Another NHS scandal erupts. Last week serious criticisms of St George’s Hospital heart unit were made by Professor Berwick who had been asked to undertake an investigation to the department when unusually high death rates were detected [3.7% for cardiac surgery compared with 2% nationally]. He declared internal scrutiny was “inadequate” and the department was riven between “two camps” exhibiting “tribal-like activity”. He commented further saying “Some felt that there was a persistent toxic atmosphere and stated that there was a ‘dark force’ in the unit.” Conversations with staff revealed they were shocked by the death rate, but “most felt that poor performance was inevitable due to the pervading atmosphere”. Two surgeons have since been suspended from their posts but sources allege that these were surgeons who, rather than being responsible for the problems, highlighted them and attempted to blow the whistle on problems at the unit and have thus been victimised by the management at St Georges [St Georges denies this].
Whistleblowers are people who bring attention to the failings of the organisation they work for. They have been described as a combination of hero and disloyal sneak, which illustrates exactly what a difficult position they are put in. They are rarely popular, are denied promotion and often have to sacrifice their careers. The scandal at Mid Staffordshire NHS Trust was one of the last major scandals in the NHS. About 500 people were estimated to have died of negligence and appalling standards of care as a result of cost cutting by management. It emerged that staff who tried to bring the crisis to the attention of their superiors were bullied into silence. Sir Professor Brian Jarman of Imperial College heads the health analytical company Dr Foster which looks at hospital statistics [It was the statistical analysis from the Dr Foster unit at Imperial which first led to questions being asked about the standard of care at Mid Staffs] he stated that the NHS still continues to foster ‘a culture that allows suppression of the truth and victimisation of whistleblowers.’ Carol Parkes wrote in the BMJ at the time
‘If no one dares to ask the unpopular questions and everybody keeps their heads down, the organisation can succumb to poor thinking, poor strategy, and poor leadership.’
The GMC states ‘make the patient your first concern’ Whistleblowing is an obligation. A doctor can be struck off the GMC registrar if he fails to report concerns. Patient care and safety should be a doctor’s primary concern. If you don’t report such matters you may not be an abuser but you can be viewed as a collaborator. It is always hard to speak out against your colleagues and employers but it is essential.
NHS staff have the knowledge and the understanding to know when care is not being properly provided by their organisations. Patient feedback is valuable but enabling staff to speak up about faults within the NHS is probably more important in the effort to improve the NHS than employing countless expensive management consultants. The Francis Report into Mid Staffordshire stated that junior doctors [who frequently move posts as part of their training schemes] and are less inured or entrenched in the ways of working of departments ‘are the eyes and the ears of the NHS.’ In my local area the CCG has a ‘MAD’ button on its website which stands for ‘Make A Difference’. Clinicians like myself press it if we feel there is a problem with care and I am pleased to say it is investigated.
Numerous scandals over patient care have occurred over the years. We had the Bristol Heart scandal in which incompetent surgeons operated on babies [the anaesthetist who reported it to the press had to find work in Australia], the Winterbourne Home scandal and Mid Staffs. NHS staff spoke up in all these cases but were not listened to! More needs to be done to protect the whistleblower!