---

NHS Whistleblowing

I am delighted to be having this debate at such an appropriate time, and I am very pleased to see the Minister, with whom I often exchange shots across this Chamber. I am also very pleased to see, behind me, the hon. Members for Stafford (Mr. Kidney) and for Cannock Chase (Dr. Wright), who have been, and are, closely involved in whistleblowing issues. The debate is absolutely relevant. First, the country was staggered by the revelations from mid-Staffordshire, after which people inevitably asked why no doctor or senior nurse appeared to have spoken out. Then, at almost the same time, we got the answer with the case of the whistleblower from Brighton. She admitted that she had done wrong in breaching confidentiality, but felt that she was doing good by exposing publicly and effectively the standard of hospital care. She thought that was exactly the right thing to do, but she has been struck off. That has raised an absolute furore in the press, and there has been a petition by the Royal College of Nursing. The letter that I liked best was a short and brief one in The Independent of 20 April, from a lady called Fleur Ball, from Plymouth, who wrote:""I surely can't have understood this properly. A nurse has been struck off, not for failing to care for elderly, terminally ill patients, but for breaching their confidentiality by revealing how little care they received…And this only after alerting managers to the appalling lack of care given on that ward."" I looked up the Nursing and Midwifery Order 2001 and discovered that the conduct and competence committee has four options of punishment when it feels that allegations that have come before it are well founded. In this case, it elected to give the harshest punishment because, according to the report of the judgment, the panel's view was that""the misconduct found is fundamentally incompatible with being a nurse."" It is not my place to express a particular opinion about the correctness of that decision, because it could well go to appeal, but one can say that it has been an absolute disaster for anyone in the NHS who was thinking of whistleblowing. Surely, the habit of leaving helpless elderly patients in pain, in filthy beds, without food or fluid, is incompatible with being a nurse, or indeed a doctor, if he or she condones it by not speaking out. Recently, the Select Committee on Health had a trip to New Zealand, which was a long way to go, but was extremely useful. I have the Chair of the Committee's permission to comment on one or two things. We met the chair of New Zealand's Quality Improvement Commission, who told us:""The excuse, 'I'm too pushed to do better,' is rubbish."" The Royal College of Nursing has produced a very useful booklet called, "Dignity at the heart of everything we do: Defending Dignity—challenges and opportunities for nursing". It says in the executive summary:""As one nurse explained: 'I believe there is always a way around obstacles and primarily it is you, yourself, your actions, standards and behaviour that deliver care.'"" So, however pushed people are, it is up to them to get over those obstacles, and that should be possible even on the most stressful occasions. Otherwise, people should at least speak out and say that they cannot do something, and say what they need to be able to do it. Therefore, I ask the Minister an absolutely straight question: is there no way of reviewing or reversing the independent panel's decision to strike that nurse off, other than appealing to the High Court? Turning to Stafford, about which much has been said and written—there was an exemplary debate on it in this place recently, which was led by the hon. Member for Stafford—several hon. Members have expressed their amazement that there were apparently no staff whistleblowers there. Dr. David Colin-Thomé, the Government's GP tsar, wrote in the introduction to his review of the lessons learned in mid-Staffordshire:""What has particularly shocked and disappointed me is that no NHS organisations, staff or representatives of the public reported any serious concerns about emergency services in the hospital. Yet patient complaints and patient surveys all pointed to poor care."" We need to know whether senior doctors and nurses attempted to speak out and whether they were silenced. I know that the Government are against it, but an independent inquiry is probably the only way to find out. I have permission to raise this matter in the Health Committee tomorrow, when I will see if its members will consider taking on an inquiry into whistleblowing. Personally, I am not sure whether that would be the best way of getting at doctors and nurses, and I might suggest, tomorrow, that a small group of Committee members, who are not in any way related, geographically, to the problems in that area of Staffordshire, could go there and meet one or two representatives, completely anonymously, just to talk about what they tried to do, if they tried to do anything. My interest in whistleblowing arose after a number of complaints at home about the out-of-hours service that has taken over in Worcestershire. Three staff have talked to me about their concerns, which I quickly passed on to the chair and chief executive of the primary care trust, with whom I have a very close relationship, and I am glad to say that they are taking it very seriously, having ordered an independent review. Already, sources tell me, that service is improving, so I have not had to go to the press about it. Why are staff scared? Allegations of bullying in the NHS are rife. If we look at back editions of the Health Service Journal, the editions of 2 April, 16 April and 23 April all had articles about bullying in the service. Thinking about it from the point of view of senior nurses and senior doctors, they are dependent on their managers for their jobs, their mortgages, their advancement, their salary and their salary increments. What has changed from my day? I am often accused of being a dinosaur, and it was some time ago, but in my day a hospital was run by a team that included a senior nurse, a consultant and an administrator. They were all part of the team that ran the hospital, delivering the best care possible for their patients, and there were no secrets—they knew what was going on. If they had a bad doctor, or if the standard of nursing was appalling, they knew about it and addressed it. The Minister probably will not like what I am going to say next, but since the purchaser-provider split, the emphasis has had to be on finances, competition and targets, primarily, other than patient outcomes. A split has occurred between managers and staff, and that can lead to these sorts of disasters. In some cases, but not all, it is noticeable that when a doctor or nurse moves from a purely clinical role to one that involves a large amount of management, their loyalty is tested. Are they fully loyal to the patients and staff, or to the management of the trust? That is where a problem arises. What can be done about that? I have one or two suggestions. First, the Public Interest Disclosure Act 1998 is vital. I obtained a copy of a health service circular produced way back in 1999, at the back of which an annex provides a summary of the main provisions of that Act. The most useful paragraph is the one headed "Wider Disclosures", which is so important I must read it out because I desperately want the Minister to publicise it widely. The circular states:""Wider disclosures (e.g. to the police, the media, MPs, and non-prescribed regulators) are protected if, in addition to the tests for regulatory disclosures, they are not made for personal gain and if they satisfy a further two provisions. That is the concern must have been raised with the employer or a prescribed regulator, unless, there was reasonable belief of victimisation…there was no prescribed regulator and there was reasonable belief that there would be a cover up, and the matter was exceptionally serious. If one of these preconditions is met and the tribunal is satisfied that the disclosure was reasonable, the whistleblower will be protected."" My first suggestion is that that paragraph is widely publicised. The hon. Member for Stafford had two—he had more, actually, but I refer just to the first two—board meetings in public. Of course such meetings have to be in public. People must be given a chance to report what is going on and their suspicions. Again, in Prime Minister's questions today, I think the right hon. Gentleman mentioned that there should be stronger patient and public involvement. We have these funny things called LINks—local involvement networks—which are very variable across the country. Where were they in Stafford? Presumably, they had not really got off the ground—in fact, all over the country LINks have been slow to set up. I shall mention another point from New Zealand. In one hospital that we visited, it was a strategy for all the staff to ask whether the patient would pass the granny test— "Would you mind your grandma being in that hospital?" I do not think that I have quoted Private Eye before, but I have a regard for that publication and what it sometimes publishes. In the 17 to 30 April issue, we were reminded:""In a 2006 Healthcare Commission survey, only 27% of Mid-Staffs staff said they would be happy to be treated in their own hospital—a powerful indication that standards were unacceptable"." What a condemnation! Since this debate was announced, I have had a number of communications. A helpful communication was sent by Dr. Rod Storring, who asked why the question to which I have referred is not still asked. He points out that a number of related questions can be answered by staff anonymously and he suggests that those could be used""as litmus paper as to whether a Trust is functioning well"." These statements are, I think, still in the staff survey:""I am able to do my job to a standard I am personally pleased with…I can decide on my own how to go about doing my work…I am consulted about changes that effect my work…Senior ""managers where I work are committed to patient care…Care of patients is my Trust's top priority…I am able to deliver the patient care I aspire to…Senior managers act on staff feedback."" I agree with Dr. Storring. Those statements should be put to staff anonymously as a litmus paper test of how the trust is doing. Finally, I do not know whether this is possible in the UK, but I shall mention a radical change. In New Zealand, they have a health and disability commissioner who is accessible to patients and staff through outreach work. He believes—these are not quotes; they are his thoughts on the matter—that patients must have an independent medical opinion available to them and an easily available advocate, which he regards as his job. He would welcome whistleblowers, provided they have a real case about which to blow the whistle and they are absolutely honest. If the mid-Staffordshire and Brighton cases achieve anything to improve the future quality of care, it will be to blow wide open the fact that there is protection for whistleblowers and that they can speak out without fear of victimisation.