Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Nurturing a Whistleblowing NHS
- Amit Patel (29 May 2009)
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changing the face of whistleblowing
- Brian P Dromey (29 May 2009)
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Déjà-vu all over again?
- David C Harding (29 May 2009)
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Whistleblowing
- Christopher L. Manning (3 June 2009)
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Motiviations for and against whistle blowing
- Sarah C Rennie (3 June 2009)
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Change in standards
- Joan McClusky (3 June 2009)
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Clinical accountability in the NHS? Whistle for it.
- William G Pickering. (6 June 2009)
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Re: Change in standards
- Umesh Prabhu (6 June 2009)
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"To Be Or Not To Be A Whistle Blower"
- Kadiiyali M Srivatsa (19 September 2009)
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Whistle blowing is injurious to health
- Jayaprakash S Gosalakkal (20 September 2009)
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What concerns were raised at Basildon?
- Peter Gooderham (30 November 2009)
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Amit Patel, Medical Student Leeds Medical School
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As a current medical student, there are many aspects of the course that encourage us not to stay silent when we something is not quite right, with patient care being of highest importance. This is of course reiterated by GMC guidance given to doctors.1 However with individuals like Margret Heyworth and Dr Stephen Bolsin seemingly being treated badly for doing what many of us would feel right, i.e. saving lives of patients by questioning acts which may not be in a patients best interest, how can the NHS nurture a culture of whisteblowing? Dr Bolsin is now the hospital head of anesthetics as far away from England as possible, and spent the best part of a decade trying to blow the whistle and defend himself around acts which were proven to seriously impair children’s lives.2 Both Dr Bolsin and Margret Hayworth faced challenges which meant them loosing their jobs, passions and livelihood, all in the name of whistlblowing. Does this not set an example for other doctors and indeed medical students, encouraging a culture of maintain silence or loose your job? No doubt there are cases every day where concerns for patient wellbeing don’t reach the media and are dealt with in an appropriate manner, but in a society where doctors are respected less and less, cases like Shipman, Bristol and Staffordshire only further damage the reputation of the NHS. When prominent examples of leadership like the BMA chairman and the Care Quality Commission chairman indicate that whistleblowers are reluctant to raise concerns due to the fear of being bullied,3 how can healthcare professionals feel obliged to blow the whistle which would surely be a culture in which the NHS should operate. For students and healthcare workers, ethical issues now have another facet of doing what is right, as Peter Gooderham states “your damned if you do, damned if you don’t”.4 1 General Medical Council. Good Medical Practice (2006). http://www.gmc- uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp 2 BBC News. Bolsin: the Bristol whistleblower. http://news.bbc.co.uk/1/hi/health/532006.stm 3 BBC News. Doctors 'must root out bad care'. 16 April 2009. http://news.bbc.co.uk/1/hi/health/8002900.stm. 4 P Gooderham. Changing the face of whistleblowing. BMJ 2009;338:b2090 Competing interests: None declared |
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Brian P Dromey, Medical Student Leeds Teaching Hospitals NHS Trust
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The Secretary of state for Health is apparently unable to understand why clinicians "are somehow concerned about whistleblowing", the implication being that clinicians who do not blow the whistle are selfishly putting their own needs before the well being of patients. One can hardly blame clinicians for being extremely cautious when blowing the whistle. I doubt that there is any action which could bring a promising career so quickly to an abrupt end than blowing the whistle. The cases of Dr Bolsin and Margaret Haywood clearly demonstrate that whistle-blowing within the NHS is not appreciated and that if the whistle- blower does not heed 'warnings' and exposes the situation they should expect to become unemployable, unemployed or both. Reports into the case of Harold Shipman and the events at the Bristol Royal infirmary have exposed the unwillingness of senior management to heed the warnings from clinicians, to act on the information given to them by clinicians or to protect whistle blowers, indeed the opposite is the case. I would put it to the Hon. Secretary that clinicians see little point in pointlessly sacrificing themselves, their families and their medical careers when no action will be taken to correct the situation. The obligations of clinicians in regards to whistleblowing have changed but adequate procedures to protect the whistleblower have yet to be put in place. Surely it must have struck someone in the Department of Health that if it takes a BBC documentary to expose such appalling levels of care something is very wrong with the way whistle-blowers are treated? Competing interests: None declared |
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David C Harding, Medical Student University of Leeds
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With Margaret Haywood becoming the latest casualty of blowing the whistle in the NHS, I am beginning to wonder if we have made any progress at all. This culture of “threats and bullying” [1] was uncovered and published following the Bristol Royal Infirmary Scandal 10 years ago, yet steps taken to improve the system are still failing individuals like Margaret Haywood. In 1999, then Health Minister John Denham stated that the government was committed to, “freedom of speech and creating a climate of openness everywhere in the NHS.” He launched the initiative of appointing a ‘truth protector’ within hospitals and health authorities, whose role was to “deal with employees' concerns and help launch investigations.” [2] The government is intending to have implemented new responsible officers by 1 October 2009. [3] Their duties are set to include “Handling complaints and concerns relating to the conduct and performance of individual doctors.” Whilst I understand they will have other roles (including revalidation), there seem to be striking similarities in their job descriptions. [4] Perhaps these new officers will be the catalysts for a change in attitude towards whistleblowers, but I remain skeptical. How will they be more effective at changing the climate in the NHS than their truth protector predecessors have been over the last 10 years? References 1. BBC News. Doctors ‘must root out bad care.’ 2009 April 16. http://news.bbc.co.uk/1/hi/health/8002900.stm. 2. http://news.bbc.co.uk/1/hi/health/434789.stm 1999 September 1 3. http://www.dh.gov.uk/en/Managingyourorganisation/ Humanresourcesandtraining/Modernisingprofessional regulation/ProfessionalRegulationandPatientSafety Programme/TacklingConcernsLocally/ResponsibleOfficers/ index.htm 4. http://www.dh.gov.uk/en/Managingyourorganisation/ Humanresourcesandtraining/Modernisingprofessional regulation/ProfessionalRegulationandPatientSafety Programme/TacklingConcernsLocally/ResponsibleOfficers /FAQ/DH_084876#_10 Competing interests: None declared |
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Christopher L. Manning, Director UPstream Healthcare Ltd Teddington TW11 9HG
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People's willingness to highlight justifiable concerns is predicated upon their working in a safe, sound and supportive context. The term 'whistle-blowing' implies that such a function is special or exceptional. It should better be a thoroughly systemic and systematic part of any organisation's gathering of feedback-intelligence that informs it how well, or not, it is doing? Just as there is a good argument for the effectiveness of early intervention in many clinical conditions, it seems perverse that the NHS, as a self-claiming 'earning organisation' is nor regularly factoring in all available experiences and feedback to inform and optimise its functions. The message from many who have worked with doctors who have blown their cover, as well as any whistle, and then lost their jobs and careers in the NHS, is "don't do it", at least alone. The rhetoric and the policies are full of worthy words, but many have mortgages to pay off and families to educate, as well as any duty of care to the public and those they manage, employ or treat. The best way of ensuring that the NHS is never "world class" will be to create the climates of fear, bullying and despair that prevent good, honest and aspiring employees from being able to talk about how they feel about their work and what they are asked, cajoled or forced into doing. It's not good enough to expect individuals to do this alone; psychotoxic and perversely incentivised behaviours now need to be rooted out from the top down. Many taxpayers and citizens have little or no understanding of how the NHS functions behind its front-end. It is time they did; in just the same way as party political systems are now coming under the same scrutiny. Yours Sincerely
Competing interests: None declared |
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Sarah C Rennie, PhD student Department of Surgery, University of Otago, Dunedin, 9060. New Zealand
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Peter Gooderham states that we need "Statutory protection, support from regulatory bodies and a culture change" to support the propogation of whistle blowing. I would argue that we need to consider more carefully the professions attitudes and opinions of whistle blowing. In a study we conducted of medical students at a Scottish Medical School in 2000 only 40% of students felt they had a responsibility to blow the whistle if necessary and only 13% would actually do it [1]. Interestingly when the data was analysed by years it was revealed that as students progressed through medical school they appeared to become more antagonist to whistle blowing. Factors given as motiviation not to blow the whistle on peers included camaraderie, retaliation by peers, the view that although behaviour is wrong -it is an accepted norm, self-preservation, not student's responsibility, no clear guidelines, futility, requirement of proof and uncertainty regarding what constitutes misconduct. Factors given as motivation to blow the whistle included consequences for patient, maintenance of standards, perpetrator needing help, personal morality, vindictiveness against peers, to ensure peers are punished. These views were from medical students, - they have become todays doctors. We need a similar study of doctors views to inform any whistle- blowing policies. 1. Rennie SC, Crosby JR. Students' perceptions of whistle blowing: implications for self-regulation. A questionnaire and focus group survey. Med Educ 2002; 36:173-9. Competing interests: None declared |
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Joan McClusky, Medical writer New York, NY 10003
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The practice of punishing whistleblowers is as common in the US as in the UK. And perhaps part of the problem is in how whistleblowers are viewed against the larger practices and institutions of a society. The most minimal kind of analysis or introspection demonstrates how ludicrous it is to punish someone for exposing dangerous or illegal activities, particularly in healthcare. And who on Earth could defend such behavior? Yet the delusion continues to guide practice when it is incorporated into "instutional practices" or "protecting the organization or profession." An institution that fosters and promotes fear regarding exposure of harm is an institution that needs to be rethought from the bottom up. Whistleblowing should be renamed and rethought of as part of professional standards and standards of good citizenship. And not exposing harm should be what people are afraid of. Competing interests: None declared |
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William G Pickering., Doctor NE3
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Mr Gooderham, presumably a lawyer, makes mistakes when discussing “whistleblowing” and, like medical-politicians and other doctors, is mesmerised by the term such that it becomes the driver of his thinking. The real issue is single elementary clinical errors, and how best to make the perpetrators promptly accountable so the errors cease and serial disasters are nipped in the bud. And, by the way, the blowing of whistles did not start with Bristol; or even a decade earlier at Cleveland [1]. Indeed, it preceded even the diazepam prescription madness of the 1970s. “A whistleblower is a person who informs on another ...”, writes Gooderham. If so, then the chief whistleblowers (and the most numerous and important ones) are patients. They of course, nationwide and daily, are seldom listened to. They may receive an earnest, perfunctory apology (as if that is punishment enough for the doctor). But there is no bringing of the doctor to book: no fines: no certainty ‘lessons have been learned’. “Whistleblowing”, he writes, is “hazardous” for doctors and nurses. Patient complaints are pretty hazardous too for patients. They and their family often have to return to same doctor whom they complained about. That doctors are more worried about their careers being blighted than righting a wrong speaks volumes for the prevailing mentality of the UK State NHS [2]. Stay quiet: keep your salary. Never be astonished that patients resort to help from the press who are still the only potent regulators of those on a State payroll. Gooderham and others should carefully note that the surfeit of in- house regulations to which doctors are being constantly subjected (to ensure their salary), are of a supreme irrelevance to the prompt identification of elementary clinical errors. These vaunted regulations are but a conspicuous (and expensive) ruse to publicly claim the medical stables are being cleaned. By writing his article, Gooderham, unwittingly one suspects, at least illustrates their uselessness with regard to clinical accountability. William G Pickering. wgpi@hotmail.com June 5th 2009 References: 1. Pickering W G. Glasnost and the medical inspectorate. J of the RC of GP. Nov 1988. p517. 2. Pickering WG. Systematic clinical accountability is required. BMJ Nov 2003; 327: 1109; doi:10.1136/bmj.327.7423.1109 Competing interests: None declared |
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Umesh Prabhu, Consultant Paediatrician Fairfield Hospital, Bury BL97TA
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The fundamental problem in our NHS is lack of true leadership and NHS culture. There are three types of NHS cultures and/or leaders. 1. True leadership and 'Fair and Open' culture - In these Trusts whistle blowing is encouraged, maliciousness is dealt firmly, patients are protected, doctors and nurses are helped, supported and guided. Success is celebrated, clinicians are valued, errors are accepted, lessons are learnt, accountability is encouraged, and punishment is the last resort. One can see brilliant Clinical and Medical directors. 2. Blame culture - Clinical and Medical Dictators, Club culture, 'Old Boy's network', punishment is rife, errors are not tolerated or covered up depends on whether you are a member of inner circle or not, if you are in the inner circle then errors are ignored even if it affects patient safety, action taken depends on who you are and not what you did, appraisal, revalidation and Multi-source feedback is used as a tool to blame and get rid of 'unwanted' doctors and nurses and fear is rife. 3. Anything goes - Poor medical leadership, full of clinical and medical deadwoods, people are chosen for the wrong reasons, no one has any interest, passion or commitment, tick box exercise, managers dominate, clinicians are ignored, cover up is rife, poor in dealing with complaints, litigation, clinical incidents, no one knows who is in charge of what, ivory tower management and Board, whistle blowing is ignored, bullying, harassment are ignored, everyone thinks he/she is in changed, full of confusion. So, there is nothing wrong with the whistle blowing but the question is what happens once the whistle is blown and sadly it depends on the leadership or lack of it. Competing interests: None declared |
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Kadiiyali M Srivatsa, Gp GU2 7YB
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Are there any doctor like me, who are getting fed-up with what is going on in the National Health Service and feel sad and helpless?. If you are one and thinking of blowing the whistle or motivating yourself to do something about this, please do not listen to these pundits who write and encourage you to blow the whistle. If you have family with young children, please think twice because your family and friends will also start blaming you for being foolish. If you still decide to blow the whistle, please be prepared to feel lonely, isolated and watch the tower you built over the years crumble right in front of your eyes. Even the patients who once trusted and adored you will move away from you, making you feel as if you are a child molester. This is sad scenario, because the GMC and BMA publish articles to encourage would-be whistleblowers should seek advice from their defence bodies, and possibly the BMA or Public Concern at Work but are they supportive?. You will be doing a big mistake if you write a letter expressing your concerns about policy decisions or clinical practice implemented by the government that is supported by some doctors. Soon you will be the one who will be investigated, even though you point out and have documents to prove gross discrepancy in clinical practice, treatment and management. The PCT & health authorities will ignore your concerns, continue their investigation and will threaten to refer your name to GMC or Clinical Performance Advisory Group. The torture you will be subjected to for months based on some flimsy evidences will turn your life upside down. After the investigation is over they may tell you that they have no evidence to discredit you or your clinical practice, but the damage is alredy done. What ever the outcome may be, you are the one who will suffer, loose the enthusiasm, confidence to continue working as a doctor. Its sad to see doctors who uphold and defend "Medical Ethics" are the ones who have been shunned away and prosecuted. If our GMC expects us "NOT TO HARM" our patients, and come forward to report if we notice, then why are they turing a blind eye and allowing the authorities to walk all over the doctor who speak the truth to defend "Medical Ethics"? Reference (1) Changing the face of whistle blowing :Editorial;BMJ 2009;338:b2514 (2) Whistle blowing is crucial for a "world class" NHS; BMJ 2009;338:b2514 Competing interests: None declared |
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Jayaprakash S Gosalakkal, Consultant Paediatric Neurologist LE1 5WW
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Unless there is a complete change in culture forget whistle blowing even those who try to improve established "Bad practises" risk isolation. Other than the formal route there are very many ways in the modern NHS to sideline what the establishment considers as "trouble makers”. Steve Bolsin is probably the extreme end of this spectrum. Due to the libel laws in UK it is also difficult to raise issues easily because unlike Erin Brockovich the ordinary coal face doctor does not have the wherewithal to stand up to the clout of the establishment. We had an example of a prominent doctor’s forum recently clamping down on all discussions on a dismissed doctor. First we need to establish "Freedom of speech" and reasonable protection from libel laws before we can have any kind of transparent and free discussion Competing interests: None declared |
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Peter Gooderham, Lecturer in Law & Bioethics Centre for Social Ethics & Policy, School of Law, Manchester University, Manchester. M13 9PL
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Dear Editor, Another story about an NHS hospital is reported in distressing terms, including allegations of hundreds of unnecessary deaths. [1] In my BMJ editorial about whistleblowing earlier this year, I anticipated further scandals and regrettably it appears that this was accurate. [2] As I discussed then, a remarkable feature of the aftermath of Stafford was the readiness of ministers, the Care Quality Commission (CQC) and others to blame NHS staff for not raising concerns. It soon became apparent, particularly in evidence given to the House of Commons Health Committee, that in fact staff had raised concerns, but they were not acted upon. This included the comment, "The concern which has been reported back to us is that people felt those incident forms were going into a black hole or into a waste paper basket."[3] Another attempt by the authorities to blame frontline clinical staff for managerial failings will not be acceptable. I would therefore suggest that as part of the investigation of what happened at Basildon, the actual concerns raised by staff should be assessed, together with evaluation of actions taken as result. Staff who raised important concerns should be thanked and, if they wish, publicly recognised. The CQC, which makes much of its powers, should urgently consider weighing in with active support for NHS staff who raise concerns. Not to do so would be to miss a very important opportunity. I wrote to the Chairman of the CQC on 17th April 2009 asking, among other things, what protection it proposes for whistleblowers, and what obligation it proposed on managers to investigate concerns. I have not received a reply. [1] R. Smith, 'Failing hospital condemns hundreds to death,' Daily Telegraph, 27 November 2009. http://www.telegraph.co.uk/health/healthnews/6665429/Failing-hospital- condemns-hundreds-to-death.html Accessed 27 November 2009. [2] P. Gooderham , 'Changing the face of whistleblowing,' BMJ 2009;338:b2090, doi: 10.1136/bmj.b2090 (Published 27 May 2009) [3] House of Commons Health Select Committee. Uncorrected Oral Evidence, 3 June 2009, at http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/uc151- vi/uc15102.htm Accessed 27 November 2009 Competing interests: None declared |
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