Editorial

Openness and transparency in health services is widely accepted as being a pre-requisite of being a ‘learning organisation’ and developing a ‘patient safety culture’. I have used this editorial on a number of occasions to discuss the need for a ‘Duty of Candour’ with patients, when things go wrong in healthcare. There have been interesting developments in that direction as a result of the furore over the Health and Social Care Bill, and our campaigning. However, I want to take this opportunity to discuss the need for support and protection of so-called ‘whistleblowers’ – healthcare staff who try to do the right thing by raising the alarm about unsafe care. At AvMA, we believe that the support and protection of whistleblowers is very much linked to the need to be open with patients. Increasingly, in fact, whistleblowers are turning to AvMA, a patients’ organisation, as the most useful source of support in seeking the changes that are needed.

In July, to mark the anniversary of the Bristol Inquiry, Private Eye published a special supplement on whistleblowing. The stories are both shocking and uplifting in terms of the bravery of the whistleblowers concerned. However, it is clear that the NHS is still prepared to punish and bully whistleblowers, and close its ears to the warnings they provide. One is reminded that one brave doctor, Dr Steve Bolsin, was responsible for lifting the lid on Bristol and suffered as a result. Whistleblowers were ignored or bullied at Mid Staffordshire, the latest of our high profile hospital scandals. In another famous scandal, that of Baby P, paediatrician Dr Kim Holt repeatedly tried to warn management at Great Ormond Street Hospital that their systems were leaving vulnerable children at risk and was not only ignored, but punished.

Kim Holt's experience also serves to remind us of another aspect of the NHS's treatment of whistleblowers which is so scandalous. The NHS tried to buy Kim's silence by offering her £120,000 as part of a ‘gagging clause’ in a proposed settlement. To her great credit, she refused to accept it. But millions of pounds have been spent on gagging clause settlements, where individuals have been in no position to reject it. Many more millions have been spent on lawyers’ fees in attempts to grind whistleblowers into submission.

Andrew Lansley, on becoming Health Secretary, not only kept his promise to hold an inquiry into Stafford, but also promised to do something to protect whistleblowers. However, we are yet to see anything materialize, and the original proposal of altering the NHS Constitution would do little or nothing to actually protect or support whistleblowers.

AvMA has been contacted by a number of whistleblowers who share our vision of an NHS which is genuinely open and honest with patients, and supportive of healthcare staff who seek to act in the interests of patients. Working together, we believe that we can be an even stronger force. There is a sense that momentum for change is growing. Chair of the Health Select Committee, Stephen Dorrell MP, recently announced that the committee would be taking a long hard look at the subject of whistleblowing. There are soon to be recommendations about whistleblowing from the Mid Staffordshire Inquiry. These will surely be more reassuring than Andrew Lansley's proposal to alter the wording of the NHS Constitution!

Another opportunity presents itself with the Health and Social Care Bill. Already the Government have sought to demonstrate it is listening, by promising a “contractual” duty of candour (a standard clause in providers’ contracts). Whilst a step in the right direction, this is not enough. What is needed is a clear and enforceable statutory duty on all healthcare organizations. A sensible solution would be to combine this with statutory duties to support and protect whistleblowers.