Hazel McHaffie

General Medical Council

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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Murder most foul

Twenty years ago a much loved and respected doctor was arrested. He was found to be  the world’s most prolific serial killer of all time (250 victims over 30 years and counting) . His name has become synonymous with evil: Dr Harold Shipman.

Back then the culture in this country was one of respect and trust for doctors, and in the small working-class town of Hyde near Manchester, this particular GP was revered for his dedication and compassion. He would visit vulnerable patients at all hours, stay with them during their last breaths, personally phone their relatives to break the news. When investigators came snooping the locals resisted their suggestions of sinister malpractice fiercely.

Oh yes, they knew lots of elderly people in his practice died – they even jokingly called him Dr Death – but it never entered their heads that this was in any way untoward. They were just grateful that he cared enough to be with these neighbours during their last hours on this earth. He seemed invincible.

And he believed he was. After all, he’d survived a report to the General Medical Council (GMC) relating to his personal drug addiction, he’d successfully forged prescriptions and wills, acquired legacies from patients, as well as conning the good people in his practice. When he was questioned by the police, he displayed breathtaking arrogance and insolence, spinning absurd stories, even at one point sitting with his back to his interrogators.

Photo courtesy of Photolia

Listening to the harrowing testimony of those caught up in this horrific case, it’s not difficult to understand the despair of the policeman who took his sheaf of evidence to the GMC back in 1976, twenty three years before the doctor was finally tried, only to be waved away without a hearing himself: this august medical body deeming Harold Shipman ‘no danger to the public‘, just needing some rehabilitation. If only!

In the end the law enforcement officers investigated a total of 900 deaths spanning decades; they exhumed numerous bodies; they traced his killings back to 1972; they are almost certain that the estimate of 250 deaths by poisoning is a conservative one. But Shipman never admitted his guilt, never expressed remorse; a senior forensic psychiatric said he felt none. Imprisoned for life he waited only till he had assured his wife Primrose the best settlement possible, before, on the eve of his 58th birthday, in 2004, taking the last life: his own.

Twenty years ago, but it is still as vivid as it was then. Some crimes are indelible. I was mesmerised by the documentary shown on independent television last Thursday evening. We all carry burdens from the past, but they can be as nothing compared with those borne by local friends of the ‘good doctor’, nurses who saw but didn’t dare protest, policemen whose hands were tied, relatives who thanked the doctor who had killed their loved ones. If you’ve ever been betrayed by someone you trusted, you’ll know it’s a peculiarly deep hurt.

I’m in the business of medical ethics. This story is way, way outside my scope. Had I written it into fiction no one would have believed it. It would have sunk without trace; Shipman never will.

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