By Minh Alexander, Redundant whistleblower, Consultant Psychiatrist 1999 to 2013 27 December 2014
The CQC is an arms length body of the Department of Health, accountable to The Secretary of State for Health, who must account to Parliament. Procedurally, the CQC must align itself with Department of Health (DH) strategy[1].
What does CQC behaviour say about DH strategy regarding whistleblowers?
The CQC has been well known to chant to whistleblowers seeking help and protection, the DH mantra: “It’s an employment issue”.
On 22 December 2014 a CQC Non Executive Director tweeted, albeit in a personal capacity:
“At the moment, it is an HR/employment issue. Unsure how this can change tbh”.
When a whistleblower commented that it was scandalous that CQC seemed to have no role in protecting whistleblowers, that person was accused thus by this CQC Non Executive Director:
“If you twist words & attack, you damage the cause”
When I opined that the “HR/employment” comment was very alarming, and that poor HR governance and whistleblower suppression were patient safety issues, I too received a similar response:
“You are twisting my words – unhelpful. This is behaviour that needs to stop…”
The CQC has a history of poor HR governance, and of a bullying culture. In my view its ineptitude in handling whistle blowing, both by its own staff and by staff from the bodies that it regulates, has been clear.
In 2011 I wrote to the CQC to question the fact that it had no published policies on whistle blowing. It seemed to me that this dearth of written commitments was a natural extension of the CQC’s poor values and attitudes to whistle blowing, and to whistleblowers.
So, have things changed under the new the CQC regime?
When Raj Mattu and colleagues whistle blew to the CQC’s predecessor body in 2001, it “mystifyingly” passed their names to the Trust’s CEO.[2] Raj subsequently endured a decade of catastrophic persecution, including countless complaints about him to the GMC.
Fast forward to the present. In November 2014, veteran whistleblower Shiban Ahmed passed dossier to the CQC about 22 cases of unsafe circumcision, and expressed concerns that the CQC had not done enough previously about his disclosures. In response, a CQC inspector copied an email about his disclosure to his employer. Shiban has since been suspended and referred to the GMC.[3]
Not a lot of change evident there then.
Perhaps the CQC should reflect on the degree to which its activities trigger whistle blower persecution, and its responsibility for severe detriment and suffering that follow.
No apology from the CQC is apparent for what has happened to Shiban, or the fact that very unsafe circumcisions of children continue, despite his repeated disclosures. Instead, there is a carefully worded denial:
“The CQC has not reported Mr Ahmed to the GMC or to his trust and has not invoked any disciplinary action against him”
When faced with pressure to protect a whistleblower, a CQC response may include protestation that it has no legal powers to do so. I have personal experience of this particular CQC rebuttal.
On the matter of the CQC’s powers, the above CQC Non Executive Director tweeted on 22 December 2014:
“You need a legal basis. Otherwise no point”.
Whilst the CQC’s claim that it has no formal powers to protect whistleblowers is arguable, we all know that a great deal is done by influence. Early in my journey, a supportive and effective CQC inspector protected me. I know it can be done, and it should be a model for CQC practice.
However, the mayhem often starts when the CQC turns a blind eye, fails to respond appropriately to whistleblowers’ disclosures, and claims that it has no jurisdiction to protect. Washing of regulatory hands can be a green light for whistle blower suppression and victimisation.
Continuing, un-rectified, gross injustices to whistleblowers, and failures by the CQC to act appropriately, light up that particular neon beacon. Homelessness, grave illnesses and financial ruin are poor reward for dedication. Whistleblowers are also still forced to make disclosures through the media.[4]
Despite the new CQC regime’s claims that it would be more responsive to concerns, and that it would operate more transparently, an FOI enquiry forced the CQC to admit, on 17 June 2014, that it had undertaken no “central analysis” of the reasons behind 981 whistleblower disclosures, received in the preceding 12 months.[5] When I recently asked the CQC if it would carry out an analysis and publish it, the CQC did not answer the questions straightforwardly. Instead, it said my enquiry would also be dealt with as an FOI request. Will the CQC meet the fast approaching deadline for disclosure 29 December 2014, or will it tarry?
Transparency is also lacking in the CQC’s failure so far to publish its evidence to Sir Robert Francis’ review on whistle blowing. In an interesting form of words, the CQC stated in its December 2014 report, “Complaints Matter”, that it would publish a “fuller account” of its activities when Sir Robert publishes. [6] However, I have received no response from David Prior (CQC Chair), to several requests for the CQC to clarify if this means that CQC will publish all of the evidence that it has submitted to Sir Robert.
I can see no valid or credible reason for organisations’ submissions to the Speak Up review remaining confidential. Opacity serves only to avoid constructive challenge and scrutiny. Is the CQC’s failure to publish its evidence a symptom of unaccountability, and image management, by a “comfort-seeking” organisation? [7]
“Comfort-seeking behaviours are defined here as being focused on external impression management and seeking reassurance that all was well; consequently, what was available to organisations was data, but not intelligence. Serious blind spots could arise when organisations used a very limited range of methods for gathering data, were preoccupied with demonstrating compliance with external expectations, failed to listen to negative signals from staff or lacked knowledge of the real issues at the frontline. Comfort-seeking tended to demonstrate preoccupation with positive news and results from staff, and could lead to concerns and critical comments being dismissed as ‘whining’ or disruptive behaviour”.
The CQC asserted in “Complaints Matter” that it had consulted whistleblowers about its handling of concerns. However, this was based on focus group data. No information was given about methodology and numbers. Tellingly perhaps, the CQC has not responded to questions about whether it will arrange transparent, independent audit of whistleblowers’ experience of its handling of their concerns.
The CQC’s joint investigation with Monitor into the reported dysfunctional culture at the Christie, [8]did not support the concerns of several whistleblowers. This does not bode well for the CQC’s application of FPPR in relation to whistleblower suppression.
In my view, the altruism and commitment of whistleblowers, some who lose their careers, their livelihoods, their health and family life, does not seem matched by suitably principled behaviour by CQC.
Watchdogs should be protectors, but history shows that they can in fact become bottlenecks.[9]
What would Lord Sugar say to Nero? “You’re fired”?
If Secretary of State, you aspire to “More Gandhi, less Stalin”, please note that Mahatma Gandhi once said:
“Action expresses priorities”.
Please re-align CQC strategy urgently, and please ensure that whistleblowers and would be whistleblowers are not harmed or deterred by any hostile acts of commission or omission.
The safety of patients depends on staff who are free and safe to speak up.
New fundamental standards for all care providers will come into force in April 2015. However, two regulations for NHS bodies that form part of these came into force on 27 November 2014.
Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour come into force for NHS bodies in November 2014. ‘NHS bodies’ means NHS trusts, NHS foundation trusts and special health authorities.
The fit and proper persons requirement outlines what providers should do to make clear that directors are responsible for the overall quality and safety of care. The duty of candour explains what they should do to make sure they are open and honest with people when something goes wrong with their care and treatment.
The fundamental standards, which will be implemented in April 2015, will replace the existing essential standards of quality and safety. They will include guidance for all sectors on the fit and proper persons requirement for directors and the duty of candour.
A care home boss who revealed the identity of a whistleblower has been banned from nursing for six months.
Jennifer Kirk was not present at the Nursing and Midwifery Council (NMC) conduct and competence committee hearing but had admitted multiple charges of misconduct.
Mrs Kirk, who was employed as manager at Ashlea care home in Callander, failed to investigate properly an allegation that the deputy manager had been accessing pornographic websites at work.
Concerns had been raised by another employee, named only as Miss 1, on February 1 2013 and Mrs Kirk later told the subject of the complaint who had made it.
In addition, she did not notify the appropriate protection agencies of the incident, and she did not suspend the deputy manager until April 6 last year.
In a written submission to the NMC, Miss 1 stated that she used the home’s computer on January 31 last year and noticed that the internet history showed various pornographic websites had been accessed on January 16.
She took a photograph of the computer screen with her mobile telephone and reviewed the nursing rota, which indicated that the home’s deputy manager was the nurse on duty at the time.
She said she told Mrs Kirk the following day but the manager did not take the complaint seriously.
The deputy manager then made it clear to Miss 1 that he knew she had found the information on the computer and had told Mrs Kirk.
The matter was later reported to the Care Inspectorate in Scotland and Stirling Adult Support and Protection by another member of staff.
The Care Inspectorate ruled that Mrs Kirk should have investigated the concerns properly and protected the identity of the member of staff who raised the complaint.
An internal investigation by the company which runs Ashlea, Mauricare Dumpark Limited, found that Mrs Kirk had breached its whistleblowing policy.
She also admitted making more than a dozen medication blunders in April and May 2013.
She failed to ensure that medication — including anti-psychotic, osteoporosis, painkilling and antibiotic drugs — was administered as prescribed, or recorded as administered, to 10 residents at the home.
Additionally, between April and May 2013 she failed to ensure that there was an effective audit trail of medication received and administered to residents in the home.
Imposing a six-month suspension order, the NMS said: “Given the seriousness of the facts admitted and found proved, the panel considers that Mrs Kirk’s conduct is a serious departure from the standards expected of a registered nurse and, as such, did not uphold the reputation of the profession at the relevant time.
“The panel considered that a period of suspension would be sufficient to protect patients and the public interest.
“The panel noted that Mrs Kirk has had an otherwise unblemished history as a nurse.
“However, the panel has not seen any evidence of remediation and, as such, concluded that Mrs Kirk still represents a risk to patients.”
Martyn Halle and Tim Rayment Published: 21 December 2014
Surgeon Shiban Ahmed accuses the health regulator of failing to prevent boys from having cruel and unsafe circumcisions, often carried out privately for Muslim children for non-medical reasons (Phil Tragen)
A PAEDIATRIC surgeon who tried to expose “barbaric and amateurish” circumcision of boys, including babies, is facing disciplinary action for raising his concerns with the patient safety regulator.
Shiban Ahmed has fought for more than a decade to get the Care Quality Commission (CQC) and its predecessor, the Healthcare Commission, to protect children from cheap circumcisions carried out by poorly skilled GPs. In some cases, boys aged six to 10 are tied to tables or forcibly held down while a local anaesthetic is injected directly into the penis. The anaesthetic often proves ineffective and the operation follows with the child still screaming in pain.
Ahmed recently presented a dossier of cases to the CQC. He also accused the regulator of failing in its duty after learning of new examples of “cruel” and unsafe operations in clinics he had previously reported.
The CQC responded by contacting his employer, University Hospitals of North Midlands NHS Trust (UHNM), to allege that he had breached patient confidentiality.
Last week the trust said it was referring him to the General Medical Council (GMC), which has the power to strike him from the medical register.
Ahmed became aware of dangerous circumcisions when he was asked to carry out corrective surgery after botched operations. He believes the only safe place to circumcise school-age boys is in hospital with a trained surgeon.
The cases often involved boys from Muslim families. In most of Britain circumcision for cultural reasons is not available on the NHS and, as the procedure costs at least £1,400 in hospital, parents turn to GPs who charge £200-£300.
Many of the problems were in Birmingham, where the operation is available on the NHS and where the health service pays GPs £190,000 a year to perform circumcisions at a cost of £90 per child.
Some young patients nearly died after circumcisions and Ahmed recalls having to remove part of a boy’s penis. Others lost so much blood they needed intensive care.
The surgeon started touring mosques to publicise the dangers, making clear that he was not opposed to circumcision, which has moderate health benefits, but wished to see it done safely.
He also set up a private clinic to offer circumcision under general anaesthetic at a similar price to GPs. He says he takes no fee from the operations.
As a result of his outreach work, families reported their experiences and he asked consent to pass cases to the CQC.
As some of the case histories were given to him by telephone, Ahmed says he took advice from the information commissioner and the GMC before recording the conversations and passing them to the CQC in a dossier of 22 cases.
“My children were tied down onto the table,” says one of the written statements in his dossier. “My children went through great discomfort through the pain of the operation as well as that of being tied down by heavy strings.”
Another complainant says: “I lost a lot of blood to the point where my life was in danger.”
Two surgery receptionists had earlier told Ahmed how a boy undergoing circumcision ran screaming to a lavatory and locked himself in, bleeding heavily. The child’s father fainted and “pandemonium” broke loose.
“I am still seeing children with the most terrible complications,” Ahmed said. “Some are so bad they cannot be corrected and have left babies and children maimed for life. I cannot understand how the NHS is allowing this.”
Ahmed submitted a file of cases two months ago to Amanda Reynolds, an acting inspection manager at the CQC. They included the recorded telephone calls.
Listening to the recordings, she was uncertain if the correct consents had been obtained and decided to treat them as covert. Reynolds wrote to Ahmed, raising her concerns, but also sent her email to the trust which began looking at the case. However, Ahmed was unable to explain himself to the trust because he had consent from the families to discuss their complaints only with the CQC, not with his employer.
Last Monday, Nick Coleman, the trust’s “responsible officer”, told Ahmed he was forwarding his case to the GMC for investigation.
Ahmed is a serial whistleblower who has made allegations in the past of unsafe surgical practices at Stafford Hospital and at Alder Hey Children’s Hospital in Liverpool.
His concerns at Alder Hey led to an investigation by the Royal College of Surgeons, but the full report has yet to be published. He is suspended by Alder Hey and UHNM for allegedly disclosing patient details to the CQC.
Fiona Bell, an NHS campaigner, called on Jeremy Hunt, the health secretary, to intervene. Hunt has previously said that NHS whistleblowers should be protected.
“I will be writing to Mr Hunt to seek assurances that this brave doctor is not sanctioned in any way for raising concerns to protect children,” she said. “I was told the government supports NHS staff raising concerns so I would expect protection for Mr Ahmed.
“One would expect those who have harmed children to be investigated by the NHS and CQC as well as by the police and social services.”
UHNM said: “Clinicians at the trust are working with the CQC to provide support for one of its non-NHS inquiry’s [sic] following a request for our assistance.”
The CQC denied reporting Ahmed to his trust, even though Reynolds appears to have alerted the trust in her email dated November 4.
“The Care Quality Commission is very concerned about reported cases regarding the safety of circumcisions brought to our attention by Mr Ahmed,” the regulator said. “We listened to these concerns and responded quickly by carrying out a number of inspections at services. We have taken action in relation to what was found during the inspections.
“The CQC has not reported Mr Ahmed to the GMC or to his trust and has not invoked any disciplinary action against him.”
A leading child doctor said that restraining boys for circumcision was illegal and “in the same bracket as female genital mutilation”. Dr Martin Ward Platt of the Royal College of Paediatrics and Child Health said: “It would ride a coach and horses through the rights of the child.”
Fiona Bell, NHS whistleblower and an avid campaigner, wrote to Jeremy Hunt, Secretary of State and Ed Jones, Special Advisor, in 14 October 2014, raising serious concerns on behalf of a Morecambe Bay whistleblower, regarding a nurse who allegedly went around turning off the drips off elderly end of life patients in order to speed up their deaths.
Fiona, hoped that due to the serious nature of her complaint, matter would be urgently investigated.
However, to her amazement, Fiona received the following response:
From: <DoNotReply@dh.gsi.gov.uk>
Date: 6 November 2014 16:53
Subject: Response to your Query : – Ref:DE00000892418 – your recent correspondence to Jeremy Hunt and Ed Jones
To: fbell226@gmail.com
Our ref: DE00000892418
Dear Ms Bell,
Thank you for your correspondence of 14 October to Jeremy Hunt and Ed Jones about Mr xxxxxx. I have been asked to reply.
The Department of Health has noted the concerns in your correspondence. However, as mentioned in previous replies to you, ministers and Department of Health officials are not in a position to discuss personal employment issues.
Thank you for raising your concerns.
Yours sincerely,
Jeremy Vooght Ministerial Correspondence and Public Enquiries Department of Health
Shockingly, Department of Health instead of urgently investigating, responded by viewing early demise of the elderly patients as an employment issue and refused to comment.
Fiona, in her true form, refused to give up and wrote again:
Dear Mr Hunt,
Below is the response from your office from my email highlighting the concerns of a whistle blower , The concerns raised were advising of a nurse whom allegedly went around turning off the drips off elderly end of life patients in order to speed up their deaths .
Therefore I would like some one to explain to me and the public , how this is a personal employment matter? I’m pretty sure if you asked any member of the public, ” is this a personal employment issue or a matter that requires further investigation and full support for the whistle blower,”? Common sense would prevail and the public would expect a full investigation of all allegations.
The bog standard response from your office is part of all that is wrong and only aids those trying to cover up wrong doing. Quite frankly a disgrace that the DoH continue their “business as usual approach towards the whistle blower” it does not inspire confidence for the future or any future recommendations that may be made by the review .
For the record I am not asking for a discussion, I am requesting that these allegations are investigated fully by an independent body.
There are far too many whistle blowers left without employment and astoundingly still, in some very recent cases gagged , Those that cover up or do wrong are promoted or let go quietly.
Regards
Fiona Bell
The matter was then brought to the attention of the media via this website.
This was blogged and was tweeted and retweeted by the public as they were appalled by
the response from Department of Health. It was clear that despite Francis’s Review and huge awareness of whistleblowing and raising concerns, promises by Department of Health to be committed to change, this has not happened in practical terms. Instead Department of Health had carried on brushing aside raised concerns as ’employment issue’, irrespective of what has been highlighted. There had been, disappointingly, no change in responses from Department of Health to people raising concerns.
With continuing pressure from the media, department of Health, seven weeks later, apologized and sent the following letter:
Clearly, it still takes a determined campaigner, the media and public pressure to direct the Department of Health into appropriate action. This is despite of much publicised NHS whistleblowing cases, and promises of change by the Secretary of State, who commissioned the Francis’s review. We have a very long way to go.
Russell Dunkeld says drips to give drugs had been interfered with (PAUL COOPER)
A WHISTLEBLOWING nurse has revealed how managers at a scandal-hit NHS trust ignored allegations that a colleague was hastening the deaths of patients.
Russell Dunkeld told his bosses at Royal Lancaster Infirmary, part of University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), how a nurse on his ward had boasted of speeding patients on their way by interfering with drug and saline drips.
The 60-year-old resigned, suffering stress, when his concerns were not investigated. Managers later gagged him from speaking out as part of a compensation deal.
Under the trust’s whistleblowing policy, Dunkeld should have had a response within 21 days. But it was three years before his claims were acknowledged. Even then there was no proper investigation.
Last month, however, an NHS campaigner arranged for him to give evidence to a government-ordered inquiry into the unrelated deaths of 16 babies and two mothers in the maternity unit at Furness General Hospital in Barrow, part of the same NHS trust. Dr Bill Kirkup, who is chairing the inquiry, expressed grave concern that the trust had ignored Dunkeld’s allegations.
Dunkeld had worked on a ward at the Royal Lancaster Infirmary with a mix of seriously ill patients, some of them terminal cases.
“I discovered that fluid drips and drips to give drugs to patients had been interfered with,” he said.
“Either they had been shut off or there wasn’t an adequate flow. If patients don’t get adequate fluids, they die. This nurse’s view was that they were going to die anyway, so all she was doing was helping them on their way.”
When he challenged her over one patient, he was shocked by her response. “Well, he is terminally ill,” the nurse allegedly replied. “What are you doing when you give these patients fluids? You are just killing them slowly, aren’t you?”
The confrontation was overheard by another nurse, who agreed with the first, Dunkeld said: “She told me, ‘Well, she’s right, isn’t she?’ ”
Dunkeld, who worked at the hospital for 20 years, said: “The tampering with drips had been going on for some time. These weren’t just one-offs. In the normal course of events one might expect to find one or two a year turned off by mistake. I was finding up to three in a single shift.
“How many patients suffered and died due to interfering with the drips, I don’t know. They weren’t all terminally ill.”
The drip-tampering nurse had already been disciplined for neglecting a patient and was accused of hitting another. When she resigned, Dunkeld was told that nothing would be done about his complaint.
“I can’t believe they let her leave without reporting her to the Nursing and Midwifery Council,” he said.
“She could be working somewhere as a nurse now and doing something similar.”
In 2009 Dunkeld resigned because of stress. He received compensation of £16,000 after managers admitted failing to investigate his complaints. Still no inquiry was launched into the drip-tampering. Most of his money went on legal fees. He is no longer in nursing and instead works as a part-time barman in a pub.
“I love nursing,” Dunkeld said. “I have been forced out because I raised serious public safety concerns that weren’t investigated.”
Today UHMBT is in special measures after a Care Quality Commission inspection earlier this year raised concerns about the standards of care, particularly at the Royal Lancaster and Furness General.
In a statement, the Trust said it had improved the way it handled whistleblowing: “The Trust did carry out investigations into many of these concerns, in 2008 and again in 2009, but it has been recognised throughout the NHS that the way in which staff concerns have been addressed and investigated in previous years was sometimes not good enough. As a result our Trust, like many across the country, has worked hard to tighten its whistleblowing policies…
“Unfortunately, the lack of detailed evidence available to us… means we are unable, so many years later, to substantiate the issues he [Dunkeld] raised.”
The Department of Health said: “We take these concerns extremely seriously… We are absolutely clear that NHS staff who have the courage to speak out in the interests of patient safety must be listened to.”
Consultant cardiologist Dr Kevin Beatt has won a two-year legal battle
Blew the whistle over conditions at Croydon University Hospital in 2011
Raised concerns over staffing shortages, poor equipment and bullying
But Dr Beatt was then sacked by Croydon Health Services NHS Trust
Damaging allegations against him included claim he was mentally unstable
Trust say they are ‘disappointed’ with tribunal’s decision and will appeal
Consultant cardiologist Dr Kevin Beatt (pictured) was sacked after he blew the whistle on hospital conditions following a patient’s death
A renowned heart specialist who raised the alarm over a hospital’s failings was unfairly dismissed in a calculated attempt to damage his reputation, a tribunal has ruled.
Consultant cardiologist Dr Kevin Beatt has won a two-year legal battle with Croydon Health Services NHS Trust, which sacked him in September 2012 after he raised the alarm about staffing shortages, ‘appalling’ equipment and workplace bullying.
He voiced his concerns following the death of heart patient Gerald Storey, 63, at Croydon University Hospital in June 2011.
It was a routine angioplasty, an inquest heard in 2013, but a senior nurse had been suspended hours earlier – without Dr Beatt’s knowledge – and her absence contributed to the patient’s death.
Dr Beatt, a renowned specialist who led the hospital’s well-regarded department for interventional heart procedures from 2007, should have been afforded protected whistleblower status but instead lost his job in a case he claimed provided a damning demonstration of the trust’s attempts to cover up failings.
The trust argued it dismissed him ‘for making unsubstantiated and unproven allegations of an unsafe service’, but the employment tribunal ruled there was ‘no consistent evidence’ of gross misconduct and chief executive John Goulston, whose evidence it criticised as inconsistent, had ‘failed to carry out a fair process’.
Between 2008 and his dismissal, Dr Beatt raised a catalogue of concerns about inadequate equipment, bullying and harassment of junior employees, removal of key staff, a lack of competent nurses and the failure to properly investigate serious incidents.
First published Wednesday 3 December 2014 in Local news
Last updated 14:10 Thursday 4 December 2014
Your Local Guardian: Photograph of the Author Exclusive by Chris Baynes, Reporter
Dr Kevin Beatt was unfairly dismissed for raising concerns about safety at Croydon University Hospital Dr Kevin Beatt was unfairly dismissed for raising concerns about safety at Croydon University Hospital
A leading heart doctor who blew the whistle on safety following a patient’s death at Croydon University Hospital was unfairly dismissed amid a calculated attempt to damage his reputation, a tribunal has ruled.
Consultant cardiologist Dr Kevin Beatt stands to receive thousands of pounds in compensation following his landmark victory in a two-year legal battle with Croydon Health Services NHS Trust.
The trust sacked him in September 2012 after he raised the alarm about staffing shortages, “appalling” equipment and workplace bullying. From July 2013: Man dies during routine operation at Croydon University Hospital after lead nurse is suspended
From June 2014: Croydon University Hospital suppressed safety concerns after patient death, claims ‘whistleblower’ Dr Kevin Beatt
Dr Beatt, a renowned specialist who led the hospital’s well-regarded department for interventional heart procedures from 2007, should have been afforded protected whistleblower status.
But instead he lost his job in a case he claimed provided a damning demonstration of the trust’s attempts to cover up failings.
The trust argued it had dismissed him “for making unsubstantiated and unproven allegations of an unsafe service”.
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Mr Goulston was interim chief executive at the time Dr Beatt was sacked after joining from a regional provider development role with NHS London in May 2012. He became chief executive of Croydon Health Services NHS Trust in February 2013.
The London South Employment tribunal ruled the doctor was unfairly dismissed solely or principally because he made a protected disclosure.
It is believed to be the first time an NHS whistleblower has won such a legal dispute on that point.
Between 2008 and his dismissal, Dr Beatt raised a catologue of concerns about inadequate equipment, bullying and harassment of junior employees, removal of key staff, a lack of competent nurses and the failure to properly investigate serious incidents.
In January 2010, he voiced serious fears to then medical director Tony Newman-Sanders that the cardiology unit’s radiation equipment, the oldest in use in the country, was putting patients and staff at risk.
He was accused of fabricating his concerns so he could treat patients elsewhere, but six months later the machinery was condemned and replaced after breaking down during an operation.
Friction between the cardiologist and hospital directors came to a head in July the next year, when a 63-year-old patient died during a routine procedure after a senior nurse was suspended without Dr Beatt’s knowledge.
Dr Beatt, who was left for 20 minutes without a nurse with even basic familiarity with the operation, described the suspension as “the most overtly reckless act” he had witnessed in his career.
He said he would not have begun the procedure had he known the nurse had been suspended.
The tribunal heard that four days after the death Dr Beatt was verbally threatened by Nick Hulme, then the trust’s chief executive.
Mr Hulme, who resigned in February 2012, allegedly warned the doctor not to make accusations about his managers in relation to what happened.
Mr Beatt told the tribunal: “I felt very intimidated by Mr Hulme’s statement and it was a clear warning to me that the trust did not want me to raise patient safety concerns and wanted to protect the management team from any suggestion that their decision to suspend Sister Jones may have contributed to the death.”
Your Local Guardian:
‘Intimidation’: Nick Hulme, the trusts’s former chief executive, allegedly threatened Dr Beatt
The trust claimed Dr Beatt’s criticisms were “vexatious” and calculated to ensure the restoration of Sister Lucy Jones, and in September 2011 it began disciplinary proceedings that culminated in his sacking.
But at an inquest at South London Coroner’s Court last year, coroner Dr Roy Palmer ruled Sister Jones’s absence had contributed to Gerald Storey’s death.
And the tribunal found there was “no evidence” Dr Beatt had an ulterior motive and that “extremely damaging” and “entirely false” allegations had levelled at him during a investigation into the Mr Storey’s death.
Those included claims by Dr Asif Qasim, the hospital’s clinical lead for medical specialities who had been repeatedly accused of bullying staff, that Mr Beatt was mentally unstable.
Witness statements made to the serious untoward incident inquiry into Mr Storey’s death had also been altered, the tribunal found.
Employment judge Gill Sage, the tribunal’s chair, said: “The tribunal therefore conclude on all the evidence before us that the respondent has not shown that the reason for dismissal was misconduct.”
She added the panel believed a “misleading” press statement about Mr Beatt’s dismissal, issued following the inquest 10 months later, had been “calculated and was likely to cause damage to his reputation”.
The tribunal, which sat between May and October this year, also unamimously ruled Dr Beatt had been subjected to detriment as a result of making a protected disclosure as a whistleblower.
But it dismissed a claim for unauthorised deduction of wages because Dr Beatt had not raised a grievance within the designated time limit.
Your Local Guardian:
‘Inconsistent’: Chief executive John Goulston’s evidence to the tribunal was criticised by the judge
After tribunal’s ruling, Dr Beatt told the Croydon Guardian he believed the trust systematically tried to silence concerns.
He said: “Essentially they ignored some of the statements made to the serious untoward incident report and submitted their own version.
“There’s no doubt in my mind that what they do is, if things have gone badly wrong, instead of saying things have gone badly wrong, they try to cover it up.
“The bigger picture here is it’s not just this case they’ve done it on. They’ve done it on lots of others.
“At the end of the day it is in order to misrepresent events to the patient and their relatives. That needs to be exposed.”
He said the legal battle and the trust’s decision to refer him to General Medical Council had taken “a very considerable toll” on him and left him unable to find work within the NHS, adding: “That’s why they do it.
“They do it because it will prevent me from getting a job and that will prevent me from pursuing them in court because I won’t be able to afford the costs.”
Dr Beatt said he believed the trust had spent “more than £100,000” fighting his case, which he was only able to pursue because his lawyers Linklaters agreed to work pro bono.
A spokesman for Croydon Health Services NHS Trust said it would appeal the ruling.
He said: “We are clearly very disappointed with the tribunal’s decision.
“Having sought legal advice, the trust is in the process of submitting an appeal against the judgment, to the Employment Appeal Tribunal.
“We take all concerns about patient safety extremely seriously, as well as allegations of bullying against any of our employees.
“It is everyone’s responsibility at Croydon Hospital Services to uphold great care for patients, and for our staff to know that they will be listened to and supported.”
This is the man who’s calling on Westminster to investigate what he calls a “dysfunctional Whistleblowing system in Northern Ireland.”
Kevin Murray, a nurse originally from Dublin, but who trained in England and worked in Northern Ireland for most of his career, said: “I had initially raised concerns last year over the treatment of a brain injury patient who required round-the-clock care.
“What I witnessed while the patient was under the so called care of the Belfast Trust constituted neglect and abuse.”
Just a few weeks ago, the 44-year-old was awarded an undisclosed sum of money from the A24 Group staffing agency which supplies staff to the Belfast Trust after being denied agency shifts.
Mr Murray has now taken to petitioning Westminster in the hope that he can have the issue of whistleblowing for doctors and nurses raised in parliament.
His online petition requires 100,000 signatures before the subject is brought before parliament. It can be found here.
Mr Murray claims that he was denied the shifts because of his attempts to report the case of the young patient in January of last year.
He said that when he used nursing notes, official Belfast Trust documents, to try to report his concerns, he was met with a wall of silence and was accused of breaching data protection laws.
“We as doctors and nurses have an incumbent duty of candour when on duty,” Mr Murray said.
“This means that when we see something that we feel puts a patient at risk, we must report it. But managers are using the Data Protection Act to try and silence us and brush us under the carpet.
“I tried to raise my concerns without success.When I tried to further my complaint, I stopped receiving shifts.
“I fear that whistleblowing complaints within the health sector in Northern Ireland are not being progressed. A system without a whistleblowing system of procedures cannot work. I did everything by the book, and still, it did not work.”
Mr Murray has now launched legal proceedings against Belfast Health and Social Care Trust for misfeasance in public office.
“I followed the guidelines and procedures,” He said. “I used the Nursing and Midwifery Council guideline pamphlet called ‘Raising and Escalating Concerns’.
“I even wrote to Health Minister Edwin Poots, and I received a receipt of my query, but I’ve never heard anything back from him.”
“One can only assume that the Belfast Trust is a law unto itself. When I complained about the trust to other organisations, I was merely deflected back to the Trust, the organisation my concerns were initially raised about.”
In recent months the Sunday World has been investigating the case of Mr Murray and the patient at the heart of the case – working closely with the patient’s family.
When we asked the Belfast Health and Social Care Trust to comment on the concerns surrounding the case of the patient, they said: “Belfast Trust are fully aware of these issues however we cannot comment on any individual case.”
After losing his job, Mr Murray described his heartache at having to walk away from the profession he loves.
“I’ve worked in health care since I was 18years old,” he said. “I’ve been a registered nurse for the last 20 years. I consider myself an Irish man, but an English nurse.
“It cost the taxpayer £133,000 to train me as a nurse. That is an investment in me as a professional that I take very seriously. It’s soul destroying to see that I’m no more than a disposable investment.”
The Northern Ireland chair of the of campaign group Patients First, Aiden Hanna, told journal The Nursing Standard that Mr Murray’s case “highlights that there are no protections for whistleblowers in Northern Ireland.”
The Secretary of State for Health talks about new regulations for a more open and accountable healthcare system and the launch of MyNHS.
As part of our determination to make the NHS the safest and most transparent healthcare system in the world, I want to tell you about two new important regulations that came into force yesterday.
The first is the Statutory Duty of Candour, which places a legal duty on hospital, community and mental health trusts to inform patients of mistakes which have led to significant harm or death. This is a key response to Francis, and a significant step towards a more transparent and open NHS. At the same time, the General Medical Council and Nursing and Midwifery Council are consulting on a new Professional Duty of Candour which would mean that there would be an obligation on doctors, nurses and other health professionals to inform patients when something goes wrong. This is all designed to bring concerns into the open much more quickly, so that we develop a learning and improvement culture. I hope it will mean the NHS becomes the first healthcare system in the world that starts to get close to eliminating avoidable harm, including the 1,000 avoidable deaths we have every month across the system.Jre
The second new power is about ensuring strong and safe leadership in healthcare organisations. Under new regulations, all NHS board members will be required to undergo a Fit and Proper Person’s Test before they are appointed. During its inspections, the Care Quality Commission will check that NHS Trusts have strong systems in place to ensure they are appointing the right people to hold these important roles. Importantly, the Care Quality Commission now have the power to remove directors who have overseen poor care. These tests will be extended to care homes in April 2015.
Finally another step towards creating a more transparent and accountable culture was the formal launch of MyNHS last week, a new part of the NHS Choices website that enables patients and professionals to compare the performance of hospitals, consultant services, GP practices, care services and local authority. MyNHS includes searchable data on staffing, patient safety, mental health and food quality, along with many other areas of care. Over time, more data will be added and MyNHS will become an increasingly powerful resource for patients, doctors and local NHS commissioners.
We should be proud that we are probably already the most transparent healthcare system in the world – this will take us even further. So thank you for the part you are playing to make it possible.
Dr Raj Mattu: ‘I’m not alone: there are hundreds of whistleblowers crying out for help. In fact, I’m almost unique in that I’ve come out the other end.’Photograph: Richard Saker for the Guardian
In his former life, Dr Raj Mattu was an internationally recognised cardiologist. On course for a professorship in London, he nonetheless jumped at the chance to return to his home town of Coventry in 1997, to set up a medical school at Warwick University and help turn the large district Walsgrave hospital into a teaching facility. It was a choice he would live to regret.
He found problems straight away. Patient safety was at risk through broken equipment and misallocation of resources; there were factions among staff and tensions with management. In the months before he arrived, senior clinicians had narrowly failed to pass a vote of no confidence in CEO David Loughton. Little was as it should be.
As the youngest consultant but one of the best-trained, Mattu worked long hours trying to improve things. All the same, one issue kept returning: the so-called “5 in 4” system of squeezing an extra bed into cardiac wards designed for four, a policy that left essential services such as oxygen, mains electricity and suction less accessible to some patients. Already convinced this was quietly costing lives, staff including Mattu pleaded for the practice to end, but management wouldn’t listen.
When the inevitable day came, it was on Mattu’s watch. A man of 35 went into cardiac arrest and staff could neither reach the tools they needed nor rearrange the beds in time. They watched in shock as their patient’s life drained away; afterwards the furious cardiologist and two senior nurses filed a serious clinical incident report. The 5-in-4 policy was not reviewed.
Now cardiac consultants passed a vote to replace their management-friendly clinical director with Mattu, but CEO Loughton rejected their choice. Instead, Mattu was offered a pay rise, which the medic interpreted as trying to buy his silence, and refused. When the Care Quality Commission (CQC) came calling in April 2001, he was one of five clinical staff to raise the alarm. Mystifyingly, the CQC passed the complainants’ names to Loughton. Yet when its report emerged that September, chief executive Peter Homa spoke of the “worst ever [patient safety report] produced for any Trust” and an “excess death rate” of 60% (against a subsequent high of 29% at the notorious Mid Staffs).
When Loughton denounced the CQC findings, and insisted to the BBC that no one had died or been harmed because of the 5-in-4 policy, something snapped inside Mattu. After taking advice from the General Medical Council (GMC), British Medical Association and Medical Protection Society, Mattu appeared on Radio 4’s Today, revealing that, in the opinion of medical staff, at least two patients had died unnecessarily on overcrowded wards, and that management knew and had done nothing. So a whistleblower is made.
So why now? Partly, it’s because economic self-interest has become king. If a senior executive earns £400k, or £1m, he or she has a lot to lose. A whistleblower is a threat to the business – and in UK law, a threat to a management whose first legal duty is to shareholders, rather than customers or workers. Globalisation and the internet have further loosened the old social and commercial ties.
Who are the whistleblowers, and what makes them do it when most of us don’t? The Hollywood-created image is of the awkward outsider; brave, but destined for maverick isolation anyway. In short, not like us. But most of the people I meet in the course of writing this article are essentially conservative. They spoke out because they felt they had to. The real story lies in what happened next.
***
Last month I sat in Raj Mattu’s kitchen, eating biscuits and drinking tea. He told me that the decision he made back in September 2001 still haunts him every day, that his lives then and now might as well belong to different people.
At medical school, he had trained with world-renowned experts, been drawn to cardiology, and risen through the ranks fast. Then came Coventry. After Mattu spoke to the BBC, management moved quickly, and a disgruntled temporary doctor levelled a charge of bullying against him. Mattu and two fellow consultants were suspended; all were prevented from talking to colleagues or the media, their disputes recast as employment matters rather than public interest disclosures.
Dr Raj Mattu.Photograph: Richard Saker
Soon, the single complaint against Mattu had become 35, then 200, ranging from questions over his qualifications to charges of serious criminal conduct outside of work. These were sent to the GMC, CQC, the Strategic Health Authority and three different police forces; by 2009, all had been investigated and found to be false. Mattu was also subject to three separate tax inquiries, despite having undertaken no private work. In 2010, ill and suffering from depression, he was finally sacked by managers who questioned the validity of his ailments and found him “unmanageable”.
Before we met, Mattu and I spoke several times on the phone, including one conversation so full of names, dates and surreal events that I almost doubted his sanity. Two hundred charges? How could there be that much smoke without a fire? He sighed. “You clearly come from the same world I like to live in. But what you describe is not what happens. I’m not alone: there are hundreds of whistleblowers crying out for help. In fact, I’m almost unique in that I’ve come out the other end.”
Last April, 13 years after Mattu spoke up, an employment tribunal that ran for six months produced a remarkable 400-page document that detailed the systematic destruction of one man’s career by managers, some of whom remain in the NHS and one of whom, David Loughton, isnow a CBE. The report found that management had created a culture of fear, and Mattu had been victimised for raising concerns over patient safety; he will be awarded compensation. The case against him, meanwhile, is thought to have cost the NHS £6m-£10m so far.
Today Mattu betrays little bitterness, and says he was helped by a city-wide campaign. Local ska band the Selecter played a benefit and at a celebration party, attended by 1,200 people, where singer Pauline Black(a radiologist) duetted with him on the Beatles’ Let It Be and Hey Jude. Music, he thinks, has kept him sane. Two years ago, his wife Sangeeta secretly entered him for the Voice; he was invited to the heats, but didn’t find the time to go.
But there were dark times, too. The couple had wanted to start a family, but felt unable to while the case was ongoing. Now they are thinking about it. And you know what? Theirs is the happy story.
***
Eileen Chubb’s story reads like a lost chapter from One Flew Over The Cuckoo’s Nest. Sitting in her south London garden, it occurs to me that her apparent ordinariness is what makes her so remarkable. She provides a window into the mechanism of whistleblowing, and also our curious, contradictory response to those who do it.
Chubb left school at 16 and worked as a manager in a local bakery chain, before deciding on a career switch in her early 40s, following her mother into care. With no experience, she opened the phone book and called the first care home she saw. Isard House was run by Bupa for Bromley council, and she was offered a job at once, on the advanced dementia unit. “It’s hard work,” she says, “but caring for those people was a privilege, because they were special, priceless. The trick was finding a way through to them. And there always was a way.”
Chubb talks about the residents she loved: Lil, a mischievous Scot in her mid-90s with a penchant for cutlery hiding and late-night booze-and-chip expeditions. And Jessie, who could scarcely speak and was afraid of the bath, until Eileen discovered that if she sang Daisy, the fear would vanish and words would come back as she sang along.
Chubb’s appointment as team leader to another unit was bittersweet, because she had enjoyed her own and respected the staff. But when she returned to check on her friends, she found something had gone terribly awry. A new team leader seemed to spend most of her time watching television, while residents slept in their own urine and went unfed. Several times, Chubb found her shouting or pushing residents, with junior carers following suit.
Eileen Chubb.Photograph: Richard Saker
Chubb raised her concerns; nothing happened. Finally, after hearing that six colleagues had done the same, she wrote to Bromley social services. Fearing a backlash, she offered the other six the chance to lie low, but they all stood by her as the horrified head of social services launched an investigation and informed police, who raided the home and made arrests. A subsequent report found painkillers had been withheld, unprescribed drugs dispensed on a whim and records falsified.
Game over? No. Bupa attacked the report; a campaign of intimidation by care home staff began, and two of the group were forced off sick with stress. A year later, an industrial tribunal found in the seven’s favour, its report a study in establishment fudge. It was later revealed that there had been no prosecutions because there had been no police investigation; the problem staff, including the team leader, had been dispersed to other Bupa homes.
Led by Chubb, the Bupa 7 refused to accept the tribunal’s ruling or any compensation payment, and rejected substantial payoffs the company offered in exchange for silence. After two years of fighting and being unable to get work in the care industry, most were in dire financial straits, despite huge public support: at one point, the local paper gave them jobs as cleaners. Undeterred, Chubb bought the Penguin Guide To Law, for £3.99, and set out to hold Bupa to account.
That was 13 years ago. Two of the seven are working in care again; the rest have rebuilt their lives around other things. Chubb runs a charity, called Compassion in Care, and is a founder of the Whistler, which fights to expose poor conditions in care homes and to help those who speak out. A powerhouse of citizen activism, she is driven not by ideology but by a simple sense of right and wrong. She dates her transformation to her first meeting with Bromley social services, when she opened her mouth to speak and was startled by the voice that emerged – clear and ice-cold with rage.
“People who didn’t know me then never believe this,” she laughs, “but I was the sort of person who didn’t make a fuss. I had a soft voice and if I had to say something, I’d say it nicely and quietly.”
There was no history of rebellion, not even at school? “Oh no, I wouldn’t get my socks dirty. I was scared of my own shadow. But those people in Isard House were easy to fight for. Someone like Jessie should have been cared for in her old age, not dragged down a corridor screaming.”
She was never tempted to take the money? “Not if they’d offered a million pounds. If the judge had awarded us money and condemned Bupa, fine, but taking the money with no admission of guilt would have been insulting all those who’d been abused. If Bupa didn’t accept responsibility, then other people in other homes would pay the price. To allow them to cover it up by paying us would have made us abusers as well.” Almost as an aside, Chubb recalls her father, a construction worker, being so deeply affected by the death of a young co-worker who drilled through a mains cable that he organised a whip-round for the family, and remonstrated so forcefully with site managers that he was out of work for some time afterwards.
She admits her new life has cost her friends, mostly because her politicised interest in the world leaves her easily bored by everyday, trivial concerns. In any case, campaigning is her life now and money is still tight. As with Raj Mattu, the most curious thing is the way former colleagues, those who had been guilty of no wrongdoing, turned on Chubb and her small cohort after they raised the alarm. I could see no sense in this behaviour, but it turned out to be key.
***
C Fred Alford, professor of government at the University of Maryland, is the author of Whistleblowers: Broken Lives And Organizational Power, a study into the personal impact of whistleblowing. It makes for an alarming read. Surprise discoveries include a finding that seniority offers little protection, and that it makes no difference whether a concern is first raised inside or outside the organisation. Of Alford’s three dozen-strong sample group, most lost their jobs and never worked in the same field again; many also lost their families, as court cases and tribunals dragged on for a decade and more. A majority suffered from depression, with alcoholism common. In another study, half the sample group was found to have gone bankrupt. All of this tallied with the people I talked to: the sanctity of whistleblowing may be written into law, in both the UK and US, but for most it will be a traumatic experience. “The greatest shock,” Alford says, “is what the whistleblower learns about the world – that nothing he or she believed is true.” Hence the “nuts and sluts” narrative we find in relation even to celebrated whistleblowers such as Karen Silkwood, Erin Brockovich, Julian Assange and Edward Snowden. This is a narrative we embrace, because it makes us feel secure: they brought it on themselves.
***
A common cry after the financial crisis of 2008-9 was, “Why did nobody see this coming?” – but the best risk management execs had. In the US,Eileen Foster, executive vice president of fraud risk management at the giant Countrywide home loans company, saw and called the mortgage irregularities that earned CEO Angelo Mozilo a staggering $470m between 2001 and 2006 (the vanity plate on his car read FUND-EM) and would play an outsize part in sinking the US economy. She was proved spectacularly right, but claims to have had 145 job applications turned down thereafter. Her colleague Michael Winston, a board member, was similarly dumped and pilloried after refusing to write a report for Moody’s credit ratings agency that he believed would be false.
Paul Moore was head of risk management at HBOS, a holding company for the Royal Bank of Scotland and Halifax brands. HBOS gambled on bad mortgages and payment protection insurance (PPI) and lost £10bn in 2008. It was bought by Lloyds, then rescued with £37bn of public money. HBOS did more than any other institution to bring UK banking to its knees – but it had been warned.
Moore trained as a barrister and went to work for a financial services firm in Swindon because he knew the hang-gliding would be good. From there he moved through American Express and KPMG before joining HBOS in 2002. Asked whether his job involves annoying managers, he admits that willingness to deliver unwelcome truths is important, but adds, “Risk management is not about going slowly, it’s about going as fast as you can and managing the risk. Formula One has less residual risk than angling, for instance. So I’m the risk management adviser, and the chief executive is the driver. It’s my job to say, ‘Hang on – if you carry on that way you’ll blow up the engine, or run out of fuel, or make the brakes too hot.’”
Has he often been placed in that position?
“I’ve seldom said, ‘You’re going to blow the engine up!’ But I did at HBOS.”
Alarm bells rang in late 2003, when he noticed 12% of profits were coming from the sale of mortgage PPI. He looked across the business and saw aggressive managers pressuring staff to meet wild sales targets (“We’ll never hit our sales targets selling ethically,” one told him), and non-executive directors with insufficient expertise to apply oversight. Worse, upon asking questions, he found “a cultural disposition to resist challenge, often aggressively”. Regulators were worried, too: if their insistence on raising the amount of cash HBOS had to keep in reserve had been made public, as it should have been, negative market reaction might have forced a rethink. But HBOS’s CEO, James Crosby, was also a non-executive director of the main regulatory body, the Financial Services Authority (FSA).
Paul Moore.Photograph: Richard Saker
When HBOS paid its auditors KPMG $1.2m to investigate Moore’s claims, its report questioned not just his views, but his professionalism, integrity and stability. Already sacked by Crosby and shunned by former colleagues, Moore says he read the report and wept. “The auditors and accountants are at the rotten heart of everything,” he says. “You know, I got to the point where I actually thought they were right and I was wrong. I came to think I must be a terrible person.”
In contrast to Eileen Chubb and the Bupa 7 – and more typically of whistleblowers – Moore was on his own. For the first time in his life, he began to sweat to the point where he had to wear sanitary towels under his arms in meetings and – already a heavy drinker – he grew capable of downing a bottle of vodka in half an hour, terrifying his wife and confusing his children. He reads me a birthday card from his then 17-year-old son: “Everyone has flaws,” it says. “I like to look past the flaws and see the good in people, and there’s a lot more good in you than you give yourself credit for. I truly am proud of you and everything that you stand for, which is mainly integrity and truth. Just stay true to yourself and keep on doing what you’re doing. It’ll all work out eventually.”
Fired 10 years ago, Moore says he has gone into recovery only this year. “When I say it nearly killed me, it’s not a metaphor. I am a confident, resilient person. To crush me is a serious thing.”
Moore sued HBOS for unfair dismissal and accepted a half-million-pound settlement – in return for his silence. It was to presage the worst of his crisis: “I remember lying on my bed, seeing duty to my family on the one hand and knowing these people have got away with blue murder on the other. You’ve sold your soul to the devil.”
Later I am contacted by another casualty of the banking industry, a financial adviser in a branch who saw mis-selling by policy, reported it and was turned upon by company and colleagues. Like Moore, Lynne Edwards accepted a payoff and signed a gagging clause four years ago, encouraged by lawyers eager to be paid. Like him, she’s haunted by it. “If I knew then what I know now, about how it eats away at you and keeps going on… The bank paid their fine and carried on as before. When I go to job interviews, they ask why I left and I have to lie, so I’m still in limbo. What’s it been for?”
Perhaps most shocking is her contention that her former employers lied to regulators. On reading the FSA’s report, she tried to warn them. “But they said, the bank has been fined now, so it’s dealt with. I was referred to the whistleblowers’ helpline. It ends up being a burden: you’ve done it, you’ve blown the whistle, and that’s what you are from that point on. You’re a whistleblower.”
Kate Kenny of Queen’s University in Belfast and Harvard’s Safra Centre, author of a book about whistleblowing in the finance industry, says she has been surprised by “the amount of work that goes into a being a whistleblower”, meaning the constant reading of documents, rebutting of arguments, exposing of lies and learning about the law, all while struggling to hold your personality together: in short, by the fact that it’s a full-time job which – usually without warning – takes over your life.
Of my sense that whistleblowing is on the rise, she says: “In finance it’s too early to tell. The regulators are receiving more tipoffs, and yet no whistleblower came forward about Libor.”
***
Why is the psychological impact of whistleblowing so extreme? David Morgan is a psychoanalyst who works with whistleblowers, often on a pro bono basis for clients who have lost their livelihoods. “At first, when they talked about how paranoid they were and how many people were after them, I saw them very much like ordinary patients and treated them accordingly,” he says. “But after two or three months I became paranoid myself: I realised what they were talking about was real, not just a mental health issue – their lives were under threat.”
Is there a process of recovery, as with alcoholism or bereavement? “Yes, there are three stages. First, ‘I’m gonna do it’ and the excitement about standing up and being counted. Then there is disillusionment, when you realise you’ve been left standing on your own and that colleagues who said they’d stand by you haven’t. And the third stage is that any underlying psychological problem, to do with a relationship, depression or whatever, is exacerbated enormously. There’s a real feeling at this stage that they’ve lost everything.”
The therapist’s job is to help a patient find something good in their life to hang on to. Most of us like to think we would stand up and be counted when faced with wrongdoing, but the hard truth is that most of us don’t. What makes whistleblowers different? Most of us, Morgan suggests, employ psychological mechanisms such as “splitting” to manage moral conflict (in other words, we don’t think about it too much); whistleblowers don’t. This means those most inclined to do it are the least equipped to cope psychologically. They often also have a courage drawn from an ideology, religion or strong set of principles, Morgan adds, from “a sense of belonging to something greater than the organisation they work for, whether God, humanity or some broader community”.
Are there any who don’t recover? “I’ve seen people go mad, yes, and start to identify with their attackers or turn in upon themselves. It’s very frightening. People are suddenly plunged into a world they didn’t know existed, where the rules they thought applied don’t. Think about it: you do something idealistic, because you think it’s right, then you end up being seen as the corrupt one. And one can always find some reason for blaming oneself, at which point people can really struggle. Someone like Eileen Chubb, who has this huge ideological underpinning, this belief in care and compassion, is at a real advantage.”
Chubb also had a group around her and a supportive husband. What if you don’t have that? And what if you have an entire nation ranged against you? Christoph Meili is Swiss, and was working as a security guard when, on his rounds one night, he stumbled across a tranche of second world war era records in a storage room at a major insurance company. Interested in history, he looked more closely and found ledgers full of insurance policies held by German-Jewish customers up to 1945, at which point they were unilaterally frozen by the company. Of special poignancy were stacks of letters from destitute Holocaust survivors and victims’ families, begging for the policies’ terms to be met – all dismissed on spurious technical grounds. Security is a respected occupation in Switzerland and Meili could boast two degrees, but he didn’t need them to recognise these papers as significant, so he hid a handful in his coat and found a photocopier, but in the time it took the machine to warm up, he lost his nerve.
Two weeks later, he found another large stash of historical documents at the giant bank UBS, including two black ledgers detailing loans made to German companies before and during the war. Among these companies were a maker of chemicals used in concentration camps and others active at Auschwitz. As the war neared an end, corporate registrations had been transferred to Swiss banks in order to keep their assets from the Allies.
Christoph Meili: ‘A voice in my head said, “It’s not your responsibility, this is serious, take the ledgers back.” But another voice wouldn’t let me’.Photograph: Douglas Graham/Congressional Quarterly/Getty Images
But there was worse, because Meili realised this was no archive store: it was a shredding room. He looked closer and found details of profit accrued from the “forced sale” of real estate in Berlin between 1930 and 1945 – knowledge of which banks had always denied. He knew that the Swiss government had just passed a law forbidding destruction of war records, but also that – technically at least – to take them would be theft.
He took the ledgers home, parked them on his kitchen table and went out to walk the dog. A voice in his head said, “It’s not your responsibility, this is serious, take them back” but another voice wouldn’t let him. His worried wife suggested handing the files to a Jewish cultural group she knew. So Meili did, expecting that to be that.
Two days later, a Jewish community leader pulled up in a big black Mercedes, with news that the UBS papers had been passed to financial police in Zurich. Meili was speechless. Scared. “You’re a smart guy – you’ll be OK,” the man said, but the next day Meili arrived home to find a lawyer there, inviting him downtown to make a statement, just as news arrived that he had been suspended from work. He took his wife and children (whom he’d had to scold for scribbling on the ledgers) for a burger, then stepped into a bizarre new future.
A press conference was called. Meili told reporters the information he had released belonged not just to the Jewish community, but to the public at large: “The Swiss people should know their banks were involved with Nazi corporations.” Now the world’s press was on his doorstep but, as nearly all whistleblowers will tell you, he found this comforting, because the press lent protection and support. For three weeks, Meili was a hero and the banks promised to set up a $200m fund for Holocaust victims. He met some elderly survivors who would now be helped, and he felt good. But the feeling didn’t last long.
Meili’s problems started when the US-based Anti-Defamation League arrived to present him with an award and announce the creation of a $36,000 legal defence fund in his name, while also launching a $28bn lawsuit on behalf of Holocaust victims against the banks. “The problem is that what I did wasn’t about money,” he says. “It was about history and helping the poor people whose lives had been ruined by what these banks had done. But when money came into the picture, so did politics.”
Now the Swiss public assumed him to be rich (he was unemployed and on benefits), and the mood changed, emboldening an already cagey indigenous media to weigh in with stories painting him a liar and a traitor; a turncoat who couldn’t follow orders; a gold-digger and even a Mossad agent. Then the Swiss authorities launched a judicial investigation intohim.
As with Chubb and Moore, the rightness of Meili’s actions is so clear that the narrative of his life from this point on is hard to credit. Following death threats to him and his family, an Act of Congress signed by the then president Bill Clinton granted them shelter in the US on 1 January 1997. The US Jewish community organised a stipend to help while framing a case against the banks. Meili claims to have been handed 35 humanitarian awards in the years after he blew the whistle, but still he struggled to find work. His wife left with their children; he later remarried and had another child, but struggled to support that family and, rootless, lost them, too.
Five years ago, Meili’s mother persuaded him to return to Switzerland and he sits in his small living room in Wil, near Zurich, as we Skype. When he arrived home, the Swiss Broadcasting Corporation website ran a piece headed “Christoph Meili returns – as hero or villain?” which looks bizarre from all but a banker’s perspective. He has been on three different work programmes since returning and attended a mental health clinic, “because I needed some help, you know, my self-esteem was so down, I had to build myself up again.” He says his eldest daughter, now 21 and studying at an American college, has just been to visit, but that her brother won’t speak to him. He works part-time selling Bosch tools, and a third marriage has been good so far, which is perhaps why he’s able to laugh again. “But it’s not the same. I miss my kids. I’ve missed them growing up, it was taken from me.”
He has an outstanding lawsuit against a Swiss newspaper, he tells me, because every two years a tabloid returns to harass him. So he’s still a pariah? Now he softens. “Actually, it’s getting better. Every Saturday at work I have one or two people look at me and go, ‘Hey, you’re that guy!’ but most are nice about it now. After the financial crisis, they say, ‘You’re the guy that first came out against these banks.’ And then they’re happy to see me.”
Which is all to the good, but still some way short of a happy ending.
***
Why do we idealise whistleblowers in the abstract, yet turn on them so readily in the flesh? The loneliness and isolation that comes with the territory seems to feed our view of them as weird misfits who have merely found their natural state. In the words of one, quoted by Professor Alford in Whistleblowers, “I have seen the truth and the truth has made me odd.” That perception is self-sustaining. Why do we need it?
In search of an explanation, I wind up at the door of 81-year-old Dr Philip Zimbardo, conductor of the 1971 Stanford prison experiment, and latterly called as an expert witness to the Abu Ghraib trials. His experiment has been repeated countless times around the globe, with a multitude of variables, and is soon to be revisited in a Hollywood movie starring Billy Crudup.
Philip Zimbardo’s 1971 Stanford prison experiment, in which 18 students were divided into ‘guards’ and ‘prisoners’.Photograph: Duke Downey/San Francisco Chronicle/Corbis
Famously, Zimbardo’s study involved dividing a group of students into prisoners and guards, then monitoring their behaviour. But within six days the proceedings had to be stopped, as guards grew brutal and prisoners passive and distressed. Most surprising was the apparent fact that personality type (as tested beforehand) afforded little indication of how particular individuals would act; that the most important predictive factor was situation. In conjunction with his former classmate Stanley Milgram’s eponymous and equally groundbreaking experiment, in which test subjects were persuaded by authority figures to administer apparently painful – even fatal – electric shocks to people they believed also to be test subjects, Zimbardo’s research is compelling. Stir in fellow psychologist Solomon Asch’s finding that even the strongest-willed individuals find the burden of standing out from the crowd unbearable over time (in this case a classroom full of peers briefed to answer questions wrongly) and we have a clear picture of ourselves as social creatures who, for the most part, would rather be wrong than isolated.
What does this mean? That our healthy and necessary desire to be social can be turned against us within bad systems, or by bad leaders. Or, as Zimbardo says, “The potential for perversion is inherent in the complexity of the human mind.” Further, where our desire to be social clashes with our underlying values, “we will go to remarkable lengths to bring discrepant beliefs into some kind of functional coherence”. Which is to say, we protect ourselves by rationalising. This is precisely what the whistleblower doesn’t do.
Zimbardo has just launched an organisation called the Heroic Imagination Project, which aims to furnish people with the psychological skills they need to become whistleblowers. “Stanley [Milgram] and I were interested in the same question: how do ordinary, normal people get caught up in these awful things that keep happening, from the Holocaust to Rwanda. And part of the answer is to look at people who don’t, and find out what we can learn from them. For me, whistleblowers are people who are simply more attuned to a situation, who are able to step back, even where they’ve been closely involved in things, and go, ‘Oh my God, this is wrong. How can I stand up or speak out to try to change it?’”
Encouragingly, he thinks this can be taught. “With the project, we’re trying to train ordinary people to be willing to do the right thing. So we’re running programmes, mostly focusing on high school and college students, because we can train them in basic psychological principles that encourage them to speak out – but to take wise and effective action, not risky, not dangerous.”
Asked for a single piece of advice, he offers: “Ideally, whistleblowers should always form a small team, because when you’re a whistleblower against a powerful system, the system dismisses you as a fanatic. But if you have three people, what you’re saying becomes a point of view.”
No wonder professor Alford says that “everything you need to know about whistleblowing, you learned in kindergarten”. Perversely, he goes on to claim that this is a greater problem in individualistic western cultures than in societies where conformity is overtly valued. “Research shows that in Korea, say, they know how groupish they are,” he says. “What happens in America – you know, the land of the free and home of the brave, where the lone sheriff rides in and cleans up the town – is that we have this language of independence and we don’t have a language to talk about how utterly cowardly we are when faced with group pressure. We’re all afraid of stepping out of line. And whistleblowers don’t like it, either, which is why support groups are so terribly important.”
The good news is that whistleblower support and advocacy groups are springing up everywhere, in the UK and abroad. While writing this, I received daily updates from whistleblowingtoday.org. In the UK,compassionincare.com, thewhistler.org, whistleblower.co.uk andWhistleblowers UK all offer support to anyone courageous enough to need it. And while the UK’s ineffective public information disclosure legislation has been sunk further by the government’s introduction of £2,000-plus charges to access employment tribunals (leading to a 70% drop in the number of claims), US legislation is producing results.
Louis Clark of the Government Accountability Project (Gap) in the US, which champions public and private sector whistleblowers, describes his organisation’s tactics as being about replacing the lost “circle of support” with a new one, drawing on those who might benefit from the released information. As the aggressor agency tries to focus attention on the whistleblower, Gap turns the attention back to the original problem. At this stage, Clark tells me, it’s amazing how often relationships within the aggressor group start to break down.
Better still, US law recognises whistleblowing as positive: once a worker has been accepted into this category, sacking them becomes extremely difficult, requiring the production of “clear and convincing evidence” that it would have happened anyway. Just as importantly, the Department of Justice can and does insist that a worker be given their job back pending any court case or tribunal.
“I think whistleblowing is happening more because people believe it can make a difference,” Clark says. “These days we seldom lose a case when there’s a public hearing. And it was noticeable that the argument about Edward Snowden in the US was not over whether whistleblowing is good – it was about whether he counts as a real whistleblower. That’s a big change and in time it will change us all.”
Read the attachment then tell me is this just a personal employment issue or does this also require further investigation as I have requested. This is the response you get from those in power , when you blow the whistle in order to save life, 600 submissions to the Francis review so far, I really thought having met those in power many times now, they would realise, we really do expect change
Dear Mr Hunt,
Below is the response from your office from my email highlighting the concerns of a whistle blower , The concerns raised were advising of a nurse whom allegedly went around turning off the drips off elderly end of life patients in order to speed up their deaths .
Therefore I would like some one to explain to me and the public , how this is a personal employment matter? I’m pretty sure if you asked any member of the public, ” is this a personal employment issue or a matter that requires further investigation and full support for the whistle blower,”? Common sense would prevail and the public would expect a full investigation of all allegations.
The bog standard response from your office is part of all that is wrong and only aids those trying to cover up wrong doing. Quite frankly a disgrace that the DoH continue their “business as usual approach towards the whistle blower” it does not inspire confidence for the future or any future recommendations that may be made by the review .
For the record I am not asking for a discussion, I am requesting that these allegations are investigated fully by an independent body.
There are far too many whistle blowers left without employment and astoundingly still, in some very recent cases gagged , Those that cover up or do wrong are promoted or let go quietly.
Regards
Fiona Bell
———- Forwarded message ———-
From: <DoNotReply@dh.gsi.gov.uk>
Date: 6 November 2014 16:53
Subject: Response to your Query : – Ref:DE00000892418 – your recent correspondence to Jeremy Hunt and Ed Jones
To: fbell226@gmail.com
Our ref: DE00000892418
Dear Ms Bell,
Thank you for your correspondence of 14 October to Jeremy Hunt and Ed Jones about Mr xxxxxx. I have been asked to reply.
The Department of Health has noted the concerns in your correspondence. However, as mentioned in previous replies to you, ministers and Department of Health officials are not in a position to discuss personal employment issues.
Thank you for raising your concerns.
Yours sincerely,
Jeremy Vooght Ministerial Correspondence and Public Enquiries Department of Health
This is a question for staff and patients in the NHS.
Sharmila Chowdhury 4 August 2014
As an NHS staff if I suspect something is wrong, simplest thing would be to raise my concerns to my line manager. Simple. After all, we have decided to work for the NHS because we care? We care for patients and other staff who are placed under our care. Our managers would be grateful to us, surely, and make arrangements to investigate and where appropriate, put things right. After all it’s in patients’ interest. Wrong. This is not how the NHS currently works in many hospitals, care homes, institutions and clinics.
Staff do need to raise concerns – why? Because, like in most walks of life, there will be situations which needs special attention. There could be issues, such as potential fraud, mismanagement of resources, safety issues, staff training issues which can relate to both staff and patients. There are of course, numerous more examples. As staff we have it ‘ingrained’ into us as part of our training about having ‘duty of care’ and reporting anything that we feel needs attention. Doing otherwise and ignoring would constitute neglect. Staff being able to safely raise concerns is vital to patient safety.
One of the earliest NHS whistleblower who has been in the public domain has been Steve Bolsin, who first raised concerns over 20 years ago about children’s heart surgery at Bristol. He is now based in Australia. Since then not much has changed. Whistleblowers’ raised concerns are still ignored despite in many cases, having extensive evidences. Whistleblowers are subsequently victimised and persecuted and find themselves being accused with false counter allegations, despite in most cases there are lack of evidence of any wrong doing. In some cases hyped up to be more serious than it really is as in David Drew, who was accused of quoting bible in a meeting. This was deemed to be more serious than the concerns he had raised about child safety, which led to the death of a child due to arrogance and neglect.
Whistleblowers within NHS come from a wide range of occupation, which include Chief Executives, such as Gary Walker and John Watkinson. Both raised patient safety concerns and both lost their jobs.
Since becoming a whistleblower myself, nearly 5 years ago and developing my website, I have been in contact with numerous whistleblowers. Many of the cases are devastating where the whistleblower have suffered gross injustice. Many cases are truly heartbreaking.
One example, is that of a senior staff member who was raised concerns about dealings with child abuse. She has now not only been left without a job, she is homeless, and now lives in a friend’s garage and depends on provisions from food bank. Another is a single mother of 2, who also now has to rely on food bank and in due time may have her home repossessed. I too, am likely to lose my home soon whilst suffering cancer.
My case is perfectly summarised by Courtesy of NHS Mess @NH_Mess
Many of the whistlebowers face years of stress. Many end up having counselling or have nervous breakdowns. It has profound effect on close family & friends. Many relationships breakdown under stress as in reported cases of Edwin Jesudason and Gary Walker. Sangita, Raj Mattu’s wife on Channel 4 news said that they have been unable to have children due to ongoing legal battle and stress. There are also known whistleblowers who have committed suicide or have suffered mental breakdowns, as it all got too much for them. Their health take a toll. David Drew has suffered serious health problems, despite leading a healthy life. I have developed cancer, which numerous consultants believe is stress related.
There are very few known whistleblowers who have faced legal battle with their trust and have return to their workplace. I only know of one – Ramon Niekrash. However, he was left with legal fees of £120,000. Nearly all NHS whistleblowers, once dismissed, never return to their workplace. Very few continue to work in their field of expertise and even fewer manage to secure permanent posts. This is because of existence of blacklisting within the NHS. There is of course in addition gradual loss of skills once being unemployed. For many, only option is to leave the country and look for work in other parts of the world, such as Steve Bolsin.
So why do whistleblower’s bother to raise concerns or blow the whistle where not only are their concerns on the whole are ignored but their whole career is destroyed? Because on most occasions, they feel they are simply doing their job and are confident that their concerns will be sorted. Very few give a thought for their own safety as naively it never enters their head. However, having made an example of a whistleblower, trusts send out a strong message to other potential whistleblowers. Many are deterred from speaking up. This means that patient’s safety is compromised. If staff are too scared to speak up, it means that the risk factor is never investigated, let alone sorted.
So why are whistleblowers persecuted? In some cases by bringing to light the concerns could be a source of embarrassment to senior managers and could attract unwanted publicity. It could be a costly expense to fix and organisations may have targets they have to meet. Individuals within the organisation may have vested interest for example, as in cases of theft and fraud. It could also be due to basic retaliation of ‘I go or they go’ (this could be due to the whistleblower having raised concerns about them) or it could be that individuals are looking out for their colleagues who have done wrong, but have a strong position in their organisation.
Those spending public money covering up their wrongdoing have been getting away with it for over 15 years, since Public Interest Disclosure Act, PIDA, was introduced.
The Chief Executive, The Medical Director and The HR Director are ultimately responsible within Trusts to ensure that victimisation of whistleblower does not happen, but unfortunately far too often, they are part of the victimisation. Trusts are given easy access to legal funds which are paid by taxpaying public. These funds are authorised by the Department of Health and paid out by The Treasury.
Ironically, huge sums of money which should have gone into patient care is used to fight and get rid of whistleblowers – the very people who care and want to protect the patients and the health service. It would be interesting to survey the tax paying public to have their views on their hard earned money is continually being wasted on getting rid of whistleblowers. After all, they are paying for this wastage. Raj Mattu’s case is a good example, where not only did Raj suffer for 13 years, but it has costed the tax payer £20m. Money which should have been used to benefit the patient. In addition, more recently, case of Arjuna Weerasinghe, where seven figure settlement is now being considered.
Of course, it isn’t just money that is being wasted, but there is also huge waste of expertise at all levels, which is being drained from the NHS. The very people who care what happens in the NHS are the very people who are being removed and having their lives destroyed.
Why is this allowed to happen? Nearly all whistleblowers once they realise they are in trouble and are in need of urgent help their first port of call is to their unions. I have yet to meet a whistleblower who has been successfully supported by their union throughout the ordeal. I am not sure whether this is due to lack of understanding, lack of money, or simply they want to remain in good terms with individual organisations. Strange as it may seem, in some instances, unions have turned on their own members.
The next step for a whistleblower is to get legal advice. Some firms are happy to give free short advice over the phone. Consultations can be expensive but vary. Mine cost £398 per hour, four years ago. Often with no money, whistleblowers setlle for ‘no win, no fee’ arrangement. However, legal costs escalate at an alarming rate. Many turn to policies in their home insurance. This has certainly saved the day for many, such as Anabelle (Loo) Blackburn and Jennie Fecitt. However, unfortunately some, such as mine, there was an opt-out clause, where if you belonged to a union, your policy will not be covered. My legal fees had escalated to £130,000 on a ‘no win – no fee’ basis.
Nearly all whistleblowers I have come across had written to both Care Quality Commission and Department of Health for help. Virtually all have been left without help, despite having strong evidence. Nearly all have received a standard reply, which stated that they could not get involved due to ongoing legal case. So, where is a whistleblower to go when they find themselves in deep water? Nowehere, is the answer. No one will intervene or inspect surroundings of the case. Cases are frequently dragged out over years before reaching a settlement. This is often deliberate attempt by Trusts who have endless legal funds to drain any funds that the whistleblower may have, to reach a settlement in their desperation. Also, if they are on ‘no win –no fee’ arrangement, they often have to settle out of court with substandard pay-outs, often just enough to cover their huge legal expense.
In contrast, trusts and organisations are fully supported with advice and access to funds by The Department of Health. So, stating that either Department of Health or Care Quality Commission cannot get involved in their response to a whistleblower is untrue. They do get involved, but simply not on the side of the whistleblower.
So, having suffered over the years and finally reaching some sort of settlement, you would think that there will be some help. No, is the answer. With career and any remote job prospects, livelihood, personal life and health destroyed, there is simply no help. Even when proven to be a whistleblower by courts, there is no help. Whistleblowers are left abandoned. So, who should be there to ensure that whistleblowers, responsible members of our society are taken care of? Fingers currently point to Jeremy Hunt and The Department of Health. After all they are ultimately responsible for the running of the health service. To say that they ‘cannot get involved’ is no longer acceptable. Hunt has instigated review into NHS whistleblowing led by Sir Robert Francis QC. Results and recommendations of which are due in November. This is a step forward. However, any recommendations made will need to be effectively implemented and not ignored.
I have yet to hear of any senior managers, directors, executives held to account for their treatment of whistleblowers. Yet, nearly all NHS organisations now have whistleblowing policies. Clearly, written policies are not worth the paper they are written on if no one acts on them. It needs a responsible governing body to take responsibility and ensure that all staff, patients and public for whom they are in charge have an in depth understanding, compassion, leadership and willingness to drive this forward. Until this happens, lives of both patients and staff will continue to be destroyed.
For more information and articles on whistleblowing visit sharmilachowdhury.com
Express & Star – StaffordshirePUBLISHED: November 3, 2014 9:59 am LAST UPDATED: November 3, 2014 12:17 pm
A hospital security manager was removed from an investigation into allegations that a patient had been inappropriately restrained because he was involved in another ‘whistle-blowing’ inquiry, a tribunal was told.
David Ore
Nursing director at the Dudley Group of Hospitals NHS Trust Denise McMahon told an employment tribunal she feared a conflict of interest if David Ore was to oversee the investigation.
But Mrs McMahon said Mr Ore had not been suspended from his post as security manager at Russells Hall Hospital, and had rather been granted ‘special leave’ which was for his own protection.
Mr Ore, who was sacked for gross misconduct following a disciplinary hearing in April 2013, claims he was unfairly dismissed for raising concerns about the way patients were restrained.
Mrs McMahon said at the time Mr Ore was temporarily removed from his duties on January 7 last year, he was already involved in another employment tribunal with ‘a whistle-blowing element’.
She said the investigation into the restraint of a patient referred to a specific set of circumstances, and had Mr Ore raised them at his impending tribunal, it could have led to the identification of the patient.
“We were concerned there would be a conflict of interest,” she said.
“I was seeking to protect patient confidentiality.”
Mr Charles Crow, representing Mr Ore, asked why his client could not have remained in his post but been excluded from the investigation.
Mrs McMahon said that had been looked at, but not considered to be practical.
Mr Crow said Mr Ore’s removal from his post had all the characteristics of him having been suspended from his position, but Mrs McMahon said that was not the case.
Mr Crow said special leave would in normal circumstances be something that an employee would ask for, and would not prevent them from returning to work should they want to.
He asked Mrs McMahon: “Have you ever heard of an employee who has been granted special leave being escorted from the site?”, to which she replied that she had not.
However, Mrs McMahon said that the the key difference between Mr Ore’s situation and that of a suspension was that he was not at that stage being investigated for any allegations of wrong-doing.
“We felt it was within the spirit of special leave,” she said.
Mrs McMahon said she was aware that on a number of previous occasions Mr Ore had voiced concerns about the way patients were being restrained.
The Dudley Group of Hospitals NHS Trust says Mr Ore was sacked for allegedly acting dishonestly by using the staff car park when he was not authorised to do so, and alleged aggressive behaviour towards an individual.
BMJ 2013;346:f2338 doi: 10.1136/bmj.f2338 (Published 19 April 2013)
PERSONAL VIEW
No doctor should be untouchable
Even very senior doctors must be subject to the same codes of conduct, and to the same sanctions when they are breached, says seasoned whistleblowerPeter Wilmshurst
Peter Wilmshurst honorary consultant cardiologist, University Hospital of North Staffordshire, Stoke on Trent ST4 6QG, UK
Allegations that Jimmy Savile sexually abused children and vulnerable hospital patients surfaced after his death, when he was no longer protected by the English defamation laws. These laws were designed to protect the wealthy and famous from allegations by poorer citizens by making it difficult and expensive to defend a defamation claim, even if you are telling the truth. Should we blame the cover-up entirely on the libel laws?
There were those in authority at the BBC (where Savile had star status), in hospitals where he had unprecedented access, and in the criminal justice system who had heard reports of his misconduct but failed to act. Victims were told that their testimony would count for little compared with the word of the television star and charity fundraiser. Savile was valuable to the organisations and his victims were not. Savile himself bragged that he was untouchable. Other organisations that have covered up misconduct include the Catholic church over child abuse by priests, and the South Yorkshire Police over their failings at the Hillsborough disaster. Organisations protect their members, and senior members are, like Savile, often powerful and untouchable. I believe, based on observation of the outcomes in several cases in which I have been involved, that the medical establishment is no different, with senior doctors being untouchable. Indeed, once, when I raised concerns at a meeting at the Department of Health about a senior doctor, I was even told that he was
“untouchable.” I know that over many years the General Medical Council had refused three times to investigate allegations about him from other doctors (not from me). On 23 November 2012, the Department of Health wrote to me that the current chief medical officer is unable to discuss the issue with me “due to pressure on her time.” Refusal to hear allegations will allow later denial of knowledge of them.
The GMC investigates serious allegations about doctors, but in my experience it will often refuse to investigate the most senior doctors.
I reported Clive Handler to the GMC for financial misconduct. When he appeared before the professional conduct committee, the chairman of the committee, Peter Richards, had to stand down from the hearing because, in his role as medical director of Handler’s hospital, Richards had agreed to conceal Handler’s misconduct from the GMC.1 2 The GMC refused requests from its own solicitors and from me to take action against Richards, who had clearly broken the GMC’s rules on reporting misconduct by other doctors. Richards, who held many senior positions, including chairman of the Council of Deans of UK Medical Schools and Faculties, returned to chair hearings at the GMC after Handler was suspended from the medical register. Senior managers at the Royal Brompton Hospital knew that over many years Professor Peter Collins had used qualifications he had not been awarded.1 2 They knew that he had obtained three posts using false qualifications and that he put them on his letters. The whistleblower was informed by letter from the chairman of the board of governors that unless he dropped the matter his career might suffer. I reported Collins to the GMC. The GMC informed me that no public hearing was required because they had accepted a private assurance from Collins that he would not use false qualifications again. In the few years before and after the GMC’s decision on Collins, seven more junior doctors faced public hearings for claiming qualifications they had not been awarded. Six (Rashid Rhalife-Rahme, Seth Atardo, Ashoka Prasad, Afolabi Ogunlesi, Abu Shafi, and
Ashutosh Jain) were removed from the medical register and one (Sahmin Pandor) received a reprimand.2 They differed from Collins (educated at Cambridge and St Thomas’) in many respects, including the fact that most had only once claimed qualifications they had not been awarded. The GMC does not allow a doctor to voluntarily remove his or her name from the medical register when he or she is under investigation. However, twice, when I reported heads of medical institutions to the GMC for concealing research misconduct within their institutions, the GMC informed me that, as a result of administrative errors, each had been allowed to remove their names voluntarily, so the GMC could not investigate my allegations. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I have defended three libel claims brought by a US medical device company, and I have reported several doctors to the GMC. Provenance and peer review: Not commissioned; not externally peer reviewed.Despite legislation meant to protect whistleblowers, I am aware that an NHS trust and a health authority spent more than £2.5m (€2.9m; $3.8m) in legal fees before getting a whistleblower (a junior doctor) to accept a legal settlement that included a gagging clause preventing him from revealing illegal activity by a senior doctor. A deanery was complicit in the victimisation of the trainee. Allowing for additional management time and the financial settlement with the doctor, the protection of a senior doctor probably cost the NHS more than £5m. If we are genuinely going to put patients first, then nobody, no matter how senior they are, can be untouchable. However, this will only happen when we have a cultural change in healthcare, with promotion of real openness and real protection for whistleblowers, plus reform of the English libel laws to provide a genuine public interest defence.
Wilmshurst P. Dishonesty in medical research. Med Leg J 2007;75:3-12.
Wilmshurst P. The General Medical Council—a personal view. Cardiology News Oct/Nov 2006;10:13-15.
PUBLISHED: 13:53, 31 October 2014 | UPDATED: 14:51, 31 October 2014
Jean Haydr had worked at Tameside General Hospital for 12 years
She was about to be promoted to senior nurse when she was fired in 2013
Colleagues claimed she taunted patients and threatened physical violence
Mrs Haydr said she was dismissed for raising concerns over patient care
Tribunal ruled that she was unfairly dismissed over ‘professional jealousies’
Sacked: Mrs Haydr was unfairly dismissed by Tameside General Hospital, Greater Manchester, in 2013, following accusations from colleagues
A nurse who raised concerns over the standard of patient care at a hospital was forced out of work after colleagues launched a smear campaign against her, a tribunal has found.
Jean Haydr, 48, was set to be promoted to senior nurse at Tameside General Hospital, Greater Manchester when she was sacked in 2013 following false allegations by other nurses.
‘Jealous’ colleagues wrongly accused Mrs Haydr, who was described as a ‘committed and competent’ nurse, of turning up to work smelling of alcohol and of ‘violating patients’ dignity’.
Mrs Haydr, from Dorylsden, Greater Manchester, claimed that she was dismissed for raising concerns over the standard of patient care at the hospital, where she had worked for 12 years.
Now an employment tribunal has found that the mother-of-three had a ‘difficult relationship’ with her colleagues, who had ‘professional jealousies’ about her promotion.
One colleague who claimed that Mrs Haydr had mocked a patient by putting a sticky note on their back that had ‘loser’ written on it later admitted that she never saw the word on the note.
While an allegation that Mrs Haydr had taunted a patient by drawing fish and chips on a plate instead of giving him food was dismissed as ‘light-hearted banter’ with a patient with whom she enjoyed a ‘good relationship’.
The tribunal also found that accusations that Mrs Haydr arrived late for work while smelling of alcohol and that she made threats of physical violence were unfounded.
However, it did find that Mrs Haydr breached social media policy by ‘discussing trust business’ on Facebook – but ruled that she should not have been dismissed without notice or payment in lieu.
The hearing concluded that Mrs Haydr was unfairly dismissed because of accusations from colleagues who ‘did not like’ her.
Mrs Haydr said that she was relieved her ordeal was over.
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‘Committed’: Mrs Haydr had worked at Tameside General Hospital for 12 years and was set to be promoted to senior nurse when she was sacked. The tribunal found that other nurses had ‘professional jealousies’
But she said the ongoing tribunal had left her out of work, ‘blacklisted’ by the NHS and struggling to look after her three children. It is understood she wants to return to nursing.
A spokesman for Tameside Hospital said the trust was ‘disappointed’ with the outcome.
Doctors in Scotland will give evidence to English inquiry into care home abuse, led by Sir Robert Francis
SCOTTISH ministers have been urged to set up an independent review of the treatment of NHS whistleblowers amid claims by opposition politicians and patient groups that staff who speak out continue to face “disturbing” levels of bullying, harassment and victimisation.
Doctors from Scotland have given evidence to a review held in England, chaired by Sir Robert Francis QC, who recently led the inquiry into the health scandal at NHS Mid Staffordshire. The review aims to improve patient safety south of the border by improving protection for NHS whistleblowers and creating a culture of greater transparency.
However, criticism has been levelled at the Scottish government for failing to hold a similar review amid a number of high-profile cases in Scotland which have highlighted the backlash faced by staff who decide to raise concerns about patient safety.
A spokesman for the Scottish government said that it had established an anonymous telephone line
The Secretary of State for Health talks about how improving the safety and quality of care can reduce costs in the NHS.
Last week I visited Birmingham Children’s Hospital, where the staff are rightly proud of the quality and safety record they worked hard to achieve. They are leading the way in bringing the highest safety standards to paediatric care, and are ambassadors of the Sign up to Safety campaign.
BCH is one of over a 100 trusts that have joined the campaign – which aims to reduce avoidable harms by 50% and save 6,000 lives over the next three years.
The enthusiasm shown for Sign up to Safety is a remarkable testament to the ongoing commitment of the NHS to learn the lessons of the failings in care at Mid Staffs. I am delighted that so many trusts are on board, and I look forward to many more joining them to help make the NHS the safest healthcare system in the world. To join them click here: Sign up to Safety.
While visiting BCH, I spoke to staff about the value of safe care – not just for patients, but for the NHS too. I talked about how unsafe care is costing the NHS between £1bn and £2.5bn each year – money that could be invested in more front line staff, better training, better equipment and more time for you to care.
A poster and leaflet are now available for you to display in staff areas – highlighting the value of safe care and the potential savings that could be made and reinvested by reducing avoidable harms. Click here to download the poster and poster/ leaflet.
Of course, not all cases are avoidable, but poor care is expensive and wasteful. It’s down to all of us to prioritise safer care for patients.
I know that NHS staff work tirelessly to ensure the safety and welfare of their patients, but it is important for patients to know the steps they can take to keep themselves safe.
Information and advice is now available in the form of an airline-style safety advice video and information card, which hospital patients can use. The video has already been piloted with positive feedback from patients and staff. You can view the video here, and share it with your patients. It can be incorporated into your hospital’s website so patients can watch it before they come into hospital, and hospitals with the Hospedia patient media system will be able to show it to patients once in hospital.
There is so much excellent work being done across the NHS on improving patient safety and compassionate care which is making a real difference for patients. The respected Commonwealth Fund already rates the NHS as leading the world in patient safety, and I know that the NHS is full of organisations and individuals ambitious to do more. They tell me that being the best healthcare system for safety is not enough for them. They want patients to have an NHS that is the first healthcare system in the world with the same safety standards as the airline industry. What I have seen and heard this week gives me real confidence that we are now on that journey. Thank you for your continued commitment to keeping patients at the heart of all you do.
PUBLISHED: 11:17, 15 October 2014 | UPDATED: 12:28, 16 October 2014
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Heart surgeon Peter O’Keefe has been suspended on full pay for more than two years, at a cost to the NHS of £250,000
A heart surgeon has been suspended on full pay for two-and-a-half years at a cost to the taxpayer of up to £500,000 while he faces bullying allegations.
Consultant Peter O’Keefe, 49, has been on ‘gardening leave’ since April 2012 amid fears he has been targeted as a whistleblower for raising concerns about patient care.
The NHS in Wales is continuing to meet his salary of around £95,000 a year while having to pay a similar sum to another surgeon filling his role.
Mr O’Keefe was suspended from the University Hospital of Wales in Cardiff after being accused of bullying junior colleagues.
But 18 months previously he voiced concerns about the treatment of a patient who suffered serious brain damage. His intervention resulted in a critical report into safety failings.
Mr O’Keefe has been prevented from working at a time when his hospital has been heavily criticised for lengthy waiting lists for cardiac procedures.
The Conservatives accused health bosses of wasting money that could be spent on treating patients by ‘dithering’ over the disciplinary hearing – the latest in a series of scandals to hit the Labour-run Welsh NHS.
Cardiff and Vale University Health Board denies there is any link between the surgeon’s suspension and his earlier complaint about care standards.
A friend of the cardiothoracic surgeon said Mr O’Keefe suspects he was victimised for speaking out.
One source told The Sunday Times: ‘There was annoyance on the intensive care unit that he had reported the matter.’
But a spokesman at the Cardiff and Vale University Health Board told MailOnline, that is ‘absolutely’ not the case.
‘We absolutely reject the suggestion that the suspension of the surgeon in question is in any way related to any concerns he may have expressed about the care of patients,’ he said.
‘The process of suspending a consultant is not one that this health board enters into lightly.’
His case was highlighted by the Conservative opposition in the Welsh Assembly yesterday, as an example of waste in the NHS.
Shadow Health Minister Darren Millar said: ‘When serious allegations are made against any member of NHS staff, it is right that such claims are thoroughly investigated.
‘But there is no reason why it should take over two and a half years.
‘Against a backdrop of a crisis in cardiac care that has seen Welsh patients sent to Bristol for treatment because waiting times were so severe, the Welsh NHS cannot afford to have specialist surgeons suspended for two and a half years on full pay.
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The 46-year-old was sent on ‘gardening leave’ in April 2012 and a formal investigation was launched by health bosses at the University Hospital of Wales in Cardiff, pictured. While they declined to comment on the allegations against Mr O’Keefe they said the case has nothing to do with the standard of his work
A barrister appointed to chair the case was taken ill earlier this year, causing a delay. The hospital has been forced to employ a locum consultant to cover Mr O’Keefe’s work, at a cost thought to be close to the £94,000 salary the heart surgeon, pictured, is paid
WELSH CARDIAC CARE CRISIS
In July 2013 it emerged the University Hospital of Wales had been branded ‘dangerous’ in a damning new report, that said patients were at risk because of increased waiting times.
The Royal College of Surgeons (RCS) warned people waiting for heart operations at the hospital in Cardiff were ‘dying regularly’ and some children were suffering as a result of the delays.
The report said:
Children were being fitted with hearing aids because of a lack of time and resources to insert grommets to treat ear infections
Patients were suffering complications because of delays in treating kidney stones
A&E and intensive care units were ‘frequently gridlocked’ with patients ‘often stacked up in corridors and ambulances’.
In May bosses at Cardiff and Vale University Health Board confirmed plans to invest £2.4million in tackling surgical waiting lists.
It came as the RCS acknowledged improvements had already been made.
Dr Graham Shortland, the health board’s Medical Director, said: ‘There has been an incredible amount of work to improve surgical services over the last year and things have moved on considerably.
‘However, we do know that there is still much to do and we are only at the start of delivering our ambitious proposals.
‘The Welsh NHS is reeling from Labour’s legacy of record-breaking cuts.
‘Yet a health board which last year had its accounts qualified for breaching its spending limits can afford to pay a senior surgeon a near-six-figure salary while suspended and pay similar salaries to locums to cover his workload.
‘Health chiefs must end their dithering approach which is wasting NHS cash that could be spent improving patient care and reducing cardiac waiting times.’
Dr Richard Lewis, Welsh Secretary of the British Medical Association, said: ‘I can’t comment on the circumstances of this particular case, but long suspensions are never good for the individual concerned or for the health service.
‘If an individual is able to return to work after a disciplinary hearing, they will require retraining after a long period of absence.’
Dr Graham Shortland, the medical director for Cardiff and Vale University Health Board, said: ‘We do not take disciplinary steps lightly, but believe that when serious allegations are made the University Health Board has a duty to patients, staff and the people we serve to investigate such allegations thoroughly.
‘We can confirm that a surgeon has been suspended since April 2012. We have been following the Welsh Government’s disciplinary procedure in order to ensure there is a full and fair investigation.
‘Unfortunately, through no fault of either party, the process which has already taken far too long, has been held up. However, we hope to be able to secure a way forward in the next few weeks.
‘Due to the legal and confidential nature of such issues we are unable to say anything further.
‘We would like to reassure the public that the health board is doing all it can to bring this matter to a swift resolution which is in the best interests of all involved.’
The board confirmed that Mr O’Keefe’s surgical work was being covered on a locum basis to minimise delays for patients.
Locum costs are on the consultant pay scale between £72,927 and £94,679.
Mr O’Keefe, who qualified as a doctor in 1987, did not wish to comment.
Surgeon Shiban Ahmed accuses the health regulator of failing to prevent boys from having cruel and unsafe circumcisions, often carried out privately for Muslim children for non-medical reasons (Phil Tragen)
SHARMILA CHOWDHURY 