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
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.