I have been both a general practitioner and journalist for twenty years, breaking the story of the Bristol Heart Scandal in Private Eye in 1992 and giving evidence to the eventual Public Inquiry seven years later. Much of my journalistic work involves supporting and protecting NHS whistleblowers, while allowing their concerns to be made public in a way that could help protect patients from avoidable harm. One of the saddest elements about the high rates of death and brain damage for babies undergoing complex heart surgery in Bristol was that the problems were well known within the heart surgery community and regulatory authorities, and yet no-one – save for whistleblower Stephen Bolsin – saw fit to act.

Despite legislation to protect those who blow the whistle in good faith, I am not convinced that the lot of the NHS whistleblower has improved much over 20 years, nor that we have got any better at stepping in to protect patients from harm when concerns are raised. This is well documented in the recent Private Eye supplement, Shoot the Messenger. The Francis Inquiry may well find that NHS staff are now even less likely to blow the whistle, rather than more.

Staff that do blow the whistle are frequently marginalised, counter-smeared and suspended, and many subsequently agree to a modest pay off with a gagging clause to protect themselves from personal and professional ruin. The gagging clause is counter to DH guidance and technically not enforceable under PIDA, but few whistleblowers have the strength and legal resources to risk breaching it, and so their legitimate safety concerns are never made public and there is no evidence that they have been addressed.

Gagging clauses seem to occur in all walks of life for all sorts of reasons, and it may be that some are used by staff themselves to hide their own failings when they move jobs. However, the wider point remains that public money should never be used to suppress information that may be in the public interest. Gagging clauses provide management with a powerful tool to suppress stories of medical harm and cover up management wrongdoing (particularly the failure to act swiftly and appropriately when concerns are first raised).

I believe that many doctors who have previously been silenced would welcome the opportunity of openness and it might ensure action is taken on long standing safety problems. To maintain trust in the NHS, we need to explain why and how public money has been used to silence doctors. It would not harm the profession for this information to be released, and it may even improve it. In future, I would hope the CQC will assess the culture of the NHS by asking hospitals to provide evidence of how they responded to whistleblowers’ concerns, and whether the whistleblowers  were happy with that response, rather than unable to comment.

Promises, promises

The most any government can hope for when it comes to the NHS is that it leaves it in better shape than it found it.  The hugely disruptive structural changes of the Health and Social Care Act are unlikely to amount to much more than jumping up and down on the spot come 2015, and funding will have flat-lined or dipped.  But the Government has made a number of  bold  half-promises that could make a big difference to patients. Will they keep any of them?

Routine services should be available 7 days a week.  This is currently ‘under investigation’ by  NHS Clinical Director (and former heart surgeon) Bruce Keogh. There seems little point in lighting and heating hospitals all weekend but only offering emergency services, and it’s outrageous that your chance of surviving hospital depends on whether you get sick ‘in hours’ or ‘out of hours.’ According to a Health Service Journal survey, NHS chief execs rate the ‘out of hours’ safety of their hospitals as only 5.9/10. The theory goes that if routine GP and hospital services were available throughout weekends, there would be fewer unnecessary emergency admissions. But Keogh’s plan requires investment, resources and union backing.

Performance of individual surgeons to be published in the summer. Another of Keogh’s, this will apparently start with ten surgical specialties (adult cardiac,  vascular, upper gastro intestinal, colorectal, orthopaedic s, bariatric (weight loss), urological, head and neck, thyroid and endocrine and interventional cardiology). If it can be done in a fair way that doesn’t discriminate against surgeons taking on harder operations and doesn’t hinder surgical training, it’s a great idea. It might even stop orthopaedic surgeons dabbling with unproven joint replacements (Eyes passim). It was first promised after the Bristol Inquiry only 12 years ago (Eyes passim ad nauseum).

Hospitals will be forced to own up to mistakes. So promises health minister (and former obstetric trainee) Dan Poulter. The ‘duty of candour’ was another key recommendation of the Bristol Inquiry.   Poulter is proposing to make it ‘contractual’ (from April 2013) rather than ‘legal’,  which would give it less weight and may exclude GPs and dentists. Minimising the harm done to patients, and being honest and compassionate when harm does occur, are both vital for a humane NHS but it remains to be seen if this promise is genuine or just a move to pre-empt the Mid Staffs Inquiry report.

A national database of children at risk. Another Poulter promise, to track 11 million children through school, social care, hospital and GP visits and quickly alert staff to those who may be ‘at risk’ from abuse. Another laudable plan, first considered by Labour in 2000 after the Victoria Climbie tragedy. The ContactPoint database – which cost £224 million to set up – was scrapped by the coalition for ‘privacy and security reasons’, and switched off in August 2010.

 ‘Ofsted style’ ratings for hospitals and care homes.  Jeremy Hunt is keen on this, with hospital ‘superheads’ brought in to tackle poor performance. This suggests Hunt has little confidence in the CQC and Monitor to keep the NHS up to scratch, and that a visionary leader can be persuaded to be parachuted into a failing hospital to turn it around. Labour tried this with mixed results. Given the number of hospitals currently in financial crisis and providing patchy care, this will need a steady supply of superheads. Or maybe the basket cases can be rescued by ‘super’ Virgin or Circle.

All pensioners to be tested for dementia. Hunt has shown a commendable interest in dementia but any benefits of earlier diagnosis have to be carefully weighed against the harms of anxiety and misdiagnosis. According to the Torygraph, the Hunt plan sees bank and shop workers trained to ‘identify the condition’. Is this wise?

MD