By Brian Jarman    

Dr Foster Unit, Imperial College Faculty of Medicine, 

London EC4Y 8BN, UK

In the past decade, quality of care and patient safety in British hospitals have become the focus of increasing public, professional, political, and regulatory concern. The 2001 inquiry into paediatric cardiac surgery at Bristol Royal Infirmary concluded that the Department of Health was unable to respond to an issue of quality of care, even though the Department of Health accepted that ultimate responsibility rests with it and the Secretary of State for Health.1 The Bristol Royal Infirmary Inquiry warned that quality of care problems could recur in the National Health Service (NHS) in future. After the recommendations of an external investigation of Bristol were implemented, the adjusted death rate at the paediatric cardiac surgery unit dropped from 29% to 3% within 3 years.2 The families of children who underwent cardiac surgery at Bristol should have been told of the lower mortalities at other units.

In 2001, the Dr Foster company published the first of their annual Good Hospital Guides in UK national newspapers: these included hospital standardised mortality ratios (HSMR).3–5 The HSMR is the ratio of the number of observed deaths in a hospital over a certain time to the number that would be expected if the hospital had the national death rate accounting for the adjustment factors, such as age, sex, diagnosis, and emergency admission. Although it has limitations, the HSMR is a trigger to ask hard questions and understand where performance may be falling short. Since 2003, the Dr Foster website also reported monthly mortality alerts6 for particular diagnoses or procedures for NHS organisations and professionals. From April 2007, these alerts were sent by letter from Imperial College London to the chief executives of any English NHS hospital trust that was found to have a risk-adjusted death rate for a particular condition that was double the national rate in the preceding 3 months, and the chance of it being a false alarm was less than 1 in 1000. The letters were copied to the hospital regulator, the Healthcare Commission (and now to its successor the Care Quality Commission [CQC]).

In 2007, when the Mid Staffordshire General Hospitals NHS Trust was supported by its oversight Strategic Health Authority for Foundation Trust status, its HSMR published in the Good Hospital Guide was the fifth highest of English acute trusts.3 The Department of Health cautioned the public against using HSMRs to judge the relative safety of hospitals.7 The Department of Health was not informed of the high HSMR or mortality alerts at Mid Staffordshire when they agreed, in June, 2007, to approve the trust’s application to Monitor, the Foundation Trust regulator, for final approval.8 Monitor was told by the trust that Mid Staffordshire’s apparently high HSMR was an artifact of coding.8 David Nicholson, initially Chief Executive of the Strategic Health Authority and later of the NHS, said the data that were available to the regulators did not indicate a problem at Mid Staffordshire,9 even though the trust had logged on and seen its mortality alerts 847 times.10 Nicholson considered Mid Staffordshire “singular” and not illustrative of a systemic problem, an attitude described by the Mid Staffordshire NHS Foundation Trust Public Inquiry Counsel as very dangerous and not supported by evidence to the Inquiry.11 The trust is now considered by Monitor to be neither clinically nor financially sustainable.12

Robert Francis’ inquiry into the problems at, and regulation of, Mid Staffordshire NHS Foundation Trust found a widespread culture of denial, and he, his Harvard experts, and Bruce Keogh, Medical Director of the NHS, all considered that monitoring HSMRs had provided grounds for investigating the trust.8,13 The Department of Health chief analyst suggested it was a “system failure” not to have done so, and Keogh agreed that problems at Mid Staffordshire would have been spotted earlier by the Department of Health had that happened.8 The Francis report documented the appalling care received at that trust8 and as a result the Prime Minister David Cameron asked Keogh to investigate the 14 trusts with the highest death rates.14 Keogh’s report found that none of the trusts could be given a clean bill of health and action plans were produced for each.14 The Secretary of State for Health Jeremy Hunt announced that 11 of the trusts would be placed into special measures for fundamental breaches of care.15 The HSMRs of 11 of the trusts had been identified in the 2007 Dr Foster Good Hospital Guide as significantly high, including ten of the 11 that were placed into special measures in 2013.3,15 I notified seven of the 14 hospitals to the then Secretary of State for Health in 2010 and he referred them to the CQC.10 However, individual cases of clinical quality were, and are, not investigated by the CQC or the Health and Safety Executive; the NHS has no investigator of poor clinical care. That is a regulatory gap that should be closed.8

As with the Bristol Royal Infirmary, the national systems for ensuring quality and patient safety had failed at Mid Staffordshire and nationally. Why did that happen? Before the Bristol Royal Infirmary Inquiry there were systems in place that dealt with performance management and clinical outcomes,10 and after Bristol there were great promises16 with the formation of the National Patient Safety Agency (NPSA) and the Commission for Health Improvement (CHI), which detected the problems at Mid Staffordshire in 2002.8 However, between 2003 and 2004 things went wrong. Ian Kennedy referred to what Gordon Brown described in a 2005 speech as a “bonfire of the regulators”.17 CHI was abolished and replaced by the Healthcare Commission, which was slow to detect the appalling events at Mid Staffordshire.8,18 The NPSA acknowledged significant under-reporting of safety incidents18 and was abolished, with its functions incorporated into the CQC. The Independent Review Panels that investigated patients’ complaints about hospital services not resolved at the hospital were abolished, and in 2011–12 only one of 375 written hospital complaints had been formally investigated by the Ombudsman.19 The independent Community Health Councils were abolished in 2003. During the Mid-Staffordshire Public Inquiry, the chairmen of the three main health-care regulators commented on the difficulties they faced. Ian Kennedy, of the Healthcare Commission, stated: “The engagement of the Department of Health was one of interest… quality of the care provided by the NHS was not part of their agenda.”20 Barbara Young, of the CQC, stated: “The reason the government didn’t like tough reports was because they were running the services that were being reported upon.”21 William Moyes, of Monitor, stated: “The culture of the NHS, particularly the hospital sector, I would say, is not to embarrass the minister.”22 The then Minister Andy Burnham said “The impression of us all was that we would just, you know, constantly do what was meant to be the thing that Number 10 wanted or that we were all, you know, unthinkingly piling this stuff through. We weren’t.”23

Since the publication of the Francis Report8 things are changing. The CQC Chairman, Chief Executive, and most of the Board have been changed and, with the Chief Inspector of Hospitals for England, the CQC will undertake thorough inspections in future using trained, professional investigators.24 The Parliamentary Health Service Ombudsman has called for improvements in the way hospital complaints are handled and said that she will formally investigate ten times as many patient complaints.25 There is an intention to abolish the widespread so-called gagging clauses that undermine the culture and transparency of the NHS.26 Francis has recommended a statutory obligation to observe a duty of candour for health-care providers and registered medical and nursing practitioners, and a criminal offence for non-compliance.8 However, as Don Berwick’s recent report on patient safety for the Department of Health makes clear, it is important that this judicial intent does not lead to punishing or criminalising clinicians for unintentional mistakes or involvement in failed systems.27 The existing criminal law can deal with bad cases. Continuous learning and improvement,28 monthly mortality alerts, adjusted death rates,8,27 regular patient and staff feedback, and targeted, skilled hospital investigations could lead to a safe NHS, ideally without a culture of denial8 or gagging clauses.

To improve the quality of care in UK hospitals I would reintroduce the Independent Review Panels and Community Health Councils and develop monthly complaints alerts similar to the mortality alerts. Regulation would be more independent if the CQC reported in public to Parliament, and there would be better communication if it were integrated with Monitor. Additionally, it is important to ensure there are minimum staff-to-patient levels12 of doctors and nurses, with 65% trained nurses3 and regulation of health-care assistants. I would aim for total physicians per head of population at the EU average.29 Ideally I would also like to see training introduced for the boards of trusts and for them to have equal representation of patients, clinicians, finance, and managers. There has been a decade of concerns about the quality of care in our hospitals: patients have been ignored, the regulatory systems have failed, and there has been a culture of denial. With political will the proposed reforms could lead to marked improvements.

I am employed part-time as the Director of the Dr Foster Unit at Imperial College London. I am paid a consultancy fee by Dr Foster Intelligence for my international work on advice and involvement with development of international relations and am paid as a part-time Senior Fellow at the Institute for Healthcare Improvement in Cambridge, MA, USA.

1 The Bristol Royal Infirmary Inquiry. Learning from Bristol: the report of the

public inquiry into children’s heart surgery at the Bristol Royal Infirmary

1984–1995. July 2001. CM 5207. London: Stationery Office, 2001.

2 Aylin P, Bottle A, Jarman B, Elliott P. Paediatric cardiac surgical mortality in

England after Bristol: descriptive analysis of hospital episode statistics

1991–2002. BMJ 2004; 329: 825.

3 Dr Foster Intelligence. Dr Foster April 2007 Good Hospital Guide. http://

drfosterintelligence.co.uk/wp-content/uploads/2011/06/The-Hospital-

Guide-2007.pdf (accessed Aug 8, 2013).

4 Jarman B, Gault S, Alves B, et al. Explaining differences in English hospital

death rates using routinely collected data. BMJ 1999; 318: 1515–20.

5 Bottle A, Jarman B, Aylin P. Strengths and weaknesses of hospital

standardised mortality ratios. BMJ 2011; 342: c7116.

6 Bottle A, Aylin P. Intelligent information: a national system for monitoring

clinical performance. Health Serv Res 2008; 43: 10–31.

7 Martin N. Revealed: lottery of death rates in hospitals. The Telegraph,

April 24, 2007. http://www.telegraph.co.uk/news/uknews/1549493/

Revealed-Lottery-of-death-rates-in-hospitals.html (accessed Aug 8, 2013).

8 The Mid Staffordshire NHS Foundation Trust. Public Inquiry Chaired by

Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust

Public Inquiry. 3 vols. London: Stationery Office, 2013. http://www.

midstaffspublicinquiry.com/report (accessed Aug 8, 2013).

9 Hansard. The Health Committee, HC 982–ii. House of Commons, page 22.

Report of The Mid Staffordshire NHS Foundation Trust Public Inquiry.

March 5, 2013. Sir David Nicholson KCB CBE, question Q203. http://www.

publications.parliament.uk/pa/cm201213/cmselect/cmhealth/uc982-ii/

uc98201.pdf (accessed Aug 8, 2013).

10 Mid Staffordshire NHS Foundation Trust Public Inquiry. June 13, 2013.

Statement of Sir Brian Jarman. Paragraphs 25–27. http://www.

midstaffspublicinquiry.com/sites/default/files/evidence/Brian_Jarman_-_

witness_statement.pdf (accessed Aug 8, 2013).

11 Mid Staffordshire NHS Foundation Trust Public Inquiry. Oral hearings. Dec 1,

2011. Page 193, lines 5–6. http://www.midstaffspublicinquiry.com/sites/

default/files/transcripts/Thursday_1_December_2011_-_transcript.pdf

(accessed Aug 8, 2013).

12 Monitor. Monitor—contingency planning team, Mid Staffordshire NHS

Foundation Trust, assessment of sustainability, January, 2013. http://www.

monitor-nhsft.gov.uk/sites/default/files/publications/MSFT%20

Sustainability%20Final.pdf (accessed Aug 8, 2013).

13 Robert Francis, QC. Notes for presentation of letter to SoS submitting Mid

Staffs Independent Inquiry. Feb 5, 2010. http://www.midstaffsinquiry.com/

assets/docs/Report-presentation-by-Robert-Francis-QC.doc (accessed

Aug 8, 2013).

14 Keogh B. Review into the quality of care and treatment provided by

14 hospital trusts in England: overview report. July 16, 2013. London:

NHS England, 2013. http://www.nhs.uk/NHSEngland/bruce-keoghreview/

Documents/outcomes/keogh-review-final-report.pdf (accessed

Aug 8, 2013).

15 Hansard. House of Commons. Hospital mortality rates. July 16, 2013.

Column 927. http://www.publications.parliament.uk/pa/cm201314/

cmhansrd/cm130716/debtext/130716-0001.htm#13071683000004

(accessed Aug 8, 2013).

16 Department of Health. An organisation with a memory. London: Stationery

Office, 2000.

17 Mid Staffordshire NHS Foundation Trust Public Inquiry. May 4, 2011.

Oral evidence of Sir Ian Kennedy, day 77. Page 33, lines 3–23. http://www.

midstaffspublicinquiry.com/sites/default/files/transcripts/Wednesday_4_

May_-_transcript.pdf (accessed Aug 8, 2013).

18 House of Commons. Patient Safety Health Committee. Measurement and

evaluation, paragraph 36. http://www.publications.parliament.uk/pa/

cm200809/cmselect/cmhealth/151/15106.htm (accessed Aug 8, 2013).

19 Jarman B. Professor Brian Jarman guest editorial: not many complaints are

investigated. nhsManagers.network, May 14, 2013. http://www.

nhsmanagers.net/guest-editorials/not-many-complaints-are-investigated/

(accessed Aug 8, 2013).

20 Mid Staffordshire NHS Foundation Trust Public Inquiry. April 4, 2011.

Witness statement of Sir Ian Kennedy, paragraph 39. http://www.

midstaffspublicinquiry.com/sites/default/files/evidence/Sir_Ian_Kennedy_-_

witness_statement.pdf (accessed Aug 8, 2013).

21 Mid Staffordshire NHS Foundation Trust Public Inquiry. Oral hearings,

day 110. July 4, 2011. Page 74, line 20. Page 75, line 9. http://www.

midstaffspublicinquiry.com/sites/default/files/transcripts/Monday_4_

July_2011_-_transcript.pdf (accessed Aug 8, 2013).

22 Mid Staffordshire NHS Foundation Trust Public Inquiry. Oral hearings,

day 93. June 1, 2011. Page 11, line 24. Page 12, line 1. http://www.

midstaffspublicinquiry.com/sites/default/files/transcripts/Wednesday_1_

June_2011_-_transcript.pdf (accessed Aug 8, 2013).

23 Mid Staffordshire NHS Foundation Trust Public Inquiry. Oral hearings,

day 115. Sept 6, 2011. Page 138, lines 2–5. http://www.

midstaffspublicinquiry.com/sites/default/files/transcripts/Tuesday_6_

September_2011_-_transcript.pdf (accessed Aug 8, 2013).

24 Care Quality Commission. Consultation on changes to the way we inspect,

regulate and monitor care services. July, 2013. http://www.cqc.org.uk/

public/sharing-your-experience/consultations/consultation-changes-waywe-

inspect-regulate-and-monito (accessed Aug 8, 2013).

25 Donnelly L. Ombudsman: patients suffer from a “toxic cocktail” in NHS.

The Telegraph, Aug 12, 2013. http://www.telegraph.co.uk/health/

healthnews/10238221/Ombudsman-Patients-suffer-from-a-toxiccocktail-

in-NHS.html (accessed Aug 13, 2013).

26 Hammond P. The NHS is still not safe for whistleblowers. The Times,

March 15, 2013. http://www.thetimes.co.uk/tto/opinion/thunderer/

article3713910.ece (accessed Aug 8, 2013).

27 National Advisory Group on the Safety of Patients in England. A promise to

HOC HEALTH COMMITTEE  Tuesday 16 December 2014

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.

  [1]http://www.cqc.org.uk/sites/default/files/documents/cm_0114310_item_10_appendix_1_cqc_framework_agreement.pdf

 [2] http://www.theguardian.com/society/2014/nov/22/there-were-hundreds-of-us-crying-out-for-help-afterlife-of-whistleblower

 [3] https://sharmilachowdhury.com/2014/12/21/the-nhs-is-allowing-babies-to-be-maimed/

 [4] http://www.independent.co.uk/news/uk/home-news/shocking-footage-shows-elderly-residents-being-taunted-and-abused-at-essex-care-home-9303888.html

 http://www.bbc.co.uk/news/uk-27906730

 http://www.theguardian.com/uk-news/2014/dec/14/labour-pledges-yarls-wood-centre-investigation

 [5] https://www.whatdotheyknow.com/request/whistleblowing_nhs_analysis

[6] http://www.cqc.org.uk/sites/default/files/20141208_complaints_matter_report.pdf

[7] http://qualitysafety.bmj.com/content/early/2013/08/28/bmjqs-2013-001947.full.pdf

 [8]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/379803/Christie_Review.pdf

 [9] http://www.washingtonpost.com/politics/federal-diary-whistleblowers-get-a-defender/2011/10/18/gIQAtnvfvL_story.html

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.”

Sunday Times 21 December 2014

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.”

 By Sharmila Chowdhury 14 December 2014

 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:

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.

For more details on the case:  https://sharmilachowdhury.com/2014/12/14/ignoredwhistleblowers-claim-of-nurse-who-killed-slowly/

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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But the employment tribunal ruled there was “no consistent evidence” of misconduct and that chief executive John Goulston, whose evidence it criticised as inconsistent, had “failed to carry out a fair process”.

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 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.

 Watch the dynamics of whistleblowing

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

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 whistleblower Peter 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.

Cite this as: BMJ 2013;346:f2338

© BMJ Publishing Group Ltd 2013

• Peter O’Keefe was sent on ‘gardening leave’ in April 2012
• He is still being paid his £94,000 and the hospital in Cardiff has had to recruit a locum consultant to cover Mr O’Keefe
• The total cost to the NHS is thought to be more than £500,000 as a result
• A formal investigation was launched by health bosses in Wales but a barrister appointed to chair the case was taken ill earlier this year
• Health chiefs declined to comment on the details of the case against Mr O’Keefe but said it was not to do with the standard of care he provided  

By LIZZIE PARRY FOR MAILONLINE and SAM MARSDEN FOR THE DAILY MAIL

PUBLISHED: 11:17, 15 October 2014 | UPDATED: 12:28, 16 October 2014

+3

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.

+3

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

‘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.

30 September, 2014 | By The Press Association

   Noel Finn

I have experience of raising concerns in the NHS and private providers of NHS services. I am not represented by Patients First or any other organisation.

My experience in NHS was whilst employed as a service manager from 2006-2010, and involved many concerns which were raised over 3 years including: inaccurate reporting of performance data; fraudulent activity of medical staff; experiences of bullying; dangerous working environment; inadequate service cover and staffing levels.

These concerns were raised as I became aware of them and reported directly to my line managers, senior managers and service leads as appropriate; through supervision, various forums and meetings.

Most concerns were not addressed or resolved satisfactorily i.e. the problems remained or created another problem, therefore I continued to pursue issues in an effort to seek resolution.

Eventually, I became more isolated and managers and colleagues alienated me. During the same period I was tasked with improving the standards and performance of the community services I managed, which involved performance managing some of the staff and implementing change. Where performance management was required I ensured that I sought advice and support from HR throughout, and made reasonable adjustments for people to adapt to change. However, on two separate occasions different staff members raised allegations of bullying against me in response to such management. Both allegations proved unfounded, however on both occasions I was ‘operationally suspended’ i.e. temporarily removed from my role whilst the investigation was held. None of the staff members concerned faced any disciplinary actions following false allegations, and my managers, investigators and HR ignored my concerns that I was being victimised. On commencement of the second allegation I also raised a grievance which included all of my concerns to that date, and at that point the investigation was escalated to a disciplinary hearing. The organisation did not follow ACAS guidance and tried to pursue the disciplinary before the grievance, however then arranged to hold the grievance and the disciplinary on the same day.

On this day the disciplinary was immediately thrown out without question, and despite a massive file of my concerns to that date, these were given scant regard although my grievance was partially upheld. However, I was never allowed to return to my role as service manager on the grounds that I needed time away to heal from the experience. Following the outcome of my grievance I questioned the outcome, reinforcing that I needed to return to the role I had held, however I was told by the director that if I insisted on this, the disciplinary investigation would be resumed. I was promised that at the least, I would be able to return to meet with the team to be vindicated, but this did not happen and I later learned that the allegers both received apologies from the director for the experience they had suffered, and an implication that my being moved from the team was as some form of disciplinary action.

I was moved to a team to be managed by someone who was known to have had previous allegations of bullying against them, who then directly bullied me, following which I resigned.

Whilst working my notice, I also raised my concerns in writing to the CEO and other senior directors, but received no acknowledgement or response.

I had support from an RCN officer during the disciplinary and grievance and that was very helpful. I was then passed to the RCN legal team for assessment of my case after I resigned and a case was put forward for constructive dismissal as a result of whistleblowing and an application made to the employment tribunal (ET). This was the first time that I saw my actions as ‘whistleblowing’. The whistleblowing element was removed from the case early on by the judge due to a timing issue. The case reached a conclusion before tribunal, but I was ‘gagged’ from speaking of my experience.

I wrote to the CQC to escalate some of the issues I had raised as they still had not been addressed. One concern regarding dangerous working premises, when raised by the CQC led to the Trust immediately removing the team from the building and relocating them – I had raised the same concern over a period of three years and no action had been taken in that time. The CQC also wrote to me to advise that other concerns had been put to the CEO who had given assurance that issues did not remain but that evidence would be sought at the next inspection. I was also advised to take my concerns to the parliamentary ombudsman, which I later learned was inappropriate as they act only on behalf of patients. I also received an apology from the Trust which is subject to confidentiality outside my immediate family.

My second experience was whilst working for Serco Healthcare at Yarlswood Immigration Removal Centre.

Following my experience in the NHS I was unsuccessful in applying for numerous jobs in the NHS, initially at the same level (service manager) as I had been employed, but then at entry level and ‘bank’ roles, turning also to private healthcare. Eventually after a period of almost 2 years I commenced employment as a bank nurse at Yarlswood in January 2012.

After a few weeks I was asked to take up the post of Mental Health Lead-tasked with developing mental health pathways on a 3 day per week contract.

I quickly identified concerning mental health issues which needed addressing. Mostly acute in nature and related to risk – i.e. suicide and self-harm. I also identified that officers did not have relevant training to manage these risks and some had negative attitudes towards these behaviours and residents.

In March 2012 the role increased to 4 days per week due to the increased demands.

From the start I fed back all my findings and concerns to operational and healthcare managers and made suggestions on how these could be addressed. I also raised concerns around a lack of clinical supervision for healthcare staff.

I also uncovered issues with access to emergency NHS mental health services for residents.

The healthcare manager suggested I put my concerns into a business plan for consideration. In completing this I researched previous reports and inspections into Yarlswood including HMIP 2011, IMB 2010, and Bedford needs assessment and found the same concerns had been raised before. I also found that some policies and processes were not being implemented appropriately. The business plan included all of my concerns and findings, and different suggestions for change based on existing models of mental health care provision in similar populations. I made it clear within the business plan that the status quo could not remain as it was not sufficient to address the needs and safety of residents.

I sent the business plan to the healthcare contract manager on 1^st October 2012. Following this the manager made it clear they were not happy with the plan and began to act with increasing hostility and began to bully me: making increasing demands on my work with the prime concern of fulfilling contract obligations; being increasingly critical of my work; making a false accusation of shouting against me; and physically pushing past me aggressively on one occasion.

Eventually I requested a reduction in my hours back to 3 days per week as the bullying was intolerable. In response the manager said that I would no longer be mental health lead and that my role would be completed by a different mental health nurse each day. I expressed my concern that this undermined the service and did not address any of the issues I had raised.

I reported the incidents of bullying and escalated my concerns to the regional manager. A grievance was formally raised on my behalf on 1^st November 2012, whilst I was on leave.

I returned to work on 5^th November 2012 and was immediately suspended by the Centre manager, for ‘failing to follow the instructions of healthcare management’. I was never given any detail of what I had failed to do, and never received any detail of the investigation despite it being progressed to a hearing in January 2013. The terms of reference were also very vague and indicated that there was no evidence to support my alleged misconduct. I was also instructed to contact a named manager before 10am on each day that I would normally be on duty. Serco never followed ACAS guidelines or employment law with regards to the whole investigation as it continued despite my grievance never being concluded.

I wrote to all managers to say that I considered my suspension to be a direct result of my raising concerns, but this was ignored. I also raised my concerns, and provided written statements during each of my meetings with investigators but was told that it was not the appropriate venue to address them.

The initial grievance outcome was appealed based on it being unfair due to my suspension; that it had many inconsistencies; that it was inappropriately handled (both the grievance and disciplinary were overseen by the same manager); and that my concern that the suspension was in response to me raising concerns had not been addressed.

The appeal process was initiated under another director, but was never concluded. The disciplinary hearing was put on hold only after the intervention of the RCN rep. Arrangements were made for me to enter Yarlswood under supervision to access evidence in support of my grievance and my claims that I had ‘whistleblown’, but this was cancelled at the last minute.

As no progress was made and the concerns I had were still not being addressed, I escalated all of my concerns to the then CEO of Serco Chris Hyman, and further raised to Valerie Michie, Serco MD.

Throughout my suspension I was supported by an RCN Rep who was very supportive.

A senior director was tasked to help resolve my concerns. They arranged a confidential meeting for me, my union rep and a member of Serco’s legal counsel. It was agreed that an investigation would be held into the concerns to be completed within 6 weeks, and that I would be interviewed as part of this. Terms of reference for the investigation were agreed at the meeting, but were later diluted so that they only looked at contractual obligations.

Myself and the RCN rep recommended that Serco report my concerns to CQC and have them involved in the investigation. However, the counsel said they contacted CQC informally who advised an internal investigation was sufficient.

Serco subsequently nominated their own external investigator, but I was never interviewed.

It was also agreed that the senior director would look into my disciplinary and agreed that I could stop reporting to the named manager by telephone on my normal days of duty.

Initially the director asserted the validity of the disciplinary. When I challenged this quoting the evidence, the suspension was immediately lifted and the investigation was dropped without explanation.

A meeting was then arranged with me, my union rep and a senior HR director to resolve my employment issues. My union rep and I stated that issues including the grievance should be resolved before my return to employment. However, both directors disagreed and instead offered 3 options – return to Yarlswood, redeployment or leaving the company. Details of the first 2 offers were provided, but were deemed inappropriate. Therefore I asked for further details on the 3^rd option as this was not provided at the time.

As the investigation into my concerns had not started and Serco refused to inform CQC, my concerns were escalated to Bedford CCG by the RCN on my behalf, stating that I was also available to talk to them for further detail.

As the commissioning arrangements for Healthcare at Yarlswood were in transition my concerns were forwarded to NHS England, who then spoke to the manager who had bullied me; Home office and the CQC. However, the concerns were not disclosed in detail and I was never contacted. HMIP and CQC both later performed inspections and did not record that disclosures were made and therefore did not look at the issues. Through a FOI request I later learned that CQC were not given any detail of the disclosures from Serco despite asking for them.

At the 6 week deadline the investigation had still not been started, and I was forced to resign my post.

My case was then referred to the RCN legal team. They advised that whilst it was clear that I had whistleblown and suffered detriment, they would not argue for constructive dismissal or apply to ET as they would not take the financial risk. Their analysis on the success of my case was flawed. They advised to negotiate a settlement. I expressed concern from the outset that Serco’s actions against me were a serious concern for the nursing profession and therefore in the RCN’s and public interest to address, but they refused to pursue due to constraints on funding. I proceeded therefore with the advice but insisted on an open apology as part of the remedy.

Twice the legal officer made serious errors and resolution was still not in sight as the deadline for application to ET approached which the RCN still refused to support, therefore I withdrew from the RCN and sought independent legal advice.

My new legal team agreed to make an application to ET and advised me to apply for legal fees under my household cover or ask RCN to cover my expenses. Neither option was successful so I had to self-fund.

During the whole experience I became very depressed and reluctantly started antidepressants in late 2013. At the request of Serco and my legal team I was seen by an independent psychiatrist for assessment. The psychiatrist suggested I had suffered Occupational injustice, and that I was not recovered sufficiently to return to a clinical role, he also suggested that moving into an unskilled role may be demeaning, therefore recovery was difficult to determine.

I was subjected to additional stressors through this process and continued expenses when I expected the case to be resolved. The case was eventually concluded over a year after resignation and I have received an open apology from Serco which recognises that the action taken against me was as a result of raising concerns, in the public interest, and was inappropriate.

Main problems were that people consistently did not listen or even acknowledge what I was saying, and did not act. In both experiences people made judgements about me as a troublemaker and for managers it seemed the easiest way to address problems was to get rid of me, anything else was too complicated.

There seemed to be a stronger culture of achieving targets and my concerns seemed to get in the way of achieving those.

In both experiences, colleagues often quietly agreed with my concerns but refused to speak out in fear of reprisals.

RCN legal team I believe have a conflict of interest with regards to nursing as their financial constraints prevent the public interest being served. The ET is not a fit place for whistleblowing as it is meant to represent individual employment issues and not the public interest. Timing issues should not be relevant to whistleblowing. Whistleblowers are not experts in employment law but healthcare companies have HR and legal teams on hand to advise at every opportunity meaning they have the upper hand. Finances also put employees at a disadvantage and thanks to Mr Vince Cable, the very individuals, who need to have a voice are unable to do so due to cost pressures, unemployment and having to pay for Employment Tribunals. On the ET application the new ‘whistleblowing box’ was ticked but the information was not raised to regulators, when I called the local Employment Tribunal office they did not even know who the CQC or HMIP were, this was shocking as the raised concerns need to be forwarded onto them. To this day I am still not aware if this has been done.

Regulators and responsible bodies failed consistently and more often took the assurances of organisations at face value rather than going to the source or exploring assertively in greater detail.

The experiences I had could be likened to abuse, however I think this is not at all appreciated or acknowledged anywhere and is not possible to resolve via ET.

I also submitted evidence to the Healthcare select committee and the Home affairs Select committee and have received no response or acknowledgement.

I believe the fact that the issues I raised related to mental health and latterly also immigrants, meant that they were less likely to be addressed as less priority or attention is given to these areas, and the present government does not make it any easier for these groups of people.

There should be a duty for all NHS (including commissioned providers) to report all concerns openly and for these to be taken to the board as the first step for oversight, assurance and accountability.

The CQC should have an independent element which is solely responsible for addressing whistleblowing concerns to ensure quality this includes involvement with other providers such as NHS England.

Whistleblowing detriments should not be taken through ET’s and should not be sectioned off into mild, moderate and severe pay-outs, this is nonsense; the detriment is a subjective thing, you can’t measure one against the other, people react and cope differently.   It should have a separate process to ensure that public interests are not kept secret and any organisation found to have acted inappropriately against whistleblowers should be put in front of a public committee for scrutiny.

Apology from Serco after 3 years:

‘I have not been formally interviewed by any authorities to date, and despite an apology on both account on whistleblowing no one from CQC  HMIP and CCG NHS England Monitor had interviewed me the assessment of Yarlswood in 2013 some 4 week after i resigned was reported to be fit and well, yet CQC ort HMIP never interviewed me despite knowing about the whistleblowing, furthermore  they refused to peruse the document from Serco and myself . The CQC board had refused to talk with me directly, instead they passed my concerns down the line. I  have recoding of these meeting not one had a clue about why they where meeting me. where is the accountability for the board they keep talking about it so freely, “transparent” its not, they need challenging.’