“Directors who were unfit prior to the introduction of Regulation 5 in November 2014 are outside our remit”

“While CQC will have regard to information on when convictions, bankruptcies or similar matters are to be considered ‘spent’, there is no time limit for considering serious misconduct or responsibility for failure in a previous role.”

“CQC exercises discretion about whether to consider old information which is not current”

 

“The application of this new regulation is not clear-cut or straightforward, and we have put systems in place to enable us to consider information on a case by case led by the most senior levels in CQC and supported by senior policy and senior legal colleagues”.

a) Whether you have advised anyone else that “Directors who were unfit prior to the introduction of Regulation 5 in November 2014 are outside our remit”?

 

b) Whether you will amend your advice to these individuals given that CQC now says its original guidance of 27 November 2014 (on retrospective scope) stands?

 

c) Will CQC revise its FPPR guidance of 27 March 2015, to include the original, crucial 27 November 2014 advice that “there is no time limit for considering serious misconduct or responsibility for failure in a previous role”?

From submission to Department of Health consultation on the implementation of the Freedom to Speak Up Review, by Minh Alexander former consultant psychiatrist, 4 June 2015

“Francis greatly emphasised the example of the Cultural Ambassador at Staffordshire and Stoke on Trent Partnership Trust (SSOTP) as supporting evidence for his proposal to introduce whisteblowing guardians nationally. He featured the SSOTP model in the Freedom to Speak Up report. At the launch of his report Francis told whistleblowers that the present incumbent had proven that such a post could work.

Few facts had been offered about the provenance or efficacy of the model, other than that a low staff uptake had prompted this arrangement, and that uptake subsequently increased “dramatically”. No other parameters were explored in Francis’ report. Details of staff contacts with the Ambassador have now been requested from the Trust and are awaited.

The Ambassador post was established two years ago in April 2013. The Trust has confirmed to me that no evaluation of this new role has yet been carried out. [1]

The Trust signals an intention for evaluative research to be carried out, but no decision has been made yet on how this will be done.

What then are the other sources of information that might shed light on the effectiveness of the model?

Local press reported that recent, significant external whistleblowing disclosures were made about the Trust. It is alleged that staff reported externally because of issues of organisational culture and because little was done to rectify safety issues despite managers being made aware of the problems. [2,3,4] If so, this raises a question of what is contributed by a Guardian-type role where there are particularly serious and knotty problems that an organisation might find threatening. For example, some of these external disclosures ultimately led to regulatory action on staffing levels, which may in turn present other challenges for a Trust seeking Foundation status.

Notwithstanding, it is recognised that external whistleblowing is often an indication of an internal blockage of some sort. The Trust’s response to press coverage of leaks was to emphasise to its staff that internal reporting was encouraged, but there was no clear acknowledgment of failure to engage with staff. [5]

Some external disclosures by SSOTP staff have been made to CQC. A full list of disclosures has been requested under FOI arrangements and is awaited. Meanwhile, remarks in a CQC inspection report of 19 March 2015 may reflect tensions inherently thrown up by an Ambassador role:

“Action the provider MUST or SHOULD take to improve

• Review the internal communication arrangements for the Ambassador for Change to ensure transparent lines of communication and staff feel reassured that the role is organisation wide, not part of the management process”

It would be understandable that any Ambassador role, irrespective of the person in post, may be viewed hesitantly if staff are wary of management commitment to transparency.

NHS Staff Surveys for SSOTP in the last 3 years, against national averages for comparator trusts, do not show major changes over the period in which an Ambassador post was established:

These figures give only a rough indication of some of the issues, and may be affected by factors other than the work of an Ambassador. Broadly though, they are not by any means proof that an Ambassador model clearly generates improvement around issues of raising concerns. Confidence in the fairness of incident procedures remained slightly below average. When a measure about staff’s sense of security in reporting concerns was added in 2014, this was slightly below average too.

Whistleblowers, who have seen all that the most corrupt employers can do to manipulate and pervert processes, do not have any expectations that closed organisations will be transformed by Trust-appointed whistleblowing Guardians. In such trusts, Guardians will at best be ignored, and ineffectual as a result of impassable systemic issues. More likely, the worst organisations will appoint in their own image. The role could be used to help conceal continuing whistleblower reprisal whilst falsely white washing organisational reputations. The analogy of prefects from Tom Brown’s school days comes to mind.

There is another indication that Francis’ whistleblowing Guardian experiment will fail. There is already evidence that some organisations are ignoring Francis’ recommendations that:

(i) Whistleblowng Guardians posts should be dedicated roles

(ii) The Whistleblowing Guardian role should not be on top of someone’s existing duties

(iii) Whistleblowing Guardians are ideally in a professional role, to gain the trust and confidence of colleagues.

Of concern, these are examples of whistleblowing Guardians that have been quickly appointed by NHS organisations whilst the DH consultation has been taking place:

“Formally appointing the Executive Director of Nursing, Quality and Governance as the Trust’s Freedom to Speak Up Guardian”

“…also appoint: Assistant Director, Corporate Governance as the ‘Freedom to Speak Up’ Guardian”

“The identification of one official Freedom to Speak Up Guardian, to concentrate on the assurance side, proposed to be the Director of Quality and Assurance”

“The Head of Governance, who is identified as our designated officer in the Raising Concerns Policy, to also take on the role of ‘Freedom to speak up

Guardian”

“…Director of Communications and Business Services… has also been appointed by the Audit and Governance committee as the “Freedom to Speak Up Guardian”

These appointments are clearly at odds with the Freedom to Speak Up review’s intentions. Arguably, they show corporate bias, little prioritisation of whistleblowing governance, and failure to appreciate (or care about) the nuances of staff advocacy. It is questionable that Trusts were told that they could move ahead with making arrangements before the Department of Health Speak Up consultation had taken place. However, their actions are part of the evidence that the Trust-appointed Guardian model lacks sufficient robustness and credibility.

A whistleblower contributor to the Francis review, who has worked in a established Guardian type role for some time, has very clearly advised that such a role can make a contribution but:

“… is in no way  a panacea for remedy to prevent further scandals within the NHS.

And the whistleblower remains of the opinion that:

“In order to change the culture a proper whistleblowing inquiry is necessary”

This person remains conscious of the marked imbalance of power, disadvantage and stress that staff face when raising concerns. In common with the majority of whistleblowers, this person emphasises that until root causes are genuinely addressed, the overall dysfunction will continue.

Robert Francis stipulated that Trust-appointed Guardians must command the confidence of Chief Executives. Where the Chief Executive is corrupt, this is clearly nonsense, as the Guardian would have to act corruptly too, in order to command the Chief Executive’s confidence. This contortion of logic lies at the heart of Robert Francis’ fatally flawed proposal.

It is also important to note that the more robustly those in current Guardian-type posts advocate for patients, the more likely it is that they will experience retaliatory mistreatment. This has reportedly sometimes been very serious.

In summary, Trust-appointed whistleblowing Guardians are the lynchpin around which Francis’ proposals are built. Given the lack of evidence that such posts can be relied on as the key intervention to prevent whistleblower reprisal or to reduce fear, and evidence that organisations are already making inappropriate appointments, the Freedom to Speak Up review falls.”

[1] Correspondence with Stuart Poynor SSOTP Chief Executive, 1 June 2015

[2] Leaked NHS dossier: nurses log concerns over care. D Blackhurst, Staffordshire Sentinel, 2 April 2015

[3] Leaked NHS report reveals dying patients left alone and in pain, staff at breaking point, Staffordshire Sentinel, 2 April 2015

[4] NHS ordered to appoint more district nurses in North Staffordshire, Staffordshire Sentinel, 9 May 2015

[5] Health staff told ‘don’t speak to press’ after regional daily expose. David Sharman, Staffordshire Sentinel, 5 May 2015

Postscript 20 June 2015

Comments were sought from the Ambassador at SSTOP. These were received after the submission above was made to the Department of Health. I add them here for completeness. It is the Ambassador’s view that:

“The ambassador role works alongside a range of mechanisms within the Trust to support staff to raise concerns and anecdotal evidence indicates that less staff are taking sick leave or leaving the organisation because they have been listened too and supported.

The Trust is committed to openness and transparency, however changing culture across such a large organisation is a process which will undoubtedly take a significant period of time to successfully achieve and more does still need to be done.

We know there are pressures on the services and staff are working flat out to try to keep pace with growing demand and expectations and the Trust is working hard to ensure teams are able to deliver quality care.

It is encouraging staff have had the confidence to raise issues either with the CQC or with ourselves and the Trust recognised many of the themes raised by staff. Following recent press reports regarding incidents, I would have liked this person to have felt they could approach me direct but obviously felt they could not.

Staff continue to be encouraged to use existing internal mechanisms to ensure that support and appropriate action can be taken to resolve any issues as quickly as possible.

With regards to evaluation of my role, there are plans to establish when and how this will be done”.

The data from SSOTP about staff contacts with the Ambassador is awaited.

Minh Alexander

To: Helen Vernon CEO NHS Litigation Authority, 18 June 2015

Dear Ms Vernon,

Re: NCAS and implementation of Sir Anthony Hooper’s recommendations on protecting NHS whistleblowers

Thank you for your letter dated 8 May 2015, which I received by email on 23 May, and which is copied below.

It is good to hear that NCAS provides national training for case managers and case investigators on vexatious concerns. I would be very grateful if NCAS could share the details of its training guidance on vexatious concerns, as this material is of obvious interest to whistleblowers who often find themselves the subject of vexatious referrals to NCAS.

Given that NCAS accepts that concerns may be raised vexatiously against doctors, I struggle with your advice that:

“NCAS does not investigate concerns and we rely on the integrity of the information provided by both the referring organisation and practitioner in our dealings with a case.”

 “As stated previously NCAS has no remit to assess or test the veracity of the information provided by either party.”

It seems to me that if NCAS accepts that vexatious complaints are made, it should not rest content with its current lack of procedural safeguards against the persecution of innocents. NCAS has great power. A referral to NCAS can be hugely stressful and also damaging to a doctor’s reputation. Yet whistleblowers who are maliciously referred to NCAS report that NCAS typically refuse to engage with them, even when provided with evidence of false allegations by employers. Instead, it is the experience of whistleblowers that NCAS will continue to approve harmful employer actions.

I have to question the value that NCAS adds if it makes no effort at all to challenge or dissociate itself from trumped up processes, even when provided with evidence. If you are correct in asserting that NCAS has no remit at all to investigate, then this seems a very serious structural flaw that should be addressed. This is especially so when NCAS continually reminds employers of the importance of accuracy, through the standard disclaimers in NCAS letters of advice. I would be grateful to know if NHSLA would be prepared to seek changes in NCAS’ remit, to enable a degree of investigation and fairer treatment of whistleblowers.

It is relevant to note here that Sir Robert Francis advised regulators to seek amendments to their regulations, if necessary, in order to protect whistleblowers more effectively. [1] I feel that a similar principle should apply to NCAS.

I should also point out that it is in fact senior doctors, acting as MHPS case managers [2], who are often key culprits in the victimisation of medical whistleblowers. Training such managers to recognise vexatious concerns misses the point. What is needed are mechanisms to hold them to account. That is what Sir Anthony sought in his proposal that registered doctors should sign referrals and attest to truth:

“68. Failure to answer the question truthfully would no doubt lead to the signing doctor’s fitness to practise being investigated and, if discovered during the course of the investigation, would be an important factor in assessing the credibility of the allegation”. [3]

I would be grateful to hear from NCAS, once it has considered GMC’s response to Sir Anthony Hooper’s recommendations, on whether it will introduce a comparable safeguard in its process.

Lastly, I must disagree with your assertion that PIDA currently protects staff who raise concerns. You say:

“Furthermore, the Public Interest Disclosure Act 1998 protects workers that disclose information about malpractice at their workplace, from suffering detriment as a result of having made a disclosure providing certain conditions are met”.

Numerous authorities, Sir Robert Francis amongst them, now acknowledge that PIDA is weak and does not protect whistleblowers from reprisal. It only provides compensation after the event.

“..the existing legislation is weak” 

“..it provides remedy rather than protection against detriment” [1]

I think that unless NHSLA recognises that PIDA does not protect NHS whistleblowers, there is a risk that it will not formulate proportionate action or undertake appropriate reform of NCAS. Continuing injustices to whistleblowers place patients at risk, and they are also very wasteful.

Yours sincerely,

Dr Minh Alexander

cc  Sir Jeremy Heywood, Cabinet Secretary

     Health Committee

     Public Accounts Committee

     Sir Anthony Hooper

[1] Report of Freedom to Speak Up Review on NHS whistleblowing by Sir Robert Francis, February 2015

[2] Maintaining High Professional Standards in the Modern NHS, a framework for the handling of concerns about doctors and dentists in the NHS, DH 2005

[3] The handling by the General Medical Council of cases involving whistleblowers. Report by the Right Honourable Sir Anthony Hooper to the General Medical Council, 19th March 2015

Daily Record   1 JUNE 2015  BY CHARLIE GALL
PROFESSOR Zygmunt Krukowski blew the whistle on the way Aberdeen Royal Infirmary was being run and it is claimed NHS Grampian are taking ‘revenge’.

The Queen’s personal surgeon has been suspended from his duties at Aberdeen Royal Infirmary.  The Queen’s personal surgeon (right) has been suspended from his duties at Aberdeen Royal Infirmary

THE Queen’s personal surgeon in Scotland has been suspended from operating after a probe into whistleblowing.

It is claimed NHS Grampian bosses took “revenge” on Professor Zygmunt Krukowski for blowing the whistle on the way Aberdeen Royal Infirmary was being run.

Krukowski heads the team on standby to care for members of the Royal Family if they require treatment while staying at Balmoral on Deeside.

The professor is understood to have highlighted serious concerns over health care in the region.

A second surgeon, Wendy Craig, who works in the same surgery department, has also been suspended for raising concerns following dignity at work reviews.

It’s understood the pair were seen as troublemakers by bosses and there is no medical reason for their suspensions.

A source said the pair had been left “devastated and angry” and felt they had been “professionally destroyed” for raising concerns.

Reuters/Russell CheyneProfessor Zygmunt Krukowski is the Queen’s personal surgeon.
They were said to feel the time had come for “a judge-led” inquiry into the management of NHS Grampian.

Yesterday, an NHS Grampian spokeswoman said: “It is our practice not to discuss
individual members of staff.

“NHS Grampian recognises that, in the main, employees do their best to achieve high standards of conduct and do not attend work with the intention of behaving inappropriately whether that is to other individuals or in the conduct of their role.

“It is inevitable, however, that some employees may, on occasions, fail to meet
acceptable standards.

“There are robust policies in place to promote the resolution of such difficulties in a supportive, fair, consistent and proactive way.”

It emerged that some operations, including cancer surgery, had been postponed because of the suspensions.

Aberdeen Royal InfirmaryAberdeen Royal Infirmary
The spokeswoman added: “We would like to apologise to any patients affected

“We have been and will continue to be in contact with affected patients.”

NHS Grampian hit the headlines last year when three separate inquiries were launched into Aberdeen Royal Infirmary and Woodend Hospital.

The situation, raised at the top of the Scottish Government and in parliament, led to the departure of board chairman Bill Howatson and chief executive Richard Carey.

A review by the Royal College of Surgeons of England found “very serious allegations” about the “behaviour, competence and probity” of medical staff in general surgery at ARI and called for fundamental reforms to the department.

A second review by Healthcare Improvement Scotland (HIS), which was ordered by the government, also lamented the conduct in general surgery and its impact on patient care.

The following is further evidence as to why proper support is needed to help NHS whistleblowers:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609467/

‘Don’t shoot the messenger’: the problem of whistleblowing in general practice

 Br J Gen Pract. 2013 Apr; 63(609): 214–215.

 Nigel Mathers, Professor of Primary Medical Care

University of Sheffield, Sheffield and Vice-Chair of RCGP, London.

Liz Sillitoe, Former Policy Officer

RCGP, London

BACKGROUND

On the 9 June 2010 the then Secretary of State for Health, Andrew Lansley, announced a full public inquiry into the role of the commissioning, supervisory, and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust. The Inquiry was chaired by Robert Francis QC, who has made recommendations to the Secretary of State based on the lessons learned from the failures of care provided by the Trust between January 2005 and March 2009.¹

The Inquiry heard oral evidence from six GPs whose surgeries are situated within the Trust catchment area. This focused largely on the extent to which the GPs were aware of problems at the Trust.

The Francis Report raises a number of serious issues about NHS ’whistleblowing’ and identifies failures in the application of current whistleblowing policies. The NHS, and GPs in particular, face unique problems in whistleblowing.

A CAUTIONARY TALE

‘The GMC guidance states that GPs have a duty to raise concerns. When I contacted the GMC, they recommended that I contact the BMA. The BMA recommended that I contact my [medical defence organisation] MDO. My MDO recommended that I contact the BMA’

All doctors have a duty to act when they believe patients’ safety is at risk or that patients’ care or dignity is being compromised.² This paper defines ‘raising a concern’ as doing so through the normal internal structures of accountability and ‘blowing the whistle’ as highlighting a concern to individuals outside of these structures, often externally, and normally after failing to successfully raise the issue through the expected internal routes.

When a GP decides to act as a ‘whistleblower’, for example because of concerns about the patient care provided by a GP colleague, he or she may have an additional challenge because in a practice partnership professional, financial, and social interdependency coincide; this is very different to the position of other doctors in a secondary care setting who have a contractual relationship with, and are normally employees of, an NHS body such as a trust. The GP contract however, is not a direct contract of employment and although under the current law, the Public Information Disclosure Act (PIDA)³ should, in principle, give protection to all ‘workers’, this protection has not yet been defined for GPs. A ‘test case’ is shortly to go before the courts but as things stand, NHS bodies can claim that whistleblowing policies only apply to employees and that they have no specified duties towards GPs. This is further complicated by the fact that GPs may be both providers of care and private employers at the same time. In the case of salaried GPs, where a GP is an employer, the situation can become even more complicated and at present the position remains unclear.

In addition, the MDOs may take the view that their duty is not to support one doctor making allegations against another and professional bodies such as the Royal Colleges do not themselves currently provide formal individual support to whistleblowing members; rather generic advice and ‘signposting’ to available websites and information.⁴ The whistleblowing policy of other professional organisations such as the BMA, which might have been expected to provide individual support to members, provides advice to secondary care employees or medical students and may take a similar view to that of NHS trusts towards GPs. Furthermore, local medical committees (LMCs) may find themselves with conflicts of interest if one or both doctors are members of an LMC.^5–7

All of this means that a GP whistleblower may find themselves in a situation where they have little or no professional support, and this, of course, may act as a profound disincentive for a GP to ‘stick their head above the parapet’. When this is added to the current NHS ‘blame culture’ towards individuals⁸ and the substantive risks of whistleblowing in terms of hostility, marginalisation and the threat to a doctor’s career,⁹ it is quite remarkable that there have ever been any GP whistleblowers at all!

1. ‘I contacted ‘Public Concern at Work’ and ‘Patient First’: both organisations gave advice and offered sympathy but gave me no practical support’

Recent changes to the NHS Constitution contain an expectation that NHS staff will raise concerns about safety, malpractice or wrong doing at work that may affect patients, the public, other staff, or the organisation itself as early as possible and will be supported in doing so.¹⁰ The Care Quality Commission (CQC) classifies GPs as ‘other workers who provide services to the registered provider’ as they are not directly employed by the NHS¹¹ and their website guidance for providers does give a full explanation of the policies, the law, and expectations on how to raise a concern. Public Concern at Work (PCAW) is the whistleblowing charity established in 1993 which provides free confidential advice to people who are concerned about crime, danger, or wrongdoing at work.¹²

However, although a number of such resources are available to GP whistleblowers (such as Whistleblowing Helpline [http://wbhelpline.org.uk/] and Patients First [http://www.patientsfirst.org.uk/]), many of them are not ‘fit for purpose’, since they do not offer a great deal in the way of practical support through the specific complexities faced by GP whistleblowers. Such practical support must be the role of the professional organisations.

1. ‘I did face immediate hostility, was marginalised and a campaign of retribution lost me my position and yet nobody seemed willing or able to influence this’

Although legislation was passed 14 years ago to support the rights of whistleblowers,³ there is little evidence that it has in practice provided protection to individual NHS whistleblowers: indeed the consequences for an individual whistleblower can still be devastating as the quote above from the ‘live’ case illustrates.

Hammond¹³ in his evidence to the Francis Inquiry stated that ‘staff that do blow the whistle are frequently marginalised, counter-smeared and suspended and many agree to a modest payoff with a gagging clause to protect themselves from personal and professional ruin’.

There are many recent examples of such denigration and ‘gagging clauses’ (compromise agreements) in the NHS.⁹

The widespread use of compromise agreements in the NHS is clearly contrary to the public interest, especially when it involves issues of patient safety. The recent letter from Sir David Nicholson (Chair of the National Commissioning Board) about adequate support being provided to whistleblowers in the NHS and the requirements of Health Services Circular 1999/1998¹⁴ sought to discourage the use of such agreements, but this was more of a request rather than an instruction.

There is no doubt that whistleblowing can be a courageous, difficult, and detrimental thing for the individual. To report any sort of concern, let alone whistleblowing, means bringing into question the judgement of another doctor or health professional; something which is (rightly) taken very seriously. However, since patients trust their GPs more than any other professionals, they are more likely to confide in them and expect them to take action when issues about patient safety are brought to their attention.

WHAT NEEDS TO BE DONE?

The failures of care in Mid Staffordshire were quite appalling and all doctors including GPs, should and are required to raise concerns which they may have about patient safety.² This did not happen and it is thought that up to 1200 patients received dreadful care, dying prematurely while managers were chasing productivity targets.¹

In such circumstances there is an ethical imperative for us as GPs to act, initially by ‘raising a concern’ but if our legitimate concerns are not properly addressed, then whistleblowing may have to be our last recourse; with all the potentially disastrous consequences for us as individuals. The creation of clinical commissioning groups (CCGs) offers an opportunity for some of these issues to be addressed and the issuance of Whistleblowing Guidance to CCGs is not only an imperative but also a matter of urgency if tragedies like the Mid Staffordshire case are not to occur again within the NHS.

RECOMMENDATIONS

• The respective roles of the professional bodies (the GMC, BMA, MDOs, LMCs and the Royal Colleges) need to be clarified in cases of GP whistleblowing: a joint statement about the position of GP whistleblowers should be agreed and publicised.

• Whistleblowing policies and guidance for CCGs should also be distributed: these could be developed from existing resources such as the whistleblowing helpline¹²and the recently adopted RCGP policy.⁴

• The RCGP and other Royal Colleges should offer generic support and guidance for whistleblowing members by signposting available resources and providing referral to appropriate sources of advice.

• All practices should have whistleblowing policies in place and GPs should know who to go to for advice and support when they have concerns about the quality or safety of patient care.

Finally, and most importantly, we all need to help create a responsive, open, and supportive cultural environment in the NHS: not only by improving transparency but also by using the legislation which already exists to protect whistleblowers from retribution.

We owe this to our patients.

Notes

Provenance

Freely submitted; not externally peer reviewed.

Consent

Quotations a, b, and c are from a ‘live’ GP whistleblower case and are used with the full knowledge and consent of the person concerned.

REFERENCES

1. The Mid Staffordshire NHS Foundation Trust Inquiry Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009. 1 Chaired by Robert Francis QC.http://www.midstaffsinquiry.com/assets/docs/Inquiry_Report-Vol1.pdf(accessed 15 Feb 2013).

2. General Medical Council . Raising and acting on concerns about patient safety. GMC; 2012.http://www.gmc-uk.org/guidance/ethical_guidance/raising_concerns.asp(accessed 15 Feb 2013).

3. Public Interest Disclosure Act (PIDA): Section 43K ERA. http://www.pcaw.org.uk/pida43g-section11#43k(accessed 15 Feb 2013).

4. Royal College of General Practitioners Whistleblowing in the NHS. RCGP Policy document.http://www.rcgp.org.uk/policy/rcgp-policy-areas/whistle-blowing-in-the-nhs.aspx(accessed 15 Feb 2013).

5. BMA Practical Support at Work: Whistleblowing — who can help you. http://bma.org.uk/practical-support-at-work/whistleblowing/who-can-help-you(accessed 15 Feb 2013).

6. BMA . Whistleblowing. Advice for BMA members working in NHS secondary care about raising concerns in the workplace. BMA; 2009. document no: 50185. (accessed 28 Jan 2013).

7. BMA Negotiating for the profession. Whistleblowing. http://bma.org.uk/working-for-change/negotiating-for-the-profession/whistleblowing(accessed 15 Feb 2013).

8. BMA . NHS culture adds whistleblowing insult to patient injury. BMA; 2012. http://bma.org.uk/news-views-analysis/news/2012/october/nhs-culture-adds-whistleblowing-insult-to-patient-injury(accessed 15 Feb 2013).

9. Hammond P, Bousfield A. Shoot the Messenger How NHS whistleblowers are silenced and sacked.http://drphilhammond.com/blog/wp-content/uploads/2010/07/Shoot_the_Mesenger_FINAL.pdf(accessed 15 Feb 2013).

10. National Health Service The NHS Constitution.http://nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview.aspx(accessed 15 Feb 2013).

11. Care Quality Commission . Whistleblowing: guidance for providers. CQC; 2011.http://www.cqc.org.uk/search/apachesolr_search/guidance%20on%20whistleblowing(accessed 15 Feb 2013).

12. Public Concern at Work (PCAW) http://www.pcaw.org.uk/(accessed 15 Feb 2013)..

13. Witness Statement from Dr Phil Hammond to Francis Inquiry.http://drphilhammond.com/blog/2013/01/18/private-eye/witness-statement-from-dr-phil-hammond-to-francis-inquiry/(accessed 15 Feb 2013).

14. Department of Health Compromise Agreements and the Public Interest Disclosure Act 1998.http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_132261(accessed 15 Feb 2013).

Croydon Guardian 8 April 2015
by Chris Baynes, Reporter – Croydon

Jeremy Hunt, left, has been urged to end “victimisation” of whistleblower Dr Beatt

Health Secretary Jeremy Hunt has been criticised for his inaction over the “horrific victimisation” of a whistleblower doctor at Croydon University Hospital.

By Adam Brimelow Health correspondent, BBC News

A former NHS boss who says he was sacked for raising patient safety concerns has asked the health secretary for an apology and a “comparable” job.

In a letter to Jeremy Hunt, ex-United Lincolnshire Hospitals Trust boss Gary Walker argues he is a whistleblower whose actions have been vindicated.

But he says he has been blacklisted from working for the health service.

The Department of Health in England says it will be looking carefully at the issues raised in the letter.

Gary Walker’s letter says that, as chief executive of United Lincolnshire Hospitals Trust, he warned senior health officials that patients would come to harm if it was forced to comply with NHS targets.

The letter sets out, point-by-point, why he believes he is a whistleblower, and how – in his view – this led to his dismissal and being blacklisted by the NHS.

He goes on to argue that his actions were vindicated by events, as evidence grew of rising death rates and a high number of safety incidents, but says he was “gagged” by a compromise agreement, which he broke two years ago.

Mr Walker cites recent reports that looked into whistleblowing from the health select committee of MPs and Sir Robert Francis QC as supporting his call for an apology and “practical redress”.

He writes: “The practical redress you offer will need to be individual to those who raised concerns and the harm they suffered but I would expect that whistle-blowers simply want an apology and a job that is comparable to the one they were forced from.”

‘High-achiever’

The letter is copied to the chief executive of NHS England, Simon Stevens, and shadow health secretary Andy Burnham.

It also includes a full CV which, he says represents a “highly successful career” which was ended as a result of raising concerns about patient safety and misconduct.

He says: “I continue to be blacklisted by the NHS despite a high-achieving career prior to raising concerns about patient safety.”

In response to the letter, a department of health spokesperson, said: “We want to make the NHS the safest health system in the world and creating an open and honest culture where patients and staff are listened to is vital to improving care.

“This government has made important changes to protect whistle-blowers by outlawing gagging clauses in contracts and introducing new laws in this parliament to protect those who speak up.”

The department says every NHS manager and leader is to have training on how to raise concerns.

The Mail on Line    By PAUL BENTLEY   PUBLISHED: 27 February 2015 

• Freedom To Speak Up Review published report revealing culture of fear
• Sir Robert Francis sought evidence from hundreds of doctors and nurses
• Concluded whistleblowers ‘bullied and ostracised’ for speaking up
• Scathing letter from three high profile whistleblowers calls for inquiry
• Say their careers have been ruined and still no action has been taken 

NHS whistleblowers are demanding an independent inquiry into their treatment by hospital managers after a long-awaited report was declared a ‘whitewash’.

In a scathing letter to the report’s author, they accused him of failing to hold any managers to account and leaving patients at risk of serious harm.

The NHS’s ‘Freedom to Speak up Review’, which was published a fortnight ago, told how whistleblowers have faced a culture of ‘fear, bullying and ostracisation’ for daring to speak out.

But whistleblowers whose careers have been ruined said still no action has been taken to address the concerns about patient safety that they have been making for years.

Despite hearing awful reports about failures and cover ups over patients’ deaths, the report’s author Sir Robert Francis has ‘ignored’ their stories, they said.

Scroll down to read the letter in full  

‘We expected that you would have taken action in these matters which involved patient harm, death and fraud,’ the whistleblowers have written to Sir Robert.

‘Those responsible have not been held accountable. Lessons have not been learned. Patients and their relatives have not been told the truth.

‘We consider this failure to address our concerns a serious flaw in your review.’

The letter, which has been signed by three NHS whistleblowers, added: ‘We feel that we have not been taken seriously, which has been our experience as whistleblowers all along.

‘It seems appropriate to us that you allow independent scrutiny of all the submissions so that these matters can be addressed.’

Sir Robert was commissioned last June by the Government to head the review into whistleblowing in the NHS.

He previously led two inquiries into the scandal at Mid Staffordshire hospital, where 1,200 patients died needlessly.

Some 600 NHS staff spoke to the barrister and his team, who were also overwhelmed by 19,800 responses from other employees to an online survey.

Sir Robert reported that whistleblowers are too often derided as ‘snitches, troublemakers and backstabbers’.

He said many had, in effect, been blacklisted by the NHS, facing being ‘victimised’ by managers, forced out of their jobs and unable to find other work.

The barrister made 20 recommendations – including a ‘whistleblowing guardian’ at each hospital – which the Government has promised to enforce in an attempt to change the culture of silence in the health service.

NHS whistleblowers, however, have since confronted him, outlining their ‘serious concerns’ that his report has failed to address any of the specific concerns made by NHS staff about the alarming treatment of patients.

The letter has been signed by three high profile whistleblowers, including Dr David Drew, a top paediatrician who was sacked after claiming he had witnessed a cover up over a child’s death.

It has also been signed by Sharmila Chowdhury, a senior radiography manager who spoke out about a £250,000 fraud at her Trust, and a third colleague who asked not to be named.

Dated February 23, 2015, the letter states: ‘We have now had an opportunity to digest your report and have a number of serious concerns.

‘More than 600 individuals made detailed submissions to the quantitative review.

‘We suppose that many, like us, assumed that you would take these seriously as disclosures made in the public interest and act on them. That is what you told us when we first met you.

‘You have allowed situations where patients are at risk and where managers act defensively out of self-interest to continue unaddressed.

‘Amongst the other 600 plus submissions there must be, and we know there are, more examples of fraud and unresolved patient risk.’

They went on to demand that the submissions are now properly dealt with under ‘independent scrutiny’.

After the report was published, there was particular unease about a key clause which advised whistleblowers not to speak to the press, saying they should only do so as a ‘last resort’ to avoid causing ‘considerable distress’.

Dr Drew told the Mail he was publicising the whistleblowers’ letter to Sir Robert because ‘the press seems to be the only way to squeeze the truth out’.

He added: ‘History will judge Francis badly. He failed whistleblowers and offered a get out of jail free for managers. And that adds up to failing patients. The whole point was patient safety but he ignored all our reports.’

In his review, Sir Robert said: ‘What I heard during the course of the review from staff, employers, regulators and unions and others leaves me in no doubt that there’s a serious problem in the NHS.

‘Too often, honestly-expressed anxieties have met with hostility and breakdown of working relationships. Worse still, some people suffer life-changing events, they lose their jobs, their careers and even their health.

‘We heard all too frequently of jobs being lost, but also of serious psychological damage, even to the extent of suicidal depression.

‘In short, lives can be ruined by poor handling of staff who have raised concerns.’

Health Secretary Jeremy Hunt told the Commons: ‘The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care.

‘The message must go out that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.

‘We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns.’

Last night, Sir Robert Francis said: ‘I was asked by the Secretary of State to review the way concerns are handled and how those who raised them are treated.

‘I was not asked to investigate or pass judgement on the concerns themselves and made it very clear to all concerned that I was not going to do so.

‘It would be inappropriate to comment on individual contributions, as these were shared with me in confidence.’

A Department of Health spokesman added: ‘Since Mid Staffs, there have been significant changes to make the NHS the safest and most transparent healthcare system in the world.

‘We are confident Sir Robert Francis’ recommendations will help create a more open and honest culture, and we want to change the law in this Parliament so staff feel more able to raise concerns — creating Freedom To Speak Up Guardians will also support them to do so.’

Responding the Dr Drew’s comments, a spokesman for the Walsall Healthcare NHS Trust said the issues Dr Drew raises have been addressed through two formal legal processes, ongoing since 2009.

He said: ‘In 2012 the case went to an Employment Tribunal and we are satisfied with the outcome of the case and that of the recent Employment Appeals Tribunal that dismissed Dr Drew’s claims.

‘We would like to reiterate that this case did not question Dr Drew’s skills as a paediatric consultant and on behalf of the Trust would like to say that we regret that the situation had to get to the Tribunal stage.

‘As a Trust we actively encourage and support our staff to raise an issue if they are concerned about patient care.’

Meanwhile, responding to Ms Chowdhury’s concerns, a spokesman for London North West Healthcare NHS Trust – which now includes Ealing Trust – said: ‘The Trust commissioned an independent report which was undertaken by Parkhill counter fraud services.

‘They found no evidence of wrong doing on the part of the two consultants named in the allegations.’

Read more: http://www.dailymail.co.uk/health/article-2971737/Appalling-treatment-NHS-whistleblowers-investigated-Staff-ostracised-hospital-bosses-demand-independent-inquiry-whitewash-Francis-Report.html#ixzz3T1kz27zs
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Sent via e-mail

 19 February 2015

 Rt Hon Mr Jeremy Hunt

Health Secretary

Dear Mr Hunt

Re: Review into NHS whistleblowing led by Sir Robert Francis QC

I had written to you on 30 May 2014, of my desperate case as a NHS whistle-blower (https://sharmilachowdhury.com/2014/06/03/letter-to-jeremy-hunt-2-help-justice-for-sharmila-chowdhury/)

 You subsequently after much media pressure, commissioned the review into NHS whistleblowing, led by Sir Robert Francis. Although many were sceptical about this, quite rightly as it now transpires, some of us were naively optimistic.

Although we were advised that the investigation was ‘an independent review’, on hindsight one would have to question whether Sir Robert Francis, who is a non-executive director of CQC, is really ‘independent.’

After much anticipation and delays of over three months, the report was finally published.

To my huge disappointment and those of other NHS whistleblowers, none of the essential requirements necessary to protect a whistle-blower was recommended in the report.

For me these were key failures:

1.     No recognition of parts played by CQC and DH during whistleblowing cases. Yet nearly all NHS whistleblowers, I have come across, have sought help from both CQC and DH who have been turned away stating it’s ‘an employment issue’ and ‘therefore cannot get involved’. This practice I have no doubt will continue.

2.     No recommendation for a public inquiry into historic cases. This was almost unanimously seen as a vital step forward by whistleblowers and their supporters. Without a public inquiry there is no transparency and no learning from cases.

3.     No recommendation for intervention when a whistleblower faces employment dispute – which is nearly always the case following raising concerns. Failure to implement interventions will mean, nothing will change and whistle-blowers will continue to face hefty legal costs, the public will continue to fund Trusts’ cover-ups. These may drag on for years. By which time careers of whistle-blowers have been destroyed, homes are lost and health are damaged. Patients will also have lost a valued member of staff and taxpayers have lost vast sums of money. More importantly, patients will continue to be placed at risk.

4.     No redress for suffering whistleblowers. I had asked for reinstatement of full income and pension in cases where there is a career loss. Despite now having a full knowledge what whistleblowers endure you have shamefully chosen to do nothing. Some whistle-blowers are totally destitute.

      This is despite it being recommended recently by the Health Select Committee, ‘We expect the NHS to respond in a timely, honest and open manner to patients, and we must expect the same for staff. We recommend that there should be a programme to identify whistle-blowers who have suffered serious harm and whose actions are proven to have been vindicated, and provide them with an apology and practical redress.’

5.     There is no help available with legal expenses when whistleblowers face ruin due to extensive legal battle. This contrasts with fulsome support afforded to Trusts, with the approval of DH and the Treasury. Highlighting this hypocrisy, current cases show that this purse remains wide open to Trusts.

6.     There will be no ‘Independent’ Governing body who will investigate whistleblowing cases. By ‘independent’ I refer to an organisation outside the remit of DH and CQC, who have previously failed to support whistleblowers. Having a workplace ‘guardian’ is hardly independent and will be of no value and will do little to encourage confidence. Additionally having an independent National Officer will not provide effective support – ‘to advise NHS organisations to take appropriate action where they have failed …..’

7.     No recommendation for help with jobs of same stature and income. Page 26 Principle 12 as you know is wholly inadequate.

I had already written to you on this matter as this is an example I have found myself in. ‘Finding an alternative employment’ is simply not good enough. Trusts being forced to take on a whistleblower does not bode well. Neither is it good for a whistleblower to be forced into a job which is not their background or expertise. This leads to stress and a strained relationship with their employer, and bullying can result.

If alternative posts are to be found then these posts need to be permanent and of same pay, expertise and stature to the one lost. If whistleblowers are ill and or de-skilled, they should also be fully supported with either rehabilitation, with pay, and or a fair pension, as appropriate. The bottom line is, it should be clear to all that whistleblowing does not result in loss.

Imagine Mr Hunt finding yourself losing your job and someone finds you an alternative post in something completely unrelated. For example, taxi driving or selling fast food, at minimum wage. Would you be happy or feel grateful?

8.  There is no robust recommendation for swiftly holding to account the many corrupt individuals who covered up. This is despite reams of evidence that Sir Robert accepted was consistent and credible. In my own case, those who victimised me, and covered up fraud, remain happily employed.

I am enclosing a link to an article on response to Francis’s review.

https://sharmilachowdhury.com/2015/02/17/response-to-francis-report/

You have listened to us but have continued to ignore our request for genuine help.

Personally, I continue to face a very uncertain future whilst suffering from cancer. I may be homelessness in due course. Yet, you have chosen not to intervene. Additionally, you have refused to organise an independent investigation into my raised concerns.  This shows the hollowness of the review exercise, and the government’s response.

Those that were responsible for possible fraud and my dismissal are still in employment. The lack of accountability sends a clear message that one can bully and get away with it.

You have turned your back on NHS whistleblowers and by doing this you have also turned your back on vulnerable patients, who depend and trust staff to speak up when they see wrongdoings. You have also failed the tax paying public whose hard earned monies continue to be wasted.

I urge that you reconsider your actions and offer genuine help to NHS whistleblowers, and to re-open cases through a full Public Inquiry.

With Kind regards

Sharmila Chowdhury

After much publicity and media coverage Sir Robert Francis was commissioned a review into NHS whistleblowing

After three month delays Francis report into whistleblowing was finally published on 11 February 2015.  There were numerous media coverage of the publication of the report.

What about the coverage after published report? Here are some of them:

Russia Times

Daily Mail

ITN News

Independent on Sunday

The Telegraph

So what did NHS whistleblowers and their supporters think?

Eileen Chubb 

Gary Walker 

Fiona Bell:

Well the long awaited Francis report on whistle blowing , The review its self was finally an acknowledgement of the fact all is not well in our NHS . For years many of us having been highlighting these problems at great personal cost. It has taken many years to simply get the acknowledgement that something needed to be done. 

Would we have had the Francis report without the persistent pressure ? Without the help of Social media , some straight talking ,open emails and of course the help of our national press highlighting our concerns? I suspect not . 

The review team had to work within the terms of reference, That I accept , however I don't believe those in power can clap their hands in joy and claim to have addressed the issues raised and found us all a miracle solution . Why are those that bullied , harassed and hounded good staff out of their jobs still in post? 

Who protects the guardians? And will we now have a new wave of unprotected naive whistle blowers that assume because of the review it is now safe to speak up? 

Has anything really changed ? Has there been a culture change over night? was there at the very least a public apology from. Mr Hunt ? An apology may seem unimportant when there are much bigger issues, but let's face it, if a government/DH/nhs can't deliver a simple basic apology to all those that have lost so much, then what hope is there for the complete culture change? 

In order for all to move forward the issues of the past need to have been addressed , Nothing has changed for those that sacrificed so much in order to protect patients . Friday 13th Canary Wharf I met yet again with a whistle blower , despite The Francis review, the trust in his case continue to persecute. Beware there is no overnight fix, those that bully, victimise, persecute have not been disciplined nor are they likely to be . 

It is often said to me patient complainants suffer in the same way whistle blowers do , it's true. Being a Nhs whistle blower and complainant I have seen this time and time again , many patients themselves, their families are still afraid to complain , leaving issues unresolved . It is the same for whistle blowers . 

Patient families still continue to knock on the door for help despite the other Francis Report , I don't expect my case load to decrease in the coming year . Whistle blowing & Complaining comes with a heavy price tag , The day you dare to speak up is the day your world is turned upside down and life is never ever the same again. 

On the plus side through out the past 7 years I have had the privilege of meeting some incredibly brave people . 

Jo Gilbert

The Francis report was not only 3 months late but could have easily been written without anyone ever meeting a live whistleblower. It is virtually a lit. review that contains readily available information about what employers do to whistleblowers, collated from existing reports and research.

 Will it make one iota of difference to current whistleblowers? (“Current” is defined as those of us who are still asking and waiting for help four, five, ten years after we reported and were vindicated. There is no such thing as “historic” whistleblowing.)

 The answer is “No”. It will make no difference whatsoever. Francis and the report editors intentionally neglected to include any suggestions about what will be done to right the wrongs that everyone acknowledges has been done to those of us still fighting for justice.

 Will it make a difference to those who might have been “future whistleblowers”? Probably. It is likely to discourage them from making protected disclosures as they have now seen a written report which confirms that many are not protected, and have no recourse. The report confirms that whistleblowers are bullied, illegally sacked and blacklisted by the NHS, ESRs contain illegal and inaccurate data; they will probably see their careers terminated and are likely to lose their homes and families too. 

 The word “consequences” appears in the report 16 times. In 14 of those cases it refers to consequences of reporting that are experienced by whistleblowers. In one instance the report quickly and vaguely skims over a suggestion that NHS managers will receive “consequences” for doing what it recognises – 14 times – that they do. It simply says “there will be consequences” and does not even suggest what those should be or who will charge them with the offences (p.163, 7.5.8. The other case, p.105, 5.5.15, refers to the reference that will be made in 7.5.8).

 We have proved that NHS staff, Board members, NEDs, failed to do their duty, ignored PIDA, committed misconduct in public office and received rewards for their co-operation: Promotions, contracts, payoffs, prestigious positions. Who would voluntarily discontinue this lucrative practice?

 These are the facts. Until justice is done for those still struggling and fighting for it, who need nothing more than cash to buy it, this is never going to be over. This is not a life. It is a barely tolerable existence, we did nothing to deserve it and it gets progressively worse. It is not historic. It is daily. 

 There must be consequences for the many identified NHS staff and NEDs who have destroyed whistleblowers, ridden the Magic Roundabout and are still employed – either within or outside the NHS – before we will accept that our situations are sufficiently understood, are being taken seriously and are being corrected. So far there is no evidence that this is even being considered. There is no safe way to blow the whistle. We waited, tentatively hopeful, for months, for nothing.

Will Powell:

History has repeated itself, yet again, with regards to Sir Robert’s Report on whistleblowers as it would appear that there is no recommendation to address the injustices suffered by individual historic whistleblowers notwithstanding some have lost both their beloved careers and homes. I am told that some may have even lost their lives as a consequence of suicide.

I see whistleblowers and NHS complainants fighting the same cause and that is to improve patient safety issues within our NHS. However, the establishment see us as the enemy, not because we are wrong, but because we expose gross failures in the system and individuals, which is clearly detrimental to the wellbeing of our NHS. The establishment would rather cover up errors than address them for the better of all. There is conveniently no accountability when protocols, guidelines and laws are blatantly breached and that’s exactly how the establishment, in my view, want it to stay. I believe Sir Robert has failed again to ensure accountability when whistleblowers are vilified for speaking out.

It also frustrates me so very much when I hear arguments that healthcare professionals fear being open and honest about errors because of the alleged blame culture. All patients request is that doctors who make mistakes should be honest and accept responsibility for their actions – is that really too much to ask in a purported democratic country? It’s not the blame culture that healthcare professionals should fear but the consequences when they decide to lie and cover up their mistakes. The cover up culture in the NHS is like a very naughty child – it needs to receive appropriate punishment to make it stop.

Paul Cardin:

By SOPHIE BORLAND and CLAIRE ELLICOTT and DANIEL MARTIN FOR THE DAILY MAIL  PUBLISHED: 23:56, 11 February 2015 

• Lead Barrister said whistleblowers treated as ‘snitches and backstabbers’
• Called for guardians at each NHS trust to protect those who expose abuse
• But report contains no extra legal protection for those who come forward
• Campaigners brand it an ‘affront’, ’empty words’ and ‘disappointing’ 

A report into the NHS’s shocking treatment of whistleblowers was yesterday branded a ‘whitewash’ that will do nothing to protect staff who raise concerns.

The long-awaited findings warned of a culture of ‘fear, bullying and ostracisation’ within the health service that punished doctors and nurses who dared speak out.

But whistleblowers whose careers have been ruined after issuing warnings over patient care were furious that among the 20 recommendations were no sanctions against bosses who bullied staff or made them sign gagging orders.

There is also growing unease about a key clause in the report which strongly urges whistleblowers not to speak to the Press – advising staff instead to talk to journalists only as a ‘last resort’ to avoid causing ‘considerable distress.’

One measure even includes a full-time ‘whistleblowing guardian’ at every hospital and Trust to whom staff could go with their concerns.

Led by barrister Sir Robert Francis, who chaired two major inquiries into the Mid Staffordshire hospital scandal, the report told of how whistleblowers are too often derided as ‘snitches, troublemakers and backstabbers.’

It said many are ‘victimised’ by managers, forced out of their jobs and unable to find other work because they are in effect blacklisted in the NHS.

The Government has promised to enforce all of Sir Robert’s 20 recommendations and other key reforms aimed at changing NHS culture so that staff can raise concerns without fear of reprisals.

Yet whistleblowers said the document contained ‘empty words’ that failed to protect staff and deterred them from speaking to the media – which in the past had helped them expose numerous NHS scandals.

Many felt they had no choice after their concerns were repeatedly ignored by hospital bosses and watchdogs. Gary Walker, the chief executive who was sacked from United Lincolnshire Hospitals after raising concerns that patients were dying, said the recommendations were an ‘affront’ to whistleblowers.

He called for criminal sanctions against managers who forced staff to sign gagging agreements.

Mr Walker, 43, was ordered to sign a £500,000 gagging order in 2012 which he bravely defied by speaking to the Mail the following year.

 Barrister Sir Robert Francis, who drew up the report after helping to lead inquiries into Mid Staffordshire Hospital, said whistleblowers were often regarded as ‘snitches, troublemakers, and backstabbers’

John Marchant, who lost his job as head of security at The Dudley Group Foundation Trust after raising concerns that patients were being restrained, said: ‘No one is being held to account.

‘The CEOs (chief executives) at these hospital Trusts are still CEOs and if they get a lot of complaints they just move to another position as a CEO,’

Julie Bailey, who helped expose the Mid Staffordshire scandal after the death of her mother Bella in 2007, said the report was ‘disappointing’ and did not go far enough.

She called for criminal sanctions against managers who victimise whistleblowers.

‘The new report is a little disappointing,’ she said. ‘There is no more protection for whistleblowers as a result.

‘Robert Francis’ recommendations from the Mid Staffs report were that there should be criminal sanctions against these people.

‘He didn’t want a blame culture but we need people held to account in society as a whole.

‘Until we start doing that, we are never going to get a change of culture in the NHS.’

Sir Robert was asked by the Government to lead a review on the treatment of NHS whistleblowers last June after heading two inquiries into Mid Staffordshire hospital which concluded that at least 400 patients died from neglect.

The barrister and his team spoke to 600 NHS staff while 19,800 other employees gave their views on an online survey.

His 222-page report concluded that managers were inclined to ‘delay, defend and deny’ allegations made by whistleblowers – often because they were implicated.

Sir Robert said: ‘What I heard during the course of the review from staff, employers, regulators and unions and others leaves me in no doubt that there’s a serious problem in the NHS.

‘Too often, honestly-expressed anxieties have met with hostility and breakdown of working relationships. Worse still, some people suffer life-changing events, they lose their jobs, their careers and even their health. 

 

Tory Health Secretary Jeremy Hunt (left) promised to call time on bullying within the NHS, backing all of the report’s proposals, a move echoed by shadow Health Secretary Andy Burnham (right) 

‘In short, lives can be ruined by poor handling of staff who have raised concerns.’

Health secretary Jeremy Hunt promised to call time on ‘bullying, intimidation and victimisation’ which has ‘no place in our NHS.’

He told the Commons: ‘The only way we will build an NHS with the highest standards is if the doctors and nurses who have given their lives to patient care always feel listened to when they speak out about patient care.

‘The message must go out today that we are calling time on bullying, intimidation and victimisation, which have no place in our NHS.’

‘We will ensure that every member of staff, NHS manager and NHS leader has proper training on how to raise concerns and how to treat people who raise concerns.’

Labour also backed the recommendations and Shadow Health Secretary Andy Burnham said there was ‘plenty of common ground’ between the two parties,

He added: ‘Our shared aim must be to create a climate where any NHS worker feels able to raise concerns, confident they will be listened to and that appropriate action will be taken and not face mistreatment as a result.’ 

GOING PUBLIC ‘SHOULD BE LAST RESORT’ TO AVOID CAUSING ‘DISTRESS’

 Omission: The report does not recommend any extra powers to protect whistleblowers who decide to make their allegations public (file image)

The Francis review does not suggest any reforms on the issue of whether whistleblowers who go public should be protected.

Instead, it merely says the status quo should apply – hidden away on page 190 of the report.

In just a few paragraphs, Sir Robert Francis says that staff should only contact the Press as a ‘last resort’.

He wrote: ‘For a disclosure to be made straight into the public domain, to someone who is not a prescribed person, a higher bar applies.

‘I am not proposing any changes to this. Disclosures to the Press should be a last resort. There is a strong possibility of misrepresentation if the facts have not yet been investigated.

‘This can be damaging. It can cause considerable distress to the individuals involved, to the organisation as a whole, and can worry the public unnecessarily.’

According to the report, lawyers currently consult an amendment to the Employment Rights Act 1996 for guidance on whether a whistleblower would face disciplinary action or the sack. It states that staff can only speak out if the disclosure is considered ‘reasonable’.

In addition, other conditions must be met including that the worker should ‘reasonably’ believe that raising a concern with their boss could be of ‘detriment’ to them.

Whistleblowers could still be protected if they felt damning evidence was in danger of being concealed or destroyed, or if they felt they were being ignored.

NHS workers victimised for revealing hospital scandals to Press

FORCED TO SIGN GAGGING CONTRACT

 The NHS chief executive sacked after raising concerns that patients were in danger, last night branded the Francis report an ‘affront’ to whistleblowers and patients.

Gary Walker submitted a large body of evidence to the inquiry but was never asked about his experiences or his recommendations.

He told the Mail that the report was a ‘whitewash’ and that it provides no extra protection for staff who raise concerns.

‘Patients are dying and whistleblowers are being sacked for pointing that out,’ he said.

‘The report doesn’t address that and Francis clearly hasn’t understood the seriousness of the problem. He’s a man of the establishment and he protects the establishment and has produced the report that you would expect. Francis has pulled his punches.

‘This report will not change the NHS at all. I don’t see any change in culture as a result. There is no extra protection for whistleblowers as a result of this report.’

Mr Walker, 43, was sacked as chief executive of the United Lincolnshire Hospitals NHS Trust after raising concerns that meeting targets were being put ahead of patient safety.

He was forced to sign a £500,000 gagging contract, but broke his silence with the Daily Mail following the Robert Francis report into Mid-Staffordshire where up to 1,200 patients died unnecessarily.

‘I broke my gag because his report failed to apportion any blame and did not hold any individuals to account,’ he said.

‘This has now happened again. All the people who have gagged whistleblowers in the past will carry on in their jobs with their big fat salaries and will not be held to account. The solution is to sack the people who victimise the whistleblowers.’

Mr Walker said that an independent person from outside the NHS should be appointed for whistleblowers to bring their concerns to.

‘It’s not safe for whistleblowers to report their concerns to employers,’ he added. ‘It’s been proved by the hundreds of whistleblowers out there who have been sacked, gagged and had their lives destroyed after reporting concerns.’

Last night, other NHS whistleblowers told of their fury that their former bosses had not been named and shamed and branded the report a ‘whitewash’.

‘HIRED TO FIDDLE DEATH FIGURES’

NHS whistleblower Sandra Haynes Kirkbright said no one had even bothered to call her to hear her story for the Francis report.

The administrator was suspended for almost three years after claiming she was hired by The Royal Wolverhampton Hospitals NHS Trust to fiddle death figures.

‘I am still in limbo,’ she said. ‘Nobody called me about the Francis report. They don’t want to talk to me now. They didn’t care enough to call me.

‘Has anything changed? This is all just about a political agenda.’

13-YEAR BATTLE OVER UNFAIR DISMISSAL

Top surgeon Raj Mattu warned that whistleblowers were ‘no safer’ following the report.

The doctor was unfairly dismissed and persecuted for a decade after warnings over cardiac patient safety at University Hospital Coventry but was cleared of wrongdoing after a 13-year battle costing the taxpayer £10million.

He said of the Francis report: ‘He’s given charge of the solution to the very people who were part of the problem in the first place – those who were instrumental in the Mid-Staffs cover-up and instrumental in cases against whistleblowers like myself and David Drew.

‘Leopards don’t change their spots. I would say to NHS whistleblowers, you are no safer today than you were yesterday. This is a missed opportunity to make the NHS safer for patients.’

John Marchant lost his job as head of security at The Dudley Group Foundation Trust after raising concerns that elderly patients and children were being restrained against their will.

Of yesterday’s report, he said: ‘No one is being held to account.

‘The CEOs at these hospital trusts are still CEOs and if they get a lot of complaints they just move to another position as a CEO.

‘Why publish it? It is not holding people to account. Just another whitewash.

‘CATASTROPHIC’ FAILURES WARNING

Paediatrician David Drew, who was sacked after complaining about ‘catastrophic’ failures at Walsall Manor Hospital, said the report failed to address previous whistleblowing cases.

‘What we want is all our old cases opened up, so we can have some actual retribution,’ he said.

‘We need our jobs back, our careers back. We need a proper public inquiry and to have the individual cases looked at.

‘There have been some evil CEOs. The whole toxic lying and bullying has to come out. Some of the bosses should go to jail for what they have done.’

FORCED OUT AFTER REPORTING £250K LOSS

Sharmila Chowdhury, who has suffered cancer since losing her job, said that it was ‘scandalous’ that no one had been held to account.

The radiography manager for Ealing Hospital NHS Trust was sacked for telling bosses that £250,000 of public money had been lost through moonlighting by two medical consultants.

‘It’s scandalous that we have lost our jobs, careers and in some cases our homes and health, yet still no one has been held to account,’ she said.

‘The CEOs are left to enjoy a normal life despite their wrong-doing, while whistleblowers who did their job and spoke up have been left with nothing.’

SPOKE OUT ABOUT BRUTAL TREATMENT

David Ore, who was fired for complaining about the brutal treatment of patients at the failing Russells Hall Hospital in Dudley, said the report contained ‘empty words’.

‘The report is grossly unfair to the frontline workers who raise concerns then get ignored, marginalised and accused of trumped up accusations,’ he said.

‘It’s a lot of empty words that will have cost the public a few million pounds to say what we all knew already.’

By PAUL BENTLEY and LUCY OSBORNE FOR THE DAILY MAIL  7 February 2015

• Sue James used loophole to bank bonus as Trust declared massive losses
• She was rehired day later to continue earning salary of almost £200k a year
• Once offered £250k to gag surgeon who spoke out about poor patient care
• Executive now faces being investigated and could be fired under new laws 

An NHS chief who tried to gag a whistleblower has claimed an extra £155,000 by ‘retiring’ for just 24 hours.

Sue James, 58, used a loophole to bank the tax-free bonus as her Trust declared millions of pounds in losses.

She was then rehired a day later to continue earning her salary of almost £200,000 a year.

The executive – who once offered £250,000 of public money to silence a surgeon who spoke out about poor patient care – was last night branded ‘morally reprehensible’.

She faces being investigated by watchdogs and could be fired under new laws, if found to have been involved in ‘serious misconduct or mismanagement’. Incredibly, she has refused to apologise or hand back the money, maintaining she is ‘fully entitled’ to the payout.

The case is revealed today by the Mail as Sir Robert Francis QC prepares to publish a long-awaited report into whistleblowing in the NHS.

It is expected to highlight the extraordinary ways in which whistleblowers have been persecuted into keeping quiet while bosses have been hugely rewarded. Tory MP Charlotte Leslie, who sits on the health select committee, last night said: ‘The disgusting audacity of this is beyond words.

‘People who do the right thing in the NHS get fired and lose their livelihoods and careers and people who do the wrong thing jump on the lucrative managerial merry-go-round, parasiting money off the NHS that should be going to front-line staff and patients.’

Andrew Percy, a Conservative MP who also sits on the health select committee, added: ‘It is morally repugnant. At a time of intense pressure on the NHS senior managers should not be profiteering by retiring and then returning to do the same job. Most people would find it disgusting.’

James, who lives with her husband Peter, 60, in a £500,000 cottage in rural Shropshire, has been chief executive of Derby Hospitals Foundation Trust since 2011. The pay package came even though her failing Trust lost £15.7million, declaring a financial deficit for the first time.

On top of her salary of more than £190,000, she claims about £3,000 a year in expenses and was awarded between £152,500 and £155,000 in pension-related benefits. She claimed the huge tax-free sum by retiring on March 30, 2014. She was re-hired 24 hours later, meaning she could receive her pension while still earning her gargantuan salary.

The supposed retirement and re-instatement was never announced, but buried in the small print in the hospital’s accounts. The chief executive job that she refilled a day later was never advertised.

James may also have broken the rules of her pension. Under certain circumstances she should only have been allowed to come back to work after retirement if she worked for a maximum of 16 hours a week for the first month.

Derby Hospitals never reported that its chief executive was working part-time for a month. Neither James or the Trust would say why her retirement was never announced, why they never advertised for a new chief executive or why James was then reinstated without telling the public.

They would not say whether she worked part-time for a month last year. James did not respond to a request to apologise or to give the money back and would not comment on calls for her to resign.

In 2013, former actress Sue James described her role as chief executive at Derby Hospitals Trust as ‘like living a soap opera’. She added that if you are ‘an adrenalin junkie’ a hospital is a wonderful place to work because ‘you are touching the whole range of human emotions every day’.

She was previously chief executive at Walsall Hospital for seven years from 2003, where she was accused of overseeing the ‘persecution’ of whistleblower Dr David Drew, head of the hospital’s paediatric department.

After telling James about his concerns about safety, Dr Drew was eventually dismissed for failing to obey orders and accused of using religious references at work. James offered him £247,000 in public funds and a good reference to go quietly. She joked it would be a ‘nice birthday present’. After refusing, he was sacked.

Months later, James became chief executive of Derby Hospitals Foundation Trust. Dr Drew has now taken legal action to have James removed from her job. Last night, he compared his former boss to a ‘second-hand car dealer’.

He said: ‘Sue James is on such a big salary already. Why does she need more?’

Derby Hospitals Foundation Trust said: ‘Mrs James has shown herself to be an excellent chief executive. In accordance with HMRC regulations our chief executive, in the same way as many other individuals, has chosen to draw on her pension entitlement early and continue to work.’

The NHS is set to be heavily criticised over the victimisation of staff who dared to blow the whistle on poor practice.

Leading barrister Sir Robert Francis – who carried out two reports into the Mid Staffordshire hospital scandal – will unveil a series of recommendations on Wednesday, designed to protect staff who speak out.

His report has been delayed by two months after his inquiry team was deluged by comments from thousands of worried staff.

The review team has received 17,500 online responses and 600 by post – although some may have been in touch more than once.

Last month, MPs said that despite some improvements, many staff have been put off by the experience of others.

A report by the Commons health select committee said: ‘The treatment of whistleblowers is a stain on the reputation of the NHS and has led to unwarranted, inexcusable pain for the courageous individuals affected.’

Sir Robert’s review into whistleblowing was ordered by Health Secretary Jeremy Hunt last summer over fears that those who want to raise concerns are staying silent over fears of being bullied or forced out of their job.

Although such treatment is particularly associated with the target-driven culture under Labour, there are still cases where those who speak out are being treated shockingly.

In January a senior cancer doctor was suspended by his trust for writing critical articles about the Health Service. Professor Joseph Meirion Thomas was put on two weeks’ gardening leave by the Royal Marsden Hospital in London.

Last year, the Mail highlighted the case of cardiologist Dr Raj Matu, whose NHS trust spent £10million trying to silence him after he warned of patients dying on overcrowded wards. He was suspended from Coventry’s Walgrave Hospital in 2000 and later sacked, but finally vindicated in April when a judge ruled he had been unfairly treated.

In 2010, Gary Walker was dismissed as chief executive of United Lincolnshire Hospitals NHS Trust after raising fears that a Labour drive to meet targets compromised safety. He claims a £500,000 taxpayer-funded gagging order was used to stop him speaking out.

Two years ago, after the trust he ran and several others were warned about high mortality rates, he broke his silence.