For the last 6 months, I've been researching and writing a 'special report' for Private eye on NHS whistleblowers. I've been working with a former barrister, turned investigative journalist, Andrew Bousfield, in the hope that it'll reduce the risk of me getting sued. The special has just hit the stands as I write this (in Issue 1292), so all we can do is sit back and wait for the writs to arrive.
The title, Shoot the messenger, pretty much gives the game away. Despite the supposed protection of the Public Interest Disclosure Act, the NHS is still very adept at stamping on staff who try to raise legitimate concerns. We've featured stories of consultants and CEOs whose careers have been destroyed when they tried to do the right thing. So imagine how hard it is for junior doctors or nurses to raise concerns?
GPs have far more independence than our hospital colleagues and—if consortia are ever allowed to cut loose—we should have the freedom (and responsibility) to monitor for poor care in the services that we commission. When I debated with Andrew Lansley at the last Tory conference, I argued that there would only be a point to commissioning if we know about the quality of services we're buying. Otherwise, it's just a game of pin-the-tail on the donkey.
As well as all the business plans, care pathways, and risk assessments, commissioners need to see copies of all complaints and whistleblowing concerns, and also the trusts' responses to them—and whether those raising the concerns were happy with the response. Before we can 'do no harm', first we have to count the harm. Medicine is unique among legalised industries in that it causes significant harm as well as enormous benefit. Recent research from America suggests that one-third of hospital admissions result in some form of harm1 and the closer you look for it, the more you're likely to find it.
We need everyone on board—patients, relatives, and staff should be encouraged to step in to stop it, or failing that, report it so we have continuous 'harm alarms' (like smoke alarms) on every ward and in every GP surgery.
Back in the real world, it could be a while, and several more Bristol- and Mid Staffs-type disasters, before the NHS takes harm seriously so in the meantime we're heavily reliant on whistleblowers—people who not only spot something that's about to go pear shaped but speak up and do something about it. They should be heroes, but are more often treated as outcasts and crushed by the system. But whistleblowers can fight back by joining forces. Patients, relatives, clinical staff, local journalists, MPs, and even the odd lawyer can together provide more effective safety monitoring in the NHS than any regulator, and far better protection against persecution than the Public Interest Disclosure Act.
We've just launched a website (www.medicalharm.org) to allow you to submit information and documents that we may put in the public domain, and will build networks of individuals who wish to raise concerns about medical harm and help find ways to reduce it.2 We're also hoping to prompt the Health Select Committee to look closely at NHS whistleblowing, and advise on how to best protect those who raise concerns and their patients. If you want to read about some inspiring whistleblowers, read Shoot the messenger and browse the site.2 And please comment and spread the word.
Dr Phil's Rude Health Show is at the Edinburgh Fringe, 8–27 August
- Classen D, Resar R, Griffin F et al. ‘Global trigger tool’ shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 2011; 30 (4): 581–589.
- Hammond P, Bousfield A. Medical harm website. www.medicalharm.orgG
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