The health service needs whistleblowers

Published in The Independent (September 9th, 2009)

Soon after Alan Milburn became Health minister in 1997, he wrote to employers across the National Health Service telling them that staff must have “maximum freedom of speech” without fear of victimisation. Two years later, a ground-breaking piece of legislation gave legal protection and uncapped compensation to whistleblowers in Britain. Only Japan and South Africa have statutes of similar force.

Since then, the NHS has fought hard to introduce a culture that encourages staff to report malpractice. But as ever with our health service, the outcomes do not always match the intentions. Public Concern at Work, an independent charity that provides a helpline for whistleblowers, says that one in four of its calls are from people working in health and social care. Almost half of these concern patient abuse and public safety.

These are worrying figures, given such helplines tend to be used by people who have, literally, come to the end of the line. “We’ve had laws protecting whistleblowers for 10 years,” said Peter Carter, general secretary of the Royal College of Nursing. “They are not worth the paper they are written on if they sit in a drawer and gather dust.” He commissioned a survey of 5,000 nurses earlier this year that found nearly two-thirds had raised issues about care, but one in three saw no action taken and one in five were discouraged from reporting concerns.

The RCN has taken up the case of Margaret Haywood, a veteran nurse struck off in April after secretly filming neglect of elderly patients for a BBC documentary. She was found guilty of misconduct by the Nursing and Midwifery Council, a verdict that smacks of a profession closing ranks and which will only intimidate other whistleblowers.

What made this verdict all the more depressing is that it came just a month after the report into one of the worst scandals in recent NHS history, in which up to 400 patients died as a result of shortcomings at Stafford Hospital. An inquiry discovered receptionists carrying out medical checks and patients left without food, drink or medication. It also found that incident reports highlighting problems ended up in the bin and complaints went unheeded.

Since writing in this paper about failings encountered in the NHS, I have received scores of emails from patients dismayed by the quality of their care – and from health care staff desperate to improve the service. Too many say there is a culture of cover-up, and are worried about speaking out publicly. ‘The prevailing culture is to stifle the slightest dissent,’ said one hospital doctor.

This must change. Any enlightened organisation should embrace criticism as a way to confront shortcomings and improve its service. Whistleblowers need to be encouraged at every level, not threatened over their career prospects. This is especially true in a vast, monolithic organisation such as the NHS, where costs are soaring and when the issues raised can be a matter of life and death.

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