We’re all whistleblowers now

Last year, I wrote a special report for Private Eye with the journalist Andrew Bousfield. It was called ‘Shoot the Messenger – How NHS Whistleblowers are Silenced and Sacked’ and had some extraordinarily powerful stories in that even the Eye’s lawyers were a bit twitchy about. In the event, we weren’t sued. Far from it, the report was cited in an early day motion in the Commons and appeared in both Health Select and Public Account Committee meetings. Even better, it was shortlisted for the Martha Gellhorn Prize for Journalism.

Martha Gellhorn was one of the most distinguished journalists of the 20th century. She reported on the effects of the US Depression, chronicled the rise of fascism in Europe, covered key military confrontations in Western Europe, stowed away on a hospital ship to report on the D-Day landings and entered Dachau with American troops in May 1945. In 1966 she covered the war in Vietnam and in the 1980s she wrote about the wars in El Salvador and Nicaragua. She reported from Panama in the wake of the US invasion and later exposed the appalling plight of street children in Brazil.

The award in her name is for journalism that ‘challenges secrecy and mendacity in public affairs’ – or ‘official drivel’, as Gellhorn called it – and ‘raises forgotten issues of public importance, without fear or favour.’ We didn’t win, but it’s good that the plight of those who dare to speak out for patient safety in the NHS and suffer grievously as a result is getting more public recognition.

Since the report was published, the NHS Constitution has been strengthened to support whistleblowers, an NHS whistleblower hotline has been introduced, the GMC and NMC have reiterated the professional duty of doctors, nurses and midwives to raise concerns and the Department of Health has once again stressed that the use of gagging clauses by NHS lawyers that suppress patient safety information must cease.

I’m sceptical that these are anything other than a superficial, pre-emptive response to the impending Mid Staffs report. A key question for the latest public inquiry into NHS failings is why – with a plethora of regulators, professional duties and a law, the Public Interest Disclosure Act, specifically designed to protect whistleblowers – did no-one blow the whistle when it was evident to many staff the standards of care were appalling? Were they desensitised into accepting how dangerous and overstretched the frontline of the NHS can be? Were they too frightened to speak up? Did they not know how or did they simply not care anymore? Whatever the reason, the GMC and NMC could potentially have hundreds of referrals on their hands for failing to speak up, yet it’s hard to see how mass punishment will make the NHS safer.

The Health Foundation has done a lot of good work on making systems safer, but they can only flourish in the right environment and, as Henry Ford famously observed, ‘culture eats strategy for breakfast’. The bellwether of an honest, open, accountable culture is how an NHS organisation listens and responds to challenge, either from those on the front line or staff and patients. The new ‘quality focused’ Care Quality Commission needs to measure not just the number of user complaints and whistleblowing concerns, but examine how they were responded to and ask the complainants whether they were happy with the outcome.

As GP commissioners become the supposed new powerbrokers in the NHS, it’ll be interesting to see how much power they really have and how likely they are to listen and act on the concerns of their colleagues, and avoid the top down silencing and reputation management that so often happens in such a politicised and increasingly corporate system. Medicine and nursing are unique amongst professions in their capacity to do significant harm as well and a huge amount of good, and yet the culture of openly acknowledging the harm we do, and measuring it on a daily basis to learn from and minimise it, is still a long way off.

When I chaired this year’s Patient Safety Congress, I asked 700 delegates to raise their hands if they thought the Health and Social Care Act would make the NHS safer. Not one hand went up. On the contrary, most thought it would make the NHS less safe. When I asked NHS Chief Executive David Nicholson if he was opposed to the reforms, he said – rather cleverly – that ‘I wouldn’t have the imagination to come up with them myself.’ But we know that the toxic mix of massive structural change and huge fiscal savings creates a perfect storm for future NHS disasters.

Nicholson conceded that the Mid Staffs recommendations could directly contradict some of the reforms. Amidst all the confusion, doctors must be brave and stand up for patients, not pensions. We are all whistleblowers now. And if we raise concerns in sufficient numbers we simply can’t be gagged.

Phil Hammond is a GP, writer, broadcaster and comedian.