The issues in the NHS for whistleblowers have been recognized for decades. Sadly, several reviews have failed to secure substantial action to prevent reprisals against whistleblowers. The most recent, the "Freedom to Speak up Review" led by Sir Robert Francis QC was no different. It has been far easier for governments and the healthcare professions to pay lip service to the idea of protecting whistleblowers. This is particularly acute in the UK as almost all healthcare is the responsibility of government. Taking whistleblowers seriously would involve a degree of political risk.
The Francis Review was fundamentally flawed in its execution. There was not any attempt at a systemic review of whistleblowing. Further there were inherent conflicts of interest for many of the actors. Advisers to the review had vested interests and undeclared conflicts that were not vetted. Francis himself had represented NHS management as a barrister in the Bristol Inquiry against Prof Steve Bolsin ( a whistleblower). It is reasonable to consider that the government's claim that this review was "independent" was entirely misleading. Sir Robert Francis was seen as a “safe pair of hands”, given his work on the Mid Staffordshire Public Inquiry which has served the interests of the Conservative Party so well.
No medical organisations were investigated or held to account, for example the various professional regulatory bodies and the medical Royal Colleges. Historical cases were not assessed to see what changes in patient safety measures may be required to change the future for the better. Flaws in past cases and a failure of accountability were not criticised or addressed. Both the Francis and Hooper (GMC-commissioned review into medical whistleblowers) reviews based on the "no blame" concept will not achieve any system change or accountability . What is required is a “just culture”. Without apportioning blame, there can be no accountability. Systemic corruption, mismanagement and threats to patient safety will continue undeterred. Neither review will act as a deterrent for bad organisational behaviour.
Sadly the small group of whistleblowers were satiisfied with a review, rather pushing for the full public inquiry. They now bitterly regret this decision apparently. Francis’ recommendations offer no real protection for whistleblowers in the future. They only give the appearance of doing something, without committing the government to doing anything substantial.
It's for this very reason that a statutory public inquiry is urgently required. A body of reliable evidence is required to ensure workable and realistic recommendations. From this, effective solutions could be developed to make sure the NHS changes in the future. Two areas that would be helped by this inquiry are preventable deaths and reducing the current high cost of medical litigation. Currently the NHS litigation bill is £15.7 billion. Many of these proceedings result in out of court settlements. This results in a failure of accountability by the NHS to the public. [ Financial Times].
These conclusions were drawn from the research paper Whistleblowing and Patient Safety: The Patient's or the profession's interest at stake?
"Our recommendations are firstly that the profession, through the GMC or BMA Council, should commission a Consultation Group on Reporting Poor Care. This Group will examine the consequences to all parties from incidents of reported poor care. Second, the Government should consider establishing a Health Select Committee Review [solely] of Whistleblowing that would make impartial recommendations to Government and the profession. Third, the Government should consider setting up and resourcing a National Whistleblowing Centre similar to that in the US. We believe that only by open public scrutiny will constructive change be cemented into exemplary clinical practice"
This can be downloaded here:
For all that Jeremy Hunt talks about “intelligent transparency” and how the difficult process of effecting change has been painful, he has singularly failed to grasp the nettle. The failure of protection for whistleblowers continues to protect the vested interests of NHS managements and senior healthcare professionals. Instead, he has presided over a process of “show trials” using the stories of whistleblowers which have not been vetted to present himself as the champion of patients. Vexatious whistleblowers are a very real problem. Sir Robert Francis himself commented that it would be impossible to sort the intricacies of many of the whistleblowing cases he reviewed. That was certainly no exoneration of the supposed whistleblowers involved.
Many of the whistleblowers involved in the Francis Review were from one campaigning group with strong links to large legal firms. Medical negligence lawyers have no interest in improving the NHS, only in litigating against it. This achieves very little, and arguably is the biggest driver against a culture of openness and improvement.
In reality, the NHS's culture has not changed as demonstrated by the Bristol, Shipman and Mid Staffordshire Inquiries. This closed door culture obsessed with protecting its own has now sought to create a facade that they are "improving the system.” This gives the public a false sense of security. The Mid Staffordshire Inquiries took a broad brush approach to whistleblowing and made recommendations that have no evidence to demonstrate their success. Many aspects of whistleblowing such as the impact of organisation reprisal were not examined by the Inquiry. In the interest of patient safety, we must insist that a full blown public inquiry is undertaken immediately.
1. Has seen parts of the damning Department of Health files held on me where DH officials discussed prosecuting me in 1999 to set an example. It's a pathetic situation when junior doctors are targeted by officialdom to conceal poor health care. The Department of Health redacted those files heavily but here are some extracted documents. [ Ward 87 ]
2. I do not support AVMA, Patient First or any organisation that encourages litigation against the NHS.
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