They act as ” judge, jury and executioner” when whistleblowers raise patient safety issues
By David Ward, a former consultant cardiologist at St George’s Hospital, Tooting, London
All staff working in the healthcare professions should be regulated for very obvious reasons. Most of them are but NHS Trust managers (non-medical) are not. Why? Given that managers have enormous and disproportionate powers to initiate investigation, (enlisting private investigators is not unknown) restrict activities, refer to disciplinary hearings and regulatory bodies such as the GMC [ General Medical Council ] and the CQC, [Care Quality Commission] suspend and dismiss healthcare staff – most notably well-meaning, hardworking doctors for raising concerns about patient safety – shouldn’t managers should be regulated just like other NHS workers?
Doctors are obliged to raise concerns if they see problems which may affect patient safety (Duty of Candour, Reg 20 HSC Act 2008 and 2014) pejoratively called “whistleblowing”. It is a matter of patient safety. We know that the reactions by Trust managements to doctors raising concerns can destroy careers and family lives. Suicides of staff under persecution are not unknown. A few courageous people may resort to the corrupt Employment Tribunal process after dismissal. Trusts spend £millions (yes, really!) to defend their untenable self-appointed positions as “judge, jury and executioner”. Where does this money come from? You and me, the taxpayer. Does the victim (whistleblower) have equal access to such resources? Of course not! In fact, they are often sent the bill (aka a cost threat, a merciless device not worthy of a civilised society and in this context used to force the claimant to concede the case) for the huge legal expenses of the Trust’s lawyers. (I’ve seen a well-known law firms’ cost sheet, it’s mind-blowing).
Who initiates the actions that can result in these disastrous consequences? Yes, the Trust managers; sorry, but it’s true. (OK, sometimes medical managers are complicit as we have seen in recent dismissals – shame on them). This process must be taken away from management and regulation could incorporate this. As many recent cases illustrate, PIDA (1998) forces a Trust to deny that “whistleblowing” had any part of a dismissal despite the prior narrative being clearly laden with raising patient safety concerns. It urgently requires updating.
No winners in this egregious process
There are no winners during these egregious processes. Trusts are deprived of money that would be better spent on care. Doctors and nurses who have families to support but may be left without employment even in times of severe need such as the recent pandemic, their careers and family lives in ruins. Mental problems are not uncommon, why wouldn’t they be? Doctors who are required to cover for suspended and dismissed colleagues have to put in more hours. Dismissed doctors often find it difficult to get work in other Trusts. I know of cases where the management at the index Trust interferes with (including preventing) the appointment of a whistleblowing doctor elsewhere.
Managers (and their acolytes) should be banned from acting as “judge, jury and executioner”*. That’s not in keeping with open and fair justice, is it? (Human Rights Act,1998, Article 6). Stop disciplinaries just initiate prompt investigation (thereby reducing risk of further harms) of the concerns, analogous to the inquisitorial French system of discovering the facts – not the damaging adversarial approach prevalent at present in these situations.
Stop trusts wasting £millions on law firms
No wasting £millions on law firms and costly (very costly) barristers, no claimants (victims) forced to sell the family house, move abroad, give up the profession, no months of waiting for court hearings (often many, recurring over years – I know of at least 2 cases of dismissed doctors whose cases in the Employment Tribunal system have dragged on for a decade or more), less mental illness.
Pastoral care for staff who raise concerns? That would be a constructive, cost effective and beneficial alternative approach, wouldn’t it?
Just one last thing: in any given Trust does anyone remember the patient safety concerns that triggered all the iniquitous nonsensical sequence of particular events, what they were about and whether steps have been taken to rectify the deficiencies which led to the concerns in the first place (which may have included avoidable deaths)? Have they been documented other than by the person who initially raised the concerns? Were they formally registered? I doubt it. They are usually buried in a fog of emails and shrouded by a cloud of managerial vengeance directed toward the whistleblower. Perhaps some of the simple and inexpensive ideas mentioned here could be explored.
Does anyone really think that NHS managers should be exempt from regulation?
There is of course one simple solution: ban the suspension and dismissal by Trusts of medical staff who raise patient safety concerns in good faith. They are doing society a favour. *The Political State of Great Britain, for October 1717, Vol.XIV:398]
Make a one-time donation
Make a monthly donation
Make a yearly donation
Choose an amount
Or enter a custom amount
Your contribution is appreciated.
Your contribution is appreciated.
Your contribution is appreciated.
DonateDonate monthlyDonate yearlyPlease donate to Westminster Confidential
£10.00
Westminster Confidential 
As soon as I raised a complaint at Derbyshire NHS Trust, I became a problem, no longer a patient. What followed was a disturbing sequence of lies, abuse of power and official obfuscation as the individuals at DHCFT were prepared to go to any lengths to cover up to protect their own personal reputations and interests.
My story illustrates how ineffective the plethora of regulators, commissioners and other professional bodies are in fulfilling their duty as a protective layer of accountability and in maintaining patient safety. Above all, it shows how hard it is for patients and whistleblowers to have their voice heard when those in positions of power take every measure possible to suppress it. “Judge, jury and executioner” is exactly what the NHS is, see:
https://patientcomplaintdhcftdotcom.wordpress.com/
I make the following recommendations:
i. Executive Director and management accountability is required with a professional regulatory body to maintain standards of honesty, transparency and integrity among Executive Directors and ensure patient care and safety is prioritised and seen to be prioritised.
ii. There should be disciplinary action against any member of staff in the NHS who covers up, including Executive Directors.
iii. Trust Executive Board members should not hold simultaneous posts on their own regulatory bodies.
iv. Lawyers who act for the NHS and commit fraud, misconduct or contempt of court should be prosecuted and face hefty prison sentences as a deterrent
v. To avoid “cash for opinions” and the “hired gun” expert, a joint expert should be appointed from a panel based upon independently verified expert credentials and experts should be paid a fixed flat rate.
vi. Every patient whitleblower who raises a complaint should appoint an independent advocate to scrutinise the complaints process externally and support the patient to get their voice heard.
vii. The NHS complaints process should not be controlled by the NHS but referred to an external independent body from the start- one that is truly independent.
LikeLiked by 1 person
The current law really does nothing to encourage safe practices in the NHS or in any other kinds of work. Going to an ET as a result of dismissal is not going to get anyone to really engage their moral compass.
whistleblowing policies are self serving. A culture of speaking up and being listened to should come first. Managers should investigate complaints impartially and there should be an opportunity for complaints to be externally quality checked. Totally independent of the NHS or other. As has already been said executive directors /managers found telling porkies/covering up or putting pressure on other staff to tell lies should be disciplined. Cultural change will never happen until senior staff are held to account. I also believe that the ridiculously high salaries that these people have means that they have too much to lose. In this case high salaries does not mean that competent individuals with integrity and a passion for providing the highest standards possible are employed.
LikeLike
The odds are stacked against whistleblowers and patients alike. Whistleblowers have to use some sort of internal ‘alert’ system and patients have to lodge a complaint with the Trust before going to the Ombudsman. In both scenarios, the Trust will always have the whip hand in the process. Far better to have a system where an external investigator, brought in at a very early stage, particularly in serious cases of harm or safety, can independently examine the conduct of all involved, including the senior management.
The Post Office inquiry is soon to hear from the senior management in that organisation. It is clear that cover up was the order of the day there. Confidence in people managing the NHS will also stoop to an all time low – if it hasn’t already as a result of what went on at the Countess of Chester NHS Trust and revelations from people like Mr. Ward and cases such as Doctors Chris Day and Usher Prasad.
The government of the day sets the rules – the rules are not fit to ensure patient safety.
LikeLike
I agree with all the above. If the NHS had an open door policy, listened to people and investigated properly, they shouldn’t need to employ expensive lawyers and have Trusts cover-up their mistakes.
LikeLike
Dear David, I do agree with you that NHS trust managers should also be regulated. Is there a petition that needs to be done to get enough signatures for MP`s to bring this to debate in the House of Commons.
Kind regards,
Diane
LikeLike
Knowing how the system deals with complainents i.e. non-reply, unnecessary delays, attempts at intimidation, the nature of a board member and so on I decided that my massively serious complaint needed an investigator that bypassed the above. So in June 2023 I made a formal criminal complaint against the Trust to the Metropolitan Police. Despite hard evidence and reliable first hand witnesses nobody to date has been interviewed by the Police on the Trust side. The Police have told me that the Trust are not cooperating with them. Because of this the Police are seeking advice from their legal people. This shows the arrogance of the accused and the failure of the Police to date. Hospital Trusts and their senior people are regarded as sacred cows despite all the scandals associated with many. The Police I feel are reluctant to pursue people they regard as fellow emergency workers. Why have they just not turned up at the said hospital with their warrant cards and demanded to see the players. For nearly a year they too have done nothing aside of allowing the Trust to carryout their own investigation on a criminal complaint that has been made only to the Metropolitan Poice. I will not go away from this complaint and will consider a complaint against the Police if they do not enforce the law.
LikeLike
As we have seen with the Post Office, bodies who are given execptional positions of trust to regulate themselves are progressively proving they are just ‘Thugs in suits’. They may have once been worthy of that trust, they are no longer and it should be revoked completely. Independent and regulated bodies with powers to take action against all dishonest parties (unlike the Ombudsman Service who have become administrative lapgogs) must be introduced before Broken Britain is unmasked on the world stage for its corruption and dishonesty – no longer an example to the rest of the world. We are not as bad as some countries but people like the Post Office and NHS managers are progressively moving us to that condition. Stop them now!
LikeLike