Last
month there was a public
meeting on whistleblowing and defending public services
at BMA House. The meeting was organised by Local
East London Save Our NHS campaigns
and hosted by the London Regional Council of the BMA. The
meeting was organised to bring together NHS whistleblowers and union
members who had acted in defence of services and been victimised for
it, to share their experiences and discuss how it could be ensured
staff can speak out safely.
Speakers
were Kim Holt, Consultant and whistleblower on Haringey Children's
Services, Charlotte Monro, sacked OT & whistleblower from Whipps
Cross Hospital. Julie Davies from Haringey NUT, Tracey Boylin a HR
director for an NHS Trust who was removed from her role when she
tried to stand up for bullied clinicians,Polly Toynbee, Guardian
columnist
and Nick Clarke, Department
of Health representative working on the Francis Review 'Freedom to
Speak Up in the NHS'
The speakers recounted the harrowing
experience of raising concerns and being ignored, and then
subsequently bullied and victimised when they continued to press
concerns.
Dr
Kim Holt was suspended for 4 years for blowing
the whistle on the poor state of child health services run by Great
Ormond Street Hospital and Haringey Council.
Infamously, while she was suspended Baby Peter was the victim of
negligence as an overstretched locum consultant failed to recognise
and act on signs of abuse. Dr Holt campaigned and won her job back,
and started the whistleblowers campaign group Patients First to lobby
the government for protection for whistleblowers, and support those
who are victimised for raising concerns.
Tracey Boylin recounted her
experience and gave an insiders view of how HR departments are used
to bully, control and silence staff who attempt to blow the whistle.
Tracey laid out the regime of false accusations, disciplinaries and
intimidation staff faced from management, and how she had tried to
reverse this for the good of patients and staff.
There was an inspiring message from
Julie Davies who through her role as branch chair of Haringey NUT
related whistleblowing to the work unions do to highlight the effect
of cuts, and the detrimental effect of bullying
management and head teachers on staff and services. Julie illustrated
how unions can take the lead in protecting staff and blowing the
whistle, and how the collective organisation of a union gives individuals and
groups of staff strength to stand up to management.
Polly
Toynbee situated the regime of fear and intimidation within the NHS
in the current context of cuts, privatisation and austerity. With
Jeremy Hunt personally calling the senior management of every A&E
department not meeting its targets, she outlined
how the bullying and silencing culture emanated from the top of the
NHS,
and was enforced on institutions through the regime of targets and
sanctions which the NHS is made to operate under.
Dr
Richard Clarke gave an overview of the recommendations from the
review, and the information gathering that had preceded it. Over
600 individuals and 43 organisations wrote in response to the
invitation to contribute to the review and over 19,500 responded to
the staff surveys sent out by independent researchers. The authors of
the review met with over 300 people through meetings, workshops and
seminars.
From
this evidence, they identified 5 themes for change:
- culture change
- improved handling of cases
- measures to support good practice
- particular measures for vulnerable groups
- extending the legal protection.
There
were 2 major recommendations, and 20 principles and actions which NHS
organisations should adopt. The first recommendation was simply that
the Trust should adopt the 20 principles, and the second that the
Secretary of State should review annually the progress of
implementing them.
Many
of the principles came across as platitudinous;
“Principle
1 Culture of safety: Every organisation involved in providing NHS
healthcare, should actively foster a culture of safety and learning,
in which all staff feel safe to raise concerns. Action 1.1: Boards
should ensure that progress in creating and maintaining a safe
learning culture is measured, monitored and published on a regular
basis.”
“Principle
3 Culture free from bullying: Freedom to speak up about concerns
depends on staff being able to work in a culture which is free from
bullying and other oppressive behaviours. Action 3.1: Bullying of
staff should consistently be considered, and be shown to be,
unacceptable. All NHS organisations should be proactive in detecting
and changing behaviours which amount, collectively or individually,
to bullying or any form of deterrence against reporting incidents and
raising concerns; and should have regard to the descriptions of good
practice in this report.”
The
two substantive principles, the ones highlighted in the reviews
press release,
were that Trusts appoint a “Freedom to Speak Up” Guardian (Action
11.1), to act in an independent capacity to hear concerns and ensure
they are dealt with properly, and the creation of a support scheme
(Action 12.1) to find employment for NHS workers “whose performance
is sound who can demonstrate that they are having difficulty finding
employment in the NHS as a result of having made protected
disclosures.”
While
both commendable actions, on closer inspection they contain worrying
points. The “Freedom to Speak Up” Guardians are supposed to act
independently, but they will be appointed by the Chief Executive of
the hospital. How free they are remains to be seen. And the support
scheme for NHS workers contains the caveats “whose performance is
sound” and “who can demonstrate......as a result of having made
protected disclosures”.
As
many Trusts attempt to smear the practice and abilities of
whistleblowers as part of their victimisation, how many will emerge
from this process able to demonstrate their sound practice? And it
states they must demonstrate they have been excluded from employment
for having made protected disclosures, meaning they must have gone to
court and be recognised as having made a protected disclosure under
the Public Interest Disclosure Act. This is notoriously difficult,
and many whistleblowers never make it that far, so they will be
unable to access this scheme.
The
report, a lot like Francis earlier report into Mid Staffs in 2013,
contains many supportable points, but little that is concrete or
beneficial, and that which is, is riddled with get out clauses that
hospital management and lawyers will use to escape justice.
The most incisive comments were from
the floor, with Clare Gerada, former head of the RCGPs, stating the reports solutions seemed aimed at putting responsibility on
individuals, and not recognising the systemic nature of the problem, which would have required placing the responsibility on institutions
to solve it. The report is a continuation of the DOH practice to look
for individual failings, and cover up or gloss over the way
structural issues are the cause of many problems in the NHS.
Whistleblowing
Consultant Radiologist Otto
Chan
was damning when he took the stand, stating simply that Francis had
spent a long time on his report, but had "missed the whole
point", which was to hold people to account. Dr Chen made a
comparison with the treatment of the captain of the Costa Concordia, who was tried
for manslaughter
for the deaths of 32 crew members and passengers. "Robert
Francis and Jeremy Hunt now have the names of thousands of managers"
he said "who are responsible for covering up harm to patients,
and victimising and ruining the lives of thousands of people..... the
culture in the NHS isn't going to change until those people are put
in court, tried and held accountable for what they've done."
The
governments lack of action on this point, considering the mountains
of evidence that the inquiry has uncovered, is damning. If Robert Francis and Jeremy Hunt were
serious about addressing the bully NHS management culture, they could bring charges
against those who have lead cover ups in the present and recent past.
The review even admitted “many
of the contributions described cases that are recent or current.”
(Point 18) Whistleblowers are being victimised now or in the recent
past, and the DOH, Robert Francis and Health Secretary have evidence of this, yet
have declined to act on this information in any meaningful way.
More speakers pointed out problems
with the report, and also with the institutions which are there to
protect whistleblowers. A young doctor pointed out that the law firm
contracted by the BMA to defend members had been tangled in
corruption scandals, and half of its staff had split away, and ended
up providing legal services to NHS institutions which were fighting
whistleblowing claims.
Another consultant described how the
new hospitals being built with PFI lacked facilities like consultants
common rooms, depriving doctors of spaces to meet and discuss issues,
and making it harder to build the unity among staff needed to
collectively oppose management.
An anaesthetist spoke about how
almost every week changes were made to the surgical service at her hospital, without consulting
medical staff, and every week she sent emails to hospital management
asking for the new changes to the service to be reversed due to the
risks they created and the lack of input from clinicians in the
decision making process. Only for this to be repeated the next week,
and the next. She wondered aloud how long this would go on before she
her self was subject to victimisation for her whisteblowing
The meeting also heard from an
activist from the Blacklist Support Group, who made the connection
between the construction industry excluding union reps to allow them
to reduce health and safety costs, their collusion with the
government and police on this issue, and NHS management silencing
those who expose their similar failings.
What
are the solutions?
The
main solution as proposed by whistleblowing groups like Patient
First
or Compassion
in Care
have been for a legal duty to act on staff concerns, with serious
consequences for institutions and management who do not. They also
call for an end to the use of gagging clauses in whistleblower
settlements to allow concerns to be heard and acted upon instead of
silenced, for costs of cases and settlements to come under the
Freedom Of Information Act to ensure greater transparency, and for
the formation of an independent safety body with powers of
investigation and ability to bring prosecutions against individuals and institutions.
The
government has not carried out most of these suggestions, although
they have implemented a statutory
Duty of Candour
which requires NHS organisations and staff to inform patients of any
incidents which have or may have caused them harm. This was
criticised by Action against Medical Accidents as the DOH watered down the Duty of Candour for primary care providers, and
private healthcare providers. Again, the private health sector
escapes accountability measures which are applied to public
healthcare providers. Its probably not a coincidence that the
increasingly
privatised primary care sector was exempt from this too.
Why hasn't the government
implemented this straight forward legal change? A legal duty to act
on staff concerns would greatly reduce management and the employers
power over staff. It would force management to act on any serious
staff complaint, and prevent them changing services to the detriment
of staff and patients. I It would give staff a powerful tool to use
against management, and upset the power imbalance which exists in all
employer-worker relationships.
This is the key issue. Management
would lose their power to manage if staff could hold them to account
via such a law. It would make it near impossible to implement changes
such as cuts or privatisations which can be shown to be potentially
harmful to patients or staff. It would give trade unions a powerful
weapon to use against bosses who ignore employees concerns.
Even if just applied to the NHS or
healthcare, such a law would set a powerful precedent for all other
industries. Why should healthcare management be held to account for
ignoring staff concerns, but not management in other dangerous
industries, like construction? Construction employers routinely
ignore workers concerns over safety and victimise and blacklist trade
unionists, as outlined by Blacklist Support Group activists at the
meeting.
This is why the call for a legal change falls on deaf
ears, not because the law doesn't make sense, or because Health
Ministers are particularly uncaring. Its because of the wider
ramifications of such a law on employer-worker relationships.
In the current context of austerity
politics, where cuts and privatisations are devastating public
services which are being run into the ground at great cost to
patients and staff, this legal change would prevent management being able
to implement the changes required by the austerity regime.
This is not an issue the government
or employers will compromise on.
What
can we do instead?
This doesn't mean we should give up
hope, but we should change the perspective and strategy of
whistleblowing campaigning efforts. Campaign groups like Patients
First have been crucial in highlighting the plight of whistleblowers
and providing them much needed help and support. They are impeded
though by lack of resources and support, and overwhelmed by demand
from healthworkers reporting dozens and dozens of cases across the crisis ridden
NHS.
The NHS unions (BMA, RCN, UNITE,
UNISON) all have plenty of resources, but they have leaderships which
are complicit in many management cover ups; actions which have been
detrimental to the NHS, patients and staff.
The
latest scandalous case has been that of surgeon Edward Jesusdason who
is being
sued by the BMA
effectively for refusing to agree to a gagging clause. Jesusdason
refused to accept a gagging clause, and shared information with
another surgeon and the CQC. The BMA in return dropped his case
against the employer case and is now suing him for the costs. The
case has been covered at
length
by Dr Philip Hammond on
this blog.
NHS staff should not abandon their
unions - despite their poor record - but fight to reform them.
Whistleblowers need the support and strength that comes from unions
and collective organisation in the workplace.
Unions should be championing the
cause of whistleblowers and using their industrial strength to
campaign for change, and to protect them. If the present leaderships
are unwilling to do this, union members need to organise among the
grassroots, campaigning at branch and national level to change the
union and its leadership so that it addresses these issues properly,
instead of siding with the employer as occurs all to often now.
Health activists have been working on a
short set of proposals to present to the unions , and will publish
these shortly. It is hoped these can form the basis for campaigns
across the health unions to challenge the complicity and conservatism
which leads unions to side with management over their members.
By transforming the culture and
practice of our unions, we can mobilise their power to push for the
changes we need. We cannot hope for the government to legislate in
our interests from a position of weakness. We have to organise our
own power so our demands cannot be ignored.
System
change not legal change
We also need a long term strategy
which pushes for systemic changes to the health service and the
system we live under. The solution to unaccountable management power
isn't ultimately legal changes which leave the employer-management
power structure intact, its an overhaul and democratisation of that
structure which is required.
We need a democratisation of our
public services and wider society. Real accountability can only come
through bringing democracy and transparency into the workplace.
Management positions in the NHS should not be appointed. They should
be subject to election and recall by the staff they work over, making
managers directly accountable and creating quick avenues to redress
any wrongdoing. Senior management at board level should be elected by
staff and the wider community who the institutions serves.
Appointments should be abolished, and staff and communities given the
power to recall board members. There should be no secret agreements, and NHS budgets should be transparent and published online so they are freely available for inspection and audit. Changes to services should only come about after discussion and a thoroughly democratic process involving patients and staff.
Only by increasing democracy and
transparency in how institutions operate can we create services where
whistleblowing isn't necessary, and where staff and patients have
effective ways of holding those in power to account.
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