The GMC has urged hospital doctors to speak out if they see poor quality care in the wake of an inquiry into Mid Staffordshire NHS Foundation Trust.
An independent inquiry, chaired by Robert Francis QC, said this week that the trust had become driven by targets and cost-cutting.
Last year, a Healthcare Commission investigation revealed that at least 400 more people had died at the hospital between 2005 and 2008 than would have been expected due to poor care.
Niall Dickson, chief executive of the GMC, said: “The report does raise questions about how doctors and other professionals respond when they see poor quality care. If any doctor has reason to think that patient safety is, or may be, seriously compromised then they must take steps to put the matter right. If doctors have concerns that a member of the team may not be fit to practise they must take appropriate steps without delay.”
He added: “Doctors with management responsibility must make sure that there are systems in place through which colleagues can raise concerns about risks to patients.”
The GMC is investigating the conduct and performance of a number of doctors at Stafford Hospital following referral by the medical director.
The inquiry report claims poor care caused “unimaginable distress and suffering” for patients.
The culture of the trust was not conducive to providing good care for patients or providing a supportive working environment for staff, the report finds.
A bullying management style was outlined. “A high priority was placed on the achievement of targets, and in particular the A&E waiting time target. The pressure to meet this generated a fear, whether justified or not, that failure to meet targets could lead to the sack,” the report says.
The consultant body largely dissociated itself from management, the report says, and often adopted a fatalistic approach to management issues and plans. There was also a lack of trust in management leading to reluctance in raising concerns.
Staff morale was low and absence and sickness rates high.
The report also points to a lack of openness by the foundation trust board. It cites an incident where an attempt was made to persuade a consultant to alter an adverse report to the coroner, and questioned how candid the trust was prepared to be about things that went wrong.
Governance was weak at the foundation trust, with sub-standard clinical audit, complaints handling and incident reporting.
Appraisal and professional development were a low priority, and deficient performance was not addressed. The report says this was starkly evidenced by two Royal College of Surgeons’ reviews of the hospital’s surgical division and the dysfunction brought to light by them.
The report says: “The few instances of reports by whistleblowers of which the inquiry was made aware suggest that the trust has not offered the support and respect due to those brave enough to take this step. The handling of these cases is unlikely to encourage others to come forward, and the responses to the investigation of the concerns raised have been ineffective.”
BMA council chairman Hamish Meldrum commented: “It is particularly worrying that a culture of fear exists in some hospitals and one which prevents doctors and other health professionals from speaking out when they have concerns. In many cases doctors’ concerns are not heeded and this can inhibit their ability to take further action. We agree with the inquiry’s findings that there needs to be a much greater degree of engagement with clinicians in the management process.”
Some clinical staff were described as uncaring by patients at the inquiry, and the report heavily criticised the standards of nursing and personal care provided.
The report says: “Failure to ensure a proper level of personal cleanliness and hygiene degrades patients, aggravating the feelings of illness, disability and separation from home and familiar surroundings. A wholly unacceptable standard was tolerated on some of the trust’s wards for a significant number of patients.”
Since the original report last year, inspectors have been carrying out regular checks and say that care is now safe.
The government has resisted calls for a full public inquiry, calling it a “local failure”, despite pressure from patient groups and Conservative leader David Cameron.
Read the full report.
Read a timeline on Stafford Hospital.
Tags: Mid Staffordshire, Whistleblowing
Unfortunately, Stafford is not unique. The same uncaring attitude seems to be prevalent throughout the NHS. My uncle was recently in another DGH in the south of the country. While visiting him I witnessed supper left by another patient’s bed later removed, uneaten, with no attempt to help that patient to eat. During his time in hospital my uncle developed diarrhoea. He was told to defaecate in the bed as there were insufficient staff to take him to the toilet. This was to an old man who was very frail but had all his marbles. So much for the much vaunted dignity campaign in our hospitals!
a local failure??
are we as a profession persuaded that it is only one bad egg?
or is there a different culture being driven by the rush/push to foundation status?
I think that all doctors would be willing to highlight failures in the system that negatively impact patients, were it not for the devastating results that inevitable result from this, the huge impact on those doctors lives and careers and the vitreolic attack on those individuals by the management and frequently the press. Recently, yet again this has proven the case. I fear many, including myself, would never take this action, even in the expectation of a catastrophic failure in patient care as a result.
Damned if you do, damned if you don’t. But more damned if you do.
The trouble is when the GMC and the BMA say that whistleblowers will not be victimised but will be protected we all think they are lying. If that were not the case, why is it that we keep on reading about doctors whose professional lives were destroyed after drawing public attention to something their employer found embarrassing? After a few years of litigation many of these get given some money, but they do not as a rule get their jobs back and are probably unemployable. It may shock and surprise ivory tower doctors who never see patients that the more humble worker ants are not willing to get into this situation, but it doesn’t surprise me.
the recent report into the concerns raised by one of the paediatricians in Haringey in 2006 before Baby P identified her clearly as a whistleblower, hounded out of her job in 2007, and pressure put upon her to take money to stay quiet.
There is an opportunity to make a difference by standing together on this issue.
An online petition has been started to get her back into her post, she is still struggling with this,
go to ; gopetition.co.uk/online/34319
also Lynn Featherstone has a blog about cover up/secrecy etc etc.
Department of health say one thing and do another….
Perhaps the BMA would consider refunding the out of pocket legal expenses incurred by Ramon Nriekash.That would send a message to management.
I do not see anything new in this report; we knew the state of affairs after the Healthcare Commission Report. And a ‘public enquiry’ will not add anything - except, of course, cost!
After the last report I wrote to the GMC and the NMC to ask whether the Director of Nursing or the Medical Director had raised any concerns; and, if not, had they not been neglecting their duty? In which case, were either body going to take any action? I was fobbed off on the basis that ‘nobody had made a complaint to them’! Iam delighted to hear that some senior doctors have now been reported to the GMC by the Medical Director! But what about the Director himself (or herself)? Was he/she totally ignorant of what was going on? if so, why did they not know?
Whistleblowing has always demanded courage. The whistleblower will, almost invariably, be ‘got at’ by The Establishment. My admiration goes to those prepared to do so. BUT, as the GMC says in its documents, “our duty must always be what is in the best interests of our patients”. So, if any doctor thinks that their patient is being put at risk, they should refuse to expose them to that risk if it is an elective case - even if this means cancelling operations - and so missing targets!
Once upon a time, not so long ago, we used to have Medical Staff Committees where issues such as this could be discussed ‘privately’; and if there was genuine concern, a unified approach could be made - which is a very powerful tool. Any manager taking action AGAINST MEDICAL ADVICE would be in a parlous position indeed. But, of course, management has adopted the tactic of ‘divide and rule’ very successfully. It will take a concerted effort by the whole profession to regain our proper place in the making of clinical decisons - including whether it is safe to treat. Let no one forget that it is doctors who treat patients - not managers, Trust Board members or politicians. It is OUR responsibility to advise patients (and mangement) about safe treatment. We cannot, and must not, renege on this ‘duty of care’. And we must make it clear that we are acting on behalf of our patients.
Mid staffs is a potentially useful weapon in trying to achieve quality of care, and managers and clinical managers are running scared. However, it still relies on courage and stamina to stand up and be counted. When I talked to our Medical Director about this recently I was told that there was no culture of intimidation in the Trust and no-one had raised this before. Yet it is clear that people are scared of repercussions and personal consequences. Openness doesn’t exist in the NHS.
How can Malcolm Morrison say “I am delighted to hear that some senior doctors have now been reported to the GMC by the Medical Director” when he may know nothing about them? Perhaps they have been selected as scapegoats and offered as sacrificaial lambs - successfully to judge by this comment.
Previously referral to the GMC has been used as a very effectivesanction against bona fide whistle blowers. Remeber Dr Pal? (http://www.nhsexposed.com/healthworkers/doctors/gmc/pal_v_general_medical_council.shtml)
I apologise if ‘Splotter’ thinks I have already made a judgment. I have not! The facts are that poor practice, both medical and nursing, had been going on for quite some time. So, SOME senior doctors and nurses MUST have known about it. Apparently, so far as we can tell from the reports, none of these raised concerns or took any action to protect patients from substandard care. I am now ‘delighted’ that some docotrs are to be judged whether they failed in their duty to patients. I hope they are those that are responsible; if not, hopefully they will be found ‘not guilty’. I am still concerned that they were referred by the Medical Director, who should have known about the standard of care; and, in my view, should be up before the GMC himself (or herself) unless he/she can prove that they tried to erradicate poor care
I believe the following links raise more serious problems which need to be considered including reviewing GMC’s own guidelines on Good Medical Practice as by and large, if a doctor follows its guidelines, he is persecuted instead of being praised. Furthermore, the organization/Trust will frame him because of existing ‘Medical and Organized Mobbing’ outlined in the following links and will not get satisfactory 360 degree feedback required for GMC Revalidation process.
Can anyone urge the GMC to re-consider its Guidelines on Revalidation and do the best for patients’ care and not merely rely on Medical Managers’ witness statement who forget their primary duty as a doctor once they are recruited as Medical Director
http://gmchumanrights.blogspot.com/2010/04/alice-in-wonderland-demonstration.html#links
http://www.doctors4justice.net/2010/03/whistleblowing-in-uk-problems-and.html
http://www.doctors4justice.net/2010/04/organised-mobbing-british-oppressive.html
Because of a culture of fear and retribution in the NHS,many doctors don’t speak up. However a minority do raise concerns trusting the system and stop when they face reality and see the double standard. The GMC guidelines are clear encouraging doctors to speak up but when they do speak up, NHS Managers persecute them and refer them to GMC. There is no support for doctors when they are suspended as the GMC does not involve in employment issues, knowing the cause of suspension is because of following the GMC guidelines. The NHS Managers fabricate spurious complaints and the GMC take it as Stream 1 (more serious) especially if a doctor is from ethnic minority.
I suggest, GMC should be proportionate in its response and if a whistleblower produces evidence of raising concerns before being subjected to spurious complaints,GMC should close the matter at the initial stage as referral to FTP panel will discourage other doctors from speaking up and GMC wants doctors to highlight malpractice or wrongdoing.
Only with proportionate response by the GMC, doctors will have confidence to speak up without fear of reprisals.