Covid-19: doctors are warned not to go public about PPE shortages
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1592 (Published 21 April 2020) Cite this as: BMJ 2020;369:m1592Find out more about our #properPPE campaign
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Dear Editor,
One of the 7 core values of the NHS is compassion. The compassion is for everyone we work alongside and work for. NHS England and NHS Trusts by asking doctors not to speak up are going against one of the core values of NHS which is painfully sad. By warning doctors against speaking the truth about the prevailing situation with PPE, NHS trusts are going against the key principles of the NHS constitution, which is the very soul of the NHS.
Doctor's Association UK has been actively campaigning with regards to shortage of PPE in UK and their wider 'Learn, not Blame' campaign is driven towards creating a learning from mistakes atmosphere rather than blaming or silencing individuals. Their recent survey has been launched to highlight and tackle ongoing shortages, and to work on improving protections for whistle-blowers. This survey hopefully should bring out the voices of the doctors who have been prevented from speaking the truth.
NHS Trusts by their actions are trying to be powerful to curtail the voice of the people who work for it. As Mahatma Gandhi once said, "Power is of two kinds. One is obtained by the fear of punishment and the other by acts of love. Power based on love is a thousand times more effective and permanent then the one derived from fear of punishment."
It's up to the NHS trusts and NHS England to decide what kind of power they want.
Competing interests: No competing interests
Dear Editor
This is concerning given that is estimated that the NHS will be short of up to 1 billion items of PPE (1) but not surprising given the NHS track record of speaking fine words but not protecting whistleblowers. After I spoke up about the risks to pharmaceutical supply in the event of a No Deal Brexit last year, both Sir Robert Francis and the National Freedom to Speak Up Guardian wrote to Matt Hancock asking that he write to every member of the NHS to ensure that they had the right to speak up (2). No such a letter has ever been sent.
1. https://www.thetimes.co.uk/article/surgical-gowns-almost-gone-send-boile...
2. https://www.thetimes.co.uk/article/jacob-rees-moggs-anti-vaxxer-smear-on...
Competing interests: I am on the COVID Group of the Doctors Association UK who have highlighted the issues in relation to PPE. I am health spokesperson for the Liberal Democrats in the West Midlands.
Dear Editor
The struggle to tackle the COVID-19 pandemic has been described, aptly, as a war on an invisible enemy – healthcare workers battling it are losing their lives and also jeopardising the lives of their families and friends. The Hippocratic oath, in all its iterations, does not mandate doctors to give their lives for their patients, but such is their dedication, many workers are taking risks beyond the call of duty. They deserve all the protection they can get.
It is important for those who send workers to the frontline to bear in mind that even the best personal protective equipment (PPE) available today does not provide absolute protection; it merely reduces the chances of the user contracting the virus and it minimises their chances of passing it on to their patients. Going into battle with a rifle does not guarantee the soldier will survive but it gives them a fighting chance.
I applaud Dr Jenny Vaughan and all those who are speaking up publicly to highlight the plight of all workers and patients exposed to the danger of inadequate protection.
Doctors deserve the best PPE appropriate for the tasks they undertake and they have every right speak up if the protection is in any way inadequate, either in quantity or in quality. Stifling free speech aimed at highlighting deficiencies in availability is in no one’s interest at this critical time. There is only one team battling this dangerous disease, and that is the hardworking healthcare workers in all settings and all those who support them and the public. There is no team B. You alienate them at everyone’s peril.
History will judge us ill if we are the generation that encouraged our workers to tackle a dangerous pandemic with inadequate personal protection.
Competing interests: No competing interests
Dear Editor
NHS consultants should be aware that they have a contractual right to speak out; and their contractual right "trumps" any local policies:
NHS Consultant Contract Schedule 12, para 7: "A consultant shall be free, without prior consent of the employing organisation, to publish books articles, etc and to deliver any lecture or speak, whether on matters arising out of his or her NHS service or not."
There is a "fiduciary duty" to an employer, and a duty not to "bring them into disrepute". But as long as the statements made are factual, consultants cannot be silenced.
While it would be extremely unwise to suggest, for example, that an individual manager had deliberately obstructed good practice (which might be defamatory), sincere and honest accounts of the situation (even if not 100% accurate) cannot be portrayed as "bringing the employer into disrepute".
Of course, if the employer has failed to provide adequate PPE, the fact of their failure to do so might be construed as bringing the organisation into disrepute. But reporting the fact only exposes this. It does not, in itself, bring the organisation into disrepute. Rather, attempts to silence employees brings the organisation into disrepute.
I urge any doctors who wish to share information of this sort to join the BMA if they are not already members, and to discuss with their BMA reps how best to share this information (to avoid risk to individuals); and urge any doctors who have received "chill" communications from their employers to report this to their BMA reps as a matter of urgency.
Competing interests: No competing interests
Re: Covid-19: doctors are warned not to go public about PPE shortages
Dear Editor
This article raises a very important issue about the freedom that healthcare workers have to speak out about significant concerns that affect patient or personal safety and the types of influence that employers will use in attempts to silence staff.
The Doctors' Association UK (DAUK) have been lobbying the government on the topic of PPE shortages since February and were very much the front runner in exposing this issue. They were inundated with concerned messages from frontline staff who were scared for both patient and personal safety. This led to The Doctors' Association UK teaming up with Messly UK to create an app where doctors could report their shortages and later supporting suppliers who are distributing PPE to where it is needed.
Unfortunately, very shortly after DAUK began speaking out about PPE, they also received dozens of reports of doctors being warned not to speak out. DAUK strongly believes that doctors should be able to raise concerns and this is a key element of their #LearnNotBlame campaign and will continue to push this issue through their lobbying work.
I encourage readers to join The Doctors' Association UK as a member and to support their lobbying work by going to www.dauk.org
Competing interests: Social Media Lead for The Doctors' Assocation UK