Speaking Out Summit with Roy Lilley

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What lessons can Whistleblowers provide about how trusts can better encourage and facilitate speaking out?

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Speaking Out Summit with Roy Lilley

  1. 1. What lessons can Whistleblowers provide about how trusts can better encourage and facilitate speaking out? Gary Walker, Whistleblower, Former NHS Trust Chief Executive, Trustee Public Concern at Work Speaking Out Summit (SOS) garywalkeruk
  2. 2. Health professionals needed to think “very hard” before standing up against poor patient care, because it is “potential professional suicide” “Your employer won't thank you; the law won't protect you. You're on your own” Ramon Niekrash April 2010 garywalkeruk
  3. 3. “I couldn't encourage anyone to whistleblow.” “The patients have been forgotten in all this” University Hospital of Coventry and Warwickshire NHS Trust spent £6-10m victimising Raj Mattu April 2014 garywalkeruk
  4. 4. Ray Law, 60 Avoidable death 2010 Surgeon’s memo: “death of an otherwise healthy patient” 3rd prostatectomy on the operating list garywalkeruk
  5. 5. …targets were exerting “enormous pressure”… ”…work with you to identify what additional resources we need to provide a safe service in the future” garywalkeruk One of six incidents including WL manipulation reported in 2010 Inspection didn’t review any incident Inquest 2014 - Expert said Mr Law “would have survived” Trust investigated. Did not die because of targets. Surgeon said: "It was not normal for me to perform three operations in a day. I haven't done it since.” Narrative verdict “Lessons learned”
  6. 6. Victimising NHS Whistleblowers is unlawful and is likely to be endangering patient safety and/or the financial stability of the organisation garywalkeruk
  7. 7. NHS Whistleblower (sample in public domain) Role Issues raised Employer Outcome Tracy Boylin Director (HR) Misconduct / Fraud The Christie Sacked David Drew Doctor Patient safety Walsall Healthcare Sacked Kim Holt Doctor Patient safety GOSH Kept job* Raj Mattu Doctor Patient safety Coventry and Warwickshire Sacked Edwin Jesudason Doctor Patient safety Alderhey Forced to resign John Watkinson Chief Executive Patient safety Royal Cornwall Sacked Jennie Fecitt Nurse Patient safety NHS Manchester Sacked Sandra Haynes Kirkbright Administrator Patient safety Royal Wolverhampton Hospitals Threatened with sack** Gary Walker Chief Executive Patient safety United Lincolnshire Hospitals Sacked Ramon Niekrash Doctor Patient safety South London Healthcare Kept job*** Helene Donnelly Nurse Patient safety Mid Staffordshire Forced to move job Narinder Kapur Doctor Patient safety Addenbrookes Sacked Margaret Haywood Nurse Patient safety Brighton and Sussex Struck Off Loo Blackburn Nurse Patient safety Oxford GP practice Forced to move Job Shiban Ahmed Doctor Patient safety Alderhey Kept job**** Steve Bolsin Doctor Patient safety Bristol Royal Infirmary Forced to leave UK Sharmila Chowdhury Manager Misconduct / Fraud Ealing Hospitals Sacked Mike Chester Doctor Patient safety Royal Liverpool Sacked Kate Clarke Administrator Patient safety Dudley Hospitals Sacked David Ore Security Patient safety Dudley Hospitals Sacked/Redund * Suspended 4yrs, reinstated, service transferred ** Ongoing – Jeremy Hunt intervened *** Left with £170,000 costs **** Left with £20,000 costs, suspended twice since, and still suspended on false allegations of mental illness. garywalkeruk
  8. 8. NHS Confederation “Several of our interviewees identified a problem of a perceived or real toxicity in the wider system inhabited by chief executives, describing the environment as “brutal”, “arbitrary”, “prone to favouritism” and intolerant of risk-taking that isn’t successful.” Don Berwick “Fear is toxic to both safety and improvement” “A symptom of this cycle is the gaming of data and goals; if the system is unable to be better, because its people lack the capacity or capability to improve, the aim becomes above all to look better, even when truth is the casualty.” 20092013 https://www.gov.uk/government/publications/berwick-review-into-patient-safety garywalkeruk
  9. 9. “I heard of a fear of bullying being a possible explanation for more staff not coming forward with concerns…there was also fear among staff about the repercussions of not complying with targets. “Finally and perhaps of most concern, I found a widespread culture of denial” Robert Francis QC garywalkeruk
  10. 10. Repeated denials that whistleblowers exist has become a commonly held belief garywalkeruk
  11. 11. Culture of Cover-ups £28m and 1000 compromise deals “There is simply no way of knowing how many of these special severance payments have been made across the public sector – or whether the compromise agreements have been used to ‘gag’ employees. To date neither the Treasury nor individual departments have monitored this adequately.” The Public Accounts Committee garywalkeruk
  12. 12. Culture of Cover-ups £28m and 1000 compromise deals “We heard evidence of shocking examples of using taxpayers’ money to ‘pay-off’ individuals who have flagged up concerns about patient or child safety” The Public Accounts Committee garywalkeruk
  13. 13. Q. Have you witnessed bullying by management or a colleague in the past 12 months? A. 22% said up to 10 times - that’s 374,000 employees NHS Staff Survey 2013 Q. Would you feel safe raising concerns? A. 28% said No/don’t know - That’s 476,000 employees
  14. 14. Carter, M. and Thompson, N. and Crampton, P. and Morrow, G. and Burford, B. and Gray, C. and Illing, J. (2013) 'Workplace bullying in the UK NHS : a questionnaire and interview study on prevalence, impact and barriers to reporting.', BMJ open., 3 (6). e002628. Workplace bullying garywalkeruk 2,950 NHS staff (cross-sectional) 43% reported having witnessed bullying in the last 6 months
  15. 15. “Far too many who hold positions of power - and who could affect change - are still dragging their feet while patients and staff continue to suffer.” Helene Donnelly OBE March 2014 garywalkeruk
  16. 16. Boards are accountable for the culture of their organisations “People at the head of an organisation set the tone for the quality of care that is provided” Jeremy Hunt 14 Feb 2014
  17. 17. NHS Boards? Individuals? The Media Public & staff Politicians Who doesn’t support Whistleblowers? garywalkeruk
  18. 18. A “culture of openness” is spreading through the NHS, with almost 1,000 whistleblowers reporting poor care every month. Jeremy Hunt 4 Feb 2014
  19. 19. 1. Believe in whistleblowers (Don’t brief against them) garywalkeruk
  20. 20. “Oh yes I've spoken to whistleblowers,not genuine though.” Training event April 2014
  21. 21. garywalkeruk The NHS must stop the dishonesty of public support and private condemnation The NHS must stop the secret briefings, profiling, denial, victimisation, and internal reviews that seek to cover up wrongdoing
  22. 22. Getting the language right… "Raising concerns and whistleblowing are different things” Dean Royles, HSJ, 21 March 2014 garywalkeruk
  23. 23. Speaking out / raising concerns / protected disclosures Minor issues eg stock reordering Clinical concerns eg competency Management concerns eg risk factors (PD) Concerns about criminal offences (PD) Concerns about failure to comply with a legal obligation (PD) Concerns about health and safety (PD) Concerns about an environmental issue (PD) Concealment of any PD Raising concerns and whistleblowing are generally the same garywalkeruk
  24. 24. 2. Declare whistleblowers are an asset not a liability garywalkeruk
  25. 25. 3. Act on a whistleblower’s concern: it protect patients (Don’t shoot the messenger) garywalkeruk
  26. 26. garywalkeruk garywalkeruk
  27. 27. 24. Refuse to disclose documents. No one cares about DPA and FOI 23. Accuse a whistleblower of not raising concerns early enough 22. Delay as much as possible to push up the legal costs for the whistleblower 21. Ignore PAC and other inquiries 20. Pretend that the Public Interest Disclosure Act offers adequate protection 19. If external investigation, the trust can still organise and pay for it, recruit the panel 18. Arrange an “in house” investigation. 17. Throw public money at an employment tribunal appeals (unlimited budget) 16. Throw public money at an employment tribunal (unlimited budget) 15. Make vexatious complaints to a professional regulatory body 14. Publicly humiliate the whistleblower 13. Rely on the cowardice and apathy of the Department of Health 12. Make friends with the coroner to avoid scrutiny 11. Appoint consultants to rubbish the whistleblower’s claims. 10. Threaten to sue the whistleblower 9. Apply to the Treasury for public money to pay off and gag the whistleblower 8.Misuse the code of conduct for managers 7. Claim it’s an employment conflict 6. Allege mental health issues (very popular) 5. Threaten whistleblowers and the media with libel suits 4. Threaten reprisals against colleagues who support a whistleblower 3. Repeatedly ignore, deny or pretend to address the concerns 2. Allege actual or invented misdemeanours 1. Inflict subtle sanctions beyond legal protection garywalkeruk
  28. 28. 4. Sanction those who victimise whistleblowers (Don’t promote them) garywalkeruk
  29. 29. garywalkeruk
  30. 30. The culture must change To protect patients To support whistleblowing Boards are accountable for the culture and how they support Speaking Out 1. Believe in whistleblowers 2. Declare whistleblowers are an asset not a liability 3. Act on a whistleblower’s concern: it protect patients 4. Sanction those who victimise whistleblowers 5. Publish how you support those raising concerns Speaking Out Summit (SOS) garywalkeruk

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