The maternity unit at Basildon University Hospital has been ordered to carry out urgent improvements after a whistleblower anonymously raised serious concerns about patient safety to the Care Quality Commission (CQC). Protect Adviser Rhiannon Plimmer-Craig explores what this latest scandal says about the culture of the health sector, how whistleblowers are treated and why whistleblowers deserve better.
Since the deaths of baby Ennis Pecaku in September 2018 and 36-year-old Gabriela Pintilie in February 2019, the maternity unit at Basildon University Hospital has been subject to a number of criticisms of poor care and has been inspected by the CQC on two occasions.
The first inspection followed a month after the death of Ms Pintilie, who died due to a significant loss of blood after giving birth to her daughter. The CQC’s investigation which followed found that the maternity unit – which was once rated as ‘outstanding’ – now ‘required improvement’. After the coroner ruled that there were “serious failings”, a chief nurse at Mid and South Essex Hospital Group assured that “changes (had been made) to procedures to ensure the same situation does not happen again”[1].
Nevertheless, the maternity ward was again subject to an investigation after the CQC was contacted by an anonymous whistleblower who spoke out about patient safety. The surprise inspection found that the unit was ‘inadequate’ with ‘failings’ in six serious cases where six babies were born in a poor condition. It also found that there was a “dysfunctional” working relationship between midwives, doctors and consultants, which contributed to the increased number of safety incidents reported. Inspectors concluded that there had been a lack of learning from previous incidents and actions were not followed.
Stephanie Prior, the solicitor representing Ms Pintilie’s family, echoed these conclusions,
“You would have thought following my client’s death that changes would have been made, but you’ve got a whistleblower in May 2020 raising safety concerns… again”.
This is by no means the first scandal in the NHS and it likely won’t be the last. The investigation into the maternity department at Shrewsbury and Telford hospitals is considering more than 1,800 cases[2]. It is thought the numbers involved could make it one of the worst scandals in the history of the NHS – even exceeding the notorious Mid Staffs scandal, where between 400 and 1,200 patients died as a result of poor care.
At the heart of the NHS are the workers in the hospitals, who are the eyes and ears of the Trust. Whistleblowers are vital to exposing wrongdoing before it is too late. This is of paramount importance in any sector to ensure safe services, and particularly in the health sector, where speaking up can ultimately save lives.
Even though, in the case of Basildon University Hospital, the whistleblower did report to the CQC, it is important to highlight that they did this on an anonymous basis. Staff were aware of their Freedom to Speak Up Guardian, but had not raised concerns about patient safety with them. Maybe this is because, even in the most obvious cases of risk and wrongdoing, speaking up still feels like a massive step to take. But whistleblowers should be encouraged to raise concerns and feel welcomed in doing so. Anonymity should never be the only option for whistleblowers who want to do the right thing and expose wrongdoing. It may be that others witnessed these patient safety risks at Basildon and stayed silent because they feared the repercussions of speaking up.
Staff feeling safe and comfortable to speak up about wrongdoing is futile if they are not being listened to and appropriate action is not being taken. Senior management need to listen to concerns, learn from errors, and ensure such mistakes – which cost lives – are not repeated. Whistleblowers should have the confidence to come forward – not just that they will be listened to, but that their concerns will be taken seriously and acted on.
Organisational culture plays a fundamental role in encouraging whistleblowers to come forward. Raising concerns with the employer is usually the quickest route to getting concerns addressed, but whistleblowers can raise their concerns directly with the CQC if they are not comfortable raising matters internally.
The NHS has already taken important steps – with the introduction of Freedom to Speak Up Guardians to instil a healthy working culture – but this case reveals that there is still a long way to go to ensure staff can speak up without fear.
In Protect’s draft whistleblowing Bill, to reform current whistleblowing law, we propose that:
- There should be a duty on the employer to investigate and escalate concerns if needed
- There should be mandatory standards on how whistleblowers are treated by employers
- Employers should take positive action to prevent victimisation
Health is a heavily regulated sector already, but whistleblowers need more protection to encourage them to speak out about such serious patient safety concerns.
[1] https://www.theguardian.com/society/2020/jul/21/shrewsbury-and-telford-hospitals-maternity-services-scandal
[2] https://www.bbc.co.uk/news/uk-england-essex-51156452