This article appears as part of the Inside the NHS newsletter.

Do NHS staff feel safe to whistleblow? And when they do – what happens?

While the public messaging speaks of a “duty of candour”, the reality is that many still feel scared to speak up – and victimised when they do.

Retribution


The case of Peter Duffy is a template for how bitter and nightmarish internal disputes over safety can become in the health service.

Mr Duffy was a consultant urological surgeon at Morecambe Bay Trust in England when a 76-year-old patient, Peter Read, died in 2015. His death was subsequently ruled by a coroner to have been avoidable, but Mr Duffy became alarmed when the Trust failed to follow through with the coroner’s order to hold a Morbidity and Mortality Meeting to discuss the case.

Mr Duffy perceived this as an attempt to “cover up” the circumstances leading to the death. He reported his concerns to England’s clinical watchdog, the CQC, along with additional concerns about dangerous practices in the urology department stretching back 10 to 15 years.

In the aftermath, Mr Duffy was accused of racism by three colleagues whose practice he had flagged. He was demoted, his annual income was reduced by £30,000 due to overtime changes, and the Trust tried to alter his terms and conditions in a way that he said would make his job “untenable”.

He resigned in 2016 and was subsequently awarded £100,000 by an employment tribunal for constructive dismissal – though it did not accept that his dismissal was connected to his whistleblowing. This is notoriously difficult to prove.

Nonetheless, an NHS-funded independent inquiry subsequently identified 520 cases of avoidable harm – including deaths – at the Trust.

Meanwhile, the General Medical Council recently dropped its own 30-month probe into Mr Duffy triggered by emails dated December 2014 which appeared to implicate him in a string of clinical errors leading to Mr Read’s death.

The emails only surfaced in 2020 and Mr Duffy insists they were falsified as part of an “executive vendetta” to “flip” responsibility back to him – something the Trust denies.

The GMC said it could not “attach weight” to the emails as evidence. Mr Duffy, 61, said the ordeal left him suicidal and earlier this month he retired – five years earlier than planned.

The Herald:

Culture change?

Mr Duffy’s case may have taken place in England, but it echoes experiences I have heard time and again from medics across NHS Scotland: colleagues closing ranks to accuse a whistleblower of wrongdoing; victimisation of a whistleblower through cuts in pay, changes to their job, and malicious grievances; retaliatory GMC referrals; bullying by senior management.

Some describe being “blacklisted" so that they cannot find other NHS work, or being “gagged" by confidentiality agreements in severance packages.

I recently spent several hours with a specialist doctor who is in the process of pursuing an employment tribunal against a health board here in Scotland.

The medic had spent years trying to establish a life-saving specialist service – one patients here badly need – only to be thwarted (in their view) by a combination of cronyism, managerial dysfunction, cover up, and – when they tried to blow the whistle – bullying that left them on sick leave with stress.

Read more:

Little wonder that a recent survey of BMA Scotland members found that 24% of doctors would not feel comfortable raising a concern around patient safety or malpractice at work. Another 24% said they were unsure whether they would.

Nearly five years after The Herald first reported fears over a bullying culture at NHS Highland, Dr Iain Kennedy – the Highland whistleblower who is now chair of BMA Scotland – said doctors remain “frightened to raise concerns around patient safety or inappropriate behaviour”.

In 2021/22, a total of 96 whistleblowing concerns were officially raised across Scotland's 14 health board regions. If the BMA's survey is correct, that might be the tip of the iceberg.

Toothless?

In Scotland, NHS staff can call the Independent National Whistleblowing Officer (INWO) hotline for free and in confidence. Launched in April 2021, the service is managed by the Scottish Public Service Ombudsman (SPSO) and replaced a previous incarnation – the National Confidential Alert Line – which critics had described as “toothless”.

Is it an improvement? Some staff describe frustration on being advised to raise their concerns with their line manager – exactly the path they hoped to avoid – while others have found their concerns dismissed.

One nurse, who recently flagged concerns over what she claims were potentially dangerous errors in patient care, said that the subsequent investigation “swept everything under the carpet”, adding: “the whole whistleblowing procedure is a joke”.

Fair or unfair, it is impossible to know – but if whistleblowers lose trust in the system, we all lose in the end.

Enjoyed this week's edition of Inside the NHS? Get it directly to your inbox by clicking here 👈