A sickness at the heart of the NHS
Published by The Independent (14th December, 2015)
Two weeks ago I went to a journalism awards ceremony at which the speaker was a man who blew the whistle on malpractice within the National Health Service rather than the usual comedian or TV personality inflicted on such events. Gary Walker, a former hospital trust chief executive, spoke passionately about how he was gagged, smeared and threatened in the most appalling manner after raising concerns that pressure to meet targets was compromising patient safety.
Walker was the most senior whistleblower in NHS history and his speech, highlighting the crucial public interest role of the media, was rather chilling. He said he knew it was custom for top staff to cover-up incompetence by gagging those that sought to speak out, yet was shocked to be subject to such a restrictive silencing order that he could not even mention its existence – then threatened with being sued for £500,000 when going public. This brave man, almost crushed fighting for decent care, claims he remains ‘blacklisted’ by the NHS.
This is all too often the plight of whistleblowers, as I have seen dealing with others who sought to highlight corruption and waste in public services. Politicians promise to protect them, new regulations get published, but nothing changes. And when mistakes come to light after cover-ups, no-one is held accountable – even when involving hundreds of premature deaths as in the shameful mid-Staffordshire hospital scandal. Some of those responsible even glided on to other top jobs.
Walker’s speech underlined the complacent acceptance of the cover-up culture that exists in the NHS, often sanctioned at highest levels. The intuitive reaction seems to be denial, regardless of further pain to patients and families, not acceptance that errors can be made and determination to avoid repetition. Mistakes are hushed up, lies told, notes ‘lost’, lawyers briefed. Compensation cases descend into long, bitter battles. Sadly, we have seen lots more evidence of this corrosive secrecy in recent days.
First came a damning report by the health ombudsman highlighting the ‘wall of silence’ faced by families questioning patient deaths. It found hospitals failed to investigate cases, missed crucial evidence, lacked transparency and cleared staff despite avoidable deaths – perhaps unsurprisingly, since medics leading half the reviews were not ‘independent’ of events under examination. Parents of one baby girl left with brain damage after a mistake had to wait three years for answers; later it emerged the NHS inquiry was led by a close colleague of the doctor in charge.
Next came reports of staff in Bristol recorded confessing to blunders in another case of a dead infant, then discussing deletion of the conversation for fear of incrimination. Days later, it emerged the huge Southern Health NHS Foundation Trust failed to investigate the unexpected deaths of more than 1000 patients in four years, especially those involving people with mental health problems and learning difficulties. This revealed not only casual indifference but also deep-seated bigotry towards such people across society; another hospital apologised last week for deciding Down’s Syndrome was enough reason to place a ‘Do Not Resuscitate’ order in a patient’s medical file.
You have to wonder if use of the word ‘trust’ in these hospital titles is cruel irony. The data – correctly branded shocking by health secretary Jeremy Hunt – was uncovered only due to an independent review after the death of Connor Sparrowhawk, an 18-year-old who drowned in the bath following an epileptic seizure at an Oxford hospital. It seems incredible a boy with learning difficulties could die like this in a supposed place of sanctuary; unsurprisingly, the fatality was found to be avoidable.
Yet despite her grief, Connor’s mother confronted what she calls ‘barbaric’ behaviour from the trust as she fought its stonewalling to determine the cause of her son’s death; a lesser person might have crumbled. Originally, they attributed it to ‘natural causes’. Finally, she won an inquest that found neglect, then came the review. Yet these findings merely expose the tip of a wider national problem; after all, it is estimated an appalling 1,200 people with learning difficulties die needlessly each year due to inadequate care.
For too long the NHS coasted along on the wave of public adoration and sought to mask failures behind medical arrogance. I have seen this with my own family, heard countless cases from others. Slowly this is changing after a series of grotesque scandals as the public becomes more demanding and some staff see the benefits of transparency. Yet despite tougher inspection regimes and new duty of candour rules, the callous cover-up culture seems hideously ingrained in our ultra-defensive health system.
Hunt rightly says the NHS should learn from airlines, with their remorseless emphasis on safety and staff encouraged to voice slightest concerns. He points to Virginia Mason Hospital in Seattle, which overhauled its approach after a woman was killed by an injection of the wrong substance during a brain operation; now staff raise hundreds of alarms a month and it is one of the world’s safest hospitals. Some British hospitals are heading this way; perhaps the new Independent Patient Safety Investigation Service will prompt more to follow suit.
Let us hope so, for this routine abuse of trust and casual contempt for safety concerns is a sickness in the heart of the health service. It undermines good staff, corrodes services and is contemptuous of patients, families and taxpayers. And it can only have disastrous consequences at a time when pressures are building and costs heavily constrained.