Tag Archives: NHS

Top retired Cardiologist calls for whistle blowing to be a “routine and acceptable practice” throughout the NHS

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Dr David E Ward, retired cardiologist

This is a guest blog by David E Ward, a distinguished retired cardiologist, formerly at St George’s Hospital, South London, in response to my last blog on the case of Dr Chris Day and a series of blogs on the case of Dr Usha Prasad

The treatment of bona fide whistleblowers working in the British NHS is egregious and primitive. This is amply exemplified by many publicised WB cases over the last 2 decades: Dr Raj Mattu, Dr David Drew, Dr Kevin Beatt, Mr Peter Duffy, Dr Chris Day, Dr Usha Prasad and many others (see Google). Just think for a second or two – is it appropriate to threaten the career, the livelihood, the families of these honest doctors who were only doing the “right thing” by drawing attention to what they honestly perceived were remediable shortcomings? In fact, it is required of doctors to report any perceived shortcomings (Hippocratic Oath and all that and more recently with the “Duty of Candour”).

How is it possible – in the democratic UK – to threaten a doctor with such punitive costs that they are forced to withdraw their legitimate claims or risk potential bankruptcy? Isn’t this behaviour something we might associate with some autocracies toward the east? In the case of Dr Chris Day, the sum spent on pursuing (persecuting) him must now be more than £1,000,000! All to extinguish the career of an honest doctor who sought only to improve the care of patients in his unit. Wouldn’t it have been more sensible (litotes here) to spend that huge sum of money on improvements to the unit in question? (see CrowdJustice, http://54000doctors.org/blogs/timeline).

Successive health secretaries did ” little or nothing” to help whistleblowers

Jeremy Hunt, former health secretary now chair of the Commons health and social care committee

Successive Health Secretaries have done little or nothing to support whistleblowers. Jeremy Hunt (yes, he who did so much damage to the NHS; see Caroline Molloy, http://www.openDemocracy essay) asked Sir Robert Francis QC to report on the issue (see Google) but then ignored most of his recommendations or feebly implemented some (for example, the Freedom to Speak Up Guardian which doesn’t really work, to say the least). The last SoS for Health and SC did nothing at all to support WBs to my knowledge (OK, there is a pandemic). The present one has probably never heard of any of the names listed above or even what whistleblowing within the NHS means! What is more disturbing is that other powers-that-be, for example the NHS Medical Director, the Head of the NHS (whoever that will soon be), other Ministers etc, seem to take no interest in this problem, none whatever. The Health and Social Care Select Committee could take an interest but it is chaired by Jeremy Hunt – who is too occupied with his own self-importance and whose record as SoS speaks for itself – so I don’t expect any action there. Perhaps these grandees are too far removed from day-to-day whistleblowing in the NHS. It wouldn’t take much time to find out what is happening at grass roots.

Time to create a public register of whistleblowing cases

Some tentative suggestions:

1. Create a register of WB cases. Whistleblowing investigations are almost invariably secretive. Why? Apart from clinical details what else need to be anonymised? All reported and ongoing whistleblowing cases should be logged in an open and accessible register kept by an independent (is that possible?) body, preferably independent of the Trust and possibly the NHS and its Byzantine structures. Progress of a case should be openly documented and questions may be submitted. Resolved cases would be available, uncensored, for retrospective scrutiny. Openness might deter shady deals behind closed doors (yes, they do happen). Above all the external investigators should be accountable to the Trust and their own professional organisations.

2. Make cost threats unlawful. No Hospital Trust should be permitted to use the threat of costs against a “little person” (i.e., doctor) who cannot possibly equal the financial power of the taxpayer-funded persecution to defend themselves (yes, for it is us, the taxpayer, who pays the bill for the outrageous sums mentioned above to “thwart” the WB but we have no say whatever in the process). If money is to be spent in this process it should be wisely and fairly spent and shared equally between the participants, that is the victim (the doctor) and the aggressor (the Trust).

3. Make Internal hearings demonstrably independent of both parties. All WB cases which are subject to “internal” hearings (for example Maintaining High Professional Standards panels) are vulnerable to potentially corrupt processes (as some of the above cases probably have been). They should be heard by independently appointed persons (this will require some checking because as we have seen not all so-called “independent” chair-persons are quite as independent as they may appear – see Dr Usha Prasad blogs here) and open to external scrutiny by independent authorities or suitably qualified persons. Minutes of internal hearings should be made accessible. (Employment Tribunal proceedings are already largely in the public domain).

Make falsified evidence a criminal offence

4. Make falsification of evidence by either party an offence (I think there is a name for this beginning with “P”). If defence of a whistleblowing claim by a Trust is found to be untrue or contain false or falsified “evidence”, or in some other way is dishonest (there may be some of that in some of the ongoing current cases mentioned above…) there should be appropriate retribution for the Trust and managers involved. Incidentally, it is usually managers who instigate the persecution and recruit the heavy (taxpayer-funded) lawyer-supported defence without accepting any personal responsibilities themselves. Also, the use of public money in this way could be regarded as fraudulent and a misuse of taxpayer funds.

5. Ensure the original WB claim is clearly stated. The original concern which prompted the WB to speak out should be clearly and concisely stated in language that the “man on the Clapham omnibus” (Lord Justice Greer, 1932) can understand. It should never lose its primal status. It defines the whistleblower in the first place. WB have, by definition, concerns about the environment in which they are working. They make what is termed a “protected disclosure” (Protected Disclosures Act 2014, Health Act 2004). It is remarkable that these concerns are not infrequently submerged (or completely forgotten) by the ensuing investigative process – which is often more about the Trust and its managers avenging a perceived insult by the WB than seeking solutions.

Health Trust managers use lawyers to “crush honest doctors”

Lastly, what is it that Trusts’ and their managers are so keen to defend seemingly at any cost? Very expensive lawyers are used to “crush” an honest doctor, the “little person”. A defence possibly costing much more than it would to correct the shortcomings exposed by the WB in the first place. Is it the Trusts’ or its managers’ reputations that are at stake? Would the CQC ratings be adversely affected if the Trust was found to be at fault? Are there hidden misdemeanours which might be revealed? Why do these proceedings always come across as a potential “cover-up” by the Trust? Shouldn’t the grossly disproportionate defensive stance itself raise serious questions worthy of further investigation?

It is high time the treatment of NHS whistleblowers is once again raised at the highest level (for example, in the House of Commons following the example of Sir Norman Lamb, see report above). Too many professional lives (not only doctors but nurses, physios etc) are being destroyed for no good reason. This is bad news at any time but in the middle of a pandemic it is nothing short of scandalous. Whistleblowing in the NHS is not taken seriously enough and may be a factor persuading some doctors to voluntarily leave the profession before time. In an open liberal society with everyone working for the good, “whistleblowing” should be a routine and acceptable practice. Sadly, it is cause of great distress and stigma.

BMA and ex health minister Norman Lamb back whistleblower doctor Chris Day in patient safety battle

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Dr Chris Day now being backed and funded by the BMA Pic credit: Twitter

The tables are beginning to turn in a seven year battle which has cost £700,000 so far to the taxpayer between Chris Day, an anaesthetist in an intensive care unit ,employed by Lewisham and Greenwich Health Trust.

The case against the trust and Health Education England has been drawn out over seven years at employment tribunals and appeal tribunals. He was forced into a settlement in which he had to withdraw his allegations of patient safety being at risk at the ICU unit at Woolwich Hospital in return for the trust accepting he had genuine concerns as a whistleblower at Woolwich Hospital between 2013 and 2014. The trust , using expensive lawyers, threatened to land him with huge legal bills if he continued and started cross examining their witnesses. The allegations included poor staff ,patient ratios at the ICU and inadequate medical supervision. He also made the same allegations to Health England Education.

Trust forced him to settle by threatening him with huge legal bills

As he said: “After two and a half days of my six day cross examination I was contacted by my legal team and told that the NHS respondents had decided to inform me of their intention to seek costs for the entire four week hearing if I proceeded to cross examine any of the NHS’s14 witnesses and ended up losing the case,”

He had no option but to withdraw to protect his wife and family from bankruptcy should this threat be carried out.

“real prospect of success” says judge

But he has won the right to get the enforced settlement out aside and take his case to the Court of Appeal. In giving judgement the Rt Hon Lady Justice Ingrid Simler DBE stated in the Order of the Court of Appeal that “I consider this appeal has a real prospect of success. Permission is granted”. Simler LJ is a highly experienced Judge and she was previously the President of the Employment Appeal Tribunal.

Until now he was left with trying to raise money so he could afford to pay the lawyers to fight the trust. In the last week in what amounts to a major change of heart, the British Medical Association has decided to fund his battle. Internal sources say this may be the first time the BMA has decided to fund a doctor in a whistleblowing case.

A BMA spokesperson said:

“Chris’ case has brought into sharp public focus the challenges and adverse experiences which doctors can face when they make public interest disclosures to blow the whistle on safety concerns they identify, in the course of carrying out their job.

“Doctors have a responsibility to raise concerns they have about the safety of their patients and yet too often they are put in the position of having to blow the whistle on organisational failures when the organisation in question fails to act. The BMA’s own research shows a majority of doctors work in a culture of fear and are worried about recrimination if they speak out about patient safety concerns. The BMA has been calling for an open culture, where speaking out is encouraged and supported and where our NHS learns from concerns and errors, to improve safety for patients.

“The BMA carried out a comprehensive external review of its member support services and we are now making significant improvements in how we support whistleblowing cases and indeed all members who raise concerns within the NHS. This includes offering more specialised legal support given the complexity of such cases. We are grateful to Chris and other BMA members for their input to this review. Different processes would have been followed if Chris’s case was to arise today and we are pleased to be able to offer Chris the support he needs in the next stage of litigation in his case as well as in the wider interests of the profession and patient care”.

Chris Day said:

“I am pleased to announce that I will be accepting support from the BMA in the next stage of litigation in my case.

“I have always remained a member of the BMA and it is clear to me that the new leadership at the BMA is committed to supporting me and my family where it is able to do so. The Association has spent considerable time and effort understanding my situation and provided me with expert legal advice as I considered the best way forward.

“I know the BMA has undertaken a great deal of work to consider how it supports whistle-blower cases and it has sought to learn from the past. They have established new arrangements to ensure better support for potential whistle-blowers, including guaranteeing a meeting with a specialist solicitor and case manager that now takes place before any case is considered too weak to proceed or on cases that are initially considered strong enough to proceed where this view subsequently changes.

Sir Norman Lamb. Pic credit: Twitter

“I look forward to working with the BMA. The BMA has a critical role in ensuring that no doctor should ever be forced to choose between their career and the safety of their patients and I would encourage every doctor and medical student to join the BMA and take an active role in shaping their trade union. Doctors need a trade union now more than ever.”

Chris Day has also got the support of Sir Norman Lamb, the former Liberal Democrat health minister, who backed him while he was in government. Sir Norman is now the chairman of the South London and Maudsley NHS Foundation Trust., the neighbouring trust to Lewisham and Greenwich. Despite some concern in the NHS establishment he is to continue to support Chris Day and will be a witness.

Given the dire findings in the Usha Prasad case with Epsom and St Helier University Health Trust, reported in this blog, this development is the best news a whistleblower doctor can get.

Updated: 2663 reasons why the Parliamentary Ombudsman is not working

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Sir Robert Behrens

Earlier this year I reported on a letter sent by Sir Robert Behrens, the Parliamentary Ombudsman, to MPs on the Commons Public Administration and Constitutional Affairs Committee on why he could not implement a three year programme to improve the service for another year.

The letter revealed that Michael Gove, the Cabinet Office minister, had decided not to go ahead with a three year funding plan to make it happen until 2022. As a result the Ombudsman would be expected to concentrate on complaints about Covid19 and would not have the budget to do much about improving the service beyond laying the bare bones of the idea.

I suspected that the service might be overwhelmed and asked for the figures on the number of people on the ” waiting list” to get their complaint heard and the number of cases where people were awaiting a decision. The media office declined to give me the information immediately and converted my press inquiry into a Freedom of Information request to delay it for 20 working days.

Physical queue could stretch from Millbank Tower to Westminster Bridge

We now know why. Figures released under that FOI request reveal that the Ombudsman show that a staggering 2663 people are in a virtual queue to await to be assigned to a caseworker. If everybody physically turned up ( not allowed at the moment due to the pandemic) it would stretch from the Ombudsman’s office at Millbank Tower right along the Embankment to the Houses of Parliament and possibly across Westminster Bridge.

They also released the figures awaiting a result from their complaint. That is 2699. So almost as many people are waiting to get to get a case worker to look into their complaint as the number of people waiting for a result.. That might explain the latest figures from the Ombudsman Office’s own performance standards review which shows that only 51 per cent gave a positive reply to the point “We will give you a final decision on your complaint as soon as we can”. It means 49 per cent weren’t impressed with that claim.

The Ombudsman’s Office have also told me that nowhere in their building is there ” any recorded information confirming that “the public will get worse service this year”. This seems to me more of an act of self denial than a possible statement of fact.

The Ombudsman seem to be relying on two mitigating developments to help them overcome this frankly appalling scenario.

Planned new NHS Complaints Handling Service

They are plans for a new model NHS Complaints Handling Service that will aim to take the pressure off the Ombudsman’s Office by trying to sort out patients’ complaints before they have to go to him. But as the section on this new procedure on the Ombudsman’s website discloses that these are only draft guidance. Participation by health bodies is voluntary and as yet plans for pilot projects have not been finalised. My guess is that probably the best health trusts will pilot it, the worst won’t want to know.

The Parliamentary Ombudsman’s latest controversial senior appointment: Rebecca Hilsenrath

The second move is the appointment of a £80,000 Director of External Affairs, Strategy and Communications to drive through the new strategy and report to Gill Fitzpatrick, chief operating officer. There is a full description on the headhunters website, Hays, of the job. Today ( April 12) the Ombudsman confirmed that the post had been filled by Rebecca Hilsenrath, the former chief executive of the Equality and Human Rights Commission, who officially resigned last week. Three months ago Ms Hilsenrath was in the centre of a row that she had twice breached lockdown rules by going with her family to her Welsh country cottage. You can read about the allegations and her resignation in two articles I wrote for Byline Times articles here and here. By all accounts this is a very curious and controversial appointment.

Altogether the situation at the Ombudsman’s Office does not present a pretty picture. A cynic might say it is not a priority to put money into watchdog bodies because all it does is highlight problems when things go wrong. And a government that would love to stay in power forever wants to present the idea that the UK has world beating public services and hide anything that might detract from that propaganda.

The Parliamentary Ombudsman File

Here are previous stories on this blog on the issue

https://davidhencke.com/2021/03/20/revealed-the-ombudsmans-much-delayed-justice-train-for-50swomen-lost-pensions/

https://davidhencke.com/2021/02/21/parliamentary-ombudsman-dont-contact-us-well-contact-you/

https://davidhencke.com/2021/02/10/will-your-complaint-get-heard-as-the-government-forces-the-parliamentary-ombudsman-to-curb-its-service/

https://davidhencke.com/2021/01/25/why-the-archaic-parliamentary-and-health-ombudsman-needs-a-modern-make-over/

Lansley’s unhealthy double whammy: What you won’t know or find out about the NHS

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Andrew Lansley's unhealthy changes. Pic courtesy:www.bexleymonitoringgroup.co.uk

Update:Department of Health has replied to this blog defending their position on Freedom of Information and cutting statistics – see comments.

While battle rages over the government’s  controversial reforms of the NHS, the Department of Health has sneaked out two toxic  changes that could  seriously damage your health by promoting ignorance and restricting your rights as a citizen.

The two changes appear to be unconnected  but are extremely helpful to new private providers of  NHS medical services. One will limit information the private firms  have to provide under the Freedom of Information Act to patients and relatives, the other will help them by abolishing the collection of health statistics on the services they provide and  the quality of  staff they employ.

The first has been revealed by the authoritative Campaign for Freedom of Information who are rightly demanding that Andrew Lansley, the health secretary, amends the law so patients can be protected. See their letter at   http://bit.ly/q35AsQ .                   .

This is incredibly serious as this example  by their director Maurice Frankel  shows here.

“Suppose there is concern about the use of potentially contaminated medical supplies by hospitals. For an NHS hospital, the FOI Act could be used to obtain details of stocks of the product, the number of doses administered, the numbers of affected patients, the quality control measures in place, correspondence with suppliers, minutes of meetings at which the problem was discussed and information showing what measures were considered, what action was taken, how promptly and with what results.
This level of information would clearly not be available in relation to independent providers treating NHS patients. This would represent a major loss of existing information rights.”

The second comes from a very convoluted consultation exercise launched the day after the August bank holiday and trumpeted by Anne Milton, the public health minister, as a drive against ” red tape”.

This proposes to slash the collection of statistics by the Department of Health by 25 per cent in a rather uneven and unclear way. But it is clear that the aim is to ” minimise the burden” on the NHS and in particular the new private providers.

Half the statistics collected on the NHS workforce – which are used to improve staff training and forecast the need for skilled staff – are to be dropped. The consultation document says: “This will be of significance for non-NHS providers of NHS services as it will determine the minimum workforce information they would be required to provide.”

And also being reduced are the statistics on the very sensitive political area of waiting times, targets for treatments and capacity of hospitals. The paper says: “the content and frequency.. should remain under review so that the right information is provided by the NHS at a sensible frequency and in so doing the burden to the NHS is minimised.”

Collection of  statistics giving the national picture on mental health are being abolished and the collection of statistics on patient safety look like being hived off to a private firm.

The one area that is being improved is cancer statistic collection which seems to be tied to a pledge by David Cameron.

What is particularly disturbing is that despite the document running to 55 pages at no point is a definitive list published of what is being scrapped. See document if you can bear to here:http://bit.ly/npcHmC .

Frankly Andrew Lansley should not be allowed to get away with either of these moves. The Department needs to change its position on the former and come clean on the latter. I suggest that you make your views known to Mr Lansley at his private office at the Department of Health the email address is  mb-sofs@dh.gsi.gov.uk. If  Zetter’s Parliamentary Companion is right his direct e-mail at andrew.lansley@dh.gsi.gov.uk.

Misdiagnosis,bad prognosis then last minute brilliance: my treatment by the NHS

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preparing to go under the knife(not my operation)

Being treated by the NHS is like riding a rollercoaster or watching England play in the World Cup ( even as a non football fanatic).

One minute you cannot believe professionals can make such errors, the next you can’t quite believe how they brilliantly they got their act together.

I had the misfortune to trip over a rock on a remote headland path on the Isles of Scilly – falling flat on my face with my arm outstretched skidding across another rock. I was unable to get up unaided.

 I should have known not to do this except on Tuesdays between 2.0 pm and 4.0pm – the only time there are X ray facilities on these  islands some 30 miles from the Cornish mainland. I was later to find that while Scilly has  brilliant first aiders and paramedics who use a jet ambulance boat, its cottage hospital at St. Mary’s is a one man and a dog operation.

And unfortunately for me this was a Thursday afternoon- so no x ray without calling in an air ambulance to Penzance. I was diagnosed as to have nothing wrong with me except  sprained and badly bruised muscles and sent home with Paracetamol and Ibuprofen.

For the rest of our holiday we spent quietly on Tresco. Only after visiting my GP in Berkhamsted nearly a week later and being sent off to casaulty at Watford General Hospital, did I find I had fractured my shoulder in three places. But never mind, the prognosis was that the bones would heal by themselves. I would be sent to the fracture clinic at Watford to arrange physio.

A week later and seen by orthopaedic doctors at the clinic, it suddenly emerged that I needed an operation to restore my shoulder and upper arm to full mobility. And worse still there was only a week left to do  it, because my bones were well on the way to trying to heal themselves  in the wrong position.

Here despite a horrendous reputation trying to run a busy overstretched hospital on a  shoestring (West Herts having closed down our nearest  a&e hospital Hemel Hempstead), fingers were (metaphorically) pulled out.

Within two hours, I had a CT scan, bloods and swabs taken in case I was carrying MRSA without knowing it. Within 24 hours the hospital found me an orthopaedic surgeon, South African Andrew Irwin, who specialises in smashed shoulders and upper arms.

They had a problem- no bed. A hospital administrator -Jane Ward- came to the rescue ( remember those people politicians despise because they don’t  do front line care) and three hours before I was due to come in-had found one.

My 44 hr stay on Flaunden  general surgery ward was a minor miracle -with almost every NHS cliche in the book. The surgeon turned out to be the typical no bedside manner type – in the one minute consultation- it was simply  “you have a smashed shoulder. We’ll fix it.” The nursing care-despite staff shortages- was superb with one staffer, Trish, doing a double night shift and staying on an extra hour to  complete unfinished tasks. And while the operation took six hours -described as ” a tricky one” by a junior surgeon the next day, I actually did feel safe before and afterwards.

Slight shock at being turfed out with one hour’s notice the next day- but I suspect that with one or two patients with undiagnosed infections surrounding me, it was for my own good. Yet they managed to get me to see a phsyiotherapist, get a final X ray ( when I discovered I have a metal plate and a long pin in my shoulder), get some drugs and talk to a pain nurse and after a strong representations from my anxious wife, arrange for patient transport home.

The experience suggests -despite Labour’s spending boom –  an NHS much on the edge trying to provide best patient outcomes. My shoulder is starting to recover. All I can say is that if David Cameron or Nick Clegg – start thinking of squeezing the NHS in any way- I shall use it to thump them when I meet in the House of Commons as part of my job.