Charlotte Leslie is a member of the Health Select Committee and MP for Bristol North West.
The story is devastatingly familiar: a respected and skilled clinician speaks out about failings within the NHS Regime, and that communist block of power rounds on them, and out they go. They suffer the injustice of losing their job for pointing out failings that mean others should probably lose theirs; and the NHS loses the moral backbone and expertise of some of our finest doctors, nurses and – as in the case of whistle-blowing manager Gary Walker – managers too.
The latest victim in this bleak saga is Joseph Meirion Thomas, a top cancer surgeon at the internationally-renowned Royal Marsden Hospital in London, who was kicked out for voicing controversial views about the NHS. But we know that there are still many more.
To give Jeremy Hunt his due, he has made transparency and supporting whistle-blowers, a key priority in the cause of patient safety. He has listened where previous secretaries of state turned a deaf ear. His commissioning of Robert Francis to conduct an inquiry into whistle-blowing is very welcome, and most welcome of all is his recognition – unlike many of his predecessors – that there is a major problem to sort.
But when an organisation has become as entrenched in suppressing the truth as some corners of our NHS management and some elements within the Department of Health have, to the most senior levels, even a Secretary of State has a tough job in turning such a tanker around – not least because some of those still surrounding him may be part of the problem.
So despite all the Government action, I am sadly not so surprised to see that bullying of whistle-blowers and suppression of the truth continues, and that diabolical whistle-blowing cases are still hitting our headlines. The only silver lining is that, finally, we finally have a Government that acknowledges that such bullying happens and wants to do something about it.
But the even more sobering news is that whistle-blowing cases brought by clinicians and managers employed by the NHS may only be the tip of the iceberg. A chilling study conducted by Healthwatch last year FOI’d all 164 providers of healthcare across England to investigate if they had investigated complaints of poor care raised by “citizens” – that is visitors or contractors. 123 replied. Of those, a worrying 46 said ‘No’ when asked if they formally recorded complaints made by these third party “citizen whistleblowers”.
Even worse, they didn’t seem to know, or want to know, the requirements on them for responding to complaints from citizen whistle-blowers. Anyone is entitled to make a complaint and have that complaint dealt with properly. But all sorts of bunkum was sent back in the responses: some incorrectly claimed they could only look into it if the patient gave consent; others considered them “general feedback” and conveniently did not include them in official complaints.
The 30 providers that did reply detailing measures that they had in place collectively recorded 8,448 complaints made by citizen whistleblowers between 2011 and 2014 – representing 18 per cent of the 46,753 complaints made overall. So potentially, almost a fifth of all complaints are currently being ignored by the majority of healthcare providers. You do the maths.
So what can we do? We are not starting from zero. As I say, the Government has cast light on the problem and shown willing to tackle it. But we need more. So here are some, yes, rather muscular suggestions.
First, we need to get real about the challenge. We have learned that we cannot assume that all NHS managers put patients first. We therefore need to ensure that is it less painful for managers to acknowledge hard truths than to not. We need to introduce a regulatory body with teeth for managers, to ensure that, if a senior manager is found to have suppressed patient safety concerns, then he or she can expect proper disciplinary measures – and legal proceedings if necessary. The pain of admitting difficult truths might then seem less daunting.
Second, we need personal accountability. Financial penalties against hospitals never hit anyone personally. The Trust is fined, workers suffer the stress – but no individual is hit. In the private sector, big salaries are intended to accompany big risk. If things go bad, the top dog should feel it. (The banking sector went wrong because this didn’t happen.) But the hinterland of NHS Trust management enjoys private sector salaries but none of the private sector risk. Instead, they get public sector pensions, expenses and job protection – and we have seen many who have done a bad job go on to promotion elsewhere. This must change.
We need to find a way financially to incentivise and penalise senior managers in the patients’ interest. Perhaps a good proxy for the transparency and efficacy of a hospital’s complaints system might be the amount they spend on legal battles and gagging orders. Patients generally pursue legal action if they think there have been cover-ups. Could we find a way to link a Trust’s legal fee expenditure to senior manager salary? This might focus minds – and save millions.
Third, we politicians must collectively treat hospitals’ openness about mistakes not as a crime, but as an honest recognition of reality, enabling improvements to be made. Mistakes are a fact of life. It is covering them up that makes them toxic. We need honesty about those mistakes, and assurances that measures are being taken to prevent them in the future.