The ongoing fallout from a succession of whistleblowing scandals and cover ups is stalling vital cultural change in the NHS, say Kim Holt and David Johnstone
As leaders of Patients First, we think it’s time for an NHS Truth and Reconciliation Commission. The title is not melodramatic: the NHS is in need of both.
Its panel would be made up of patient representatives; cross-party political representation; clinical and management leaders from the NHS; representatives of the Royal Colleges and representation from the regulatory bodies. Membership would be agreed between the secretary of state and representatives of groups like Cure the NHS and Patients First.
Promoting the truth
The commission’s purpose will be to promote a process of truth about the revealed failings of patient care and an acceptance of the mistakes made, leading towards healing, reconciliation and renewed relationships between those who provided care, those who received it and those who monitor the quality of care.
‘Individuals have been left carrying the burden of clinical risks. This cannot be right’
Healthcare’s purpose is to treat people and make them feel better than before. Pockets of dysfunction and unsafe care within the NHS have taken years to become public. We now understand how near impossible it can be for both staff and families to get action about concerns. Public inquiries and independent investigations drag on for months and years. We are caught in a blame game that feeds anger and breeds a sense of injustice − but does not bring resolution or healing to any party.
How might reconciliation happen in a climate of fear and blame?
This will be difficult, and at times painful. The commission would work by considering the lessons that can be found in the many detailed inquiries into failing practice. What are the main things essential to reconciliation? Top of the list for action might be to grant a legal duty of candour, as recommended by Robert Francis QC, and campaigned for by Will Powell following the death of his son Robbie.
Families deserve no less.
The commission could be asked for concrete proposals on how to heal and bring reconciliation in different areas. These could include a duty of listening to patients and carers, and answering their concerns with honesty. Also, it might include clearly stating that every NHS body has a senior leader whose responsibility includes quality of care; learning from mistakes; listening to those who express concerns about care standards; and accepting that when mistakes have been made, it is time to enter a healing process with the grieving. This is supposed to exist, but has too often been absent.
We look to the new leadership of the Care Quality Commission to take the first step in addressing their organisation’s past lack of response to patients concerns. The CQC’s current leadership team should openly apologise to any families and whistleblowers failed by the old, inadequate inspection regime.
Individuals have been left carrying the burden of clinical risks. This cannot be right. There could be a role for the colleges to inspect from a clinically informed position whether prior concerns have been properly addressed, and if not, establish why and what can be done.
A safe space for whistleblowers
On Friday 21 June, a statement from the public accounts committee chair Margaret Hodge confirmed that since 2010, over 1,000 severance payments have been approved by Treasury, but the government do not know the reasons for these payments and whether whistleblowers were silenced. This is disgraceful.
‘Frontline NHS staff tend to know which parts of the health service are unsafe: they need a safe place to go to have these concerns investigated’
The Department of Health should lift any confidentiality clauses on health professionals, ensuring that no NHS body will pursue them legally. Whistleblowers need an opportunity to come forward and have their stories heard by the panel and the actions taken in response to their cases understood, to inform policy change.
Frontline NHS staff tend to know which parts of the health service are unsafe: they need a safe place to go to have these concerns investigated. To date, there has in general been nowhere reliable for them to take their concerns, and this needs to be addressed as a matter of urgency.
The commission could be a temporary body where serious concerns could be investigated until the system and public policy changes are implemented that will ensure reliable openness and transparency going forward.
Truth and reconciliation does not mean that there cannot be accountability. The lessons from the commission will inform how and where accountability would be expected, and who would hold responsibility for that.
Dr Kim Holt and David Johnstone are the leaders of Patients First