26 August 2019
‘Whistling in the wind’ is a very dangerous activity in the NHS. This is clearly shown in the recent book ‘Whistle in the Wind’ by Dr Peter Duffy, a consultant surgeon in urology. ‘It is difficult to describe the sheer intensity of the hatred that can characterise high profile NHS whistle-blower cases. Numerous lives and families have been destroyed by the ferocious retaliation that has followed expressions of concern within the NHS and the breaking of the unwritten code of National Health Service ‘omerta’ (p.229). He clearly identifies behaviours that are in the APPG ‘Cycle of abuse’ (see July and August blog posts), and some of the negative behaviours described in the report ‘How doctors in senior leadership roles establish and maintain a positive patient-centred culture: Research Report for the General Medical Council’ by Dr Suzanne Shale. The book very sadly details the depressing, and all too familiar, responses to raising concerns and ‘truth telling’ in the NHS. The intimidation and victimisation of the ‘truth teller’, with the resulting stress, illness and damage to career. The non-response to concerns. Underpinning this is the relentless pressure and chaos within the system and the toleration of excessive, unreasonable workloads and bad practice. Poor and mediocre treatment of the patient seems to be acceptable. There is obviously an organisational lack of concern for the welfare of patients. Rather than quality and safety being the priority, other factors dominate, such as the need to achieve targets and protection of self-interest. Allegations of racism also appear to be of greater priority than ensuring patient safety; clearly a perverse and distorted priority. Some people who failed to deliver high quality care apparently protected. The manipulation of waiting lists, for reasons of self–interest via well remunerated extra clinics, was described. Patients were also off-loaded onto other consultants to avoid taking responsibility and action. Are these practices common across the NHS? Peter Duffy considers there is a ‘…longstanding, toxic and dishonest culture’ in the NHS (p.231). He also describes the culture that existed at Morecambe Bay, only months after the publication of the very damming Kirkup report about the trusts maternity services. ‘Once again, it appeared that Morecambe Bay had tolerated a string of errors, with patients’ lives being risked, direct harm to patients, episodes of neglect and an overwhelming culture of lassitude, cover-up, deceit, bullying and complacency. Cover up and carry-on was back as the organisational norm.’ (p.113). He believes that ‘…there needs to be a comprehensive change within senior management and senior members of the medical and nursing professions in the NHS. All too often, senior clinicians, managers and executives are bent upon self-promotion, advancing their own careers ahead of others by giving the impression of being a ‘safe’ pair of hands, suppressing dissent and ruthlessly dealing with anything that might represent a threat or poor publicity for themselves, the greater organisation or ‘the Minister’…anyone stepping out of line can expect no mercy’ (p.231). There is systemic dysfunction, many avoidable deaths and damage to patients in the NHS. The central focus has to be upon the well-being and safety of patients. The NHS needs a very hefty dose of honesty and integrity; a major ‘clean up’ in the way that it conducts business.
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16 August 2019
Returning to the APPG report for Whistleblowing. ‘Whistleblowing: The Personal Cost of Doing the Right Thing and the Cost to Society of Ignoring it’ https://docs.wixstatic.com/ugd/88d04c_9754e54bc641443db902cd963687cb55.pdf I have observed that in reports there is often little mention of HR as a function and their role in enacting bad practice in organisations. It is as if HR are not there. This report makes reference to HR three times. 1) ‘One respondent reported that, after refusing to provide evidence of investigations into the grievance raised, the HR officer behaved in ‘an extremely confrontational and unprofessional manner’. In the ensuing meeting, described as ‘difficult and threatening’, the whistleblower was made feel as if [she/he] was ‘a liar and a troublemaker’. Another respondent reported that [they] were called to a disciplinary meeting, threatened with dismissal for a minor mistake. Another one wrote that she/he was criticised and ‘warned […] as to future conduct.’ (p.24) 2) ‘Sometimes the dismissal follows disciplinary action. One respondent wrote that after having blown the whistle, the HR office advised her/him to file a grievance, but when she/he did so, the organisation (a hospital charity) immediately ‘threatened [her/him] with the sack’. They then carried out an investigation against her/him and she/he was eventually dismissed, despite the HR consultant had supported her/his case.’ (p.26). 3) ‘The [NHS] FtSU scheme attracted significant criticism for failing to protect or support whistleblowers. The lack of confidence in the system was corroborated by a whistleblower who had left after being targeted for supporting a whistleblower. Further comments alleged that the guardians were using the role as a career stepping stone and that many of the guardian posts had been filled by HR with too few medical staff.’ (p.30). There are, however, ten references to ‘disciplinary action’, e.g. ‘While some accusations against whistleblowers remain merely informal, some are turned into disciplinary action against whistleblowers. Sometimes, disciplinary proceedings are used as a means to perpetrate any of the above retaliatory conducts, such as ostracising or intimidating whistleblowers, to the purpose – as reported by one respondent – to ‘cover up management failings’.’p.25). Other words are also used such as demotion, suspension, dismissal, and formal action. All of which are administered by HR personnel. The HR function is at the core of the APPG ‘Cycle of abuse’. They might at times be enablers of good practice, but they can also be enablers of very bad and damaging practice. There to protect the organisation and the managers, and sadly, as quoted above, to ‘cover up management failings’. There seems to be a lack of ethics and morality in the way they conduct their role. One of my NHS research participants said the following: “I think it’s sad that when you get a genuine whistle-blower raising concerns about standards of care. That somehow HR always seem to be on the opposite side of the line to that individual or individuals. And supporting a hard line management approach rather than again, as I would say, looking at it in terms of what is this service supposed to be about? It’s supposed to be about providing, you know, the best possible safest care for patients.” Other NHS participants saw HR as a ‘management tool’. “...101% in league with managers, and biased as hell”, as “...organisations hatchet men”. HR personnel were viewed as people who are distant, detached and separate from staff. Not seen as effective and not instructing the “...proper way of doing things”. Perceived as being aware of problems, but not taking action. People question whether many HR departments know what bullying is, or have any idea how to investigate it. They encourage, and “...facilitate bullying on many occasions”. There can be “...bullying at the top level, but HR is in the middle of it”. One person thought HR were corrupted and “...embroiled in organisational failure”. “HR directors they’re...they’re corporate, and...they’re ‘singing a corporate tune’, and...detached as those bad detached NHS managers of all sorts really”. There is an urgent need to review the role of HR in whistleblowing cases. |