The brave people willing to raise concerns in the health service can only rely on patchy systems to protect them during a process that is lagging behind the rhetoric
Recent whistleblower cases have shown that there are brave souls in our healthcare system who are willing to raise the flag on bad practice.
Amanda Pollard, a former Care Quality Commission inspector criticised the regulatory body for prioritising paperwork over care standards inspection during the Mid Staffordshire public inquiry and an anonymous doctor highlighted Maidstone and Tunbridge Wells Trust’s failure to act on staff concerns about surgeons performing key hole surgery for upper gastro intestinal cancer.
‘All too often whistleblowers are whistling in the wind’
However, their experiences suggest that all too often whistleblowers are whistling in the wind if there is no genuine desire in an organisation to learn from the exposed wrongdoing, and use it to improve the services they provide.
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The brush off
To be fair, Ms Pollard’s criticisms were accepted by both the inquiry team and the CQC’s new management. Yet, within a year she quit her job claiming she was forced out. She lost her claim of unfair dismissal at an employment tribunal.
The Maidstone doctor described how he and colleagues were “brushed off” and no action was taken.
In fact the trust did not investigate the surgeons’ practices until five patients died in 2012-13, and even then it was only after the start of an investigation that surgery was suspended, and considerable time elapsed before Maidstone shared the official report with the families of the dead patients – in April – and made the report public – last month.
‘The very fact the doctor wanted to remain anonymous speaks volumes in itself’
Both these recent examples suggest medical practitioners who are concerned about colleagues’ actions are an invidious position.
As the anonymous doctor described it, the blame game is often still at work. The very fact he wanted to remain anonymous speaks volumes in itself and emphasises just how much change is still needed within the NHS to protect patients from a situation like this ever arising again.
The vast majority of healthcare workers are committed to treating and caring for their patients in the best possible way.
Stop the blame game
Part of this vocation inevitably triggers a crisis of conscience when they identify poor or substandard care. Concerns raised by practitioners in such circumstances should be dealt with fairly and openly, moving away from a culture of individual blame to organisational responsibility that encourages all practitioners to have a voice.
Our healthcare standards campaign aims to promote accountability, rather than blame, in the NHS. For many years we have called for a duty of candour as a way of the NHS identifying mistakes in an open and accountable fashion that will lead to improvements in patient care.
Collective turning away from uncomfortable truths is, fortunately, no longer acceptable within the NHS.
‘Systems to support and protect whistleblowers through the process seem to be lagging behind the rhetoric’
We are heartened to see that the Nursing and Midwifery Council is now acting on the recommendations of Sir Robert Francis in the Mid Staffordshire inquiry.
The current consultation on its new code of practice anticipates nurses or midwives with leadership responsibilities will ensure those they manage are protected from any adverse consequences following a concern being raised. This is to be welcomed.
However, these recent cases illustrate that positive change is patchy, and that we are in a curious hinterland where whistleblowers are told they will be protected and clinical staff are encouraged to exercise their duty of candour, but the systems to support and protect them through the process seem, in some places, to be lagging behind the rhetoric.
The CQC and the NHS are in the full glare of the public eye now and need to get their house in order quickly if public trust is not to be irreparably damaged. Protecting practitioners brave enough to raise alarms must be at the heart of driving change in the NHS and, ultimately, protecting patients.
Kate Rohde is partner and head of healthcare standards practice at law firm Kingsley Napley LLP