Well done Channel 4 News and the Bureau of Investigative Journalism for their exposure of the widespread use of taxpayers’ money to silence NHS whistleblowers (Ch 4 news, 2.8.10). Many employment contracts still have gagging clauses and most doctors who invoke the Public Interest Disclosure Act (PIDA) to raise concerns about unsafe or fraudulent practice reach a settlement with their employer to prevent concerns being made public. Superficially, this smells of whistleblowers bottling it and taking the money, but when you look at the experience of those who refuse to be silenced, there’s no great incentive to do the right thing.
The NHS’s most famous whistleblower, Dr (now Professor) Stephen Bolsin, was praised in Parliament for raising concerns about standards of child heart surgery in Bristol nearly 20 years ago, and his actions were fully vindicated by a Public Inquiry. Yet he became unemployable in the NHS and relocated to Australia, where he continued his excellent work in monitoring clinical outcomes. Had Bolsin remained in the NHS, it is inconceivable that small units would have been allowed to continue operating and the Oxford heart scandal would have been avoided (Eye last).
If Andrew Lansley is genuine in his desire to support whistleblowers, he should consider formal recognition of Bolsin’s bravery1. The Mid Staffs inquiry will doubtless show that staff were either too afraid to blow the whistle, or too easily silenced, despite the many avoidable deaths occurring around them. NHS whistleblowers are vulnerable and isolated, and have few role models. The public recognition of Bolsin’s legacy would go some way to making it acceptable to speak up.
For whistleblowers who want to go the distance, the best chance of being heard is to go to court. In the UK, any payouts tend to be swallowed up by legal expenses and loss of earnings. But in the US, whistleblowers are rewarded handsomely if they help the government bring a successful case. In May, the New England Journal of Medicine followed up 26 successful whistleblowers from the pharmaceutical industry 2. On average each received $3 million for speaking up, with the range going from $100,000 to $42 million. Last September, Pfizer paid $2.3 billion to settle allegations that they illegally marketed a painkiller, Bextra, which has now been withdrawn. A proportion of the settlement was divided between the 6 whistleblowers.
Whistleblowers are rarely motivated by money, and nearly all try to ‘go through the correct channels’ first before going public. And even a large payout is scant consolation for the emotional exhaustion and stress of speaking out. In May, an employment tribunal found that John Watkinson, a former chief executive of the Royal Cornwall NHS Trust, was sacked for blowing the whistle on the failure of the Trust and Strategic Health Authority to consult the public adequately before moving cancer services. An independent review has now agreed that public consultation was inadequate, but the Trust is appealing against the tribunal findings. They accept that Watkinson was unfairly dismissed but challenge that he was a whistleblower, wary off the unlimited damages that are supposed to be awarded to sacked whistleblowers under PIDA. In the meantime, Watkinson remains unemployed – and like Bolsin, probably unemployable in the NHS.
As well as publically recognizing whistleblowers, Lansley needs to place a statutory duty on all NHS employers to report all serious concerns about patient safety or fraud to the Care Quality Commission (CQC) and Monitor for investigation and publication. Gagging clauses, and attempts to buy the silence of public sector workers raising genuine concerns in the public interest, must be outlawed. Whether the CQC and Monitor have the independence, expertise and resources to deal with all the NHS’s dirty secrets remains to be seen, but the practice of damage limitation, either by paying off staff or ordering secret ‘independent’ inquiries that never see the light of day, must end.
1 www.steve-bolsin.com/ 2 www.nejm.org/doi/full/10.1056/NEJMsr0912039