My Background

I am an NHS doctor, investigative journalist, broadcaster, campaigner and comedian. I was previously a lecturer in medical communication at the Universities of Birmingham and Bristol, training medical students and doctors to cope with difficult consultations. As a doctor, I worked part time in general practice for over 20 years, and has also worked in sexual health. I currently works in a specialist NHS team for young people with chronic fatigue syndrome/ME.

I have been Private Eye’s medical correspondent since 1992, broke the story of the Bristol heart scandal that year after being given evidence of poor care by Dr (now Professor) Stephen Bolsin. I gave evidence to the subsequent Public Inquiry and have been an advocate for NHS whistle-blowers for 22 years, covering many of their stories. In 2012, I was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Investigative Journalism for ‘Shoot the Messenger,’ a Private Eye investigation into the shocking treatment of NHS whistle-blowers (attached)

I am also a Vice President of the Patients’ Association and a patron of Meningitis UK, the Doctors’ Support Network, the Herpes Viruses Association, Patients First, PoTS, the NET Patient Foundation and Kissing It Better. I am also a fundraiser and advisor for the Association of Young People with ME.

My Thoughts

Speaking up and raising concerns is, or should be, a routine and daily part of patient safety procedures. The aim is to protect patients from avoidable harm. It should not be seen as anything unusual, rather the reverse. We should all be doing it every day. It should be in our DNA.

The priorities whenever you speak up are always

Protect Patients from Avoidable Harm. Speaking up needs to happen in real time, with a real time response. A public inquiry years after repeated avoidable harm is a sign of massive systemic failure.

Protect the Evidence. Routine real time safety monitoring should include recording, dating and keeping all serious concerns securely. Staff should be trained to follow a process of speaking up in four stages. 1. State the concerns (actual or unacceptable risk of avoidable harm). 2. State and supply the evidence in real time (even if it is incomplete). 3. State who you raised the concerns with and when, what you think needs to happen now and what the possible solutions are as you see it. 4. State what actions are taken and whether they address your concerns satisfactorily. If not, complete the cycle until they do.The above would capture the problem-solving suggestions of the member of staff as well as documenting all the evidence in real time should future inspection and improvement bodies need to see it. A key problem when staff raise concerns is that evidence can be tampered with and go missing, and information can be erroneously recalled after the event. So real time monitoring and secure documentation of serious concerns is needed. And everyone in the NHS needs to know how to do this and that it is their duty and legal obligation to do this.

Promote Transparency and Accountability. Patients and carers must be told about any avoidable harm that may have occurred, be fully involved and informed in any investigation and have clear instructions as to the chain of accountability should they wish to pursue it further.

Protect the Livelihood and Mental Health of NHS Staff. Raising serious concerns is very stressful for both those doing the raising and anyone who may be implicated in avoidable harm. Intelligent and kind inspection and improvement bodies are needed. A swift ‘no blame’ suspension of services may be needed if unacceptable risk to patients is deemed ongoing. A ‘fair blame’ culture in needed as the investigation unfolds. Rarely is a serious single error in a chaotic system the fault of an individual. However, failure to act on a clear concern to prevent a repeat is more likely to be.

Speaking Up Beyond Your Organisation but Within the NHS

This must happen when you do not believe the organisation has taken your safety concerns seriously, and patients are either being harmed or are at an acceptable risk of avoidable harm.

If your organisation does not agree with you, you have to have a secure way of protecting the evidence and protecting yourself and passing information securely to both inspection and improvement bodies for appropriate consideration and action. Everyone in the NHS must be clear what this process is, and it should happen as a matter of routine rather than under the label of whistleblowing. At this stage, the information is still remaining within the NHS, although patients and carers always have the right to make what they are told public. The NHS should therefore operate under the understanding that serious errors will always become public knowledge.

There is currently some debate about who the inspection and improvement bodies are. The CQC says itself as an inspection body only and not an improvement body. The current leadership at NHS England seems to be distancing itself as an inspection and improvement body. It is not clear, for instance, whether medical director said Bruce Keogh will continue to lead investigations into trusts with, for example, high mortality rates or concerns about heart surgery. There is an urgent need to clarify who the overarching inspection and improvement bodies are, and how members of staff, patients and carers with serious concerns should contact them. If the commissioners are to be responsible for improvement, there needs to be good evidence that they have the expertise and resources to do this.

A further complication is that the National Institute for Health and Care Excellence sets very high and admirable Quality Standards that the NHS aspires to reach. However, it does not at present set minimum standards that the NHS must reach at all times. The CQC may use such minimal standards but these need to be explicitly stated and circulated so those raising concerns can judge whether the service has fallen below an acceptable level, or whether it is ‘good enough’ without being excellent.

Some of the whistleblowing cases I have investigated have been disputes between those raising concerns with very high standards, and those defending services with ‘good enough but not great’ standards.

Speaking Up Outside the NHS

This is what most people would define as whistle-blowing, and in these days of social media and mobile phones in hospital it is just as likely that patients and carers will do this as staff. A photo of a pressure sore or of a cupboard with a bed in it is very emotive, particularly when it is posted on Twitter next to the hospital’s and chief executive’s Twitter name.

If members of staff do not believe the inspection and improvement bodies have acted appropriately to protect patients from avoidable harm, then they too should take the information outside of the NHS. How and when you do this depends on the urgency of the situation, whether patients are being harmed now or whether the risk is at some stage in the future. It also depends on what you perceive the threat to your own mental health and livelihood is. You also have a duty of confidentiality – public whistleblowing campaigns are far more successful when NHS staff and the patients/carers affected unite around common goals.

When whistle-blowers contact me, I tell them that I have never been sued in 22 years for getting a whistle-blowing story wrong, but I have never been able to get a whistle-blower his or her job back. From a personal livelihood and mental health perspective, it is a huge risk doing what you think is the right thing, and any public exposure also increases the stress levels of those who you are raising concerns about, perhaps even making the situation even riskier for patients, at least in the short term. It’s also important to get proper legal advice and advocacy, which your union and defence body may not always be willing to give – presumably because your concerns could upset many other paid up members.

For these reasons, I tell those who want to raise concerns via the media to think carefully, ensure they have considered all other angles and that they have enough evidence to support their claims, even if it is incomplete. I tell them to get legal advice, and that I will give the NHS organisation right of reply, which usually means very protracted correspondence with lawyers. I never print the identity of a whistle-blower if they do not wish it to be revealed, but organizations generally reach their own conclusions and this does not stop them trying to shoot the messenger rather than accepting they have a patient safety problem.

My firm belief is that we will always occasionally need whistle-blowing outside of the NHS, but with speaking up seen as a routine, every-day and vital part of patient safety monitoring, secure capture of concerns and evidence that can’t be tampered with or forgotten at a later date, and patients and carers told honestly and kindly whenever they have been harmed by care, the need for protracted media campaigns and hugely damaging and costly public or GMC/NMC inquiries well after the event could be reduced. But it needs strong leadership to cement this transparent, accountable, spin-free, politics-free culture in place.

Finally, people who have taken their concerns outside of their organisation with the noble intent of protecting patients may find it hard to return to that organisation but they should, if they want, be offered appropriate employment elsewhere in the NHS. In my experience, these are often the very people who could give the NHS the strong, transparent, accountable leadership it needs.