Hotline Fever

January 1 saw the launch of a new whistleblowing hotline – 08000 724 725 – for NHS and social care staff. It’s free, publically funded and available at weekdays between 08.00 and 18.00 with an out-of-hours answering service.  It’s run, for no obvious reason,  by the Royal Mencap Society. The charity understands the importance of protecting vulnerable patients but whether it has the advocacy and employment expertise to support staff  in what is often a suicidal career move remains to be seen.

Health Secretary Andrew Lansley is very keen on his new gimmick – “This will play an important role in creating a culture where staff will be able to raise genuine concerns in good faith, without fear of reprisal” – but it beggars belief that he can glibly promise both confidentiality and protection from retribution given how whistleblowers have been hunted down in the past (see Shoot the Messenger  Eye ). As soon as concerns are raised, the NHS pretty soon draws up a list of who the secret snitch might be in an attempt to shut him or her up. Threatening, counter smearing, paying off and gagging the source is far easier than investigating the allegations.

Theoretically, the hotline could be a force for good. It should document that an employee legitimately raised concerns through channels approved by the employer and demonstrate that the employer had knowledge of the concerns on a certain date. But there is no guarantee that NHS and social service employers will properly investigate the concerns or do anything other than pay lip service to promises of accountability and transparency. And if the concerns implicate those at the very top of the organization – such as the Mid Staffs scandal and the Gary Walker case (Eyes passim) – the NHS protects the most powerful at all costs.

Lansley would have been better advised to wait for the findings of the Mid Staffs inquiry before launching his hotline. Hundreds, perhaps thousands, of patients died as a result of substandard care, the chief executive claimed the mortality statistics were wrong and the strategic health authority and Care Quality Commission were complicit in the cover up. Only one nurse, Helene Donnelley, blew the whistle by reporting on the appalling care she witnessed on 50 occasions. She got no help from her union, was bullied by other staff and was sometimes too afraid to walk to her car in the dark. One consultant had also seen many patients put at risk and had reported it up through the organisation but again got no action. When asked at the Inquiry why he had not blown the whistle he replied: “Because I’ve got a mortgage to pay.”

Whistleblowers shouldn’t have to live in fear or remain anonymous on distant phone lines. They – along with patients and relatives – should be able to raise concerns openly and in person – and then be acknowledged if they help expose and prevent poor care. Each year, the chief executive of every NHS trust should be giving awards to those who have raised concerns and protected patients. Without a change of culture, a phone-line is pointless.

Meanwhile, solicitors representing a group of NHS whistleblowers may launch judicial reviews against the Care Quality Commission, NHS London and two London acute trusts – Ealing Hospital NHS Trust and South London Healthcare NHS Trust –  for failing to comply with their duties in supporting whistleblowers under the Department of Health guidance. (www.patientsfirst.org.uk). Just having a whistleblowing policy and a hotline does not make whistleblowers safe, and a professional duty to speak up is pointless if there isn’t a commensurate duty on managers to listen and act.

This point cannot have escaped Robert Francis QC, chair of the Mid Staffs inquiry, who sat through 139 days of public hearings, warned of a ‘tsunami of public anger’ and heard some limp buck passing between the Department of Health and the Care Quality Commission. He’ll also have discovered  how an organization that purports to care can be so brutal to those who challenge the system and put patients first. If you want a career in the NHS or social care  it’s often  safer to keep your head down and ignore bad care. That has to change in 2012.