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Archive - Month: August 2010

August 22, 2010

Dr Phil’s Private Eye Column Issue 1269 20.8.10
Filed under: Private Eye — Tags: , , — Dr. Phil @ 1:01 pm

Rewarding Whistleblowers

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.

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August 1, 2010

Patient Involvement – Bristol Fashion
Filed under: Bristol Pathology Inquiry — Dr. Phil @ 2:51 pm

Bristol waits with interest for the report of the Histopathology Inquiry into allegations of misdiagnosis at University Hospitals Bristol NHS Foundation Trust. Will whistleblowers be heroes or villains? Will the report say whether 26 specific allegations of misdiagnosis were upheld by external reviewing pathologists or not? Will any clinical and managerial failings have been fully investigated and reported? To quote a statement from the BRI Heart Inquiry,”the arguments will be lost if the story is focussed on personalities and not the issues”

Meanwhile the Primary Care Trusts of Bristol, North Somerset and South Gloucestershire are pressing ahead with a long overdue review of Bristol’s Pathology Services and have included Weston Super Mare as well.

Local patient groups support changes to Bristol’s Pathology services that will lead to safer, higher quality, more cost effective services. They were looking forward to involvement in a post-election style NHS Service Review – “no decision about me without me”.

But the PCTs don’t seem to have got the message. Without consulting any patient or public groups, they decided to recruit an Independent Lay Member, through an NHS recruitment process, to the Pathology Review Project Board. Although the role is to be “independent” of the NHS, the PCTs have indicated that former Non-Executive NHS Directors are especially welcome to apply.

The successful applicants have been shortlisted by an NHS panel and were to be interviewed by a panel made up entirely of NHS staff, until patients and members of the public objected.

The NHS has now unilaterally decided that two Lay Members of the Project Board will be appointed to be “independent” of the NHS by an interview Panel – where one interviewer is a representative of a Local Involvement Network (LINks) and the rest (three) are NHS staff. Patient and public members of the review will be permitted to elect two additional lay people to the Project Board.

The result of all this is that there will be four lay members of the Project Board – two appointed through an NHS appointments process (where the lay interviewer is outnumbered three to one by NHS staff), to be “independent” of the NHS, – and two elected by their peers.

The role of the NHS appointed Lay Members of the Project Board is to “ensure that the review is open and transparent”. Perhaps they could start with scrutinising the openness and transparency of their own appointment process?

It’s not clear what happens if the two NHS lay appointees disagree on any issue with the patient/public lay appointees.

NHS has the casting vote perhaps?

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