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Registering concerns about patient care is not as Health Minister Anne Milton said on Tuesday night on the Channel 4 News ‘a right’ of NHS workers. It is a professional responsibility. For complex reasons some NHS staff in some Trusts do not exercise this responsibility when they see poor care.
A Care Quality Commission spokesperson at last week’s health committee session on professional responsibility spoke of Trusts with poor leadership and a closed culture. These Trusts, like Stafford Hospital, are the institutions where problems are most likely to arise in the first place. They are also the institutions where staff concerns are least likely to be listened to and may even be suppressed. This is the situation in which any responsible healthcare professional is obliged to become a whistleblower.
The closed, secretive and often bullying culture found in such Trusts deters all but the strongest from ‘making a fuss’, ‘causing trouble’ – i.e. blowing the whistle. At Stafford there was one such person, a nurse named Helene Donnelly who repeatedly blew the whistle on the abysmal care she saw in her clinical area. The consequences she suffered for this are well documented in the evidence files at the Mid Staffs Public Inquiry and will I hope achieve prominence in Robert Francis’s report next year. Compare this with the hospital consultant who when asked under oath at the Inquiry why he had not blown the whistle on the problems he witnessed. ‘Because I have a mortgage,’ he responded.
As a senior consultant who had been head of department for seven years, I saw numerous things going wrong in my department once the Trust started to slash the cost base to prepare for its application to become a Foundation Trust and pay the mortgage on its expensive new PFI.
Many of my concerns were simply ignored. Finally I was excluded for six weeks. A transcript obtained by Data Protection Act showed that the medical director told the National Patient Safety Authority that my exclusion was necessary because I was ‘a danger to staff and patients’. All manner of allegations and suggestions were made about me. I was upsetting all the nursing staff, possibly psychotic, might be leaking information to the press on the highly confidential case of a child who had been murdered. I was obstructive and unmanageable. There was no truth in any of this account and no sane person could give it credence. None of it had ever been made known to me. None of it has ever been raised with me since.
Following my conscience
To cut a long story short I refused to accept a settlement offer with a gagging clause last year. I considered this unethical at the time and at last week’s Health Committee it was made clear that such gags are illegal and unenforceable.
I was told that if I refused this offer I would be subjected to a disciplinary procedure with the objective of dismissing me. Following my conscience I called this offer a bribe and wrote to the Chief Executive that I would not be intimidated by threats of dismissal. I was dismissed in December last year for gross misconduct and insubordination and my appeal four months later failed. The Trust’s solicitors using their knowledge of the law (which I lacked) created distance between my very clear acts of whistleblowing and the reason for my dismissal which was a technicality in employment law. This is a not uncommon strategy.
I never at any time acted in any way other than for the direct benefit of my patients as dictated by my conscience. I believe that those of us who have suffered detriment including suspension, dismissal, financial and reputational loss have a right to ask a simple question. Why when we have done all we can to safeguard our patients’ interests, recognising the risks in doing that, are we punished while other professionals – cautious about their reputations, careers, and mortgages – continue without even a hint of criticism?
I do not want any clinician punished for failing to raise proper concerns. I want the culture of some of these Trusts changed so that it becomes safe for all not to exercise their ‘right’ but their professional obligation to protect patients. PatientsFirstUK is our own embryonic contribution to making the NHS a safer place for patients by making it a safer place for professionals to speak freely.