Exposing the reality behind the spin
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 canceled 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 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
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.
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.
Author: Steve Turner. Date: 15th 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’.
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.