This is an appalling story about how 3 months after the person who expressed concerns about putting targets before patient safety was forced out of Lincolnshire’s Hospitals (in a half million pound cover up) and 9 months after the publication of the first Mid Staffordshire report, staff in Lincolnshire’s hospitals (ULHT) were being pressured to take risks with your safety. Worse the death rates became so high that the government announced, this week, a special review of safety with the number of excess deaths in Lincolnshire’s hospitals being estimated at 677 between 2009 and 2012.
Even though they tried to intimidate Gary Walker in a threatening letter and prevent him from speaking out on the BBC Today programme the intimidation and threats did not work.
Its long and complex but stick with it – it could be you or your family who are affected.
In the wake of the Mid-Staffordshire report into the NHS it would be all too easy to go down the rabbit warren of regulation and structure but that would be a mistake. Patients don’t care about things like Monitor, CQC etc. They want their local hospital to focus on safe care for them. Simple.
So what do you have to do to fix that? Do you recall the Clinton comment – ‘It’s the economy, stupid’. Well the equivalent for the NHS would be ‘It’s the culture, stupid’. The second report into Mid Staffs slams a culture where your care comes second to making some bureaucrat look good in the targets league table. If you do not fix the culture you cannot fix the NHS. Also ‘Simple’.
But why are some people surprised at what the latest Mid Staffordshire report says about NHS culture? The concerns have been around for quite some time. In January 2008 the Joint Commission International report said, on page 4, about the Department of Health/NHS culture that
A ‘shame/ blame’ culture of fear appears to pervade the NHS and at least certain elements of the Department of Health.
Furthermore it stated that this culture ‘stifles’ the development of an organisation and its ability to deliver ‘quality and safety’.
In the same year the Institute of Healthcare Improvement reported to the Department of Health giving an example, on page 24, of the mindset in the NHS that:
The NHS has developed a widespread culture more of fear and of compliance than of learning, innovation and enthusiastic participation in improvement.
They highlighted typical comments about the prevailing mindset:
The risks of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families. Ouch – so it is more damaging to your career to fail to meet targets than to kill patients?
Pretty damning indictment – a culture which cannot deliver safety. In a healthcare organisation!!! If the NHS was an airline it would have been grounded. You would have though the report was enough to get people sacked…….
Note this is 5 years ago. Who was the CEx of the NHS at the time? David Nicholson.
And of course the first Mid-Staffordshire report stated in 2009:
This evidence satisfies me there was an atmosphere in which frontline staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs.
More recent reports (November 2012) in the Health Service Journal are headlined:
NHS Chief Executives highlight a ‘climate of fear’.
So this culture has been around for some time and is still around. It is not clear whether the senior leaders of the NHS have created this culture or whether they are simply incapable of changing it. Either way can we have confidence in a change in culture, which is essential for the recovery of the NHS, whilst of Sir David Nicholson remain in post?
Chief Executive’s set the overarching culture of any organisation and must lead by example. The NHS is notorious for its negative attitude towards whistleblowers. I cannot recall incidents where senior NHS leaders have come in to protect whistleblowers and challenge what is happening to them.
The latest Mid Staffs report makes stark reading for Nicholson. Questions may remain about the degree to which David Nicholson is personally implicated in Mid Staffs, but he was involved locally in the Gary Walker case. Walker was the brave Chief Executive of the United Lincolnshire Hospitals Trust who personally blew the whistle to David Nicholson and his right hand woman, Barbara Hakin. Hakin was the head of the regional NHS in Nottingham. Walker was concerned that he and his staff were being put under pressure to meet targets when the hospitals were already dangerously overfull (echo’s of Mid Staffordshire?). Walker was forced out allegedly as a result and brought a claim against the NHS in an Employment Tribunal. In a pre-hearing for his Employment Tribunal the Judge stated that in his opinion Walkers letters to both David Nicholson and Barbara Hakin were prima facie public interest protected disclosures. Hmmmmm….. you shouldn’t sack whistleblowers and gag them. How do we know that? Because David Nicholson says so…...
Walker complained to Nicholson about the ‘culture’ of the NHS ( just like Francis) ‘that gave this country a Mid Staffordshire’ which in the case of Lincolnshire ‘threatens patients and must be stopped’ and asked that the letter be treated as whistleblowing. Nicholson was also written to about senior NHS staff ignoring a vital code designed to protect patient safety when hospitals are overfull and the conflict between national targets and patient safety.
The first cover up was a report commissioned by Nicholson which did not address they key issues of the conflict between targets and patient safety and staff ignoring a vital code. It looked very narrowly at written, yes written, evidence of bullying. In the bizarre world of the NHS you can only bully people in writing. Buckets and whitewash come to mind. Some of the key documents Walker used in his ET case such as regional staff expressing concern about patient safety in overfull hospitals apparently being ignored by more senior people saying to have to meet targets whatever demand were only released under an FOI 2 days after the review report was issued, and so were not taken into account. Now there’s a co-incidence.
Walker expected Nicholson to protect him as a whistleblower and ensure he remained in post to shield the organisation from external pressure and make sure priority was given to safety. Walker was subsequently forced out allegedly for swearing at the end of 2009. Perhaps he had every right to swear.
Being out of a job and blacklisted in the NHS Walker challenged his sacking. With his house on the line he had to settle pre-Tribunal and accept a Supergag which not only gagged him but required him to write to all his witnesses to seek to gag them as well!!!
In a quote from a the document from the Judge, which the NHS has gone to great lengths to conceal, the Judge said in connection to a letter sent by Walker to Hakin on 8th April 2009
‘I have read it. Prima facie it is a Public Interest Disclosure…it raises concerns about patient safety.
Of letters to Nicholson and the Interim Chair of the Trust dated July 2009 the Judge said
‘…they are prima facie Public Interest Disclosures’
It cost and an incredible £0.5m to settle with Walker and to keep almost 3,000 pages of documents concealed from you, the public.
It’s a lot of money so what is being concealed and what were they worried about? Read on it gets really scary now.
Walker expressed concern about the pressures at his hospitals and the consequences for patient safety should those pressures continue and he refused to put pressure on his staff to meet targets for non urgent patients. Before he was forced out a secret external report confirmed this and said of the Trust under Walker’s leadership:
‘All we spoke to acknowledged that safety had a high priority within the Trust and at the Board…the Review Team did not identify any immediate issues of concern in terms of patient safety or experience….
After Walker was side-lined and forced out all of that was about to change as shown by a series of letters recently released by the Lincolnshire Independents to local news media with a press release.
Clinician started to complain and one complained at length after being put under pressure to do an operation on a patient to meet the targets when he would not be available for post operative care. He says
‘I do not think I should be coerced into performing surgery on a patient in an environment which I consider unsafe.’
Another complained, in a letter commencing
‘In the aftermath of this unfortunate death of an otherwise well patient…’
about overcrowded surgical lists with a very clear suggestion that such overcrowding, to meet targets, may well have been a contributory factor to the patient’s death.
Most damning a Clinical Director of the Trust wrote to the Chairman in March 2010 in very stark terms about
‘bullish and ruthless pressure from above……a culture has evolved …..caused a significant shift… in the balance of care between achieving targets and the quality and safety of our services to patients.
an insidious and remorseless increase pressure that could result in poor judgements or staff taking risks with patient safety which in normal circumstances they not take.
IN OTHER WORDS ABOUT 3 MONTHS AFTER WALKER WAS SACKED AND 9 MONTHS AFTER BLOWING THE WHISTLE TO NICHOLSON AND HAKIN AND 9 MONTHS AFTER THE PUBLICATION OF THE MID STAFFS REPORT, PRESSURE WAS BEING APPLIED TO STAFF TO MEET TARGETS AT THE EXPENSE OF SAFETY.
Lincolnshire Hospitals – ULHT – continue to have some of the highest mortality rates in the country. Dr F Hospital Guide 2012 on page 14 identifies ULHT as one of only 12 trust in the country with mortality rates higher than expected on two key measures. You will see the earlier blog which reports calculations that it could be as high as 677 ‘excess’ deaths; but of course many more will have come to some sort of harm.
Given that at least 3 doctors were prepared to stand their ground and from my knowledge of staff at ULHT I doubt (and hope) that such calculations as above are incorrect. But this is not just about deaths. It is about harm as well.
Examples have been alleged of surgical patients being placed in medical wards and due to being in the wrong type of ward complications not being identified quickly enough leading to, for example, amputations.
Other documents covered up include reports from the Regional Health Authority’s own staff expressing concern that overfull hospitals such as Lincolnshire’s could be unsafe, and that ULHT’s staff were ‘tired’ due to severe pressures. Such warning were seemingly ignored by their bosses as the documents include a handwritten note allegedly by a very senior official that targets must be met ‘whatever demand’. Seriously, ‘we know your hospitals are dangerously overfull and your staff exhausted but still meet the targets’. Also under lock and key are allegations that Walker was pressured not to put the Hospitals on ‘Red Alert’ when they were full (a safety measure) presumably as it would compromise senior officials in the eyes of the Minister, with allegations of threats of financial sanctions for so doing; references to conversations with Health Department officials and the subsequent concern about the ‘consequences’ of not meeting targets; manipulation of financial information as part of a cover up again presumably to make people look good and much much more. Enough to blow the lid off the NHS – again. But unlike Mid Staffordshire there appears to be a smoking gun from the Trust to those higher up. Well several smoking guns actually.
The biggest smoking gun is that after Walker put them on notice they carried on regardless and now have some of the worst mortality rates in the country.
The £0.5m Supergag now makes some ‘sense’ at least to those potentially implicated, who’s reputations may be damaged if Walkers allegations are true and made public, but no sense at all to us taxpayers or users of the NHS.
The Lincolnshire Independents have speculated that there could be charges against those who authorised the gagging deal of misconduct in public office for the misuse of £0.5m of public funds. If the pending safety review shows that the high death rates are due to failing to heed Walker then some think charges of manslaughter against those responsible should be called for.
So here we have a mini Mid-Staffordshire only in this instance the Chief Executive blew the whistle. He personally blew it to Barbara Hakin, now on the national NHS Commissioning Board and also to her boss David Nicholson. What happened to Walker? He is now virtually unemployable in the NHS for having done the right thing. A complete reverse of those in Mid Staffs who’s negligence led to so many death; they were let off the hook.
Unless or until there is a clear out at the top of the NHS of those who have either created this culture or failed to challenge or change it, our hospitals will remain unsafe.
But don’t hold your breath.