Hazel McHaffie

Chief Medical Officer

Whistle blowing

To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.
Prof Sir Liam Donaldson (former CMO England)

Whistle in the Wind has to be the most disturbing book I’ve read this year – and probably not best tackled when we’re all rather dispirited about the rising Covid numbers, and increasing restrictions on our freedoms. Hey ho! Once started I couldn’t go back.

It tells the story of one NHS senior consultant surgeon’s battle to get his hospital/Trust to take action in the face of a catalogue of failings and dangerous practices in his place of work – abysmal clinical standards, gross imbalances in workload, extremely poor judgements, shirked responsibilities, dysfunctional relationships, financial irregularities. But the ‘guilty parties’ resented Peter Duffy drawing attention to their deficiencies, and mounted a deliberate campaign of victimisation and counter accusations against him.

At the time, the Trust’s website declared that no whistle-blower would lose their job or suffer any detriment if they spoke up to identify genuine patient safety concerns – a claim made by most large organisations nowadays. But the reality was far from the promise. Even more unbelievably, the same Trust had recently had its Midwifery Department found guilty of gross and shocking failings, a fact plastered over the media, but senior management nevertheless still appeared complacent and apathetic. Ranks closed. Honesty and truth were stifled.

Hugely daunted, Mr Duffy nevertheless eventually reported his concerns to the Care Quality Commission whose job it is to oversee safe and effective practice in health and social care settings. Until I read this book, I thought they were indeed the go-to organisation for action and a fair independent hearing. But in his case, they didn’t even attempt to corroborate his account. And furthermore, they specifically state that they will take no part in protecting the individual whistle-blower. Who knew?!

Retaliatory action against Mr Duffy escalated, and included not only malicious, false, fabricated and covert accusations – defamatory emails and letters claiming he was both racist and a bully, and had fraudulently obtained money to which he was not entitled – but also docking a substantial sum of money owed to him, and eventually loss of his job.  Accusations against him were sent to the police as well as senior management. He even received a phonecall warning him that the consultants he had reported were ‘utterly committed to revenge’. He felt ‘thoroughly hated and despised’.

In spite of his senior status and established good reputation, no one in any of the organisations set up to deal with such situations seemed to be paying any attention to his legitimate and proven concerns. There was no feedback, no support, no action.

How this man coped with seeing continuing incidences of neglect, malpractice, avoidable harm or deaths, on top of the personal vendetta against him, I really don’t know. I once blew the whistle in a much more low-key way and suffered from the aftermath of the ensuing hostility and injustice for years. Reading this book stirred the embers of that horror quite stressfully. Finally, even Mr Duffy had no appetite for submitting reports of sub-optimal care which went unheeded; he felt intimidated and frightened by the hostility and retaliation.

By now the toxicity within the hospital  – ongoing rudeness, aggression, hostility, dysfunctional behaviour and relationships, collusion, incompetence, cover up, neglect, dangerous practices – together with his own fear of some act of revenge, led to his health suffering seriously. Sleeplessness and high anxiety levels led to him suffering cardiac arrhythmias, ending up a patient himself.

But his conscience and professionalism would not allow him to turn a blind eye when the lives and dignity of patients were at stake. The General Medical Council‘s position is, after all, unequivocal:
Doctors in particular have a duty to act when they believe patient’s safety is at risk, or that patient’s care or dignity is being compromised. Our guidance sets out our expectation that all doctors will, whatever their role, take appropriate action to raise and act on concerns about patient care, dignity and safety.
He felt the weight of this duty keenly.

Colleagues and friends, however, seeing how he had been treated, were reluctant to expose themselves to the same retribution. Even when his case came to an Employment Tribunal, disclosure was limited. Witnesses were warned off from supporting him; they could neither appear nor have their witness statements seen by the Tribunal. And just four working days before the case was heard, the Trust issued an intimidating letter, telling Mr Duffy he was doomed to lose his case, and they would be pursuing him and his family for costs estimated at £108,000. However, if he would just agree to drop the case immediately in its entirety, remain silent, and agree to a non-disclosure clause, then they would not pursue costs.

To his great credit, he did not give in to these strong-arm tactics. And he was eventually exonerated, but the triumph was something of a pyrrhic victory. Even though this case was deemed an across-the-board failure on the part of the Trust and the clinicians concerned, nothing much has changed, Mr Duffy laments. Systemic failures are still ongoing; lives are still put at risk avoidably; whistle-blowers are still treated as lepers. Furthermore, he and his family have paid a colossal price for his integrity, courage and commitment to patient safety. In a massive understatement, he says he still struggles to believe the tactics adopted to silence him. I recognise that sense of incredulity and bewilderment all too easily.

The NHS, regulators and the law, all repeatedly claim the importance of safeguarding and speaking out to protect others; and they have a clearly stated duty of care to clinicians and patients. They offered this particular whistle-blower neither care nor protection. I can well imagine writing this book was cathartic for its author – at last he could present his case in its entirety. And I thank him sincerely for doing so. It was, in the end, therapeutic for me too – putting me clearly into the camp of ‘committed, responsible, caring individuals’ who summon up the strength to stand up to those who hurt or bully the vulnerable. The fact that it’s not a literary masterpiece, adds to its feeling of authenticity. It’s an unvarnished, from-the-heart, account. I can only admire the persistence and courage behind it, and wish the Duffy family well in the future.

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Coronavirus – keeping calm in a crisis

Remember that feeling when you come out of the cinema from a film, set in the wild deserted, snowy wastes of perpetual winter, and the sun is shining and people are milling? Disorientated. Discombubulated. It takes a moment for the world to steady on its axis. As a writer of fiction, I’m well used to that sense of hovering between reality and fantasy. But now it’s not just a sense – it’s for real. And we’re ALL experiencing it – every hour, every day. The greatest public health emergency of our generation. And it’s worldwide.

As a country, this week we’ve officially moved from the ‘containment’ phase of this new and spreading Covid-19 virus, into ‘delay’; desperately trying to keep demand within the capacity of our health services. On Monday things ratcheted up hugely. We’re now avoiding all unnecessary travel and social contact. My generation are deemed extra vulnerable and a protected species! … but we ALL have to take unprecedented decisions and actions.

© Can Stock Photo / nasir1614

Sound information is always key to good decision-making, but there’s so much out there, a lot of it hard to take in, sometimes even conflicting. Initially the official cautious approach of our Government was at odds with the advice of many scientists and the WHO who were looking for more draconian measures sooner. That felt troubling. Who were we to believe? For me, uncertainty was much more stressful than the fear of the illness itself. So I welcomed clearer instruction on Monday: I could now, with a clear conscience, cancel the week’s planned travel and social encounters, and prepare for a long period of increasing social isolation.

So, reviewing the situation thus far, with my ethical hat on, what influences or persuades me, and enables me to make an informed choice? Facts. Consistency. Authoritative voices. Transparency – being shown the workings behind the advice. Quiet expertise.

A concrete example: my personal opinion of the Prime Minister notwithstanding, I’ve been heartened to see him flanked by experts of undisputed scientific and medical pedigree, who add gravitas and authority to the messages given to guide us all in dealing with this ongoing and escalating crisis. Professor Chris Whitty is the Chief Medical Officer for England; Professor Sir Patrick Vallance the Chief Scientific Adviser to the Government – both men with yards of qualifications and credentials and experience. But best of all, speaking in a measured, calm and quietly dignified manner. In simple words we can all understand. It takes someone with real expertise and confidence to convey the facts in comprehensible lay terms without obfuscation or bombast, to remain unflappable in the face of challenge.

When, early on, Professor Whitty observed that rushing into panic mode and isolating ourselves prematurely was unwise, enthusiasm would wane, fatigue and non-compliance would set in, and the psychological as well as the practical consequences could be far more detrimental, I let my breath out gently. Here was a chap who understood human nature. Understood not only the epidemiological and medical aspects of the epidemic, the immensely complicated world of microbiology and disease transmission, but the lived reality of everyday Joe/Jane Bloggs. Against the bluff and bluster and pomposity that can so easily characterise people regurgitating secondhand facts and figures, these modest understated men defuse the panic. So when they tell us that THE most important thing is hand-washing and containment of nasal spray and distancing measures, we can all personally identify with such ordinary domestic strategies; we each and every one have a vital role to play in this global war effort. When they tell us that the time has now come to introduce more stringent isolation measures to save lives and reduce the burden on our front line emergency services, we can comprehend and accept the need. When they admit it will be really difficult and it will go on for a long time, we know they understand the consequences, they are in this with us.

© Can Stock Photo / coraMax

But my heart goes out to them, and all other ‘leaders’ who are called upon to make major judgements on behalf of their people/teams/dependents/clients/delegates/fans. My own personal sphere of influence is microscopic by comparison with that of these men, but nevertheless I feel the weight of responsibility. Just what is the wise and sensible choice? The devil is indeed in the detail. So, huge thanks to everyone who is doing their level best to steer us through these unchartered waters. And hats off to the countless unknowns who are quietly and effectively providing acts of kindness to cheer and support those in most need. Already this unprecedented crisis has brought out the best in people.

I rather like this apposite and quietly dignified quote from the Talmud: ‘Do not be daunted by the enormity of the world’s grief. Do justly now, love mercy now, walk humbly now. You are not obligated to complete the work, but neither are you free to abandon it.’

 

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