Changing the face of whistleblowing

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

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

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

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