‘I don’t want to hear anything bad’ – whistleblowing in health & social care.

August 15, 2019 By Steve Turner

Exposing the reality behind the spin

Summary

I am a healthcare professional, a nurse prescriber with experience in senior management in both the NHS and private sectors. I work as a clinician with vulnerable adults on the margins of society.

Over the past ten years I’ve become involved with a situation I was previously unaware of. The widespread marginalisation and victimisation of health and care staff who raise concerns about patient safety, and lose their careers as a result. I’ve learned that this problem is part of a much bigger picture which affects all of society, all industries and public sectors, in all countries of the world.

In this blog I reflect on the situation in England based on my experiences and those of the many people I have met as a result. All of whom experienced the backlash that can happen when organisational reputation trumps patient safety. One thing many of us have in common is that, put simply, we never intended to become known as ‘whistleblowers’ we were just trying to do our job to the best of our ability.

In conclusion, I look at key areas to be worked on in order to protect the public and really ‘learn lessons’. These cross all sectors and areas of work. They include the need for an individual duty of candour (duty to tell the truth); an end to self-regulation in healthcare and elsewhere, and recognition of the value to society of those who risk everything to fight for justice and truth.

A dawning realisation

I began to realise something was seriously wrong when I returned to clinical work in 2002. Having previously worked in senior management (as Head of I.T. in an NHS Trust) and management consultancy, I became concerned that my employer appeared to be putting reputation over patient safety, and if concerns were raised, they were not followed up. I recall looking at Board papers and directions to trusts from the Department of Health [DH] to try and understand this further. One thing I remember is a letter to Chief Executives from the DH which talked about creating an ‘outward-facing’ organisation. I didn’t realise at the time, what I now see as the real meaning of this, and its link to the ‘no bad news culture’. This involves putting reputation above patient safety.

Later I tried to raise my concerns with a Trust Executive at an early stage, only to be told in both words and body language that the trust didn’t want to hear anything bad. This attitude, and what I saw happening to the team and staff around me, led me to leave the NHS and become self-employed working for the NHS on projects related to medicines and prescribing. Eventually my experiences led me to make a protected disclosure in 2014 , in which I set out the patient safety concerns. As a result, the CQC requested an external investigation of my concerns in 2013.

Since being interviewed for the investigation report in 2013 I have heard nothing further. I never saw the investigation report and was never contacted about it. A recent FOI request to the CQC produced the response that my concerns were dismissed as ‘all third hand’ (which is incorrect) and I was told that the CQC had ‘lost the report’.

Prior to the FOI request, I was employed as a CQC Specialist Advisor (a zero-hours contract), however following the FOI request this contract was ended without a specific reason being given.

The wider picture in healthcare

I’ve only briefly mentioned some of the aspects of my story here. The most important thing for me was that I found out the common themes behind all genuine healthcare whistleblowers’ stories.

Three things stand out for me.

1. The psychological effect on the whistleblower

I experienced the isolation that whistleblowers are subjected to and the psychological effect this has on individuals. Suddenly you’re on your own, and people you worked with avoid you. In my case, I also kept my distance from some co-workers, as I realised they were being bullied as a result of supporting me.

For me (now self-employed) offers of work dried up and a real feeling of being ‘sent to Coventry’ set in. In addition to the loss of income, this isolation has a deep effect on my mental health and home life. I believe the approach of employers here is called ‘gaslighting’. It’s deeply troubling.

2. The NHS cold shoulder / being blacklisted

Secondly, I have discovered through meeting other whistleblowers that blacklisting of those who speak out is very common. This can take many forms, ranging from informal blacklisting, to interventions to prevent career development, to giving unsolicited (and unfair) bad references.

For those employed by the NHS the Electronic Staff Record [ESR], which is shared throughout the NHS can be used as a way of sharing detrimental information on whistleblowers. This has caused people to be denied a fair chance to gain further employment. I believe the full extent of this is yet to come to light.

In my case the blacklisting takes the form of repeatedly being given the ‘cold shoulder’ for example being excluded from meetings; letters not replied to and generally avoided. Of course, this is subjective, and maybe sometimes I’m wrong, as healthcare is a tough work environment. However, I have been subject to some clear examples of detriment.

On one occasion my company was enthusiastically awarded a contract of work one day, then the very next day the same person ‘phoned me and cancelled the order saying only that it ‘wasn’t what they wanted’. Very strange. Also last year I found out that staff from the trust I worked for are told not to speak to me, even though in one case it was to ask me a question about my clinical work.

In addition, I was deeply upset when the NHS Trust, who commissioned one of my projects, failed to acknowledge its success. A poster was presented at the NICE Conference in 2015 and it was highly commended by NICE.

Prior to the Conference, I contacted the trust to let them know of the success and all attempts to engage the trust were ignored. As you can see in the poster (which was produced by NICE) the space for the trust’s logo, on the bottom left, is empty:

In fact, I have several examples of work on the NICE Shared Learning pages, none of which have ever been acknowledged in any way by local NHS Trusts, or any healthcare organisations, in Cornwall.

Click here for the link to a recent Shared learning example Patient Led Clinical Medicines Reviews. This project also was presented live at the NICE Conference in Manchester in 2019.

3. The effect that the victimisation of healthcare whistleblowers has on patients

Thirdly, as I looked further into the problem, I began to see the full impact that the victimisation of genuine healthcare whistleblowers has on patients. This for me is the most shocking aspect of the problem.

In 2015 I set up the Turn up the Volume! Movement. This is an attempt to bring together all involved in an open and transparent way, with a focus on the core issue of patient safety.

Through this initiative I have met many more people in a similar situation and learned first-hand the effect lack of transparency and denial has on patients. This is well illustrated, for example, in the report of the Gosport Independent Panel Report (2018), where those who raised the alarm were initially listened to, then ignored and their concerns re-labelled as ‘allegations’. As a result of this, in the words of the report, ‘the lives of over 450 patients were shortened while in the hospital’.

90 second #vlog

Next steps

Based on my experience in trying to link together people in health and care with similar experiences and focus on patients, I believe there are three vitally important areas in healthcare that need addressing.

The need for an individual duty of candour

Firstly, I was shocked to find out that in the NHS the duty of candour (duty to tell the truth), brought in following the Mid Staffordshire inquiry, is an institutional duty of candour. This relies on staff telling the truth to their employer in order to highlight what went wrong. Thanks to the tireless work of campaigner Will Powell the need for an individual legal duty of candour for professionals, managers & leaders in healthcare has been demonstrated. This has parallels to the calls for a ‘Hillsborough Law’. Without this, there is no real mechanism to hold individuals to account for cover-ups and for not being honest.

Making sure initiatives are effective

Secondly, I’m disappointed at the failure to learn and improve patient safety through listening to genuine whistleblowers, whether they be patents or staff, and failure to take measurable actions to change. I believe the effect of the National Freedom to Speak Up Guardian programme needs a full independent review (from outside the NHS). Evidence suggests it is making the situation worse in some trusts, where it is used as a cover for continued victimisation of those who speak out.

Ending self-regulation

Thirdly, in common with industry, I firmly believe that self-regulation in health and care does not work and the only solution will be to set up a truly independent body to oversee and enforce this. This body must include patients, who raise concerns at great cost to themselves and their families, against all the odds, often when people have suffered and died.

Health regulators in England and the people who they regulate are often uncomfortably close. For example, I was deeply disappointed when I found out only recently that the CQC Inspector involved in dealing with my concerns raised in 2013, is now working as Compliance Lead in the same trust.

You can comment on the issues raised in this blog here: https://www.pslhub.org/forums/topic/113-blacklisting-by-the-nhsit-never-ends/

Author: Steve Turner. Date: 15^th August 2019. Revised 29th August 2019. Revised 1st September 2019, to add an outline list of the concerns I raised in 2013. Short video added 05.09.2019.

Updated 13.01.2020 with some more detail on the nature of the blacklisting.

Updated on 11.05.2020 with more examples of the ‘NHS cold shoulder’.

Updated: 11.08.2020 with link to comment via the Patient Safety learning Hub

Steve Turner RGN; RMN: Ba(Hons); P.G. Dip. Ed, is co-creator of www.patientled.education, Head of Medicines and Prescribing for #MedLearn, tweeting as @MedicineGovSte , and Associate Lecturer at Plymouth University.

Is this the profile of a healthcare radical or a troublemaker?

October 12, 2017 By Steve Turner

Steve Turner career and experience:

I began my professional career as a nurse in 1984, eventually specialising in mental health.

I spent a decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the U.S. arm of the company.

In 1999 I returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger. A spell in consultancy for a large Cancer Network followed, by leading two highly successful multi-organisational projects.

More recently I have led a successful interdisciplinary, multi-organisational prescribing project and the development of a parent held medicines record for children with complex conditions. My Associates and I have also developed, and successfully piloted, ‘patient led clinical medicines reviews’.

We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.

Steve is a nurse prescriber, Head of Medicines and Prescribing for @MedicineGov , Associate Lecturer at Plymouth University and former NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @MedicineGovSte

Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator

Steve Turner RGN; RMN; Ba (Hons); P.G. Dip. Ed.

steve@carerightnow.co.uk

Date: 18.11.2019

Boundary spanning in health and care -a short profile of Steve Turner

July 20, 2017 By Steve Turner

People ask me ‘what exactly do you do for a living?’. Because I’ve been around a bit I sometimes struggle to answer this concisely, so here’s a short summary:

My career and experience:

After ten years of traveling around the world, I began my career as a nurse eventually specialising in mental health. My appetite for learning took me through a degree in Social Policy and then into the world of healthcare I.T.

I spent the next decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the US arm of the company, working with leaders of clinical teams in the NHS.

I then returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger.

A spell in consultancy for a large Cancer Network followed, by leading two multi-organisational projects to identify the most effective information and prescribing systems. These brought clinical teams together to manage a complicated buying system in a much more efficient and cost effective way.

All of these projects have received national recognition.

I have been a NICE Medicines and Prescribing Centre Associate, sharing related information /guidance & learning with a diverse group of NICE Affiliates, and documenting outcomes. I also continue to practice as a mental health clinician, focusing on several areas including mental capacity assessments and medicines management.

In 2015, after a difficult whistleblowing experience, I founded the Turn Up The Volume! movement and speak out for patient safety through transparency, values based leadership and a just culture. We have held two successful national events, bringing together people from all areas in an atmosphere of trust and learning.

Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator.

Here’s Steve talking about one of our wellbeing projects:

Steve Turner

@MedicineGovSte

Click here for LinkedIn profile

info@carerightnow.co.uk

07931 919 330

Revised blog published: 10.09.2020

Turn Up The Volume! 2 London 26th May 2017 – A Reflection

June 23, 2017 By Steve Turner

Turn Up The Volume! 2 London 26^th May 2017 – A Reflection on the event

Summary:

Two years ago, Steve Turner, Managing Director of Care Right Now CIC, launched the first Turn Up The Volume! Conference in Bristol inviting patients, carers, NHS and social care staff to come together for the first time to discuss the problems within the NHS.

‘It was billed as a patient safety event like no other,’ said Mr Turner, ‘and it certainly lived up to its promise. There were many emotional moments as people told their stories to a sympathetic audience. The aim was to share experiences in promoting patient safety as well as helping people to speak out safely about bad practice and bullying.’

Turn Up the Volume 2 aimed to take the conversation further, make more links and help bring about actions which make a difference.

This was a ‘bootstrap’ event, which was put together by people who care about the subject, many of whom gave up their own time to be involved. It was open to anyone with an interest in the subject.

Forty people attended the event, from all parts of the UK and beyond. Delegates were from a variety of backgrounds including health & care staff, patient and public whistleblowers and academics.

The event was organised with the support of Marianna Fotaki is Professor of Business Ethics at Warwick Business School, University of Warwick.

Feedback from the event, which is still coming in, is largely positive and all constructive. As a result resources are being added to the event web pages, and an action plan is being developed. This will be openly shared with all delegates and through the web pages and on twitter under the hashtag #tutvlondon .

Aims of the event:

To provide a safe space where all involved can listen and learn from each other.
Giving food for thought and ongoing reflection.
Providing an interactive and inclusive listening exercise, where we plan to help everyone use the experiences of all those affected by cultures of fear to drive forward real change.

Throughout the day emphasis was placed on be on transforming ideas into action, and moving beyond stereotypes.

Speakers and delegates:

The morning session was chaired by Colin Leys, emeritus professor of political studies at Queen’s University, Kingston, Canada, and an honorary research professor at Goldsmiths, University of London. He is co-chair of the executive management team of the Centre for Health and the Public Interest (CHPI).

In the morning we heard from Dr Alexis Bushnell, who is a Research Fellow on an ESRC Transformative Grant, examining post-disclosure survival strategies by organisational whistleblowers (with Dr. Kate Kenny and Professor Marianna Fotaki). Then from Tracy Boylin, Human Resource professional and whistleblower, who spoke on ‘How can we use this event to make a difference?, and outlined some of the NHS initiatives that are underway.

Following this we heard from inspirational nurse Joan Pons Laplana, who spoke on Whistleblower experience and survival. Joan tweets as @RoaringNurse and has 27.5K followers. He spoke of the support he needed to keep going and in particular how he was welcomed into the BME community and found support there.

This was preceded by a short outline by Steve Turner of what happened when concerns were listened to. He gave an example of a project which came about because concerns were raised and, thanks to an open leadership approach, resulted in long term (and measurable) patient safety improvements.

There followed an interesting and powerful discussion on the current culture, where many of the delegates expressed their concerns that it remains unsafe to speak out at the moment. This included reservations and serious concerns about the effect of the Freedom to Speak Up Guardian initiative.

The final talk for the morning was given by a current whistleblower, who wishes to remain anonymous, who outlined their current situation and the background to it. This was a disturbing story which paints a picture familiar to many whistleblowers, where patient safety concerns are turned into an employment issue and the focus is distorted in a complex web of bureaucracy, obfuscation and accusations.

The afternoon session was chaired by Fergus Walsh, BBC Medical Correspondent. Our guest speaker was Steve Bolsin, the man who blew the whistle on failings in paediatric heart surgery at Bristol Royal Infirmary. This led to the Kennedy inquiry, which vindicated his concerns and was a landmark in clinical governance. He subsequently found it impossible to find another position in the UK and moved to Australia, where he became director of critical care services at Geelong Hospital in Victoria, achieving world class outcomes with the adult cardiac anaesthetic service he started. He has honorary professorial positions at Monash and Melbourne Universities.

Steve gave an account of the events in Bristol which even today, nearly 30 years later, was a poignant reminder of what happens when people try to speak up and blow the whistle and a club culture closes ranks to protect themselves and their organisations. This led to a powerful group discussion and questions to and from the panel, and highlighted ongoing concerns.

The event concluded with a session on action planning, collecting ideas and keeping up the momentum.

Dr Steve Bolsin speaking at TUTV! 2 London

Next steps:

One of the main areas of feedback is that these type of events enable people to get together who normally never meet, and that the strength of this networking, and the non-hierarchical approach adopted, will help in delivering a just culture in health & care.

Specific actions proposed included:

Building links with academic institutions and existing research projects
Linking with the BME community and leaders, who suffer disproportionately as whistleblowers and were under represented at the London conference.
Building links with whistleblowing organisations
Setting up action learning projects e.g:
- To find out more about all costs of victimisation of whistleblowers, (legal fees, settlement agreements, ‘garden leave’ etc…).
- Looking at the effect on relatives of whistleblowers
- Looking at whistleblowing in remote and rural areas
Introducing more visual displays such as one shown at the event the ‘cost of bullying in the NHS’ and using the hashtag #tutvlondon

Cost of bullying in the NHS display (figures for 7 hours) based on ACAS figures and the NHS staff survey

Promoting the Turn Up the Volume! model of engagement in England and beyond

Organiser’s comments:

‘The Turn Up event went well. I believe that together we moved things on a little. The event linked together more great people and academic institutions, and came up with some actions.

My aspiration for the movement is to demonstrate how (or if) this approach to ‘engagement’ events works. The main characteristics being that it’s open to all, non-hierarchical and aims to look at things from all angles.

My personal goal is to be able to return to the clinical work I nearly lost when I tried to raise concerns and was bullied. I was very lucky due to my unusual career, and my experience of both clinical work, troubleshooting and senor management. Many people aren’t so lucky and their continued exclusion is great loss to the NHS and Social Care. Not to mention the personal suffering and the failures to keep patients safe, which is why all genuine whistleblowers put their heads over the parapet in the first place.’

Resources:

Updates will be posted on the https://www.carerightnow.co.uk/turn-up-the-volume-resources-2/ .

Author: Steve Turner Date: 23/6/2016

Changing mindsets and delivering safe care in Cornwall together. #devocornwall

March 20, 2017 By Steve Turner

We want the best health care system in the world, & the most efficient and effective system …

We have an opportunity to do things differently in Cornwall

How do we achieve this?

The challenges in Cornwall

There’s a huge amount going on with health and social care in Cornwall. Including the Sustainability and Transformation Plan [STP]; exposure of abuse and neglect in care homes; concerns over hospital closures, delayed discharges taking up hospital beds, and devolution of services on the way.

Although I have worked in health and care for over 30 years, I struggle to keep up with the issues and understand how services are organised. This isn’t helped by the current polarisation of views.

On the one hand we have a big dose of NHS and Council ‘spin’, excessive bureaucracy and even bullying. On the other hand we have public concern, often expressed around specific issues, and sometimes based on unfounded rumours.

Neither of these positions are helpful, and neither represent the vast majority of people (public, staff and patients) who just want good services delivered by kind people who are open, accountable and transparent.

#devocornwall

We have a great opportunity now with the devolution of health and care services. This will be realised if we all build bridges, and transcend the usual hierarchical boundaries. We all need to listen and learn. Everyone, to coin an overused phrase, needs to step out of their comfort zones.

Why we need to think differently?

Several community hospitals are under threat of closure, leading to anger and dominating the headlines. Less attention is given to identifying and measuring the benefits, and any disadvantages of community hospitals. For example, can they be staffed adequately, bearing in mind this means Doctors, Nurses, Physiotherapists, Radiographers, Dieticians, Speech and Language Therapists, Social Workers etc.? Is home care a viable option for patients and carers? Are there any creative options such as bringing back the old style ‘convalescence’? Is rural isolation and lack of public transport the major issue?

It’s becoming increasingly difficult to book a timely GP consultation. This has led to several inaccurate scare stories in the press about ‘cuts’ to face to face GP contacts. This needs deep thought as there are times when easy access to a GP on the ‘phone, or on-line, may actually be a better option. Access to health information from Community Pharmacies or in NHS run clinics in shopping centres, or better health information and advice available locally, may be more effective approach. Leaving GPs free to spend more time with those who need their help and expertise most.

It’s now widely accepted that the NHS and Social Care is underfunded. Despite this there is still a great deal of duplication and waste in the system. How many times have you been asked to repeat information to Health Professionals which others already have? Do some services overlap, and are there gaps? Do different organisations link seamlessly with other organisations? Are all services accessible to all? Many people have important stories to tell on these areas of inefficiency.

Now’s the time to talk about this, find out what’s planned, and take action together. ‘Patient engagement’ key component of the STP and #devcornwall.

Patients and public need to take the lead on this. It’s not the NHS or Cornwall Council’s plan it’s ours.

Personal views of Steve Turner. MD Care Right Now CIC, a Cornish Company

Version 2

Date: 30/03/2017

This article is adapted from a letter which fist appeared in the St Austell Voice

‘I don’t want to hear anything bad’ – whistleblowing in health & social care.

Is this the profile of a healthcare radical or a troublemaker?

Steve is a nurse prescriber, Head of Medicines and Prescribing for @MedicineGov , Associate Lecturer at Plymouth University and former NICE Medicines and Prescribing Programme Associate.

You can follow Steve’s tweets @MedicineGovSte

Looking for someone who can engage people across boundaries? I’m available to speak at events and as a commentator

Boundary spanning in health and care -a short profile of Steve Turner