Good News and Bad News
Is the tide finally turning for NHS whistleblowers? Health Secretary Andrew Lansley has ordered the Care Quality Commission to keep its whistleblowing non-executive director Kay Sheldon on the board, despite CQC chair Dame Jo Williams asking for Sheldon to be sacked. Sheldon’s ‘crime’ was to speak up against the culture of the CQC at the Mid Staffordshire Inquiry last November, describing the strategy as “reactive” and driven by “reputation management and personal survival”. Sheldon contacted the Inquiry herself, and told chair, Robert Francis QC: “My main concern is the organisation is badly led with no clear strategy. The chair and the chief executive do not have the leadership or strategic capabilities required.” She was also concerned that the CQC kept repeating the same mistakes and did not consider whether it had sufficient capacity to do annual inspections.
Sheldon told the Inquiry that she had emailed chief executive Cynthia Bower with her concerns and received a phone call from a “quite angry” Williams, asking her whether she “knew what impact this email would have on Cynthia.” On the day Sheldon gave evidence, Williams wrote to Lansley asking for her removal. Instead, Bower handed in her notice and Williams must now consider her position after Lansley, following lengthy consultation and legal advice, decided that Sheldon should stay.
Whether this represents a true change of culture in the treatment of whistleblowers, or is merely an arse-covering exercise from Lansley knowing that Francis praised Sheldon for her ‘great courage’ and his report is likely to call for more like her, remains to be seen. As for the CQC, new chief executive David Behan clearly has his work cut out. A survey of 63 NHS chief executives by the Health Service Journal found that 44% were either ‘not confident’ or ‘not at all confident’ that failures on the scale of Mid Staffs would currently be picked up.
This reflects poorly not just on the regulators, but also the trusts and their boards who often don’t know what’s going on under their noses and politicians like Lansley who keep restructuring and destabilising the service, rather than focusing relentlessly on quality and safety. When the Eye broke the Bristol heart scandal in 1992, MD criticised surgeons for ‘persistently refusing to publish their results in a manner comparable to other units’. Fast forward 20 years and the Safe and Sustainable review of child heart surgery didn’t base any of its recommendations on the outcomes of the individual units because ‘a meaningful analysis of outcome data was not possible due to the low volume of surgical procedures within centres.’
So twenty years after the Bristol scandal, we still have no outcome data to prove how safe the service is and no idea how much poor performance has been covered up in that time. Bristol was only picked up because its results were so bad, it was an extreme statistical outlier. Even then, it would have remained hidden if not for the extreme bravery of whistleblower Dr Stephen Bolsin, who lost his job.
The harm caused by the lack of action to make child heart surgery safe by reorganizing it into fewer centres that are properly staffed and do sufficient numbers of operations to train future surgeons and prove they get good results is hard to quantify. But following the entirely avoidable Oxford child heart scandal (Eye July 30th 2010), a detailed analysis of results between 2000 and 2008 by Professor David Spiegelhalter uncovered more that 20 excess deaths at each of the Leeds, Leicester and Guy’s units (Eye June 2011). The number of excess deaths at Bristol was between 30-35.
Clearly something had to be done, and the reduction in the number of centres doing surgery from 11 to 7 is at least 10 years overdue. Several Eye readers have written to object about the proposed removal of surgery from Leeds (and to point out that Andy Burnham is not the constituency MP, as MD claimed) but on the evidence available, Leeds may not welcome having its outcomes over the last decade closely scrutinized. The Safe and Sustainable review was not perfect – making safety decisions without using outcome data is beyond ironic – but it has survived rigorous scrutiny by the Appeal Court and the current referral to the Independent Reconfiguration Panel supported by Burnham can only delay improvements to the service, something Labour did for a decade in office. Meanwhile, a father has written to MD about the death of his child following heart surgery in Leeds, asking if the unit is safe. Without comparative data, I have no idea. And neither does he.