Presentation made on Speaking out safely to the NHS patient safety congress 2014 by Gary Walker and Jenni Middleton

1. The analysis and now the solution
How can NHS staff and managers make its culture safer to raise concerns?
Harnessing the power of the NHS’s greatest asset – its staff – to make patients safer
Exploring trust board solutions to ensure the NHS is a safe place to speak out
Dealing with issues rather than blaming the staff – what can be done?
Ensuring your organisation isn’t the next scandal-hit place to hit the headlines

2. Helene Donnelly OBE
In Mid Staffs, 515 incident report
forms about patient care from
staff were “misplaced” between
April 2005 and August 2008
Nursing Times
8 February 2011

3. A year after Francis we asked 470 readers how their concerns were
handled…
20%
50%
30%
Don't know
Did NOT lead to an
'appropriate outcome'
Did lead to an
'appropriate outcome'
Survey carried out in February 2014 and published Nursing Times 6 March 2014

4. 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

5. garywalkeruk

6. Raising
concerns
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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.
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8. 60% of whistleblowers didn’t get a response
N-601 of a sample of 1000 garywalkeruk

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11. “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

12. http://www.inc.com/margaret-heffernan/3-reasons-whistleblowers-are-your-companys-best-friend.html
Whistleblowers are an
organisation’s best friend
Treated properly,
whistleblowers can save
you time and money
1. Whistleblowers don’t want
to go public
2. Whistleblowers are your
best early warning system
3. Whistleblowers need a safe
space to speak.

13. Victimising NHS Whistleblowers is unlawful
and is likely to be endangering patient safety and/or the
financial stability of the organisation
garywalkeruk

14. 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
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15. “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
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16. Repeated denials
that
whistleblowers
exist has become
a commonly
held belief
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17. 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
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18. 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

19. 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

20. 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

21. 1. Believe in whistleblowers
(Don’t brief against them)
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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

23. 2. Declare whistleblowers
are an asset not a liability
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24. 3. Act on a whistleblower’s concern: it protect patients
(Don’t shoot the messenger)
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26. 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 High
Court (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

27. 4. Sanction those who
victimise whistleblowers
(Don’t promote them)
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29. 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
garywalkeruk

30. Ashford and St. Peter's Hospital NHS Foundation Trust
Bedford Hospital NHS Trust
Birmingham Children's Hospital NHS Foundation Trust
Blackpool Teaching Hospitals NHS Foundation Trust
Buckinghamshire Healthcare NHS Trust
Burton Hospitals NHS Foundation Trust
Chesterfield Royal Hospital NHS Foundation Trust
Countess of Chester Hospital NHS Foundation Trust
Derby Hospitals NHS Foundation Trust
Doncaster and Bassetlaw Hospitals NHS Foundation Trust
Dorset County Hospital NHS Foundation Trust
Dudley Group NHS Foundation Trust
East Cheshire NHS Trust
East Lancashire Hospitals NHS Trust
Epsom and St Helier University Hospitals NHS Trust
Gateshead Health NHS Foundation Trust
Heart of England NHS Foundation Trust
Homerton University Hospital NHS Foundation Trust
Hull and East Yorkshire Hospitals NHS Trust
Ipswich Hospital NHS Trust
Leeds Teaching Hospitals Trust
Liverpool Women's NHS Foundation Trust
Medway NHS Foundation Trust
Mid Cheshire Hospitals NHS Foundation trust
Mid Staffordshire NHS Foundation Trust
Milton Keynes Hospital NHS Foundation Trust
Norfolk and Norwich University Hospitals NHS
Nottingham University NHS Hospitals Trust
Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust
Royal Bournemouth and Christchurch Hospitals NHS
Foundation Trust
Royal Free London NHS Foundation Trust
Salford Royal NHS Foundation Trust
Sherwood Forest Hospitals NHS Foundation Trust
Shrewsbury and Telford Hospital NHS Trust
Stockport NHS Foundation Trust
South Devon Healthcare NHS Foundation Trust
South Tees Hospitals NHS Foundation Trust
University Hospitals of Leicester NHS Trust
University Hospitals of Morecambe Bay Foundation Trust
University Hospital of North Staffordshire NHS Trust
Walsall Healthcare NHS Trust
Warrington and Halton Hospitals NHS Foundation Trust
Western Sussex Hospitals NHS Foundation Trust
West Hertfordshire Hospitals NHS Trust
Worcestershire Acute Hospitals NHS Trust
Wrightington, Wigan and Leigh NHA Foundation Trust
Wye Valley NHS Trust
Yeovil District Hospital NHS Foundation Trust
Acute Trusts Signed up so far…

31. 2gether NHS Foundation Trust for Gloucestershire
Birmingham Community Healthcare NHS Trust
Bridgewater Community Healthcare NHS Trust
Bristol Community Health NHS Trust
Cambridge Community Services NHS Trust
Central London Community Healthcare NHS Trust
Derbyshire Community Health Services NHS Trust
East London NHS Foundation Trust
Gloucestershire Care Service NHS Trust
Hounslow and Richmond Community Healthcare
Leeds Community Healthcare NHS Trust
Liverpool Community Health NHS Trust
Lincolnshire Community Health Services NHS Trust
Norfolk Health and Community Care NHS Trust
Shropshire Community Health NHS Trust
Solent NHS Trust
Staffordshire and Stoke-on-Trent Partnership NHS
Trust
Sussex Community NHS Trust
Wirral Community NHS Trust
Coventry and Warwickshire Partnership NHS Trust
Cumbria Partnership NHS Foundation Trust
East London NHS Foundation Trust
Greater Manchester West NHS Foundation Trust
Hertfordshire Partnership University NHS
Foundation Trust
Leicestershire Partnership Trust
Mersey Care NHS Trust
Northumberland, Tyne and Wear NHS Foundation
Trust
South Essex Partnership University NHS Foundation
Trust
Sussex Partnership NHS Foundation Trust
Tees, Esk and Wear Valleys NHS Foundation Trust
Community and Mental Health Trusts signed up so far…

32. NHS Blackburn with Darwen CCG
NHS East Lancashire CCG
NHS Eastern Cheshire CCG
NHS Herefordshire CCG
NHS Liverpool CCG
NHS Northern, Eastern and Western Devon CCG
NHS North Durham CCG
NHS North Staffordshire CCG
NHS Norwich CCG
NHS Redditch and Bromsgrove CCG
NHS Shropshire CCG
NHS Solihull CCG
NHS South East Staffordshire and Seisdon Peninsula CCG
NHS South Tyneside CCG
NHS Stoke on Trent CCG
NHS Wyre Forest CCG
Clinical Commissioning Groups signed up so far…

34. What do we want from you?
Sign up to SOS today (or email your Director/Manager)
Put the logo and our pledge on your website
We write a lovely story about your support on our website, which you share with all your staff
Contact fran.entwistle@emap.com or jenni.middleton@emap.com

35. The analysis and now the solution
How can NHS staff and managers make its culture safer to raise concerns?
Harnessing the power of the NHS’s greatest asset – its staff – to make patients safer
Exploring trust board solutions to ensure the NHS is a safe place to speak out
Dealing with issues rather than blaming the staff – what can be done?
Ensuring your organisation isn’t the next scandal-hit place to hit the headlines