David Prior, chairman of CQC, told the Health Select Committee this week that a ‘chilling’ culture in NHS hospitals discouraged potential whistleblowers from speaking out. In response I wrote to him, agreeing and giving a description of my experience of such a culture at Walsall Hospitals NHS Trust from 2008 to 2010 which ended in my dismissal. I have not worked since. Here is the unabridged letter:
23 October 2013
Dear Mr Prior
Re: There has been a deafening silence from clinicians for too long.
Thank you for the evidence you gave to the Health Committee yesterday and its subsequent press coverage. I agree with your thesis that good clinicians speak up for patients and good leaders will encourage staff to speak up and will listen to what they say. Gold dust.
The Midstaffs experience and survey after survey shows that staff often do not speak up believing that no-one will listen or, even worse, they will suffer personally. This was my experience at a West Midlands hospital from 2008 to 2010.
I was the senior clinician in the paediatric department and by 2008 had been head of department for 7 years. I was removed as head of department in April 2008 for daring to suggest a consultant I was managing had problems with competence. There was agreement in the consultant body with my view. The Trust failed to engage with this.
In October 2008 I raised serious concerns about mismanagement of the department. A Royal College of Paediatrics (RCPCH) review later agreed that the Trust executive had inappropriately appointed managers with no paediatric qualification or experience who were managerially aggressive (I used the word bullies) and sidelined senior frontline staff. The context to this was a cost-cutting exercise to prepare for FT application and to pay for the new PFI hospital.
I expressed concerns about proposed swingeing cuts to the nursing establishment and proposed medical redundancies. If left unchallenged these would have (and partly did) result in an unsafe service. As important, a mismanaged redundancy programme resulted in the loss of some of our best nurses and the demoralization of those who stayed.
I also reported major problems with the child protection service which the Trust was not taking seriously. A child (Child K in the Local Safeguarding Children Board Serious Case Review) died following catastrophic mistakes in basic safeguarding. No serious attempt was made to address these mistakes. A nurse with no safeguarding experience was appointed internally to mitigate redundancy numbers. A subsequent appointee was bullied out of her post by managers. The CEO suggested she was not up to the job and that managers swearing at her could be excused as they were under stress.
Children were put at serious risk through changes to in-patient accommodation made without reference to clinicians. An antiquated ward heating system repeatedly broke down over 2 winters causing sick babies to become hypothermic.
Management failed to take these issues seriously. The CEO for example took 8 months to provide an unsatisfactory written response to my concerns about safeguarding.
In April 2009 as a result of this I was unceremoniously excluded from the hospital. Documents obtained by Data Protection Act showed the Medical Director claiming to NCAS that I needed excluding as I was obstructive, unmanageable, writing defamatory letters to a manager, thought to be psychotic, leaking information to the press about Child K, might interfere with any Trust investigation of my exclusion and posed a threat to staff and patients. If that sounds a bit crazy in itself it is exactly what the telephone transcripts show. He had not mentioned a word of this to me before excluding me and never did at any future date. Not a word of it was true.
The investigation into my exclusion concluded that I had no case to answer. The RCPCH review subsequently agreed that even if the allegations made against me had been true they did not warrant exclusion. I returned to work after 5 months.
There had been if anything a deterioration in the department in my absence. The consultant I had originally complained about was repeatedly being reported to the West Midlands Deanery for bullying, making trainees afraid to speak out, being unsupportive and not attending calls out of hours. The managerial bullying was worse. One consultant had found a new job and others were talking of leaving. I wrote a comprehensive disclosure to the CEO and said that if she failed to act I would consider my obligations under the Trust whistleblowing policy discharged and I would go outside the organisation. The Trust Chair then met me with my BMA rep and agreed to commission an independent review of the paediatric department through the RCPCH.
The 3 person review panel sat in early 2010. A report was written but only 2 copies printed. I was given one and the CEO the other on 26 March 2010. The following facts about the review are now clear:
- The 3 panel members were gagged by the Trust. The CEO of the RCPCH informed me of this recently when I wrote a formal complaint about the review. The panel members he told me were unable to help his investigation because of the gags.
- I wrote to the panel chair before the review started stating that I was a whistleblower, gave incontrovertible evidence of protected disclosures to the panel at interview and yet the report, without giving any evidence, said that I was not a whistleblower.
- The report was highly critical of Trust senior management. It was suppressed by the CEO. Even the Trust board did not see it. According to one non-executive director (transcript of appeal hearing) the board accepted the CEO’s claim that it was too confidential for them to see. The CEO told my ET (agreed transcript) when cross examined on why she had not let the board see it, “Because they didn’t ask”.
- Under the review’s instruction dissemination of its findings were left entirely to the CEO. I was disbarred from having any part in this. The CEO sent a highly selective summary omitting serious criticisms of senior management to a select group. The CEO specifically altered the review’s instruction of who should see its findings in this summary. As a result middle grade non-clinical managers saw the summary but even senior clinicians who were department heads were excluded. The CEO had recently escaped a consultant vote of no confidence so this was perhaps understandable.
- The review chair refused my written requests to see the RCPCH policy his panel was working to. The RCPCH Registrar likewise refused. Lately the RCPCH has relented and provided me with its policy, “A protocol for external clinical advisory team visits” which was given to the review panel. It is clear from this that there were serious breaches of the protocol including the signing of gags which put the whole process beyond further scrutiny.
- Part of the reviews methodology was to take notes of all witness interviews then destroy them after use. This is specifically contrary to RCPCH policy and again protects the review from scrutiny.
- At no future point was any panel member willing to attend either an internal disciplinary or an external legal proceeding to be cross examined on the review. The review, its conduct and conclusions were carefully and methodically put, by the Trust and the review panel, beyond scrutiny.
Immediately the report was given us the CEO asked me to agree to all its findings and required outcomes without caveat. I expressed concern about two specific issues: the dissemination of the review which I knew the CEO would want to suppress and an instruction about the expression of my Christian faith at work which had not been raised with me in interviews and which I guessed was based on mischievous complaints by managers I was in conflict with. I got an email by return from the CEO asking me to resign. I did not. I then received an appointment for a disciplinary hearing with date, time, place and the names of panel members. I can perhaps be forgiven for thinking this was “here’s one I prepared earlier”. The hearing was a blatant breach of Trust policy as no investigation had taken place. It was stood down by the CEO after BMA representations.
The review chair was then appointed (the interview committee consisted of the CEO and Trust chair with no medical representation) as head of the paediatric department. This was helpful in his planned career move from paediatric nephrology to management. He was aware that the CEO was suppressing the report but refused to do anything. His first act on taking up the post was to meet me and tell me that unless I signed up to the findings of the review immediately I would “soon not be working in the Trust.” The BMA advised me this was discriminatory as no-one else had been made to sign anything. I did not sign.
I was then called to a meeting with the CEO with my BMA rep present. The meeting was digitally recorded. The CEO told me she and the Trust board had decided my position was untenable. This according to a non-executive director was untrue; he knew nothing about it. “We’ve been kept in the dark David.”
The CEO offered me a 6 figure sum, well above my contractual entitlement, and a good reference if I left immediately. She told us that because the SHA was involved in the offer I would have to sign a gag. The BMA and I later made separate inquiries at the SHA (including its CEO) and we were told nothing was known about this offer.
The offer in any case was in breach of the instructions laid down for settlement in Maintaining Higher Professional Standards. I called it what it was, a bribe at tax-payers expense and refused it. As a result the disciplinary procedure was restarted against me. I was finally dismissed for “gross misconduct and insubordination” In December 2010 after what my BMA rep described as a kangaroo court.
I believe I was dismissed because of the serious concerns I raised about the paediatric department particularly from 2008 to 2010. I was an embarrassment to the CEO and Trust Chair especially after the review was so critical of senior management. There is a paper trail of my claims to be a whistleblower which the Trust and review panel preferred to ignore. The layers of secrecy around the review which was conducted by a RCPCH approved panel are inimical to a patient safety culture. What kind of a Trust board can accept a service review of a department for which it has governance responsibilities being kept from it? A supine board in my opinion. The review chair was specifically complicit with the CEO in suppressing the report his panel produced.
I did my best at all times as a doctor. I kept faith with my patients, my professional code and my conscience. At my disciplinary hearing the Trust solicitor is on record as saying. “This hearing is not about the loss of a job. It is about the end of a career.” This was followed by the disciplinary panel chair who was the Director of Nursing who added, “…and never being able to practice medicine again.” There was no doubt in their minds of the consequences of my dismissal. This may give a clue as to why medics and nurses are sometimes reluctant to speak up.
My book “Little stories of Life and Death @NHSWhistleblowr” includes this material but in a more narrative form and will be published soon. Meanwhile I will publish this letter on my blog in the next couple of days, not to embarrass you in any way but to raise the profile of NHS whistleblowing.