Robbie Powell was admitted to hospital in 1989 with weight loss and vomiting. During this admission Addisonâs disease was suspected and his GPs were put on notice to refer him back to hospital if this recurred. His family were not told of this suspected diagnosis, and the existence a letter to his GPs conforming this, which his father saw, and which was independently witnessed was subsequently denied.
Robbieâs was re-admitted to hospital in 1990 and died the same day of Addisonâs disease.
In the final 15 days before Robbie died, he was seen by five different doctors, seven times, four of whom were found by a medical expert to have been grossly negligent:
Dr Paul Boladz saw Robbie two days before his death. He refused to visit Robbie at home and diagnosed glandular fever when he examined him at the local hospital. He prescribed Amoxicillin (which should not be given to suspected glandular fever patients) and booked blood tests for Robbie for two days later. Dr Boladz was deemed grossly negligent.
Dr Keith Hughes saw Robbie the day before he died. He failed to spot the symptoms of Addisonâs disease, postponed a vital blood test, was unable to carry out a crucial blood sugar test, due to out-of-date equipment, and initially refused Robbie a hospital admission. Dr Hughes was deemed grossly negligent.
But it was two doctors in particular whose actions were criticised most heavily by the CPS, regarding a possible cover-up: Dr Nicola Flower and Dr Michael Williams.
Ongoing 30-year struggle
After failing to make any headway with the complaint process and legal action, Robbieâs father Will Powell made a formal complaint against the Chief Constable of Dyfed-Powys Police in late 1999.
In the investigations carried out by Dyfed-Powys Police were found to be ‘institutionally incompetent’ by Avon & Somerset Constabulary in 2003.
Will Powell’s complaint against the Chief Constable resulted in Dyfed-Powys Police appointing an outside police force to review Robbie’s case. Detective Chief Inspector Robert Poole [DCI Poole] from West Midlands Police was appointed in early 2000.
DCI Pooleâs report, entitled Operation Radiance, which was based on the documents provided to Dyfed Powys Police in March 1994, by WP and his solicitor, was submitted to CPS York in March 2002. This report put forward 35 suggested criminal charges against five doctors and their medical secretary. The suggested changes were:
Gross negligence manslaughter.
Forgery.
Attempting to pervert the course of justice.
Conspiracy to pervert the course of justice.
Missing compuiter records
Recently I have been looking at Robbieâs computerized records. Access to these was initially refused and lies were told about whether they existed or not.
Eventually, seventeen months after the original request, some of Robbieâs computer record were produced. These are incomplete and appear to have been tampered with as Robbieâs death is not recorded and he has no episodes of care recorded on the information which was eventually produced. In addition the printout purported to be is highly suspect as it lists Robbie’s age as ’17’. Robbie died when he was 10.âââââââ
Identification of a lack of an individual duty of candour for health professionals:
Until the case of Robbie Powell, the existence, or otherwise, of a legal duty of candour for healthcare professionals had not been raised or tested in the UK civil courts.
Had it not been for the Powells refusing to accept a six figure out of court settlement in 1996 and pursuing Robbieâs case through the UK and European courts, the absence of a legal duty of candour is unlikely to have been publicly exposed by any other medical negligence case. At the time the Powells had remortgaged their home and were on benefits.
In response to the 1997 Court of Appeal ruling in Robbieâs case, Dr Brian Goss of the BMAâs General Medical Services Committee, stated in GP magazine, on 11th July 1997: âGPs could now put a gloss on the cause of death without fear of litigationâ.
The law, as it stood in 2000, was clearly set out by the European Court of Human Rights when it found Robbieâs case inadmissible and ruled there had been no breaches of the childâs human rights.
The ECHR stated âwhilst it is arguable that doctors had a duty not to falsify medical records under the common law (Sir Donaldson Mrâs âduty of candourâ), before Powell V Boladz there was no binding decision of the courts as to the existence of such a duty.
âAs the law stands now in 2023, doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even to refrain from deliberately falsifying records.â
As a consequence of refusing the initial offer to settle the case, in 1996, the Powells ended up with no compensation and an order for costs against them.
Update 12.01.2023
Both the English and Welsh Health Ombudsmen are calling for a Public Inquiry into the death of Robbie Powell.
The case remains open with the Crown Prosecution Service who now have an additional report on the anomalies in Robbieâs computerised records.
I have developed and delivered delivered teaching sessions on ethics, the law and accountability using Robbieâs case. These sessions have identified lost learning as result of the ongoing cover up. For more information on this email carerightnow@gmail.com
The Protection for Whistleblowing Bill [HL]1 which passed its second reading in December 2022, proposes the repeal of the current Public Interest Disclosure Act2 [PIDA], replacing it with an Office of the Whistleblower [OWB]. This would prevent concerns of genuine healthcare whistleblowers becoming buried under an employment issue, and their original issues being sidelined. There are many examples of this happening, the most recent being the treatment of whistleblowers who raised concerns over a nurse who was later found guilty of murdering seven babies and attempting to murder another six3. Because the people who first raised concerns were initially bullied and intimidated into silence, it was a year before the initial concerns were acted upon, during which time the nurse went on to murder a further 5 babies and attempt to murder a further five4.
Why do we need a change in the law?
Current UK whistleblowing law, the Public Interest Disclosure Act2 [PIDA], is expensive, limited in scope and beyond the reach of most whistleblowers. It is also overly complex, with cases currently waiting for over 2 years to be heard. Employers game the system to run whistleblowers out of funds.
PIDA does not protect patients and is not accessible to members of the public who blow the whistle. Currently there is no statutory provision to investigate or address the wrongdoing highlighted by whistleblowers, and whistleblowers have been denied any protection because they are not workers.
Media reports on whistleblowing in healthcare tend to focus our attention on senior people and on Employment Tribunals. Behind every high-profile whistleblower in health and social care there are many more people who are suffering detriment for speaking out and have not been able, or not wanted, to take legal action. This includes people at all levels in the organisations and from all professions. This is a drain on the resources of our health system as many take early retirement, change careers, or emigrate to remove themselves from the situation.
Sadly, when staff are unable to speak out or are silenced it falls on patients and their relatives to do this. They effectively become whistleblowers, without any legal protection.
The Protection for Whistleblowing Bill replaces PIDA and introduces an Office of the Whistleblower. This will change the landscape and help us identify root causes of systemic patient safety failings. This has the potential to save lives, halt corruption, and safeguard people who speak out.
I urge everyone with an interest to read the Bill itself and decide on your position based on the facts.
NO. The OWB will support the work of the Ombudsman by identifying themes and areas of concerns, and by setting standards for investigations.
2. Will the Office of the Whistleblower be âanother regulatorâ?
NO. The OWB will provide independent scrutiny of whistleblowing which will help support the work of regulators and bring together the various âspeak upâ initiatives that are in place.
3. Which whistleblowers will be protected by the Office of the Whistleblower [OWB]?
The OWB will protect all citizens, putting an end to the limitations and restriction set out in PIDA which limits who can be helped and who is protected. Under PIDA protection afforded is only in respect of breaches of contract between employer and employee. This approach doesnât represent the realities of the modern world and the complexities of areas such as healthcare where the customers / patients / users of services have a key role in shared decision making.
4. Will the Office of the Whistleblower only focus on high profile cases and senior people?
NO. The OWB will be available to all citizens. Currently many whistleblowers are denied protection because they are not workers. These include families like those at Gosport Memorial Hospital, residents of Grenfell Tower, and the families of victims of Maternity failings.
5. What will happen to whistleblower who were / are being protected by the Public Interest Disclosure Act when it is scrapped?
There will be a planned transition to ensure nobody is disadvantaged by the repeal of PIDA.
6. Wouldnât it be simpler, and just as effective, to amend PIDA?
NO. Whistleblowing is not an employment issue!
Employment Tribunals cannot take action or make decisions about the merits of a protected disclosure and even if they could there are serious consequences for the public interest.
PIDA is unamendable. PIDA is expensive, limited in scope and beyond the reach of most whistleblowers. It is also overly complex, with cases currently waiting for over 2 years to be heard. As a result, employers can
(and do) game the system by exhausting and running whistleblowers out of funds.
7. Are the measures in the Protection for Whistleblowing Bill based on the US âbounty huntingâ model of rewards for whistleblowers? No.
The Bill was informed by evidence from the UK and around the world. This includes whistleblowers themselves as experts by experience.
8. What is meant by ârestitutionâ for whistleblowers?
The word restitution means the restoration of something to its original state. This most accurately describes what the Office of the Whistleblower will aim to achieve. The objective is restoration of whistleblowers to the state they were in, or would have been in, had it not been for the fact they had to blow the whistle on wrongdoing.
There will be additional ways to recognise whistleblowers as part of the drive to normalise speaking up. Talk of rewards, bounty and compensation has dominated the negative narrative against change and does not reflect the real objective of Office of the Whistleblower, provision of a robust and comprehensive response to detriment imposed on whistleblowers.
9. Will the Bill and Office of the Whistleblower open the floodgates to people with a grudge and to spurious claims?
NO. The Bill includes checks and balances to be fair to all parties and contains a provision to exclude frivolous, malicious or vexatious whistleblowing claims.
10. Will the Protection for Whistleblowing Bill end the practice of âgaggingâ whistleblowers through non-disclosure agreements [NDAs]?
YES. It is an important and integral part of the Bill that will address the practice of suppressing whistleblowing.
N.B. the new law will improve compliance that has so far been absent.
11. How will the Office of the Whistleblower be funded?
The Office of the Whistleblower will be set up by the Secretary of State and initially funded by government. As time progresses the Office will become self-sufficient, being funded by fines imposed on organisations that fail to be compliant.
The Office of the Whistleblower will not receive sponsorship funding or be linked to specific organisations in a way that compromises its integrity.
12. Does the Bill define whistleblowing?
YES. One of the major failings of PIDA was the failure to use simple terms that everyone understands including defining whistleblowing and whistleblowers in law. This has watered down workersâ rights in an already ineffective law and left the rest of the public unprotected.
13. Under the Bill can people still make a protected disclosure, and who will the âprescribed personsâ be?
YES. To support this, the definition of âprescribed personsâ is changed to ârelevant personâ. This removes the constraints set out in PIDA which cause confusion and are used by employers to game the system.
14. How will the independence of the Office of the Whistleblower be maintained and monitored?
Accountability for the Office of the Whistleblower rests with the Secretary of State, who is accountable to Parliament, and to the electorate.
16. Will the Office of the Whistleblower replace Employment Tribunals?
NO. The OWB will be specifically for whistleblowing to ensure that public safety matters and retaliation are dealt with by an organisation that is properly equipt to do so. The OWB will put an end to inappropriate, and hugely expensive, use of Employment Tribunals to address whistleblowing concerns, (other employment matters including pay and discrimination will remain the jurisdiction of the ET).
17. What powers will the Office of the Whistleblower have?
The Office of the Whistleblower will have teeth. This includes powers to issue information notices and action notices, will have the power to impose civil and refer criminal offenses.
18. Can people appeal against the decisions of the Office of The Whistleblower?
19. Why do we need another organisation for whistleblowers?
We donât, The Office of the Whistleblower is a new type of body that provides independent oversight of whistleblowing and does not duplicate the work of other bodies. The overall aim of the OWB is to ensure that the public interest is protected. The work of the OWB will enhance and support all existing organisations including regulators and law enforcement.
20. What happens if whistleblowers cannot afford to pursue their case?
The OWB is a free service and will adjudicate on issues of retaliation and detriment. The Bill sets out additional support for workers who can claim âinterim relief ordersâ to offset immediate financial or other hardship.
21. How will an Office of the Whistleblower cope with the inevitable deluge of requests for help, without becoming overwhelmed?
‘The strength of the Office of The Whistleblower [OWB] lies in its ability to formally request information, commission investigations, mandate action and set standards. For the first time, the Protection for Whistleblowing Bill defines whistleblowing and includes statutory powers. The Bill introduces civil penalties for whistleblower victimisation and a new criminal offence for any person who intentionally or recklessly submits a person to detriment.
The Office of the Whistleblower is a new type of body that provides independent oversight of whistleblowing. This will help unearth the root causes of whistleblower victimisation and drive forward actions to prevent a recurrence.
The inevitable deluge of requests for help will be welcome. For the first time, these can be investigated scrupulously and effectively. Accountability will be highlighted, and lack of accountability called out publicly. This will be backed up by the development of core principles and standards for effective education and learning.
The strength of the Office the Whistleblower is that it will not be a regulator, and not replace existing successful initiatives or organisations. The work of the OWB will support them. When it comes to healthcare, patient safety will be the focus, and the inappropriate use of employment law to cause detriment to genuine whistleblowers will become a thing of the past. This includes ending non-disclosure agreements [NDAs] for whistleblowers.
The Bill is not simply a replacement for the Public Interest Disclosure Act 1998 [PIDA], it will change the landscape and offer an innovative, evidence-based approach based on the four pillars of:
Protection for whistleblowers
Investigations
Accountability
Education ‘
This summary was produced by Steve Turner, RGN, RMN, Ba(Hons), P.G. Dip Ed. Member and Co-Chair the WhistleblowersUK Healthcare Quality & Safety Focus Group.
About the Author:
Steve began his professional career as a nurse at St George’s Hospital in London in 1981. He also spent a decade working on hospital clinical systems for the American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the U.S. arm of the company. In 1999 he returned to work for the NHS, successfully revamping the Information and Technology department at an NHS Trust prior to a trust merger. A spell in consultancy for a large Cancer Network followed, by leading highly successful multi-organisational projects. In 2002 Steve returned to clinical practice becoming a nurse prescriber in a Mental Health Assertive Outreach Team. In 2014 Steve founded Care Right Now (CIC) a Social Enterprise Company delivering values-based consultancy and developing patient focused clinical education services. The companyâs work embraced all of health and social care, ranging from substance misuse to community paediatrics to care homes. Steve is now semi-retired and writing on âpatient led careâ.
About WhistleblowersUK
WhistleblowersUK is the UKâs only Not for Profit organisation. It was set up in December 2014 to provide help, information and support to whistleblowers and in November 2015 launched its campaign for the introduction of an Independent Office of the Whistleblower.
WhistleblowersUK has provides assistance to thousands of whistleblowers including representation and support in Employment Tribunals up and down the UK. It has provided assistance to international whistleblowers and collaborated with other NGOâs to prove assistance to whistleblowers in need. Each year WhistleblowersUK handles over 3500 requests for assistance and supporting evidence. It liaises with regulators and law enforcement here and around the world and provides support and input to academic research.
Appointed secretariat to the APPG for whistleblowing in 2018 WhistleblowersUK drafted 3 Bills the latest being the Protection for Whistleblowing Bill currently going through Parliament (all Bills have progressed). WhistleblowersUK have and continue to contribute to major new legislation as experts in the field of whistleblowing.
WhistleblowersUK receives no government funding for its work and relies on the generosity of whistleblowers, supporters and the public to maintain its work including support for whistleblowers and development and advancement of policy. Please support us by donating here and by joining our thriving associate membership and getting more involved in transforming whistleblowing.
For more information, please visit our website: www.wbuk.org or
The systemic silent killer â ending the stigma around whistleblowing.
Summary: In this blog Steve Turner reflects on why genuine patient safety whistleblowers are so frequently ignored side-lined or victimised. Why staff don’t speak out, why measures to change this have not worked and, in some cases, have exacerbated the problems. Concluding with optimism that new legislation going through Parliament offers a way forward from which everyone will benefit.
The scale of the problem: The hidden costs of stigmatisation of healthcare whistleblowers are immense. System wide problems in this area of healthcare are reinforced by a lack of transparency, and the failure of accountability. The consequences of this failure have been investigated many times over the years. A seminal case was that of the Bristol heart surgery scandal in the 1990s. This was brought to light by the anaesthetist Steve Bolsin and led to the implementation of a system of clinical governance (1). This advance in measures to deliver quality, consistent and safe care remains as relevant today as it ever was. More recently the investigation into the failings at mid Staffordshire (2) highlighted how a âgood newsâ only culture, where reputation management was placed above patient safety, is failing patients. Critically for me the shocking fact is that where staff who blow the whistle can’t, or don’t, speak out, are ignored or silenced, the onus to expose wrongdoing falls on patients and their relatives. This involves great personal cost.
This shameful thread of patient-led whistleblowing goes back a long way and has not stopped. Examples where patients, carers, or relatives have had to take the lead and blow the whistle include the death of Robbie Powell (3), Elizabeth Dixon (4), Oliver McGowan (5), Claire Roberts and those who died in the Belfast Hyponatraemia scandal (6), the Gosport War Memorial Hospital scandal (7), and the investigation into maternity services in East Kent (8). These patient safety scandals show no sign of abating despite the report on the failings at mid Staffordshire (2) and Sir Robert Francisâ major review into whistleblowing in the NHS (9). This is reinforced by the 2023 Bewick Review (10) which is the first of a three planned reviews into University Hospitals Birmingham NHS Foundation Trust. This review was commissioned following repeated serious concerns relating to patient safety, leadership, culture and governance, which were initially downplayed or ignored. The full story behind these failings, and their significance, has yet to fully come to light.
Patients have to blow the whistle on unsafe care. A stream of healthcare scandals, (too many to mention all of them here), have been exposed by members of the public. Key examples include the case of Robbie Powell who died of untreated Addison’s disease in 1990 (3). Thanks to the tenacity of Robbieâs father (Will Powell) this led to the clarification of the absence of an individual legal duty of candour for health care professionals (11). Despite numerous reports and failed investigations, including one of which put forward 35 suggested criminal charges, the Robbie Powell case remains open with the Crown Prosecution Service [CPS]. In addition, the former Welsh Ombudsman and the English Ombudsman are both calling for a public inquiry into the case (12).
Another case concerns those who died at Gosport War Memorial Hospital in the 1990s who were prescribed opioid medicines that were not indicated for their condition. This led to an Independent Review Panel (7) which took four years and cost ÂŁ14 million. The Panel found that 456 deaths in the 1990s had “followed inappropriate administration of opioid drugs”. In 2019 Assistant Chief Constable Nick Downing, head of the Serious Crime Directorate for Kent and Essex Police, announced that a new criminal investigation into the deaths was to take place, and the campaign for justice continues.
Other serious issues include premature deaths of people with learning disabilities and autism (13) which led to the implementation of the learning from deaths programme. On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population. The life expectancy of men with a learning disability is 14 years shorter than for men in the general population (14). There are numerous individual cases that support this finding, many of which were first highlighted by parents, informal carers, or relatives. In 2014 the Department of Health and Social Care has published a report which found that almost two-fifths of people with learning disabilities died from causes âamenable to good quality healthcareâ (15).
In 2022 a report by Dr Bill Kirkup OBE, into deaths in East Kent NHS maternity services (8) confirmed that the âonus was on patients to raise concernsâ because the culture of fear prevented whistleblowers from speaking out. âIn every case staff were aware of serious mistakes or wrongdoing but they were unaware of how to raise concerns because those who tried were subjected to peer pressure to be silent and everyone was afraid of the [personal] consequences.â These consequences were exemplified by the experience of the nursing director who was told that speaking up would harm her career. Another significant report is that into the life and death of Elizabeth Dixon (4), which contains recommendations that apply across the board: âŠâ
“(6). Clinical error, openly disclosed, investigated and learned from, must not be subject to blame. Conversely, there should be zero tolerance of cover up, deception and fabrication in any health care setting, not least in the aftermath of error. (NHSE, GMC, NMC, MoJ) ‘
(7). There should be a clear mechanism to hold individuals to account for giving false information or concealing information relating to public services, and for failing to assist investigations. The Public Authority (Accountability) Bill drawn up in the aftermath of the Hillsborough Independent Panel and Inquests sets out a commendable framework to put this in legislation⊠It should be re-examined. (MoJ)
(8). The existing haphazard system of generating clinical expert witnesses is not fit for purpose. It should be reviewed, taking onto account the clear need for transparent, formalised systems and clinical governance. (DHSC, MoJ)⊔
The amount of evidence and the number of reports that were initiated thanks to the tenacity and courage of patients, relatives, carers and parents, is truly shocking. How can we change this? How many more reports do we need? The only thing we can say with confidence is that lessons have not been learned.
Why donât staff speak out? I was recently asked âwhy don’t staff speak out?â There’s very little rigorous research on whistleblowing in health and social care, So I can only offer my personal views on this apparent absence of ethical behaviour. I believe this quote from Margaret Heffernan (Professor of Practice at the University of Bath School of Management) goes some way to explaining this:
âI have never encountered an organisation as vicious in its treatment of whistleblowers as the NHSâ (16)
If anyone has any doubts there are a string of high-profile cases to support it, including the cases of Steve Bolsin, Raj Mattu, Kim Holt, Peter Duffy and Chris Day.
When I was asked why staff stay silent my first thought was to say that those who would speak out have all left. Of course, this can’t be the full story. So, what are the other reasons? One possible reason is that people who are promoted to highly paid jobs attain these positions because they âtoe the lineâ. Organisational psychologists talk about the role of enablers and âflying monkeysâ in maintaining this culture. A flying monkey is a psychology term that refers to an enabler of a narcissistic person, a henchman so to speak. Many staff keep their heads down and don’t look too hard at what’s going on around them. Some commentators see this as a behaviour that is supported by the promotion of toxic positivity. What I mean by this is a culture of talking-up successes, however small, completely ignoring failure, and therefore missing the learning that comes from failure. The widely used phrase ârock the boat but stay in itâ (17) springs to mind here, especially the empty references to âradicalsâ and âchange agentsâ. This forms part of learning materials which are often accompanied by reams of management jargon and pseudo-science. This leads to a morally bankrupt approach where âall is wellâ (ânothing to see hereâ) and toxic positivity prevails. The belief that no matter how bad a situation is, people should maintain a positive mindset, move on and not mention it, is a way of working that is directly contradicted in these wise words by the late Professor
Aidan Halligan: “Run toward problems, especially on a bad day“
My views may sound very harsh, especially coming from someone like me who left direct employment with the NHS in 2008. It’s important to point out I believe the vast majority of NHS staff, at all levels from clerical staff and porters to senior managers and chief executives, do their best to work around the bullying and toxicity to deliver safe care for patients. Doing their best despite the prevailing culture rather than being supported by it. Sometimes biding their time and subtly subverting directives that are not in patientsâ best interests. For clinicians, the threat of being referred inappropriately to a professional body is ever present (18), and an environment where the pressure of work is extreme, exhausting and unstainable are also major factors.
For many, the prevailing culture also means that the careers of highly skilled accountable, ethical and caring staff are held back through denial of learning opportunities and promotion, and informal blacklisting which is commonplace. There’s an army of people ready for change, a huge informal network of highly motivated caring people, which is why I’m optimistic about the future.
Why have âspeaking upâ reforms failed? These are my personal views based on my experience and that of my colleagues. Since Sir Robert Francisâ whistleblowing report (9) there have been several changes designed to improve the situation. These include Freedom to Speak up Guardians, the introduction of an institutional duty of candour, the âFit and Proper Persons Testâ(19) for Board members, and the NHS Whistleblower Support Scheme. In addition, the Health and Safety Investigation Branch [HSIB] was set up in 2017, and a National Patient Safety Commissioner was appointed in 2022.
Given all the above, why has there not been a reduction in high-profile healthcare failings? In my view there are several reasons. Many believe, as I do, that the approach of the Care Quality Commission [CQC] to whistleblowing is part of the problem. We often learn from investigation reports that the CQC (and other regulators) had been listing problems in their reports for years and yet no meaningful action has been taken. âRegulatory captureâ is a serious problem, that is when regulators are adversely influenced by the people they are inspecting. This is often linked to the revolving door of staff who move from health and care employment to the regulators, and informal links which amount to cronyism. This behaviour is something that commentators have noted and which I have experienced myself (20). Patients suffer as a result.
The introduction of the National Guardian Office and Freedom to Speak Up Guardians [FTSU] in each NHS trust is also problematic. This initiative has an inbuilt conflict of interest, as the Guardians are employed by the trusts themselves. The All-Party Parliamentary Group on Whistleblowing [APPG] have heard from whistleblowers who have been failed by local Guardians sharing their experiences that included the disclosure of their identity to hospital management and boards, which resulted in retaliation. The APPG has also heard from Local Guardians who were not supported and themselves the target of retaliation after supporting whistleblowers (21). In addition, something which I find shocking is that the National Guardian Office appears to studiously avoid the word âwhistleblowingâ in its material and outputs wherever possible. This adds to the stigma around healthcare whistleblowers and is inexcusable.
Another lesser known initiative is the NHS Speaking Up Support Scheme (22) (originally titled the Whistelblower Support Scheme). There is not much information available on this scheme in the public domain. I became aware of the scheme when I was asked if I wanted to apply. Later I signposted several people to the scheme. I learned that although the scheme has benefited some people, for others it appears to have made their situation worse. Through a freedom of information request, and thanks to the intervention of my MP, I have managed to obtain a redacted copy of the evaluation of the pilot scheme which supports the view of mixed results (23). Having read this report, it is unclear to me why it hasnât been published and why it was redacted. Particularly as I think (I canât be sure of course) that one of the redactions is a comment I made. A comment I wanted to be shared.
As for the other post-Francis review initiatives, the Kark Review in 2018 on the Fit and Proper Person Test [FPPT] is unequivocal in its findings: âEssentially it [FPPT] does not ensure directors are fit and proper for the post they hold, and it does not stop the unfit or misbehaved from moving around the system.â(24) In addition, the statutory current duty of candour (25) seems, at times, to be little more than a tick box, with the responsibility for talking to patients often left to the most junior staff. A duty of candour is about simply telling the truth and is everyoneâs responsibility, not a task to be delegated. The need for a legal duty of candour on individuals has been highlighted by Robbie Powellâs father Will Powell and links to proposals for a Hillsborough Law.
The HSIB and the National Patient Safety Commissioner initiatives have some built-in limitations to what can be achieved. The HSIBâs remit does not include investigation of systemic problems. This limits the areas that they can cover. As for the National Patient Safety Commissioner, this is a new role which is very promising. Unfortunately, the scope of this role is limited, with the remit covering only medicines and medical devices. This means that these two initiatives are not able to tackle the systemic organisational cultural issues that are at the root of major patient safety failings. One thing that stands out here is that none of the above measures specifically tackle the stigma around whistleblowing in healthcare. In fact, some reinforce the stigma.
A way forward: Much has been written about healthcare whistleblowing and measures that have been implemented to promote positive change. Despite these, the victimisation of healthcare whistleblowers and the stigmatisation around whistleblowing in health and in social care has not abated. The measures introduced have so far achieved very little. In some instances, I believe, they have made the problem worse.
The Protection for Whistleblowing Bill [HL]26 which passed its second reading in December 2022, proposes the repeal of the current Public Interest Disclosure Act27 [PIDA], replacing it with an Office of the Whistleblower [OWB]. This would prevent concerns of genuine healthcare whistleblowers becoming buried under an employment issue, and their original patient safety concerns being side-lined.
PIDA is expensive, limited in scope and beyond the reach of most whistleblowers. It is also overly complex, with cases currently waiting for over 2 years to be heard. Employers game the system to run whistleblowers out of funds. Fewer than 12% of cases that go to the Employment Tribunal win.
PIDA does not protect patients and is not accessible to members of the public who blow the whistle. Currently there is no statutory provision to investigate or address the wrongdoing highlighted by whistleblowers. Many whistleblowers have been denied any protection because they are not workers.
An Office of the Whistleblower would change this and help us identify the root causes of systemic patient safety failings (26). I urge everyone with an interest in this subject to read the bill, and watch the video of Baroness Kramer introducing the second reading of the Bill (28).
NHS England (2023) About LeDeR LeDeR is a service improvement programme for people with a learning disability and autistic people. WWW: https://leder.nhs.uk/about
Steve Turner Steve is a registered general & mental health nurse prescriber (now retired) with a background including clinical education & governance, social policy, and information technology. He is a WhistleblowersUK Health spokesperson, and co-convenor of the WBUK Healthcare Whistleblowing Focus Group Steveâs digital profile: https://linktr.ee/stevemedgov
Acknowledgement: This piece represents the personal views of the author. Thanks to the team at WhistleblowersUK members of the WBUK Healthcare Whistleblowing Quality & Safety Focus Group and all the clinicians who commented on the drafts and posts of this piece. Including Dr David Church GP Locum in Mid Wales – member of Justice for Doctors [J4D] and of MPU (Doctors in Unite, the Union) who peer reviewed the first draft.
I am a retired healthcare professional, a nurse prescriber with experience in senior management in both the NHS and private sectors. I worked as a clinician with vulnerable adults on the margins of society.
Over the past fourteen years Iâve become involved with a situation I was previously unaware of. The widespread marginalisation and victimisation of health and care staff who raise concerns about patient safety and lose their careers as a result. Iâve learned that this problem is part of a much bigger picture which affects all of society, all industries and public sectors, in all countries of the world.
In this blog I reflect on the situation in England based on my experiences and those of the many people I have met as a result. All of whom experienced the backlash that can happen when organisational reputation trumps patient safety. One thing many of us have in common is that, put simply, we never intended to become known as âwhistleblowersâ, we were just trying to do our job to the best of our ability.
In conclusion, I look at key areas to be worked on in order to protect the public and really âlearn lessonsâ. These cross all sectors and areas of work. They include the need for changes in legislation, an end to self-regulation in healthcare and elsewhere, and recognition of the value to society of those who risk everything to fight for justice and truth.
A dawning realisation
I began to realise something was seriously wrong when I returned to clinical work in 2002. Having previously worked in senior management (as Head of I.T. in an NHS Trust) and management consultancy, I became concerned that my employer appeared to be putting reputation over patient safety, and if concerns were raised, they were not followed up. I recall looking at Board papers and directions to trusts from the Department of Health [DH] to try and understand this further. One thing I remember is a letter to Chief Executives from the Department of Health which talked about creating an âoutward facingâ organisation. I didnât realise at the time what I now see as the real meaning of this, and its link to the âno bad news cultureâ. This involves putting reputation above patient safety.
Later I tried to raise my concerns with a Trust Executive at an early stage, only to be told in both words and body language that the trust didnât want to hear anything bad. This attitude, and what I saw happening to the team and staff around me, led me to leave the NHS and become self-employed working for the NHS on projects related to medicines and prescribing. I followed the Trust policy, and the appropriate internal routes, including speaking to the Deputy Chief Executive about my concerns.
The Deputy CEO was then going to arrange for me to speak to the Non-Executive Director responsible, however the Chair of the Trust blocked me from speaking to them. (This is the Chair who told me they didn’t want to ‘hear anything bad’). Eventually my experiences and increasing frustration led me to make a protected disclosure to the CQC in 2014, in which I set out the patient safety concerns. As a result, the CQC requested that the Trust commission an external investigation of my concerns.
Since being interviewed for the investigation report in 2014 I have heard nothing further. I never saw the investigation report and was never contacted about it. A freedom of information [FOI] request to the CQC produced the response that my concerns were dismissed as âall third handâ (which is incorrect) and I was told that the CQC had âlost the reportâ.
Prior to the FOI request, I was employed as a CQC Specialist Advisor (a zero-hours contract), however following the FOI request this contract was ended without a specific reason being given.
The wider picture in healthcare
Iâve only briefly mentioned some of the aspects of my story here. The most important thing for me was that I found out the common themes behind all genuine healthcare whistleblowersâ stories.
Three things stand out for me.
1. The psychological effect on the whistleblower
I experienced the isolation that whistleblowers are subjected to and the psychological effect this has on individuals. Suddenly youâre on your own, and people you worked with avoid you. In my case, I also kept my distance from some co-workers, as I realised they were being bullied as a result of supporting me.
For me offers of work dried up and a sickening feeling of being âsent to Coventryâ set in. In addition to the loss of income, this isolation has a deep effect on my mental health and home life. I believe the approach of employers here is called âgaslightingâ. Itâs deeply troubling.
2. The NHS cold shoulder / being blacklisted
Secondly, I have discovered through meeting other whistleblowers that blacklisting of those who speak out is very common. This can take many forms, ranging from informal blacklisting to interventions to prevent career development, to giving unsolicited (and unfair) bad references.
For those employed by the NHS the Electronic Staff Record [ESR], which is shared throughout the NHS can be used as a way of sharing detrimental information on whistleblowers. This has caused people to be denied a fair chance to gain further employment. I believe the full extent of this is yet to come to light.
In my case the blacklisting took the form of repeatedly being given the âcold shoulderâ for example being excluded from meetings; uninvited from regular meetings I was previously part of (without a reason being given); letters and emails not replied to, a higher education establishment being told not to engage with me, and generally being avoided. Of course, this is subjective, and sometimes I may be wrong, as healthcare is a tough work environment. However, I have been subject to some clear examples of ongoing detriment. This lasted right up to, and beyond, my retirement.
On one occasion my company was enthusiastically awarded a contract of work one day, then the very next day the same person âphoned me and cancelled the order saying only that it âwasnât what they wantedâ. Very strange. Also, I found out years later that staff from the trust I worked for were told not to speak to me, even though in one case it was to ask me a question about my clinical work.
In addition, I was deeply upset when the NHS Trust, who commissioned one of my projects, failed to acknowledge its success. A poster was presented at the NICE Conference in 2015 and it was highly commended by NICE.
Prior to the Conference, I contacted the trust to let them know of the success and all attempts to engage the trust were ignored. As you can see on the poster (which was produced by NICE) the space for the trustâs logo, on the bottom left, is empty:
In fact, I have several examples of work on the NICE Shared Learning pages, none of which have ever been acknowledged in any way by local NHS Trusts, or any healthcare organisations in Cornwall.
In was fortunate in being successful in delivering the above children’s medicines project, which has had a lasting legacy – the appointment of a Peadiatric Community Pharmacist. One of my protected disclosures was about this project. Specifically that I was pressured to alter a report which highlighted the urgent need for improvements in medicines’ safety. At the time there were people in senior positions who backed me up and the report remained unchanged. Since then, all these people have left the trust. More recently the trust was caught up in a ‘governance scandal’ which resulted in the Chief Executive and Board Members who had bullied me leaving suddenly.
3. The effect that the victimisation of healthcare whistleblowers has on patients
Thirdly, as I looked further into the problem, I began to see the full impact that the victimisation of genuine healthcare whistleblowers has on patients. This for me is the most shocking aspect of the problem.
In 2015 I set up the Turn up the Volume! Movement. This was an attempt to bring together all involved in an open and transparent way, with a focus on the core issue of patient safety.
Through this initiative I have met many more people in a similar situation and learned first-hand the effect lack of transparency and denial has on patients. This is well illustrated, for example, in the report of the Gosport Independent Panel Report (2018), where those who raised the alarm were initially listened to, then ignored and their concerns re-labelled as âallegationsâ. As a result of this, in the words of the report, âthe lives of over 450 patients were shortened while in the hospitalâ.
Next steps
Based on my experience in trying to link together people in health and care with similar experiences and focus on patients, I believe there are three vitally important areas in healthcare that need addressing.
The need for an individual duty of candour
Firstly, I was shocked to find out that in the NHS the duty of candour (duty to tell the truth), brought in following the Mid Staffordshire inquiry, is an institutional duty of candour. This relies on staff telling the truth to their employer in order to highlight what went wrong. Thanks to the tireless work of campaigner Will Powell the need for an individual legal duty of candour for professionals, managers & leaders in healthcare has been demonstrated. This has parallels to the calls for a âHillsborough Lawâ. Without this, there is no real mechanism to hold individuals to account for cover-ups and for not being honest.
Making sure initiatives are effective
Secondly, Iâm disappointed at the failure to learn and improve patient safety through listening to genuine whistleblowers, whether they be patents or staff, and failure to take measurable actions to change. I believe the effect of the National Freedom to Speak Up Guardian programme needs a full independent review (from outside the NHS). Evidence suggests it is making the situation worse in some trusts, where it is used as a cover for continued victimisation of those who speak out.
Ending self-regulation & providing independent oversight of whistleblowing
Thirdly, in common with industry, I believe that self-regulation in health and care does not work, and the only solution will be to set up a truly independent body to oversee and enforce this. This body must involve patients, who raise concerns at great cost to themselves and their families, against all the odds, often when people have suffered and died.
Health regulators in England and the people who they regulate are often uncomfortably close. For example, I was deeply disappointed when I found out only that the CQC Inspector involved in dealing with my concerns raised in 2013, later became employed as Compliance Lead in the same trust.
This is why I joined WhistleblowersUK and support the Protection for Whistleblowing Bill [HL] which includes setting up an Office of the Whistleblower. This will provide independent oversight of whistleblowing and support those working towards identifying and tackling the root causes of whistleblowing. This is one of the most pressing patient safety concerns of our time. Don’t rely on anyone else’s summary of this Bill. I urge everyone with an interest to read the Protection for Whistleblowing Bill itself and decide on your position based on the facts. đ” Read the Bill here: https://t.co/mIE77bjNTV đ” Read the APPG Report on the Bill here: Whistleblowing The Personal Cost of Doing the Right Thing and the Cost to Society of Ignoring it WWW: https://www.wbuk.org/s/APPG-WB-Cost-of-doing-the-right-thing.pdf
Following on from my blog on making the most of remote consultations, I realised it would be helpful to talk about the outcome patients should expect from consultations (wherever they are conducted). This blog is based on my clinical experience, on feedback from patients, carers and relatives, and on my experience of helping look after my mother at the end of her life.
There are some simple things that everyone should come away with at the end of a consultation. Knowing the plan & what the next steps are. Where to find information on what has been discussed and what to do if things get worse. If this information isn’t made clear, ask ‘what’s the plan?’
Consultation information:
At the end of the consultation, you must:
Have agreed a plan (even if this is ‘watch and wait’, or a referral on)
Have written information on what has been discussed& where to find support
Know the signs of improvement or the signs of deterioration to look for
Know when & who to contact if things change
Know who to contact in an emergency
At the end of the consultation:
At the end of the consultation, you should know:
That your concerns have been listened to
That the agreed actions will be taken
That you can seek a second opinion if needed
That the consultation will be communicated to all involved in the patient’s care
You should also receive:
Written information on the consultation. This may be in the form of notes, a care plan or visit summary & copies of ALL communication between clinicians.
‘If you’re not provided your records (as you should be), you may wish to keep a record of your consultations yourself and / or record them. As a clinician I encourage this.’ – Steve Turner RGN; RMN; Ba(Hons); P.G. Dip. Ed
In a future blog I’ll look at communication and documentation. What form should this take? Covering all options including online access to records, patient-held notes, visit summaries, assessment letters, patient notebooks, body maps, recordings, images. How can we ensure patients & all involved have this information in real time?
Steve Turner's blog site 