Blowing the whistle on health service secrecy

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A HEALTH service whistleblower’s group has set up in Northern Ireland at a time when concerns about safety in our health and social care system are rarely out of the news.

In recent months there has been extensive coverage on the role of whistleblowers within Northern Ireland’s health trusts following the leaking of documents to The Irish News which exposed allegations of years of abuse at two former children’s hospitals.

Dr. Kim Holt, one of the best-known health service whisteblowers in England, attended the launch of the NI branch of Patients First on Monday night and said the need for protection of people who flag concerns about patient safety has never been greater.

She was the consultant paediatrician who “blew the whistle” on the inadequacies of the department which failed “Baby P”. In an interview with The Detail she set out the ways health service management stifle whistleblowers and of the huge culture shift needed to establish transparency over safety.

The term whistle blowing refers to “making a disclosure in the public interest” and it means that concerns relating to unlawful conduct, financial malpractice, dangers to the public or the environment, or actions otherwise contrary to the public interest can be reported in the workplace following the correct procedures and protecting employment rights.

The Public Interest Disclosure Order 1998 is meant to protect whistleblowers from detrimental treatment by their employer. It aims to ensure that in cases where employers punish a worker for raising issues, the employee may bring a case before an employment tribunal, which can award compensation.

Following the leaking of a 2009 unpublished report, which raised serious concerns around abuse at Lissue House and Forster Green Children hospitals, to The Irish News in October 2011 a Cabinet Office inquiry was set up to find the staff member who had leaked the information.

The Health Minister Edwin Poots backed this position. He told the Health Committee meeting on the 18th January 2012:

“I think in terms of good governance, it isn’t appropriate for people, particularly civil servants, who take matters, which concern personal details about individuals, and put that into the public domain.

“I would actually encourage whistle-blowing. Whistle-blowing is when people know that there’s wrongdoing – they bring it to the attention of the senior people within the organisation. If that is ignored, they can then take it to Ministerial level. If that is ignored, there are other means of doing that. Whistleblowing is not leaking information to newspapers, particularly information which contains personal data.”

In a recent letter to all Health & Social Care Staff from March 2012, the Health Minister underlined his commitment to ensuring good practice in whistle blowing procedures within health trusts. In the letter he outlined that:

- The first kind of action that is appropriate is to speak up within your team or to the appropriate manager- managers and leaders at all levels are responsible for creating and sustaining an atmosphere of mutual support.

- If you have any concern that speaking up in good faith will lead to a problem, there are statutory procedures that protect you if you chose to blow the whistle and draw attention to some that is a cause for concern.

- All HSC staff have a moral duty to pass on any concerns to someone who can deal with it.

He stated:

“I fully recognise that the decision to report a concern can be a difficult to make. However, if what you are saying is true, you should have nothing to fear because you will be doing your duty to your employer and those for whom you provide a service.”

Meanwhile Dr Holt says the reality of whistleblowing is often more complex:

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Dr Holt is sceptical about how effective internal procedures within our health trusts actually are when it comes to protecting individuals who flag up these issues.

After highlighting shortcomings in her own department, the same department which failed Baby P four years before he died, Dr. Holt believes not only were they not followed up but she was also victimised because of her actions. Subsequently she refused a £120,000 gagging clause and has now been reinstated as a consultant paediatrician under new hospital management at the Whittington Hospital London.

“I got to the point where I couldn’t actually stay quiet about what had happened. I knew I couldn’t go back to my job if things were as they had been, because it was a very unsafe service. It’s a difficult situation where the procedures say you must speak up, but when you do, you often face hostility, and you know actually that’s quite unjust.

“To be honest, every time that a genuine whistleblower gets sacked, it’s going to be that the whistleblowing policy has failed and that is essentially a key part of the campaign in raising awareness that if a hospital or health trust has decided that they want to get rid of someone in order to protect their own reputation, then they can do it because they have so much power and they have huge reserves of money, etc. But it’s wrong, and they need to be held to account if they’re doing it in order to protect their reputation.”

In a letter to the Chair of the Health Committee, Sinn Fein’s Sue Ramsey MLA, from February 2012 – the Health Minister outlined guidelines for the safety of care workers in the private sector.

It states that in general terms, responsibility for the safety of care workers is shared between the work and the employer; the former to ensure that they do not knowingly place themselves at risk; the latter to make sure that staff are appropriately recruited, trained and managed in the roles they are asked to perform.

According to the Health Minister, staff have a number of avenues open to them when concerns arise. In the first instance, issues should be raised with their employer. Where staff believe that their concerns have not been adequately addressed they have recourse to the Regulation and Quality Improvement Authority (RQIA); to the HSC trust that have contracted for the service in which they work or through children’s or adults safeguarding procedures; the police; and ultimately to “whistle blowing” processes.

Since setting up Patient’s First, Dr. Holt claims she is constantly contacted by people who work within both the public and private sector.

“The first thing you notice is that the problems are the same, it is quite difficult to first of all have your concerns listened to, and secondly people can end up losing their jobs or being treated in a hostile way.

“My best piece of advice would be to tell the truth and not to lose your temper, which I know can be no easy task. Out of the four pediatricians that raised concerns I am the only one left standing. I believe it was my ability to put my argument across in a considered way and not send emails in a temper, as well as an effort to be reasonable throughout, served me well in the long run. “

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Patients Firsts’ Northern Ireland branch will be headed up by Nurse Patricia Campbell, who spoke to The Detail last year about her battle with the Belfast Trust whom she believed victimised her for her trade union activity. She was eventually dismissed for a “minor accidental misdemeanor” and is currently involved in an employment tribunal with the trust.

She believes the setting up of a Northern Ireland branch of Patients First will help prioritise and highlight the shortcomings for whistleblowers unique to this region.

She said: “top of the agenda has to be a campaign ruling out gagging clauses on whistle-blowers. Compromise agreements should only be permitted in exceptional cases. Currently these contracts are used in every case. We also believe The Regulation and Quality Improvement Authority (RQIA)mustbe fit for purpose. Cases in the past have shown that the RQIA has failed to act on concerns from individuals and groups of staff.

“Also we are calling on the Northern Ireland Health Committee to review the approach the department has taken against whistle-blowing. Part of this inquiry should include a review of all cases of whistle-blowers in the past five years whether they were successful in a court or Tribunal or settled out of court prior to that. This will help paint a picture of the experience of a whistle blower who at the minute are being left in the cold.”

The Health Minister was invited to attend the launch on Monday night (16th April) but in a letter to Ms. Campbell he said he could not make it because of diary commitments, but added :

“An independent group such as yours could provide the necessary support and add to the confidence of staff to take that first step to blow the whistle.”

Dr. Holt says the ultimate goal is that within the coming years, the need for groups like Patient’s First will become less and less.

She said: “Our key aim is to change the culture within the health service so that there are no whistleblowers, where people will be able to raise concerns and that we don’t need to have these massive scandals or people going public.

“The reality is we’re not there yet. People who blow the whistle can very often feel isolated and suffer depression. They go to a very low place. You see people in a very difficult place and it will devastate them and their families, and probably ruin their lives. I just think that’s absolutely disgusting that we’re doing this to people that are trying just to do a good job.“