27 September 2012
Whistleblowers risk losing jobs, careers and friendships, and financial compensation offers little consolation for those who are vindicated. A conference hosted by the BMA will explore ways to reduce barriers to doctors expressing concerns about care
Nobody sets out to be a whistleblower. In fact, according to BMA industrial relations officer Sean Cusack, many people who raise concerns do not initially identify themselves in that way.
‘Everybody has moans and gripes,’ he says. ‘It becomes a whistleblowing issue when you’ve raised a concern you feel passionately is right and patient safety is at risk but no one is listening.
‘People start out, for example, by opposing a change in staffing levels or work practice, and at some point down the line they may be faced with the stark reality they have to either put up with it or make more noise.’
GMC guidelines, issued in March, state that doctors have a duty to act ‘when they believe patients’ safety is at risk or [their] care or dignity is being compromised’.
But for many doctors, the decision to raise workplace concerns is fraught with anxiety.
Mr Cusack says: ‘In some cases, raising serious concerns leads to a breakdown of relationships with colleagues, especially managers. No one goes to work setting out to do harm, so often the whistleblower is perceived as simply a troublemaker.’
The BMA has long been concerned about supporting doctors who raise concerns about safety, and will next week co-host a conference on whistleblowing to explore the barriers facing doctors with concerns.
The conference will feature representatives from organisations that are often contacted by potential whistleblowers, including the BMA, the GMC, the Care Quality Commission and the Department of Health.
Their views and those of doctors attending the conference will feed into BMA guidance on raising concerns about patient safety, which is currently being updated.
London consultant paediatrician Kim Holt was seconded from the Haringey community paediatric service in north London after raising her concerns about the child development centre where abuse victim Baby P, later named as Peter Connelly, was seen.
She was one of four doctors who complained about management culture and lack of resources at St Ann’s Hospital in Haringey in 2006, a year before Peter’s death.
Dr Holt cites fear as the biggest barrier for potential whistleblowers: ‘You are either raising concerns about resources or about colleagues, both of which are going to cause conflict.
Fear and danger
‘The fear is a big barrier. I think I was oblivious to it and didn’t realise how dangerous what I was doing was, but the people I worked with were terrified.
‘A lot of people who raise concerns come new to a job with a fresh pair of eyes. People [in place] learn to accept things that aren’t quite right. Everyone else thinks things are OK, so you start to doubt yourself.’
In February 2007, Dr Holt was signed off work with stress-related illness. After a long process of negotiation, in which she was supported by the BMA, and an official apology from her employer, Great Ormond Street Hospital for Children NHS Foundation Trust, she returned to work last year.
She says: ‘I realised that you are at the mercy of your employer, and if they want to get rid of you then basically they can. The law means you end up with compensation, but the whole spirit of legislation is that you shouldn’t lose your job. The ones trying to cover things up should lose their jobs.’
Following her experience, she helped found the group Patients First (www.patientsfirst.org.uk), which campaigns for the government to create policies and laws that ensure the NHS is accountable. It is co-hosting the October 2 conference, which is being held at BMA House, London.
Patients First wants an end to gagging clauses that prevent concerns raised by employees from being disclosed. It also wants the Commons health select committee to review the NHS approach to whistleblowing by looking at cases from the past five years.
A dramatic cultural shift is needed for the act of raising concerns to be perceived as a positive thing, but how can that come about?
Dr Holt, who will be one of the speakers at next week’s conference, thinks that the government needs to recognise the contribution of whistleblowers: ‘If the government or a public body said “thank you”, we could learn from this and improve care.
‘Whistleblowers should be seen in a more positive light and thanked for having brought something into the public domain. This is about the public interest. We just want to feel that we’ve done the right thing.’
GMC chair Professor Sir Peter Rubin says the regulator is committed to supporting doctors with genuine concerns, but whistleblowers would not be needed in an ideal world.
He says: ‘A well-run hospital that’s well managed and wants to learn from its mistakes does not need whistleblowers, because people are listened to.’
Agreeing to disagree
That is what Dr Holt would like to achieve. She adds: ‘Doctors and clinicians need to get used to thinking that a bit of disagreement isn’t a bad thing. It’s always been quite difficult to disagree with someone who is superior to you.
‘We need to question that. If a trainee questions me, I need to take a deep breath and listen. They may have a good point.’
Some of those involved in the issues say there have been improvements.
GMC chief executive Niall Dickson says: ‘Doctors are certainly more willing to speak out and [highlight] poor behaviour than they were a while ago.’
Dr Holt acknowledges there have been some improvements since her high-profile case went public.
‘Having gone back to my job, I’ve noticed other people are becoming more vocal,’ she says. ‘I’ve had a lot of thanks from patients and from colleagues, who say I’ve inspired them. It’s given them more courage.’
Doctors needing support can contact BMA stress counselling or the association’s doctor adviser professional counselling service.
Mr Cusack, who represented Dr Holt, urges people to deal with things internally as long as possible before going to the media. He says: ‘Come to us early if you have a concern, and you can be guided and signposted.’
Dr Holt praises the BMA for the support she was given during her case.
She says: ‘Sean came to the meetings and saw what I was up against. He would calm me down a bit and encourage me to have time out if things got difficult, and to think about what I was going to say next.’