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Content ArticleThe National Guardian's Office and the role of the Freedom to Speak Up Guardian were created in response to recommendations made in Sir Robert Francis QC’s 2015 report The Freedom to Speak Up. The office leads, trains and supports a network of Freedom to Speak Up Guardians in England and conducts speaking up reviews to identify learning and support improvement of the speaking up culture of the healthcare sector. This annual report shares intelligence and learning collated by the National Guardian’s Office, including data about the cases Freedom to Speak Up Guardians receive. Over 20,000 speaking up cases were brought last year, meaning cases remain at the record level set in 2020/21. The report also features case studies from different healthcare providers across England, sharing the experiences of people who have spoken up about a wide range of issues, and demonstrating the ways in which organisations have improved staff confidence in being able to speak up.
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Content ArticleIn December 2022, the All Party Parliamentary (APPG) for Whistleblowing heard evidence on the state of the NHS following the recent report on the avoidable deaths and life changing injuries caused to mothers and babies at the East Kent Trust. The culture at this hospital was described as one where “everyone knew the problems” and where whistleblowers were “thrown to the lions”. A culture attributed to 45 of the 65 baby deaths reviewed. This blog first appeared on the Whistleblowers UK website in December 2022.
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News Article
NHS whistleblower wins £500,000 for unfair dismissal
Patient Safety Learning posted a news article in News
A “commended” NHS nurse has been awarded nearly £500,000 for being wrongly sacked after she claimed that high workloads led to a patient’s death. Linda Fairhall, 62, a 44-year veteran of the health service, said she made 13 separate pleas to bosses warning that her colleagues were overburdened, but she was ignored each time. Fairhal told officials at the University Hospital of North Tees and Hartlepool that she was worried about a recently imposed policy that obliged nurses to monitor patients who took prescribed medicines and maintained that it led to nurses having to conduct 1,000 extra patient visits a month without extra resources. She said nurses were overwhelmed by the additional responsibility, which resulted in rising “anxiety” among staff and higher rates of absence. However, Fairhall told the tribunal in Teesside that nothing was done in response to her concerns, and ultimately a patient died. The tribunal heard that the nurse raised her last warning with officials just before she went on annual leave. On her return she was suspended and investigated for “bullying and harassment”, then sacked for gross misconduct. A tribunal has now ruled that the decision to dismiss Fairhall was “materially influenced” by her complaints regarding patient safety, with the panel adding that it could not “genuinely believe” that she was guilty of misconduct. Read full story (paywalled) Source: The Times, 4 January 2023 Read the full tribunal decision: Ms L Fairhall v University Hospital of North Tees and Hartlepool Foundation Trust- Posted
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News ArticleThe Birmingham MP Preet Gill has called on the UK health secretary to launch a major public inquiry into allegations that a bullying and a toxic culture is risking patient safety at University Hospitals Birmingham (UHB). The MP for Edgbaston, where UHB is based, said she had received complaints from staff alleging elderly patients had been left on beds in corridors outside wards due to mismanagement, and medics were discouraged from speaking out about problems. In a letter to Steve Barclay, seen by the Guardian, Gill said: “I have been inundated by messages from UHB staff, past and present, who have contacted me to share their experience of what has been repeatedly described as a toxic culture that has had an alarming impact on staff and patient care.” After an investigation by BBC Newsnight earlier this month, which found that doctors at the trust were “punished” for raising safety concerns, the Birmingham and Solihull Integrated Care Board (ICB) announced a three-part review into the culture at UHB. The first report is expected at the end of January. But Gill criticised the plans, saying she did not think it would “be sufficient to adequately investigate this scandal”, and instead called for a major independent public inquiry, similar to the 2013 Francis inquiry into the Stafford hospital scandal. “We cannot rely on an ICB investigation to solve this issue. Many of those on the ICB are former members of the senior leadership team from UHB and would not offer the independence required to recommend the changes that are so needed or give confidence to whistleblowers,” she said. Read full story Source: The Guardian, 19 December 2022
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News ArticleTwo clinicians who say they lost their jobs at Berkshire Healthcare NHS Foundation Trust after raising patient safety concerns claim the trust’s legal team brought a five-figure costs threat against them to prevent witnesses from giving evidence in a tribunal. The threat of costs liability, intended to bring the case to a halt, was made halfway through the hearing – less than 48 hours before witnesses for the trust were due to give evidence. One of the claims put forward at the tribunal hearing was that the trust had destroyed crucial evidence by deleting the email account of a former staff member. The clinicians – Samir Lalitcumar and Ahmed Ghedri – brought allegations of poor practice against current and former staff at the trust. Berkshire NHS trust claimed their allegations, including claims that the trust had deleted email evidence, were “without merit”. A fortnight into the tribunal hearing, both out-of-work medics were threatened with costs liability, known as a “drop-hands offer”, totalling more than £300,000, had they opted to proceed with their case and lost. Lalitcumar and Ghedri had brought claims of whistleblowing detriment against their former employer, Berkshire Healthcare Trust. They say they were “victimised” and unfairly dismissed as a result of having blown the whistle on dangerous care within the trust’s geriatrics services – potentially affecting upwards of 2,000 patients. Read full story Source: Computer Weekly, 7 December 2022
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News Article
Climate of fear putting patients at risk, say doctors
Patient-Safety-Learning posted a news article in News
Whistleblowers at one of England's worst performing hospital trusts have said a climate of fear among staff is putting patients at risk. Former and current clinicians at University Hospitals Birmingham (UHB) NHS Trust allege they were punished by management for raising safety concerns, a BBC Newsnight investigation found. One insider said the trust was "a bit like the mafia." The trust said it took "patient safety very seriously." It said it had a "high reporting culture of incidents" to ensure accountability and learning. Staff concerns included a dangerous shortage of nurses and a lack of communication leading to some haematology patients dying without receiving treatment, an investigation by BBC Newsnight and BBC West Midlands found. Read more Source: BBC News, 2 December 2022 -
News Article
Doctors raise safety fears at Birmingham hospitals
Patient Safety Learning posted a news article in News
Whistleblowers at one of England's worst performing hospital trusts have said a climate of fear among staff is putting patients at risk. Former and current clinicians at University Hospitals Birmingham (UHB) NHS Trust allege they were punished by management for raising safety concerns, a BBC Newsnight investigation found. One insider said the trust was "a bit like the mafia". The trust said it took "patient safety very seriously". It said it had a "high reporting culture of incidents" to ensure accountability and learning. Staff concerns included a dangerous shortage of nurses and a lack of communication leading to some haematology patients dying without receiving treatment. The deaths of 20 patients in the haematology department of the Queen Elizabeth Hospital, which is run by the trust, led to a review in 2017 by consultant Emmanouil Nikolousis. Mr Nikolousis, who left the trust in 2020, told the BBC he was shocked by the failings he found and believes patients' lives could have been saved. A report by Mr Nikolousis criticised a lack of "ownership" of patients and a lack of communication among senior clinicians. In some cases this led to patients dying without having received treatment, he said. "Certainly there should have been different actions done," he said. "They could be saved. Certainly, when you don't have an action done, then you don't really know the outcome." Mr Nikolousis said he felt he had no option but to quit after his findings were ignored and his position was made "untenable". He left the NHS after 18 years. "They were trying, as they did with other colleagues, to completely sort of ruin your career," he said. Read full story Source: BBC News, 1 December 2022 -
Content ArticleIn this blog, journalist David Hencke shares his views on the ruling of Judge Anne Martin in the case of NHS whistleblower Dr Chris Day. He argues that Judge Martin was determined to find in favour of Lewisham and Greenwich NHS Trust, glossing over the disclosure of the deliberate destruction of 90,000 emails and the use of false evidence by the Trust. She discredited the evidence of Dr Day’s witnesses, including the present Chancellor of the Exchequer, Jeremy Hunt and two senior medical experts, on the basis that they were biased.
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News Article
CQC brings in whistleblowing gurus to boost ‘independence and credibility’
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has hired two independent whistleblowing champions, Joy Warmington and Arpita Dutt, to oversee a major review of how it listens to concerns. The CQC previously announced it had appointed Zoe Leventhal KC, of Matrix Chambers, to lead the first phase of the review, which is considering how the CQC handled protected disclosures made by Shyam Kumar, an orthopaedic surgeon at University Hospitals of Morecambe Bay Foundation Trust, and whether ethnicity “played any part in the management of those disclosures”. On Friday it issued details of the second phase of the work, including that it had brought in two outside experts, and long-time champions of whistleblowers, to “help to ensure the independence and credibility of the review”. This was launched amid wider concerns about how it responds to whistleblowing concerns in the service and among its own staff, including potential discrimination and also comes as the CQC itself seeks to begin a major restructure. Read full story (paywalled) Source: HSJ, 22 November 2022- Posted
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Content ArticleThis article in Computer Weekly outlines the tribunal proceedings and judgement in high-profile case brought by whistleblower Chris Day. Dr Day claimed that Lewisham and Greenwich NHS Foundation Trust had concealed evidence when a director deleted up to 90,000 emails before he was due to testify at an earlier tribunal, concerning allegedly false and detrimental public statements about Dr Day made by the Trust. Dr Day’s lengthy legal battle first began when he was a junior doctor working at Queen Elizabeth Hospital Woolwich’s intensive care unit in 2013, where he spoke up about under-staffing at the ICU.
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Content Article
PACE communication tool
Patient_Safety_Learning posted an article in Staff safety
Supporting staff to speak up is essential to patient safety. The PACE communication tool is designed to help anyone in a team challenge an action or behaviour they feel is inappropriate. You can read more about PACE (probe, alert, challenge, emergency) and other communication tools on the Victorian Trauma System website via the link below. -
News Article
Royal Sussex Hospital: Doctors warn of unsafe maternity services
Patient Safety Learning posted a news article in News
Doctors have warned of "unsafe" maternity services at a Sussex hospital in emails seen by the BBC. In the email chain between senior staff at the Royal Sussex County Hospital in Brighton, consultants wrote of "compromises" to patient care. One doctor said during a birth "we were one step away from a potential disaster". One senior doctor wrote in the exchange that "increasing workforce issues" had contributed to making the situation in the maternity unit "almost unmanageable at times". They added: "We are making compromises to patient care every day as a result." Another wrote that their workload was often "unmanageable, and obviously impacted by the staffing issues". A senior member of maternity staff said "we are delivering suboptimal care" and "we are one step away from potential disaster". A doctor also said staff were being "stretched", and that there were delays to women's care. Another consultant wrote: "We have an unsafe service and we have to strive for better than that." Read full story Source: BBC News, 16 November 2022 -
News Article
GMC launches 'hub' to tackle racism after recent criticism
Patient Safety Learning posted a news article in News
Following the blistering verdict last week of the independent review into the General Medical Council's (GMC) handling of the notorious 'laptop' case, which highlighted the "worrying trend" of ethnic minority doctors facing disproportionate regulatory action, the GMC has launched a new resource 'hub' to support doctors facing racism at work. A new dedicated area on the GMC website offers advice on how to address racism in the workplace, and sits alongside its existing dedicated whistleblowing webpage as the latest of 12 areas in an 'ethical hub' that brings together resources on how to apply GMC guidance in practice, focussing on areas doctors often query or find most challenging, and helping to address important ethical issues. Announcing the launch, the GMC said: "Tackling discrimination and inequality continues to be an urgent priority for health services." It added: "The GMC has committed to working with organisations to drive forward change, setting targets on tackling inequality." Its equality, diversity, and inclusion targets set last year aimed, inter alia, "to eliminate disproportionate complaints from employers about ethnic minority doctors, by 2026, and to eradicate disadvantage and discrimination in medical education and training by 2031". In March this year it published its first progress report, which showed that the gap between employer referral rates for ethnic minority doctors and international medical graduates, compared with white doctors, had "reduced slightly". Read full story Source: Medscape UK, 15 November 2022 -
Content Article
GMC: Racism in the workplace hub
Patient Safety Learning posted an article in General Medical Council (GMC)
Everyone has the right to come to work without fear of racism. This resource from the General Medical Council (GMC) provides advice on how our guidance principles on non-discrimination apply when tackling racism. Where racist behaviour occurs among colleagues and patients, we recognise the fear that many doctors have of reporting these incidents. It signposts a range of support channels and highlights the duties we expect of doctors in senior positions in tackling and rooting out discrimination where it arises. It includes case studies from doctors and others on their experiences, advice and best practice. -
Content Article
The Surviving in Scrubs campaign, created by Dr Becky Cox and Dr Chelcie Jewitt, gives a voice to women in healthcare to raise awareness and end sexism, sexual harassment and sexual assault in healthcare. In this blog for the hub, co-founder Dr Chelcie Jewitt tells us more about the campaign. -
Content ArticleThis Australian study in Health Expectations aimed to evaluate the implementation of 'Calling for Help'(C4H), an intervention for parents to escalate care if they are concerned about their child's clinical condition. The study used a convenience sample of 75 parents from inpatient areas during the audit, and the authors held interviews with ten parents who had expressed concern about their child's clinical condition and five focus groups with 35 ward nurses. The authors found that there was an improvement in the level of parent awareness of C4H, which was viewed positively by both parents and nurses. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required and further strategies will be required for parents to feel confident enough to use C4H and to address communication barriers.
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Content ArticleREACH is a system that helps patients, carers and family members to escalate their concerns with staff about worrying changes in a patient's condition. It stands for Recognise, Engage, Act, Call, Help is on its way. REACH was developed by the New South Wales Government Clinical Excellence Commission in collaboration with local health districts and consumers. It builds on the surf life‐saving analogy for recognition and appropriate care of deteriorating patients by encouraging patients, carers and their families to 'put their hands in the air' to signal they need help.
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News Article
Regulator investigates lawyers acting for NHS trust over ‘gagging’ clauses
Patient Safety Learning posted a news article in News
Lawyers acting for an NHS trust are being investigated over “gagging” clauses proposed in a settlement agreement with a whistleblower who raised concerns that mistakes by paramedics in the deaths of patients were being covered up. In June, the then health secretary, Sajid Javid, announced an NHS review into “tragic failings” by North East Ambulance Service after Paul Calvert went public with claims that reports into deaths were doctored to cover up failings by staff. The Guardian has learned that NEAS’s lawyers, Ward Hadaway, are also under scrutiny – by the Solicitors Regulation Authority (SRA) – over the terms proposed by the trust for his exit agreement. The agreement, offering him £41,000 in compensation, initially included confidentiality clauses relating to future disclosures. A SRA investigation does not mean there has been wrongdoing and it does not confirm or deny whether it is examining a solicitor. However, the Guardian understands that the regulator has been in contact with Calvert about the proposed agreement. Read full story Source: The Guardian, 3 November 2022 -
News Article
East Kent maternity deaths: Trust has lost confidence of patients
Patient Safety Learning posted a news article in News
A boss at a trust which was heavily criticised in a damning report says patients have lost confidence in the care they provide. Raymond Anakwe, executive director of East Kent Hospitals Trust, said regaining patient trust would be "possibly the largest challenge". He was speaking at a board meeting two weeks after a review found a "clear pattern" of "sub-optimal" care. Mr Anakwe said: "The reality is we have lost the confidence of our patients." He also said the trust has lost the confidence "of our local community and sadly also many staff". The trust's chief executive, Tracey Fletcher, told the meeting that she believed many staff thought "enough is enough", and that the trust has to be "brave" if it's to move forward. Stewart Baird, a non-executive director, said: "I think it's clear the buck stops here with the people sat round this table, and where there are bad behaviours in the trust, it's because we have allowed it. "Where people don't feel able to speak up, it's because we have not provided an environment for them to do that." Read full story Source: BBC News, 3 November 2022 -
Content ArticleIn July 2022, Henrietta Hughes was appointed the first ever patient safety commissioner for England. The role was recommended in the Independent Medicines and Medical Devices Safety (IMMDS) review’s ‘First do no harm’ report, published in 2020, which explored issues relating to the use of Primodos, sodium valproate and pelvic mesh. Just a few weeks into her role as the first ever patient safety commissioner for England, The Pharmaceutical Journal spoke with Henrietta Hughes to find out more about her vision for patient safety in the NHS and where pharmacists fit into that.
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Content ArticleRyan Saunders is a little boy who died in 2007 from an undiagnosed streptococcal infection, which led to Toxic Shock Syndrome. According to the Queensland Clinical Excellence Division, when Ryan’s parents were worried he was getting worse, they did not feel their concerns were acted on in time. This blog outlines Ryan's Rule, a process introduced by the Queensland Department of Health to try and prevent similar events happening in future. Ryan's Rule allows patients and their families and carers to escalate serious concerns about their own or a family member's condition.
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Content ArticleThis webpage provides information about patient rights and responsibilities while under the care of John Hopkin's Children's Center. It includes the following resources and guides: Patient and family handbook Preparation Pain management Your child’s care team Rooms Meals Visitation Patient safety Parent and family journal
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Content ArticleWhistleblowing is crucial to a free and open society. The APPG Whistleblowing is committed to bringing forward root and branch reform that protects every person from the mistreatment whistleblowers are currently subjected to. The whistleblowing manifesto aims to bring forward these reforms. The Bill will establish the Office of the Whistleblower to ensure that every citizen is protected, that legitimate concerns are investigated, and that those people and institutions are prosecuted when they breach the law.
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Content ArticleThis study in Health Expectations aimed to identify barriers and facilitators to implementing a parent escalation of care process: Calling for Help (C4H). Guided by the Theoretical Domains Framework, the authors carried out audits, semi-structured interviews and focus groups in an Australian paediatric hospital where a parent escalation of care process was introduced in the previous six months. The authors found that although there was a low level of awareness about C4H in practice, there was in-principle support for the concept. Initial strategies had primarily targeted policy change without taking into account the need for practice and organisational behaviour changes.
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Content ArticleThis document outlines the standard operating procedure (SOP) adopted by University Hospitals Bristol NHS Foundation Trust, relating to parental involvement in escalation of clinical care for acutely ill children. It aims to clarify the process of empowering parents to escalate concerns if they are worried about the clinical condition and care being delivered to their child, or themselves if they are a patient. It also aims to ensure accurate and appropriate information is provided to parents on admission (elective and acute) regarding how they should escalate concerns about the care their child is receiving.
