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Why doctors don’t blow the whistle

Medicine Balls

Phil Hammond

Monday, 12 December 2011

Phil_Hammond_Blog2_December192011_2.jpgOn December 7, the Health Select Committee will hold an evidence session on professional responsibility of healthcare practitioners. One of the big questions coming out of the Mid Staffs inquiry is the apparent lack of whistleblowers, and committee chair (and former health secretary) Stephen Dorrell has put pressure on the GMC and NMC by reminding them – and the doctors and nurses they regulate – that we have a professional duty to speak up when we encounter unacceptably poor standards of care, and that failing to do so should result in sanction and perhaps even striking off.

This is nothing new – the GMC’s guidance obliging doctors to speak up came in after the Bristol heart scandal a decade ago, and the Public Interest Disclosure Act 1998 (PIDA) entitles whistleblowers who are persecuted for speaking up to unlimited damages at an employment tribunal. So why – when standards of care were so poor at Mid Staffs – were doctors and nurses not shouting about if from the rooftops?

Whistleblowing is never easy but - having studied and supported whistleblowers for twenty years and tried it myself a few times myself – I’m shocked at how hard it still is to do in the NHS. Healthcare is unique amongst industries in that it causes significant harm alongside huge benefits. A decade ago, a number of studies in many countries found that around 1 in 10 patients are harmed by hospital care, and as medicine gets more complex the risk of harm becomes greater. The working conditions in the NHS are seldom ideal with inexperienced, unsupervised staff muddling their way through, particularly out of hours. All of us have been in situations where our actions have, or may have, harmed patients and the gut reaction to observing substandard care is often a) there for the grace of God go I or b) it happens all over the NHS, all the time, so why blow the whistle here?

Since the Bristol heart inquiry, all NHS employers are supposed to have clear whistleblowing policies but the reality remains that anyone who speaks up – particularly if it goes against government targets or policy, or causes political or financial embarrassment – is viewed as a trouble maker rather than a force for good. The NHS is a monopoly employer and any employee who goes public with safety concerns can find it hard to get work elsewhere. Whistleblowers are often counter-smeared, suspended on spurious grounds, referred to the GMC for psychological reasons, isolated them from their friends and repeatedly fobbed off in their attempts to get the NHS to release information to help them prove their case. Their battle for justice can drag on for years while they face career and financial ruin. Unsurprisingly, many end up leaving their employment, accepting a pay off in return for signing a gagging clause that prevents them from ever making their safety concerns public.

Such gags are theoretically void under PIDA, but their use is still widespread in the NHS and individuals seldom have the financial clout or mental strength to take on the might of the NHS legal machine. Consultant surgeon Ramon Niekrash was suspended from Queen Elizabeth Hospital, Woolwich for 10 weeks after raising concerns about the impact of closing a urology ward was having on patient care. The tribunal found in his favour but left him with a £160,000 legal bill. Hardly an incentive to speak up.

Obliging doctors and nurses to blow the whistle without a commensurate obligation on NHS managers to listen and act on those concerns is one-sided and unworkable. What’s needed is a change of culture that frees up front line staff both to innovate when they can see ways to improve care and to speak up when patients are being out at risk. As GPs take on commissioning roles in a deeply over-stretched NHS, we may find themselves at times needing to blow the whistle and to respond to whistleblowers in services we are commissioning from.

It’s a huge responsibility and a huge change of culture for many. Less that 1% of the significant events and near misses reported to the National Patient Safety Agency came from general practice and nearly all of those from nurses. GPs traditionally like to keep problems in house but in future consortia will have to share all their data, monitor each other and pick up problems swiftly before they turn into disasters. The days of isolating and smearing intensely ethical individuals who raise concerns have to end, and it’s up to doctors to lead that cultural change. So put a sign on your door now. Whistleblowers welcome here.

Author's Image

Phil Hammond

Phil Hammond is an NHS doctor, journalist, author, broadcaster, speaker and comedian. He qualified in 1987 and worked part time in general practice for over 20 years. For the past seven years he has worked in a specialist NHS team for young people with chronic fatigue. He presented five series of Trust Me, I’m a Doctor on BBC2, encouraging patients to be more involved, assertive and questioning. Phil is Private Eye’s medical correspondent; in 2012, he was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Journalism for ‘Shoot the Messenger’, an investigation into the shocking treatment of NHS whistleblowers. In 2013 and 2014, he was judged to be one of the top 100 clinical leaders in the NHS by the Health Service Journal. As a comedian, Phil was half of the award-winning double-act Struck Off and Die, with Tony Gardner. He has done five solo UK tours, appeared on several TV shows, and has written five books.
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