By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 22 November 2017
The violence done to whistleblowers is savage. Whilst it is not in most cases physically administered violence, serious mental and physical illness sometimes occurs in the context of damage to social networks, and has included marital breakdowns. Only those who have experienced it or are close to a whistleblower, can truly understand how serious this damage can be. 1 2
The huge pressure that is brought to bear on whistleblowers in serious cases frequently includes sustained coercion in the form of false allegations. Sometimes these are of a criminal nature as experienced by NHS whistleblower Dr Raj Mattu. 3 The intense stress of living under such threats for years at a time, combined with the uncertainty of not knowing what further falsehoods will be levied, takes a serious toll.
The right to a fair trial is recognised to be a fundamental human right. Being plunged into Kafkaesque misrule by a powerful, multi-billion pound employer aided and abetted by other bodies that should help but instead choose to collude, can be a very frightening experience.
Mattu was at one point seriously ill in hospital, with an autoimmune illness that can be sensitive to stress, when he received news that he had been sacked by University Hospitals of Coventry and Warwickshire NHS Trust.4
Some early work by Soeken ad Soeken, albeit rough and limited by sampling issues, nevertheless puts a human face on whistleblowing:
Soeken and Soeken 1987 PhD thesis
The long-suffering NHS frontline is pushed and pulled in all directions with sometimes conflicting diktats from above. These often issue from those who command little moral authority because they do not live the values they preach.
A glaring contradiction is the requirement to report harm and risk under the professional Duty of Candour 5, sitting alongside flashing neon signals that simultaneously say “Shut up and go away”.
Many are quick to tell frontline staff that they must speak up, but are much less quick to defend them when they do.
The parliamentary Health Committee thundered in January 2015:
“….this committee is clear that professionals have a duty to put patients first and to come forward with their concerns”
Health Committee report on Complaints and Raising Concerns, January 2015 6
But in the same report, the committee did not go far enough in ensuring whistleblowers would be protected.
The committee made a broad recommendation for “apology and practical redress” for harmed whistleblowers, which was welcome. However, it did not prescribe any hard hitting system changes such as law reform or a public inquiry.
Instead, the committee deferred to Robert Francis, acting for the Department of Health, who was yet to publish his report of the Freedom To Speak Up Review. 7
Despite the Freedom To Speak Up Review subsequently proving to be ineffectual and a great disappointment, the Committee has done little to challenge the lack of progress or to even find out if harmed whistleblowers have received the ‘apology and practical redress’ that it asked the Department of Health to provide.
The Committee has so far refused to hold a follow up hearing on NHS whistleblowing.
The Committee is hoisted by its own petard, having ventured this opinion in its 2015 report:
“The treatment of those whistleblowers has not only caused them direct harm but has also undermined the willingness of others to come forward and this has ongoing implications for patient safety. 6
Until the system takes more responsibility and provides real protection, and not just lip service, the great and the good cannot complain if staff do not always report.
Flagrant abuses of the NHS disciplinary process continue, with unjustified suspensions and harsh, arbitrary discipline wielded by some NHS employers not just against whistleblowers but in cases of error and other matters. 8
To demand that staff must always whistleblow in the face of such hypocrisy and crushingly unjust culture is not only unrealistic but wrong. When people approach me for help pre-disclosure, I provide only information and help people to assess risk either way. I leave it to individuals to make the judgment call for themselves: to disclose or not, and to disclose anonymously or on named basis.
It is not safe to apply a blanket approach when each case may be very different. There is not only whistleblowers and the public interest to consider, but families as well, who may be profoundly affected by any decision.
As I write I think about a whistleblower who is very well known to me. They have exhausted every avenue in raising their concerns, but have been badly failed by all, including the Secretary of State for Health. The whistleblower’s reward for dedication and professionalism, and years of being put through the grinder? Uncontrolled high blood pressure and renal failure, which will now require a kidney transplant.
And have this whistleblower’s safety concerns ever been properly resolved? No.
So, don’t tell me what staff should do. Tell me what politicians and other senior figures will do to protect whistleblowers and the public interest.
Waste Industry: The NHS disciplinary process & Dr John Bestley
Post-scripts on Paula: NHS England’s apologia & regulatory reticence
Sir Robert Francis & Reform of whistleblowing law
1 What happens to whistleblowers and why. Dr Jean Lennane
Social Medicine. Volume 6, Number 4, May 2012
2 Whistleblowing. A Health Issue. Dr Jean Lennane. BMJ, 11 September 1993, Vol.307, P.667-70
3 Raj Mattu and the death of whistleblowing. Dr Phil Hammond. Private Eye Issue 1364, May 2014
4 Vindicated: NHS whistleblower backed by the Mail receives £1.2 million payout after NHS spent £10m trying to crush him after he exposed shocking failings in care, Daniel Martin, Daily Mail 2 February 2016
5 Joint statement by Chief Executives of General Medical Council, Nursing and Midwifery Council, General Pharmaceutical Council, General Optical Council, Pharmaceutical Society NI and General Osteopathic Council on the Duty of Candour
GMC guidance on Duty of Candour
NMC guidance on Duty of Candour
6 Health Committee report, Complaints and Raising Concerns, 21 January 2015
The committee made only two recommendtions in relation to NHS whistleblowing governance:
“Treatment of staff raising concerns
- The failure to deal appropriately with the consequences of cases where staff have sought protection as whistleblowers has caused people to suffer detriment, such as losing their job and in some cases being unable to find similar employment. This has undermined trust in the system’s ability to treat whistleblowers with fairness. This lack of confidence about the consequences of raising concerns has implications for patient safety. (Paragraph 114)
- We expect the NHS to respond in a timely, honest and open manner to patients, and we must expect the same for staff. We recommend that there should be a programme to identify whistleblowers who have suffered serious harm and whose actions are proven to have been vindicated, and provide them with an apology and practical redress. (Paragraph 115)
7 Robert Francis’ report of the Freedom To Speak Up Review 15 February 2015
8 Waste Industry: The NHS disciplinary process & Dr John Bestley