying prematurely while managers were chasing productivity targets.1
In such circumstances there is an ethical imperative for us as GPs to act, initially by ‘raising a concern’ but if our legitimate concerns are not properly addressed, then whistleblowing may have to be our last recourse; with all the potentially disastrous consequences for us as individuals. The creation of clinical commissioning groups (CCGs) offers an opportunity for some of these issues to be addressed and the issuance of Whistleblowing Guidance to CCGs is not only an imperative but also a matter of urgency if tragedies like the Mid Staffordshire case are not to occur again within the NHS.
RECOMMENDATIONS
- The respective roles of the professional bodies (the GMC, BMA, MDOs, LMCs and the Royal Colleges) need to be clarified in cases of GP whistleblowing: a joint statement about the position of GP whistleblowers should be agreed and publicised.
- Whistleblowing policies and guidance for CCGs should also be distributed: these could be developed from existing resources such as the whistleblowing helpline12and the recently adopted RCGP policy.4
- The RCGP and other Royal Colleges should offer generic support and guidance for whistleblowing members by signposting available resources and providing referral to appropriate sources of advice.
- All practices should have whistleblowing policies in place and GPs should know who to go to for advice and support when they have concerns about the quality or safety of patient care.
Finally, and most importantly, we all need to help create a responsive, open, and supportive cultural environment in the NHS: not only by improving transparency but also by using the legislation which already exists to protect whistleblowers from retribution.
We owe this to our patients.
Notes
Provenance
Freely submitted; not externally peer reviewed.
Consent
Quotations a, b, and c are from a ‘live’ GP whistleblower case and are used with the full knowledge and consent of the person concerned.
REFERENCES
- The Mid Staffordshire NHS Foundation Trust Inquiry Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. 1 Chaired by Robert Francis QC.http://www.midstaffsinquiry.com/assets/docs/Inquiry_Report-Vol1.pdf(accessed 15 Feb 2013).
- General Medical Council . Raising and acting on concerns about patient safety. GMC; 2012.http://www.gmc-uk.org/guidance/ethical_guidance/raising_concerns.asp(accessed 15 Feb 2013).
- Public Interest Disclosure Act (PIDA): Section 43K ERA. http://www.pcaw.org.uk/pida43g-section11#43k(accessed 15 Feb 2013).
- Royal College of General Practitioners Whistleblowing in the NHS. RCGP Policy document.http://www.rcgp.org.uk/policy/rcgp-policy-areas/whistle-blowing-in-the-nhs.aspx(accessed 15 Feb 2013).
- BMA Practical Support at Work: Whistleblowing — who can help you. http://bma.org.uk/practical-support-at-work/whistleblowing/who-can-help-you(accessed 15 Feb 2013).
- BMA . Whistleblowing. Advice for BMA members working in NHS secondary care about raising concerns in the workplace. BMA; 2009. document no: 50185. (accessed 28 Jan 2013).
- BMA Negotiating for the profession. Whistleblowing. http://bma.org.uk/working-for-change/negotiating-for-the-profession/whistleblowing(accessed 15 Feb 2013).
- BMA . NHS culture adds whistleblowing insult to patient injury. BMA; 2012. http://bma.org.uk/news-views-analysis/news/2012/october/nhs-culture-adds-whistleblowing-insult-to-patient-injury(accessed 15 Feb 2013).
- Hammond P, Bousfield A. Shoot the Messenger How NHS whistleblowers are silenced and sacked.http://drphilhammond.com/blog/wp-content/uploads/2010/07/Shoot_the_Mesenger_FINAL.pdf(accessed 15 Feb 2013).
- National Health Service The NHS Constitution.http://nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx(accessed 15 Feb 2013).
- Care Quality Commission . Whistleblowing: guidance for providers. CQC; 2011.http://www.cqc.org.uk/search/apachesolr_search/guidance%20on%20whistleblowing(accessed 15 Feb 2013).
- Public Concern at Work (PCAW) http://www.pcaw.org.uk/(accessed 15 Feb 2013)..
- Witness Statement from Dr Phil Hammond to Francis Inquiry.http://drphilhammond.com/blog/2013/01/18/private-eye/witness-statement-from-dr-phil-hammond-to-francis-inquiry/(accessed 15 Feb 2013).
- Department of Health Compromise Agreements and the Public Interest Disclosure Act 1998.http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_132261(accessed 15 Feb 2013).
Blowing the whistle – Letter to the Editor
The Times April 30 2015
Fifty doctors urge the main political parties to properly protect NHS staff who blow the whistle on unsafe care
Sir, All main parties say the health service is a priority. Yet political pledges to save the NHS and to invest in the health service are hollow and meaningless as long as politicians allow staff to be victimised, putting patient safety at risk.
There have been numerous cases where dedicated staff in the NHS have been victimised or unfairly sacked for blowing the whistle on poor or unsafe care. Sir Robert Francis in his recent report on whistleblowers said many had been subjected to “kangaroo courts”. Sir Robert also noted that black and minority ethnic staff were more likely to be victimised than staff from a white background.
We urge party leaders to acknowledge their moral and ethical duty to treat all NHS staff fairly in order to ensure safety and quality of care, to ensure zero tolerance for the misuse of disciplinary procedures to punish staff who raise patient safety concerns and to make a specific pledge that there will be a major overhaul of NHS disciplinary procedure.
Professor Parveen Kumar CBE, Consultant Physician
Dr Clare Gerada MBE, Chair – Founders Network
Dr Ramesh Mehta, President British Association of Physicians of Indian Origin
Dr Kumar Kotegaonkar MBE, General Practitioner
Professor Barbara Wilson OBE, Consultant Neuropsychologist
Dr Kailash Chand OBE, General Practitioner, Past-Chair NHS Trust
Dr Davinder Kapur MBE, Forensic Medical Officer
Dr Syed Abidi MBE, Public Health Specialist
Dr Satya Sharma MBE, General Practitioner
Dr J S Bamrah, Medical Director, National Chair British Association of Physicians of Indian Origin
Dr Parag Singhal, Honorary Secretary, British Association of Physicians of Indian Origin
Dr Santosh Mudholkar, General Secretary, British Indian Psychiatric Association
Dr Kim Holt, Founder of PatientsFirst, Consultant Paediatrician
Lady Maha Yassaie, Consultant Pharmacist
Professor Michael Kopelman, Emeritus Professor of Neuropsychiatry
Professor Narinder Kapur, Consultant Neuropsychologist
Dr Umesh Prabhu, Medical Director
Dr A Sajayan, Consultant Anaesthetist
Dr Abrar Hussain, Consultant Psychiatrist
Dr Aditya Agrawal, Consultant Surgeon
Dr Amit Kocchar, Associate Specialist, ENT
Dr Anita Mittal, Consultant Paediatrician
Dr Ankur Khandewal, General Practitioner
Dr Aruj Qayum, General Practitioner
Dr Arvind Shah, Consultant Paediatrician
Dr David Drew, Consultant Paediatrician
Dr Hasmukh Shah, General Practitioner
Dr Keshav Singhal, Consultant in Trauma and Orthopaedics
Dr Madan Samuel, Consultant Paediatric Surgeon
Dr Manjit Suchdev, General Practitioner
Dr Minh Alexander, Consultant Psychiatrist
Dr Naranjan Khosa, General Practitioner
Dr Philip Abraham, Consultant Community Paediatrician
Dr Rajan Madhok, Public Health Consultant
Dr Rajendra Chaudhary, Medicolegal Advisor, Doctors and Dentists Protection Union
Dr Ravi Mene, General Practitioner
Dr Sanchit Mehendale, Consultant in Trauma and Orthopaedics
Dr Sangeetha Kolpattil, Consultant Radiologist
Dr Satheesh Mathew, Consultant Paediatrician
Dr Shyam Kumar, Consultant Orthopaedic Surgeon
Dr Narveshwar Sinha, General Practitioner
Dr Stephen Kemp, Consultant Neuropsychologist
Dr Suresh Rao, Consultant Orthopaedic Surgeon
Dr Veronica Bradley, Consultant Neuropsychologist
Dr Vishal Sahni, Consultant Orthopaedic Surgeon
Dr Vivek Chhabra, Speciality Doctor, Emergency Medicine
Dr Yusuf Khan, GP Trainee
Dr Ramankutty Sreekumar, Consultant in Trauma & Orthopaedics
Dr V Muraleedharan, Consultant Physician
Dr Mahnaz Alsharif, General Practitioner
Health secretary: ‘victimisation’ of Croydon NHS whistleblower not my problem
Croydon Guardian23 April 2015
by Chris Baynes, Senior Reporter – Croydon
by Chris Baynes, Senior Reporter – Croydon
Kevin Beatt was sacked by Croydon University Hospital for whisteblowing on patient safety
Health secretary Jeremy Hunt has dismissed calls for him to intervene to halt the “horrific victimisation” of a whistleblower doctor at Croydon University Hospital.The Conservative MP said he would not act over the case of consultant cardiologist Kevin Beatt, wrongly sacked by Croydon’s NHS trust for raising concerns about patient safety, describing it as “a matter for the trust’s board”.Prime Minister David Cameron last month stepped in to prevent another whistleblower doctor being pursued for nearly £93,500 legal costs by an NHS Trust found to have bullied and sacked her for raising similar concerns.
But Mr Hunt, who had been repeatedly asked by a campaigner to intervene in Dr Beatt’s case, said concerns about Croydon Heath Services NHS Trust should be redirected to the trust board itself.
December 2014: ‘Landmark’ legal win for cardiologist sacked for whistleblowing on patient safety
January 2015: Health secretary urged to lauch inquiry as tribunal rejects Croydon NHS trust’s appeal of whistleblower’s sacking
David Drew, a doctor who has campaigned for better protection for NHS whistleblowers, wrote to the health secretary in January and again in February urging him to launch an inquiry into the trust’s treatment of Dr Beatt and its chief executive, John Goulston.
His second letter said: “Dr Beatt should be exonerated, reinstated and receive a full apology from the managers responsible for his mistreatment.
“Then, as I requested in my letter of January 15 I believe you should set up an inquiry into how the Trust board at Croydon conspired to destroy the career of a good doctor.”
Mr Hunt, who earlier this month told the Croydon Guardian he was unaware of the case, replied to the doctor this week.
He said: “[T]he employment of the chief executive of a trust is a matter for the trust’s board. It is for the trust concerned to decide whether a chief executive is fit for the job.
“If Dr Drew wishes to raise any concerns about the conduct of a chief executive of an NHS trust, he may wish to contact its board directly. Alternatively, he may wish to contact the NHS Trust Development Authority (TDA), which provides support, oversight and governance for all NHS trusts in delivering high quality services.”
But Dr Drew said: “Since my concerns involve the [Croydon NHS] board including the chairman I see little point in writing to them.”
He has reported the case to the TDA’s chairman.
In February, Sir Robert Francis QC published an independent report on NHS whisteblowers, who he concluded were bullied and intimidated amid a “climate of fear”.
Following its publication, Mr Hunt, who commissioned the review, told Parliament: “The whole House will be profoundly shocked at the nature and extent of what has been revealed today.
“The message must go out today that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.”
Dr Drew, in his strongly critical second letter to the health secretary, said: “Your own silence on this matter speaks volumes. And your inaction can only embolden bullying managers and make decent NHS staff even more reluctant to speak up for their patients. How can this help promote a safe reporting culture?
“It is clear that Dr Beatt’s situation is no better for having won at the tribunal nor for the work of Sir Robert Francis in exposing the scandalous treatment whistle-blowers are subjected to. No-one has called time on his oppressors.”
An employment tribunal ruled in October last year Dr Beatt had been unfairly dismissed for whistleblowing on patient safety and staff bullying.
An appeals tribunal subsequently found Croydon Health Services had no grounds to appeal the judgment, but the trust still hopes to have that ruling overturned.
Health secretary Jeremy Hunt criticised for inaction over ‘horrific victimisation’ of Croydon NHS whistleblower Kevin Beatt
Croydon Guardian 8 April 2015
by Chris Baynes, Reporter – Croydon
Jeremy Hunt, left, has been urged to end “victimisation” of whistleblower Dr Beatt
Health Secretary Jeremy Hunt has been criticised for his inaction over the “horrific victimisation” of a whistleblower doctor at Croydon University Hospital.
The Conservative MP, who spoke to directors during a visit to the hospital yesterday, has remained silent over the case of consultant cardiologist Kevin Beatt, wrongly sacked for raising concerns about patient safety, despite being urged to intervene three months ago.
Dr Beatt led the hospital’s well-respected cardiac catheter laboratory until he was fired by Croydon Health Services NHS Trust in 2013 after criticising hospital management.
An employment tribunal ruled in October last year he had been unfairly dismissed for whistleblowing on patient safety and staff bullying.
An appeals tribunal subsequently found Croydon Health Services had no grounds to appeal the judgment, but the trust has refused to drop the legal fight and hopes to have that ruling overturned.
December 2014: ‘Landmark’ legal win for cardiologist sacked for whistleblowing on patient safety
January 2015: Health secretary urged to launch inquiry as tribunal rejects Croydon NHS trust’s appeal of whistleblower’s sacking
David Drew, a doctor who has campaigned for better protection for NHS whistleblowers, wrote to Mr Hunt in January urging him to launch an inquiry into the trust’s treatment of Dr Beatt.
But Mr Hunt, who in February pledged to end a culture of bullying and intimidation among NHS directors, has not responded and this week claimed he was not aware of the case.
He told the Croydon Guardian: “I’m not [familiar with it], no. I may have had a letter but obviously I don’t have the paperwork in front of me now.”
In a strongly critical second letter to the health secretary, Dr Drew wrote: “Your own silence on this matter speaks volumes.
“And your inaction can only embolden bullying managers and make decent NHS staff even more reluctant to speak up for their patients. How can this help promote a safe reporting culture?”
In February, Sir Robert Francis QC published an independent report on NHS whisteblowers, who he concluded were bullied and intimidated amid a “climate of fear”.
Following its publication, Mr Hunt, who commissioned the review, told Parliament: “The whole House will be profoundly shocked at the nature and extent of what has been revealed today.
“The message must go out today that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.”
But Dr Drew said: “It is clear that Dr Beatt’s situation is no better for having won at the tribunal nor for the work of Sir Robert Francis in exposing the scandalous treatment whistle-blowers are subjected to. No-one has called time on his oppressors.”
Mr Hunt, centre, with Conservative Party election candidates for Croydon Gavin Barwell, left, and Chris Philp at Croydon University Hospital yesterday
He added: “Dr Beatt should be exonerated, reinstated and receive a full apology from the managers responsible for his mistreatment.
“Then, as I requested in my letter of January 15 I believe you should set up an inquiry into how the Trust board at Croydon conspired to destroy the career of a good doctor.”
Mr Hunt, who met with Croydon Health Services chief executive John Goulston and chairman Mike Bell on Tuesday, declined to comment on the case.
Speaking after the announcement of £21m funding for the hospital’s new A&E department, he said: “It is difficult for me to comment on an individual case because I don’t have all the details in front of me.
“But certainly the conversation I have had with management today is very much about culture change and creating a culture where staff feel better supported to speak out about concerns. This is not something that matters just for Croydon University Hospital, it is a matter for all NHS trusts.
“Too many places have had a culture where front-line staff have not felt able to speak out and felt they would be victimised or bullied or harassed and the result is that patient safety concerns have not been addressed as quickly as they should, so I’ll certainly be doing everything I can to champion a change of culture in the NHS.”
Asked if he would consider intervening in Dr Beatt’s case, he said: “I can’t comment on this particular case but there are cases I have got involved in.
“I met a whole group of whisteblowers before [Sir Francis’s] Freedom to Speak Up review and I hope whistleblowers have recognised that I’ve done more than any other health secretary in the past to try to improve the culture to make it easier to speak up.
“But I’m also realistic enough to recognise that these things don’t change overnight.”
The General Medical Council last month dropped its investigation into Dr Beatt, who the employment tribunal ruled been “maliciously” referred to the regulator by Croydon Health Services.
Last month, Prime Minister David Cameron stepped in to prevent whistleblower Dr Hayley Dare being saddled with £100,000 costs after she lost her case against West London Mental Health Trust on a technicality.
SHARMILA CHOWDHURY 