Professor Jane Somerville, emeritus professor of cardiology at Imperial College, talks about the issues facing doctors who raise concerns about patient safety issues in the NHS. She shares her views on the risks facing doctors who speak up and the ways that healthcare managers treat whistle blowers. She also highlights issues in the employment tribunal system and outlines the need to regulate NHS managers.
In the video, Jane mentions the employment tribunal of Dr Martyn Pitman. Since this interview was recorded, Dr Pitman lost the case he brought for retaliatory victimisation.
I'm Jane Somerville. I'm a retired professor of cardiology, having been on the staff of the Royal Brompton Hospital and Heart Hospital. I don't practise medicine anymore. I'm interested in whistleblowing doctors.
I became involved because I went to a conference at the Royal Society of Medicine which unfortunately they wouldn't repeat, although they promised to do so, and I was horrified at what is happening to people in my profession who speak up for the safety of patients.
Firstly, they're supposed to speak up for the safety of patients, it's called our Duty of Candour, and secondly the treatment by the trusts, mainly managerial, is absolutely appalling, and I decided with my colleague David Ward that we really ought to work and do something. And why should we? Well, because I'm untouchable—they can't take my career from me, they can't prevent me doing anything, they can't do anything and I'm senior enough in the profession to be able to speak with some authority, at least about how medicine works. So I thought, nothing to lose and everything to gain for my profession.
Question: How are you supporting the work to protect doctors who speak up?
David Ward and I are working with Justice for Doctors and they include us in their meetings. We try not to get involved or allied with them but they know we're on their side and we speak out, and by virtue of our seniority we get to see people, make some sensible suggestions. Working with the excellent David Hencke who is writing Westminster Confidential— the actual facts. And he has brought the facts of the most horrible tribunal that's been going on with this Martyn Pitman, a distinguished and useful obstetrician and a gynaecologist doing good work, and the Royal Hampshire has behaved extraordinarily badly, in my view.
Question: Why aren’t existing systems in the NHS protecting doctors who speak up for patient safety?
The Freedom to Speak Up Guardians are usually not strong enough to bang and say to the CEO or the chief executives or the chairman or the board. They're just not strong enough to say, “This has to stop,” so who's to stop the trust managers or the trust managing executives (who could be doctors)? Who's to stop them if they want to persecute? It is part of the coverup culture that unfortunately exists since managers came into the health service. When I grew up, which wasn't yesterday, but also my younger colleagues, we didn't have all this until we had managers. Nobody regulates managers, they can just do what they like, they don't have a General Medical Council—they don't have anything! They have no code and lots of them aren't even educated to be a manager. It needs to be properly regulated and they need not to have both the money and the command, and our foolish profession has allowed both. They have control of the money—thousands of pounds are spent on legal fees of very expensive lawyers and it's a very unjust set of arms. The litigant or the complaining doctor has almost nothing unless he happens to be a rich consultant, and the trust has everything, with these managers in control.
There's another side to this which is very, very serious, that I don't want really to touch on except to tell you and that is the question of employment tribunals. They manage to get these doctors to employment tribunals and it's not by chance that the respondents, the trusts, win 97%— that can't be justice, 97%! But I think the justice system has to look into the trouble of the employment tribunals, but it's very unjust on the doctors and very unfair ultimately for the patients.
Question: How widespread are the issues facing NHS whistleblowers?
Do I have any knowledge of how widespread it is? Answer, no. Why? Because they don't keep statistics in the Department of Health, We've asked them at quite a high level—no idea, thought it was a rather strange question. So we don't have statistics, complaints are not registered and you can't get information. And coupled with that is the improper making and signing of NDAs, which they do to the doctor and of course they're (the doctor) not allowed to go to the press, they're not allowed to speak to anybody and bad things happen even, I regret to say, suicides. To end how widespread it is, of course we don't know. It's more widespread than we think and there are more people who have suffered than we know—they're frightened to come forward. It's a culture of fear in a culture of cover up.
Question: What needs to be done to protect doctors who speak up for patient safety?
Key number one is stop persecuting doctors who speak up for the safety of patients. All that matters to us is the safety of patients and so therefore they must be given respect. They may not always be right, they may be saying silly things or they may be absolutely on the ball, but they must be listened to and they must not be persecuted by managers.
Then next comes they (managers) must be regulated in their behaviour and I am hoping, although it is very serious, that something will come of this corporate manslaughter problem that is going to be brought up. That will concentrate the minds of the managers. They'll be a bit more careful automatically. So stopping the persecution should be automatic—ordered by the Government, ordered by the Prime Minister, ordered by whoever—but they have to stop it.
Secondly, there's the question of the regulation of the funds used to have unequal arms—very expensive lawyers and leading QC's cost the Earth so the thing gets more and more and it shouldn't get to the employment tribunal. That needs looking into, but I don't think that's our business. Maybe employment tribunals do some good—not as far as the doctors are concerned. It's a very, very bad system. So let the judiciary get on and organise their own as we should organise our own medical aspects and concern ourselves about the safety of patients.
It really is urgent to do something about this in the health service. It's the sort of thing that is losing doctors and doctors in training—I mean who wants to go into a health service where the managers can treat you like dirt, and do. Safety within the health service, within the doctor's brief, is vital and absolute and primary.
About the Author
Before her retirement, Professor Jane Somerville was a consultant paediatric cardiologist at the Royal Brompton Hospital in London. She is known for defining the subspecialty of Adult Congenital Heart Disease (ACHD) and set up the Somerville Heart Foundation in 1993, which supports adults and young people in the UK with all forms of ACHD. Jane was also the cardiologist involved in the UK's first heart transplant in 1968.