What lessons canWhistleblowers

provide about how trusts can better encourage and

facilitatespeaking out?

Gary Walker, Whistleblower, Former NHS Trust Chief Executive, Trustee Public Concern at

Work

Speaking Out Summit (SOS)

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Health professionals needed to think “very hard” before standing up against poor patient care, because it is “potential professional suicide”

“Your employer won't thank you; the law won't protect you. You're on your own”

Ramon NiekrashApril 2010

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“I couldn't encourage anyone to whistleblow.”

“The patients have been forgotten in all this”

University Hospital of Coventry and Warwickshire NHS Trust spent £6-10m victimising Raj Mattu

April 2014

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Ray Law, 60Avoidable death 2010

Surgeon’s memo: “death of an otherwise healthy patient”

3rd prostatectomy on the operating list

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…targets were exerting “enormous pressure”…

”…work with you to identify what additional resources we need to provide a safe service in the future”

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One of six incidents including WL manipulation reported in 2010Inspection didn’t review any incident

Inquest 2014 - Expert said Mr Law “would have survived”Trust investigated. Did not die because of targets.Surgeon said: "It was not normal for me to perform three operations in a day. I haven't done it since.”Narrative verdict“Lessons learned”

Victimising NHS Whistleblowers is unlawfuland is likely to be endangering patient safety and/or the

financial stability of the organisation

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NHS Whistleblower (sample in public domain) Role Issues raised Employer Outcome

Tracy Boylin Director (HR) Misconduct / Fraud The Christie Sacked

David Drew Doctor Patient safety Walsall Healthcare Sacked

Kim Holt Doctor Patient safety GOSH Kept job*

Raj Mattu Doctor Patient safety Coventry and Warwickshire Sacked

Edwin Jesudason Doctor Patient safety Alderhey Forced to resign

John Watkinson Chief Executive Patient safety Royal Cornwall Sacked

Jennie Fecitt Nurse Patient safety NHS Manchester Sacked

Sandra Haynes Kirkbright Administrator Patient safety Royal Wolverhampton Hospitals Threatened with sack**

Gary Walker Chief Executive Patient safety United Lincolnshire Hospitals Sacked

Ramon Niekrash Doctor Patient safety South London Healthcare Kept job***

Helene Donnelly Nurse Patient safety Mid Staffordshire Forced to move job

Narinder Kapur Doctor Patient safety Addenbrookes Sacked

Margaret Haywood Nurse Patient safety Brighton and Sussex Struck Off

Loo Blackburn Nurse Patient safety Oxford GP practice Forced to move Job

Shiban Ahmed Doctor Patient safety Alderhey Kept job****

Steve Bolsin Doctor Patient safety Bristol Royal Infirmary Forced to leave UK

Sharmila Chowdhury Manager Misconduct / Fraud Ealing Hospitals Sacked

Mike Chester Doctor Patient safety Royal Liverpool Sacked

Kate Clarke Administrator Patient safety Dudley Hospitals Sacked

David Ore Security Patient safety Dudley Hospitals Sacked/Redund

* Suspended 4yrs, reinstated, service transferred ** Ongoing – Jeremy Hunt intervened *** Left with £170,000 costs **** Left with £20,000 costs, suspended twice since, and still suspended on false allegations of mental illness.

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NHS Confederation

“Several of our interviewees identified a problem of a perceived or real toxicity in the wider system inhabited by chief executives, describing the environment as “brutal”, “arbitrary”, “prone to favouritism” and intolerant of risk-taking that isn’t successful.”

Don Berwick

“Fear is toxic to both safety and improvement”

“A symptom of this cycle is the gaming of data and goals; if the system is unable to be better, because its people lack the capacity or capability to improve, the aim becomes above all to look better, even when truth is the casualty.”

2009

2013

https://www.gov.uk/government/publications/berwick-review-into-patient-safety

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“I heard of a fear of bullying being a possible explanation for more staff not coming forward with concerns…there was also fear among staff about the repercussions of not complying with targets. “Finally and perhaps of most concern, I found a widespread culture of denial”

Robert Francis QC

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Repeated denials that whistleblowers exist has become a commonlyheld belief

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Culture of Cover-ups

£28m and 1000 compromise deals

“There is simply no way of knowing how many of these special severance payments have been made

across the public sector – or whether the compromise agreements have been used to ‘gag’

employees. To date neither the Treasury nor individual departments have monitored this

adequately.”

The Public Accounts Committee garywalkeruk

Culture of Cover-ups

£28m and 1000 compromise deals

“We heard evidence of shocking examples of using taxpayers’ money to ‘pay-off’ individuals who have flagged up concerns about patient or child safety”

The Public Accounts Committee garywalkeruk

Q. Have you witnessed bullying by management or a colleague in the past 12 months?

A. 22% said up to 10 times - that’s 374,000 employees

NHS Staff Survey 2013

Q. Would you feel safe raising concerns?

A. 28% said No/don’t know - That’s 476,000 employees

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Carter, M. and Thompson, N. and Crampton, P. and Morrow, G. and Burford, B. and Gray, C. and Illing, J. (2013) 'Workplace bullying in the UK NHS : a questionnaire and interview study on prevalence, impact and barriers to reporting.', BMJ open., 3 (6). e002628.

Workplace bullyinggarywalkeruk

2,950 NHS staff (cross-sectional)43% reported having witnessed bullying in the last 6 months

“Far too many who hold positions of power - and who could affect change - are still dragging their feet while patients and staff continue to suffer.”

Helene Donnelly OBEMarch 2014

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Boards are accountable for the culture of their organisations

“People at the head of an organisation set the tone for the quality of care that is provided”

Jeremy Hunt14 Feb 2014

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NHS Boards?Individuals?

The MediaPublic & staff

Politicians

Who doesn’t support Whistleblowers?

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A “culture of openness” is spreading through the NHS, with almost 1,000 whistleblowers reporting poor care every month.

Jeremy Hunt4 Feb 2014

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1. Believe in whistleblowers(Don’t brief against them)

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“Oh yes I've spoken to whistleblowers,not genuine though.”

Training event April 2014

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The NHS must stop the dishonesty of public support and private

condemnation

The NHS must stop the secret briefings, profiling, denial,

victimisation, and internal reviews that seek to cover up wrongdoing

Getting the language right…

"Raising concerns and whistleblowing are different things”

Dean Royles, HSJ, 21 March 2014

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Speaking out / raising

concerns / protected

disclosures

Minor issues eg stock

reordering

Clinical concerns eg competency

Management concerns eg risk factors

(PD) Concerns about criminal

offences

(PD) Concerns about failure

to comply with a legal

obligation (PD) Concerns about health

and safety

(PD) Concerns about an

environmental issue

(PD) Concealment

of any PD

Raising concerns and whistleblowing are generally the same

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2. Declare whistleblowers are an asset not a liability

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3. Act on a whistleblower’s concern: it protect patients(Don’t shoot the messenger)

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24. Refuse to disclose documents. No one cares about DPA and FOI

23. Accuse a whistleblowerof not raising concerns earlyenough

22. Delay as much as possible to push up the legal costs for the whistleblower

21. Ignore PAC and other inquiries

20. Pretend that the Public Interest Disclosure Act offers adequate protection

19. If externalinvestigation, the trust can stillorganise and pay for it, recruitthe panel

18. Arrange an “in house”investigation.

17. Throw public money at anemployment tribunal appeals (unlimited budget)

16. Throw public money at anemployment tribunal (unlimited budget)

15. Make vexatious complaints toa professional regulatory body

14. Publicly humiliate the whistleblower

13. Rely on the cowardice and apathy of the Department ofHealth

12. Make friends with the coroner to avoid scrutiny

11. Appoint consultants to rubbish the whistleblower’s claims.

10. Threaten to sue the whistleblower

9. Apply to the Treasury forpublic money to pay off andgag the whistleblower

8.Misuse the code of conduct for managers

7. Claim it’s an employment conflict

6. Allege mental health issues (very popular)

5. Threaten whistleblowers and themedia with libel suits

4. Threaten reprisalsagainst colleagues whosupport a whistleblower

3. Repeatedly ignore, deny or pretend to address the concerns

2. Allege actual orinvented misdemeanours

1. Inflict subtle sanctions beyond legal protection

PETER GOODERHAM (1965-2011) Ways to skin a Whistleblower (not exhaustive) (adapted)

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4. Sanction those who victimise whistleblowers

(Don’t promote them)

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5. Publish how you

support those raising

concerns

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The culture must changeTo protect patients

To support whistleblowing

Boards are accountable for the culture and how they support Speaking Out

1. Believe in whistleblowers2. Declare whistleblowers are an asset not a liability

3. Act on a whistleblower’s concern: it protect patients4. Sanction those who victimise whistleblowers

5. Publish how you support those raising concerns

Speaking Out Summit (SOS)garywalkeruk