Murnaghan 23.06.13 Interview with Dr Kim Holt of Patients First about whistle blowers

ANY QUOTES USED MUST BE ATTRIBUTED TO MURNAGHAN, SKY NEWS

DERMOT MURNAGHAN: Now then, the alleged cover up at the health watchdog has highlighted the role of whistle blowers in exposing failings. This morning the Head of the Healthcare Information Provider told Sky News that lives could potentially have been saved at the Morecambe Bay NHS Trust if his warnings had been acted on. The former bosses of the CQC deny claims of a cover up but where has it left the regulator and those who want to alert the authorities to issues that they uncover? Well I am joined now by Dr Kim Holt, co-founder of Patients First and the consultant paediatrician who blew the whistle on Haringey’s NHS Children’s Services. A very good morning to you Dr Holt, you must have been watching the developments around the CQC and Morecambe Bay with great interest and I wanted to start with this issue of those who do swim against the tide, that do speak out if I can call it against the corporate culture, it is enormously difficult as you found in your position.

DR KIM HOLT: Yes, it is actually very difficult and in fact one of our Patients First members who is a midwife actually, has said that the system seems to have been set up to suppress whistle blowing rather than the opposite, which is what the official line is. So I think we are in the process of trying to turn a super tanker around and change the culture so that actually it is really possible for people in the front line to speak out.

DM: I mean is that in the sense that they say one thing, the officials and the government ministers, they say one thing but really mean another. Yes, of course you are free to speak out, this is so important, lives could be saved but, behind the scenes, please don’t rock the boat?

KH: Our main concern at the moment, well there are two things, there’s the bullying that goes on on the front line, so you might say something and then you get put down and that’s going to put you off, so that can silence people right at the start. The second thing is gagging clauses and we did welcome Hunt’s statement that gagging clauses would be banned, however I think if you look at the fine print, what we are hearing from the unions is that gagging clauses are banned only for those people who are recognised as whistle blowers. Now if your employer doesn’t recognise you as a whistle blower they might still try and gag you.

DM: Well how do you get recognised as a whistle blower? How could that be enshrined? I mean it is a general catch-all term isn’t it?

KH: There are various ideas around so people who are in a position like I was in a position, of having information which I felt was in the public interest but I couldn’t get anyone within the organisation to listen to me, was to have somewhere to go external where I could log that concern and at that point then there might be an independent …

DM: Just tell me a little bit more about that, what you did to bypass the formal process, to bypass the management ladder?

KH: I didn’t bypass it, I went through every single step of the way. I got up to board level by the end of 2007, early in 2008 I went to my MP who was very helpful, she listened to me, she asked questions. At the end of 2008 she came back to me, she then put me in touch with the CQC who I made the disclosure to in December, no in November 2008. Nothing happened, I then went back to the CQC in early 2009. They said my concerns were an employment issue – that’s a typical response. Then I went to NHS London who carried out a long protracted investigation and eventually I just thought, come on, nobody is doing anything, let’s go to … I basically decided I would just go to the media.

DM: Exactly and that is one of the traditional ways of bypassing it all but it has its dangers though doesn’t it? I mean you could be in breach of contract, the media could go nowhere with it or it could turn out that your concerns were unfounded. Of course they weren’t in your case.

KH: The media aren’t interested in every whistle blower’s concerns, not every whistle blower will feel strongly enough that they want to go to the media and it is quite a scary thing to do but whistle blowing legislation does have that, that you can go to the media if no one else is listening to you. The reality is that currently within the NHS there isn’t anywhere to go if you are an NHS whistle blower to get support and we are quite pleased actually that this has come out about the CQC because we tried to go to the CQC and we got nowhere. In fact I got a message back from the CQC that whistle blowers were not in their remit and they don’t look at individual cases, so.

DM: That’s a very important point and the other thing is about the number of potential whistle blowers there are out there and the stories the media wouldn’t cover but they are important nonetheless to the patient experience. You look inside a hospital and somebody says, look, we’re not cleaning it properly having huge implications then for hospital acquired infections but then if you speak out you are just not a team player, but you don’t have an external conduit.

KH: Exactly, exactly. What it’s about is about changing the culture within each of the teams, departments, organisations and what we’ve drawn up is a list of 34 recommendations that we think would start to make a difference to the culture. It is very encouraging that the current Health Secretary is saying people who have lied, covered up, deleted reports etc, need to be held to account. If they did that within NHS Trusts, there are examples of reports that have been hidden, reports that have been deleted, suppressed, etc and if those people were held to account that would start to shake things up a bit because at the moment senior executives can delete reports and nothing happens and they think, oh yes …

DM: What you are saying about the Care Quality Commission is very interesting, I didn’t know that, that it is not really within its remit at the moment but that has to become so because that has to become, does it not, the place where people know they can go? They know their immediate manager may take it as a personal criticism and the manager may not want to follow it any further because of the potential implications for their position so you have to have an official place where you can go don’t you?

KH: Yes, you have got to have an official place and what we’re actually pushing now is a truth and reconciliation exercise because clearly we have got ourselves into a situation that is not good. We’ve got whistle blowers coming out of the woodwork right, left and centre and there are pockets within the NHS which are very dysfunction.

DM: How many have been in touch with you then?

KH: A lot.

DM: Dozens, scores?

KH: Well I can’t individually support every single person that gets in touch with me so we have got a widening network now. We have quite an active group in Scotland for example, I know they are under a different health system but Scotland, Northern Ireland, England, two or three a week, different people telling of different things, so surgeons, doctors, junior doctors, nurses – there are a lot of people out there and they are the people brave enough to come to someone like us because even that is scary because especially because we’re in touch with the media, so they think can we trust those people, will they go straight to the media? But we are building up people’s trust and so we can speak on behalf of a lot of these people and we are collecting evidence so we have got a lot of evidence that you could put in front of the current Secretary of State and say look, this is actually what’s happening in different parts of the NHS.

DM: Do you get a sense that he wants to hear it?

KH: Not yet but we very much welcome a meeting with him, that would be excellent.

DM: Well if we get this from the Francis – and Andy Burnham was mentioning this – from the Francis Report into Mid-Staffs, this recommendation for a duty of candour within employees, then presumably you would get an awful lot more people coming to you or there would be a much more formal procedure for them to follow.

KH: They would be more confident I think. There is a lot of concern about the duty of candour that it will be the people at the bottom who will get hammered but having spoken to Robert Francis my understanding is that this is more about the organisation having a legal duty of candour and this is where we have got the issue at the moment is that doctors may well tell the truth, as I did, but the organisation decides they don’t really want that truth out there so they aren’t being held to account at the moment and that’s the bit that’s got to change.

DM: Interesting stuff. Thank you very much Dr Holt, Kim Holt there