Burying Bad News No 789
The repeated refusal of the Government to publish its ‘risk register’ for the Health and Social Care Bill is unsurprising given the culture of secrecy and cover-up in the NHS. Information commissioner Christopher Graham has now judged that the document should be published, but health secretary Andrew Lansley is likely to sit on it for 28 days before deciding whether to launch an appeal. The Bill is littered with risks, most notably that billions of pounds will be spent on another massive, rapid, ill thought-out restructure that ends up roughly where we started but with staff demoralised and patients neglected.
As one GP commissioner put it: ‘We were initially told we could choose the size of our consortium, so we went small so we could be flexible. Then we were told we had to be much bigger to have any clout so we merged with other local consortia, which was a huge hassle. Now we’ve been told we’re the wrong shape and have to mirror the local authority boundary. That’s three reorganisations in under a year. Are they making it up as they go along?’ The GP consortia (now renamed clinical commissioning groups) will be advised by ‘commissioning support organisations’ which – miraculously – are shaping up to be the same size as the Primary Care Trusts they will replace. But many PCT staff have now left the NHS so management consultants such as McKinsey and KPMG are being called in, which was probably Lansley’s plan all along. Amidst the confusion, 20,000 forgotten patients have waited over a year for treatment – slightly longer than the 18 week pledge.
Meanwhile, staff who try to raise concerns about poor patient care are being scared off by lawyers. The super-gagging of former United Lincolnshire Hospitals NHS Trust (ULHNT) chief executive and all of his employment tribunal witnesses (Eye last) prompted Peter Bottomley MP ‘To ask the Secretary of State for Health if he will instruct each part of the NHS to lift any gagging restrictions on (a) present and (b) former NHS staff that (i) have and (ii) have had the effect of withholding from the public and the media information, evidence or justified concerns about levels of care in the NHS.’
Health Minister Anne Milton replied that ‘the Public Interest Disclosure Act provides that any clause or term in a contract, or other agreement between a worker and their employer is void in so far as it purports to preclude the worker from making a protected disclosure. Health Service Circular 1999/198 made it clear that local NHS trusts should have in place policies and procedures which prohibit confidentiality “gagging” clauses in contracts of employment which seek to prevent the disclosure of information in the public interest, which includes information, evidence or justified concerns about levels of care in the NHS.’
Alas, NHS trusts often ignore both PIDA and DH circulars, knowing that a scarily worded legal letter will silence many NHS whistleblowers, especially those who have been sacked and find themselves unemployable and facing bankruptcy, without the resources to mount a legal challenge should they wish to test Milton’s theory that their gagging order is ‘void.’ The Times has unearthed 3 gagging clauses that prevent whistleblowers taking concerns about colleagues to the GMC. And Walker’s witnesses have received solicitors’ letters that state ‘Please ensure that you and your partner and immediate family do not disclose to anyone the terms of any agreement reached and we would ask that you undertake not to disclose in the future to anyone the terms of any agreement. We are instructed that our client requests that you take this request seriously and ensure you abide by this request. Further all the information and documentation our client or we passed to you was done so confidentially and is not to be distributed any further.’ As one witness put it: ‘I have seen much of the evidence which would have been heard in public in the Tribunal; in my opinion it would have been extremely damaging to a number of very senior officials within the NHS.’
The DH didn’t listen when Gary Walker blew the whistle that patients were in danger and he was sacked. Care at ULHNT then became so bad that even the Care Quality Commission spotted it (Eye last). For Milton to claim NHS staff are free to speak up about poor patient care when her own department buries it is clearly nonsense. Something for Lansley’s secret risk register, perhaps?