Echoes of the Bristol Child Heart Scandal at Colchester
NHSmanagers.net Guest Editorial
In an article for the website NHSmanagers.net, Martin Young of Michelmores Solicitors explores whether the common thread linking the Bristol Heart scandal all those years ago and the current Colchester case is actually the role of whistle blowers; and whether whistle blowers, as a mechanism, need to be more integrated into the system.
Whistleblowers again prove themselves a grassroots regulatory force.
Following a tip-off from a whistleblower, the Care Quality Commission has discovered failings at Colchester Hospital serious enough to warrant police involvement, and have made a recommendation that the hospital be placed on strict ‘special measures'. Cancer patients at the hospital were waiting too long for treatment, in breach of NHS guidelines, and senior management are alleged to have manipulated staff into amending the statistics to head off criticism.
There is a lot wrong with this emerging picture, but perhaps one of the most chilling elements is the feeling of having lived out this scene before. Michelmores continue to represent the families of children affected by failings at the Child Cardiac Surgery (CCS) unit at the Bristol Infirmary, where, in the 1990s, a culture of influence and a willingness to cook the books led to the deaths of scores of children, with perhaps as many left severely disabled. Then, as now, it took a whistleblower to expose the failures, and we are left to wonder how much has really been learnt from that tragedy.
Do targets make the NHS more efficient?
The needs of separate units within a hospital are not alike, and so this question needs to be answered on a case-by-case basis. Criticism of the now decade-old A&E target, which demands that patients are seen and appropriately treated within 4 hours of arrival at the unit, is rich and widespread. Aside from accusations that the target is more politically expedient than clinically valid, it is alleged that A&E doctors are admitting patients to hospital unnecessarily simply to avoid breaching the target (around 25% of transfers from A&E to hospital take place around 10 minutes before the crucial 4-hour mark).
The quotas for cancer waiting times seem to feature elements of this example: cancer treatment is politically sensitive, swift treatment is agreed to be medically imperative in many cases, and, as has become increasingly obvious, the set targets are frequently missed. While the unwillingness to admit mistakes is a huge concern, however, it is the reported manipulation that gives cause to wonder whether the more than ten years since the first Bristol scandal have brought about sufficient change. There is nothing intrinsically wrong with targets, but they do carry a history of abuse.
Who'd be a whistleblower?
Concealing figures is not a new trick. In the ‘old boys' club' of the Bristol CCS unit, crucial information began to be omitted from the surgeons' operation logs, and mortality data were used conservatively so as not to alarm children's patients. Stepping up and highlighting failure was an impossibility; the senior surgeons James Wisheart and Janardan Dhasmana, exercising immense influence, were unquestionable as they sought to maintain the supra-regional status of their unit. This status, bringing with it not just esteem but hard funding, was coveted even though children were dying on Bristol's operating tables, or leaving its CCS unit severely disabled.
Whenever a scandal breaks on the information of a whistleblower, we are left wondering how much longer the damage would have gone on, and how much more harm would have been caused, had that person not spoken out. Subsequently, we often witness the abuse and shabby treatment meted out to whistleblowers by their own profession. Current protection for whistleblowers is insufficient: what use is the Public Interest Disclosure Act when a culture of intrigue, bullying and ostracism can freeze out a whistleblower as effectively as any sacking? Colchester must be a warning, like the melting ice caps: without a safe environment for whistleblowers, patient safety can drift into dark places.
NHSmanagers.net is the principal information resource and representative body for NHS managers in the United Kingdom. The site hosts news, comment and culture, with a particularly fascinating 'Dark Corners of the NHS' feature.
If you would like to discuss a clinical negligence claim relating to any of the issues discussed above, you can contact Michelmores for free, for discreet, impartial advice.