What place does whistleblowing have in preventing clinical negligence?
Earlier this year, the preventable deaths of more than 450 patients at Gosport Memorial Hospital sparked anger and public debate that echoed the infamous Mid Staffordshire NHS Trust scandal in 2008.
These scandals can have damaging effects: on patients, their families, public confidence, the Trust’s reputation and the career and well-being of implicated healthcare professionals. Plus, the enormous economical strain it places on an already overstretched NHS; in the 2017/2018 NHS Resolution report, (formerly the NHS Litigation Authority) announced it had spent £2.3 billion on negligent patient claims, an increase of 30% compared to £1.6 billion the previous year.
At Protect, our charitable objective is to protect the rights of whistleblowers who have been unfairly dismissed or suffered harm after raising a public interest concern. We run a free legal advice line for employees to discuss concerns. Perhaps unsurprisingly, our 2017- 2018 advice line figures show the health and care sector the highest sector to call us; accounting for 35% of calls. The majority of these calls, 46%, are in relation to patient safety, with other common concerns about poor clinical malpractice and the maladministration of medication.
Clinical negligence is not due to professional mistakes alone, ‘systemic failure(s)’ of Trusts, as highlighted in Sir Robert Francis QC Mid Staffs inquiry are often contributory. Such failures can include under-staffing, under-resources and IT system failures, or as Francis concludes, a ‘negative culture’. In his inquiry he found leaders within the trust ‘had reacted too slowly, if at all, to some matters of concern of which they were aware’.
In the Freedom to Speak up review, a campaign to encourage healthcare professionals to voice concerns, Francis discovered NHS patients were being put at risk because staff were ‘deterred from speaking up by the fear of adverse consequences or the belief that nothing will be done.’
Today, all NHS Trusts in England have Freedom to Speak Up Guardians to help staff raise concerns they have in the workplace.
In Gosport Independent’s Panel 2018 inquest, into the historic 450 patient deaths at Gosport Memorial War Hospital, the panel found that the maladministration of ‘opioids without appropriate clinical indication’ was the preventable cause. Similar to the culture of silence at Mid Staffs, the panel found ‘nurses had raised clear concerns in 1991, but these were ignored’. This led to malpractice and negligence ‘becoming a culture and a norm for the wards involved’.
Our experience at Protect shows effective whistleblowing arrangements can create an open working culture, where staff feel encouraged to speak up with concerns investigated. This can positively affect staff well-being and lead to staff taking greater accountability for their actions, and adhering to good governance and best practice guidelines.
By 2020, the National Audit Office (NAO) estimates that NHS Resolution will increase it’s spending on clinical negligence patient claims from £2.3 billion to £3.2 billion. Worse still, NAO figures in 2017 show that in 61% of successful patient claims, the legal costs are higher than the compensation the claimant personally received for the damage suffered.
Providing staff with the appropriate whistleblowing channels can enable malpractice to be addressed sooner, or if noticed and raised early enough; harm may even be preventable. The benefits of this are threefold: notable cost savings in legal fees, protects the organisations reputation and enables public money to be spent where it is needed most; on patients.
–Most importantly, by speaking up and raising a concern you can create safer working conditions, prevent public harm; or perhaps save a life.
If you are an employee and wish to discuss a concern, or are an employer who wishes to enhance your whistleblowing arrangements, please get in touch on 02031172525 or services@pcaw.org.uk
Written by Protect Business Support Executive Olivia Bennett