Mr David Fillingham. Chief Executive of Royal Bolton NHS Trust. You are an inveterate LIAR

The above Press Release was unearthed from the archives of North Staffordshire NHS Trust. It was sanctioned by David Fillingham, the current Chief Executive of Royal Bolton NHS Trust and former Chief Executive of North Staffordshire NHS Trust.

It concerns Ward 87. It should be noted that Ward 87 had two reports - one in 1999 and one in 2001. Both upheld my concerns. The evidence can be read here. The 1999 mirrored the 2001 Report which stated

The summary of the 2001 Creamer Report concealed by the GMC stated as follows

(a) “Patient care was clearly affected by the failures identified”;
(b) “The Directorate failed to take appropriate action when the allegations were made in a statement by Dr Pal”;
(c) “Although medical and nursing staff were concerned about the range of issues...no one voiced their concerns except Dr Pal which either demonstrated a general acceptance of the issues or staff felt unable to raise concerns”.

The Press Release issued by Mr David Fillingham and his set of gremlins stated

"Where allegations were made about the treatment of specific patients, case-notes were reviewed and her claims could not be substantiated"

David also had a number of conversations with the Director of Public Health requesting that I be referred to the General Medical Council for exposing the detailed negligence of North Staffordshire NHS Trust during his reign. Of course, David now feels he has a expensive suit and a clean cut look and no one will piece together his past. It should be noted that after the findings of the 2001 Report, Fillingham left North Staffordshire NHS Trust.

Let us test whether Fillingham's press release was correct :-

1999, one year before Fillingham's press release, the following was noted

" I informed you that I had undertaken an audit of every single patient on the ward the previous week. I identified a serious lack of baseline and routine observations. In the case of some patients there was also clearly a breach of policy and there was an apparent lack of misunderstanding from the staff of the importance of such issues. I informed you that in my opinion the level of care demonstrated for some patients on the ward at the time of my audit was nothing short of negligent"Medical Division Memorandum Ward 87 From Ms Teresa Fenech Directorate Manager for Infectious Diseases City General Hospital Stoke on Trent. Reference TF/CLS/005 18th May 1999

In May 1999, the Medical Division received an Adverse Incident Form from Ward 87 which identified a malfunction of a defibrillator used during resuscitation. A two stage investigation was began.

"To summarise other discussions that we have had on the medical PRHOs, I think that the following should be addressed within the directorate as a matter of urgency - (2) They should have proper clinical supervision at all times and help from a more experienced colleague... should always be available (The New Doctor GMC), On discussion with several of them they are still working without immediate supervision for significant periods.” Dr Colin Campbell CAC/ AR/LET 2nd December 1998

We can safely conclude that David Fillingham is a dishonest man who maliciously and purposely misled the public. Radio Stoke was not the only press release he had sent. There were others. Professor Rod Griffiths and David Fillingham wished to shut my concerns down and they went about it in a very interesting way. Of course, their dishonest ways are now on the internet for all to observe. Royal Bolton Foundation NHS Trust has a high death rate. We wonder why. Mr Concealer has hidden the dead bodies just like he has always done. The problem with this kind of corruption and high level dishonesty at the heart of the current government is that there is no accountability through the NHS or the media. Of course, Fillingham is a large leopard who never changed his spots. The NHS works much like the Catholic Church - when a child is abused in a Catholic church, the priest is sent to a quiet place. The locals are not warned about the perpetrator. Similarly, Bolton was never warned about Fillingham's past. Fillingham simply arrived and took up his place and had it not been for me - no one would have noticed his slithery ways. The price of a total lack of accountability in the NHS is that Fillingham goes on to end further lives. The Department of Health continues to be in denial about Fillingham's incompetence much like the Catholic Church remains in denial about child abuse. The sad fact is that large numbers of people die and the government continues to turn a blind eye.

If David and his cronies are reading this, he should remember I am just returning the favour of the mass character assassination done to me as a junior doctor internally through the medical profession and externally through the media. It is a great shame we do not have the Hammurabi's code because if we did, David Fillingham would be out of a job.

[Ward 87 Manager] David Fillingham's Trust has Second Highest Death Rate

David Fillingham's Flying Circus

David Fillingham was the Ex Chief Executive of North Staffordshire NHS Trust and the man responsible for Ward 87. I have to write these reminders because it becomes important to ensure some accountability netwise. NHS and Accountability - do they actually go together? Possibly not. That is why David Fillingham is yet to be fired from his comfy chair at the Royal Bolton NHS Trust.

Professor Jarman, the supergeek of Imperial College has accused the Royal Bolton NHS Trust of being one of the Trusts with the highest death rates [ still]. It has the second worst death rate in the country. If we translate this in lay man's terms, David Fillingham has been discharging dead patients. They have been dying due to the above draconian regime run by David himself. Patients are apparently waking up dead following the cashectomies performed by David's management team.

As usual the Trust is in denial. Of course, my solution is to ensure David Fillingham has resigned by next week. That will not happen of course because the Trust will never acknowledge that David is a failed manager with a dubious historical record - that includes the misdemeanors on Ward 87. Of course, if managers are not admonished for their misdemeanors, dead patients will continue to be discharged. Again, there is no feedback loop or corrective mechanism to ensure Fillingham is not allowed to discharge dead patients.

Solutions for Whistleblowers

Prof B. Potentially relatively cool

Some weeks ago, Professor Jarman from Imperial College London of the Dr Foster Unit asked for my views on a reporting system for whistleblowers. Dr Al Ruby and I formulated the response below. We felt this was worth publicizing as it summarises many of the issues concerning whistleblowing. Overall, I believe Professor Jarman is a good guy. He may well feel a little unsettled by his contact with me and the publication of this document. Nevertheless, I believe this should be a matter of record. I am of the view that it is time whistleblowers were listened to and not side lined. I am not quite sure whether Jarman wished my contact with him to be a secret issue. Nevertheless, I have had some very interesting discussions with Jarman. I believe his heart is potentially in the right place and I also hope he will be instrumental in persuading the masses that a Health Select Committee Review on Whistleblowing is urgently required. He may or may not decide to contact me again after this publication - whatever he decides, I really enjoyed my discussions with him. This is the only exchange for public view. Everything else discussed will remain confidential. I would officially like to thank him for a short period of fascinating discussions. The future of course is in his hands as always. Unlike many in officialdom, Prof B as he is affectionately known has tried to solve the problem of patient safety and whistleblowing. He has also taken the time to listen to a number of ideas developed by whistleblowers. For that, he is to be commended and admired as this is a rare quality for anyone in his position. Anyhow, here are our solutions to the issue of whistleblowing.

24 March 2010 01:00

Prof Jarman,

I apologise for the delay in responding to your questions. I have been extremely busy with various issues. I have discussed this with my colleague/friend and fellow whistleblower Dr Mohammad Al Ruby and our responses are enclosed below. I am of the view that your questions should also be directed at a vast array of whistleblowers - Otto Chan Consultant, Raj Mattu Consultant Cardiologist, Ian Perkn NHS Whistleblower, Steve Bolsin, Dr Peter Wilmshurst and Dr Shreedar Vaidya, Dr Milton Pena, Robert Phipps and a number of others. I have therefore copied this email to all of them in the hope of opening a consultation via email [ since the Health Select Committee Review has been denied to us]. I understand you are due to attend the meeting at Parliament with Norman Lamb MP. Perhaps you will discuss some of the ideas put forward here.

My colleague Dr Ruby and I have come up with the following [ I have listed your questions in bold type]

1. Do you think there should there be a structured system whereby doctors who are concerned with the care being provided in their hospital [and the Inquiry covered hospital care] have a safe place where they could report their concerns to their professional representative organisation, if they haven’t been able to resolve them locally, in the knowledge that their reports could, if they wish, be confidential (but no doubt ‘discoverable’ in law)?

a. You refer to professionals as doctors. I would broaden these issues to include any health professional or manager [ NHS Employee].

b. Yes there should be a structured system whereby NHS Employees concerned with care being provided can report their concerns. On discussing the issue with a number of individuals, the organisation should not be associated with their professional representative organisation. It should be truly independent of the GMC, the BMA, the MPS, the DOH and the NHS Trusts [ ie trade unions and defence unions].

c. I believe that even raising issues locally is highly dangerous [ Milton Pena v Tameside, Raj Mattu v Coventry NHS Trust, Pal v North Staffordshire, Chan v Barts and London NHS, Holt v Great Ormond St, Perkin v St Georges]. It is even more dangerous for junior doctors. This was also outlined in the BMA Conference on Whistleblowing some years ago [ See Appendix 1 below]. The culture in the NHS has not altered and therefore local whistleblowing is not safe for any employee. Moreover, it has been established by the research conducted by Professor David Lewis [ 10 Years of PIDA], that the employee has little recourse in the law. He concludes that PIDA does not work. The government has been slow to respond to this criticism.

Protection from organisational reprisals is currently painfully low. The issue of Medical Mobbing [ Huntoon et al USA] is yet to be recognised by the organisations in the UK. Both the Shipman Inquiry and the Bristol Inquiry have detailed episodes of organisational reprisal and serious losses sustained by the whistleblower. Given the current status, it is essential to have a independent organisation associated funded by the government with support from organisations such as the National Bullying Helpline.

The USA has the National Whistleblowing Centre http://www.whistleblowers.org/ . We have no equivalent in the UK. It is an organisation that is essentially one of advocacy, staffed with lawyers etc. This kind of organisation is vital for NHS Employees in the UK because each person requires maximum support in raising concerns locally and nationally. This organisation should have a network of contacts with voluntary organisations and the NHS. Their prime concern should be to act as middleman and a wall between the NHS and the whistleblower.The immediate protection of an advocacy organisation will protect the identity of the whistleblower, provide them with their options and act as middleman to change the current status ie improve patient safety etc. Independent advocacy is the only way forward in improving the current system. It is impossible to change the culture of the NHS. Numerous studies have been done regarding the psychology of whistleblowing issues. It will take many years for people to change their attitude.

d. I believe the Mid Staffordshire NHS Trust Inquiry observed the whistleblowing issue simply without understanding or reviewing large amount of literature involved in whistleblowing. It is not acceptable for those in positions of responsibility to speculate over what will be helpful to a whistleblower. Over the years it is clear that the support for whistleblowers is painfully low. It is also clear that the current systems in place are ineffective. I believe that those who are responsible for policy and decisions within the NHS assume they understand what whistleblowers go through but don't really understand or care about the losses suffered by many. Each case is publicised by way of showing that whistleblowers are pariahs. The message given by the media is effectively " if you raise concerns, you will be destroyed". This kind of publicity is negative and encouraging of whistleblowers. It is likely to dissuade professionals when they come across poor care [ 2001 Report Creamer who stated that other staff felt unable to raise concerns]. As we are all aware, it is essential for doctors to be able to raise concerns safely without sustaining losses to their family, their career and their life. The factor in terms of human loss has never been acknowledge or recognised nationally. It is because of this failure to care about what happens to the whistleblower - the current system does not make allowances to protect that whistleblower. It often allows them to founder much like a Darwin's theory of survival of the fittest. Everyone watches in glee in the hope they will fail in some way. It is time that these losses were recognised, accepted and system put in place so those who raise concerns obtain emotional and social support for the traumatic experiences they may have been through. This would be the function of the Advocacy system for whistleblowers.

e. If the advocacy service could be created, they could safely raise concerns with the General Medical Council and numerous other authorities. This would result in less medical mobbing - as the knee jerk reaction of any Trust is to undermine and criticise the whistleblower. The GMC is often used as a instrument of harassment by those who exert their vendetta to silence the whistleblower [ Wilmshurst v GMC, Pal v GMC, Vaidya v GMC, Robert Phipps v GMC, Mattu v GMC and numerous others]. This phenomena is not recognised despite it being presented by Wilmshurst P in his document a Personal View of the GMC.

In summary, the idea of basic reporting is simplistic and needs to be thought out by consultation with those who have raised concerns. The idea mooted by various organisations does not take into account that whistleblowers require support. It concentrates on using the whistleblower to correct the system failing then not concerning themselves with what happens to them afterwards.

A robust system can only be done through a proper and effective discussion and a Health Select Committee of Whistleblowing. In my view, it is time that people stopped guessing on issues affecting whistleblowers and implementing systems without due research and discussion. One could say some methods suggested by barristers or lawyers who have never experienced whistleblowing is not evidence based. The people to ask are the whistleblowers themselves. Without their input there will never be any proper and effective service that encourages patient safety and protects whistleblowers. In conclusion, no surveys have been done using whistleblowers, no research has been done of this specific group in the United Kingdom and no consultation has been offered.

2. The current organisations would not have the resources necessary to investigate properly the reporting doctors’ concerns, but they would be able to collate them and formally report them, to the CQC.

a. The Department of Health have played a part in funding Public Concern at Work. Unfortunately, PCAW from reports by whistleblowers have been relatively ineffective [ see Perkin v PCAW]. An advocacy service funded by the government or as a social enterprise or through the National Lottery etc would be relatively cost effective. As the middle man, it would be quite appropriate to raise concerns locally and Nationally with good effect. Legal drafting of documents for whistleblowers will also save vast amounts of time and covey the messages faster. They could also conduct brief investigations by consulting the NHS Trust and other organisations by way of a FOIA and also ensure Data Protection Act requests are done effectively as a information gathering system. One of the problems for whistleblowers is their lack of legal support. Often people fail to raise their concerns effectively because of the lack of this kind of support.

b. I have found the CQC largely incapable of dealing with the concerns of whistleblowing. The CQC has neither been trained, nor does it address the concerns of lone whistleblowers at any point. Milton Pena may have had more success but his weight as consultant probably had a lot to do with this. Liaison by an advocacy organisation would probably be more fruitful here. They have the tools but I do not think they take doctors seriously at all. They would take lawyers or representatives more seriously - better paperwork etc.

c. By way of an example, the Health Commission initially told me that they could not investigate concerns raised by Whistleblowers. Four year later they subsequently changed their mind. By then it was too late. The CQC have to date failed to review Ward 87 or learn from the lessons of two reports in my favour. This is largely discarded by those in charge but it is vital to understand that if my concerns with two reports are dismissed then junior doctors who have basic concerns without supportive reports will never be looked at or investigated. This tells us more about the lack of understanding by the Health Commission now the CQC. There is no effort to improve their service for whistleblowers.

3. The ideal may be a medical organisation, independent of government and the Department of Health, with the capacity to carry out on-site inspections in response to concerns regarding quality of care reported by doctors.

The NPSA has the capacity to do this with some expansion. Again, it is extremely difficult to have a organisation independent of the government and DOH who will have enough resources to conduct the type of investigations you are stipulating. In some cases, GMC v Chai Patel, private investigation reports are not considered valid and the entire case against Chai Patel was thrown out by the GMC on that issue. This leads us to question the manner, the way and the means of creating such a organisation. A better way may be to fine tune organisations like the NPSA and the GMC or the CQC. The main complaint really is the partisan relationship between staff at these organisations and vested interests [ A Personal View by Peter Wilmshurst Consultant Cardiologist]. One of the main problems is the lack of acknowledgment that some regulatory systems are currently failing whistleblowers. The GMC is one such organisation.

4. We have seen that the system of monitoring the quality of hospital care in England was considered to be deficient by the three independent US organisations that reported to Ara Darzi in 2008 (e.g. the Joint Commission “Quality today does not drive or even influence commissioning decisions”), that they depend very largely on self-reporting rather than on-site inspections. Apparently “A Department of Health spokesman maintained that the three reports were never intended for “wider circulation” and said they were extensively discussed by experts advising Darzi on the production of his report.” (http://www.timesonline.co.uk/tol/news/uk/health/article7052606.ece) but the CQC has stated that it will continue to rely on self-reporting (see extracts below).

a. The above is extremely interesting but not unexpected. I do not believe that it is right or correct for the hospitals themselves to input and analyse their own statistics. The CQC is currently not equipped to inspect every hospital. This does not mean it could not be funded to function in that way. Moreover, it is vital that statistics collected is done by staff who are independent of the Trusts in question eg managers who have vested interests in parading good figures. I am not certain whether the audit commission could be expanded to include an area where hospitals are assessed by statistical analysis.

The Health and Safety Executive for instance has various powers - more so than any inspection organisation in the NHS. It may be an idea to widen the function of the Health and Safety Executive to include monitoring of conditions on Wards in terms of safety. The person to discuss this issue with is Arthur Briggs who has the research on this aspect. At present, I do not believe the CQC and the Health and Safety Executive function to ensure public safety. Moreover the NPSA has a fairly narrow role and does not actually function well enough probably due to their narrow remit. Again, the organisations exist but they tend to work independently - whereas proper functioning in terms of maintaining patient safety requires expansion of the roles of these organisations. They should work together in the interests of public safety as opposed to acting to dismiss concerns raised by doctors or patients. Without further discussion on this aspect with those involved in patient safety issues and those who have raised concerns - the resources will not be used effectively. In summary, there are organisations in place that could function to ensure good assessment of hospitals but the roles of each organisation has not been reviewed in view of the current disasters in the NHS costing the lives of many patients.

At present a situation exists where the system largely relies on patient reporting or complaints. The odd whistleblower may be assassinated in the meantime but that is largely hit and miss. Dr Foster may collect various pieces of data but what is absent is and alarm effecting immediate correction of problems that may exist. This will not happen until there is some form of local monitoring or safe reporting. The system is too litigation friendly and works on a defensive system. Most patients want an open and transparent system that addresses their concerns. Research from the US shows that an apology to patients often reduces litigation. The issue of the complaints system is demonstrated in http://www.nhscomplaintsexposed.co.uk/ with my colleagues excellent letter here

b. It should be noted that NHS Employees may well be whistleblowers. The same behaviour of silencing patients and their relatives also happens in the NHS but it is not recognise. Evidence from complainants suggests this to be the case. PALS already exists in the National Health Service in every hospital. PALS should be able to widen its scope to act as advocate in patient safety issues. They should be able to act on their behalf to report safety issues immediately eg shortages of staff etc etc. This should be reported to locally with a immediate response from management as to what investigations and what corrections will occur. If the matter has not improved, PALS should refer this issue immediately to the CQC who should implement a procedure to protect patients without delay.

c. Darzi has refused a Managers Regulatory body but most failures in patient safety have occurred due to failures in management - examples include Mid Staffordshire Inquiry, North Staffordshire NHS Trust - Ward 87 Reports, Tameside NHS Trust and many others. There remains no accountability for those responsible for disasters in the National Health Service. There is therefore no deterrent. Because there is no deterrent, we observe a replay of the same kind of behaviour over and over again - costing lives, increasing litigation etc etc.

d. To finally show the dimissive attitude of those in power, Lord Darzi is yet to respond to my concerns on Ward 87 sent to him last year. While he conducts many studies with many findings, he fails to address the concerns of a junior whistleblower. This attitude is endemic of most officialdom who essentially view whistleblowers as trouble makers and people not to be taken seriously. I am therefore copying this email to him again in the hope he does take some of our concerns on board and takes the time to request a Health Select Committee Review on Whistleblowing [ which is urgently required]. The last request was blocked.

e. It is important for regulatory bodies and organisations to hire staff who do not have alternative agendas and are free from bias eg Common Purpose, Scientology, Freemasonry, dual memberships, financial interests, private healthcare interests etc. Again, Wilmshurst explained elements of the lack of independence in his Personal View of the GMC. Also, the GMC's Whistleblower Protocol advises that the Director of Public Health will be responsible for conducting an investigation into "concerns" raised. It is common knowledge that this may be the source of victimisation and organisational reprisals. Moreover, the Director of Public Health has dual interests in shutting down investigations to avoid criticism and maintain funding in certain areas. This conflict of interest is not understood by the National Health Service in general. Another example is Cynthia Bower - CQC - who used to work for the West Midlands NHS Executive and may be reluctant to criticise hospitals on her watch at the time. These vested interests and apparent biases are not recognised within the NHS at all.

In summary, an advocacy organisation independent of the NHS is required for all whistleblowers. This is really the only way forward for the NHS to maintain public safety. Organisations in place should be utilised more effectively and their roles reviewed in view of the current repeated disasters in the National Health Service. The Health and Safety Executive can be expanded and funded to perform independent checks on wards, hospitals etc. Organisations are currently not working together in the interest of patient safety. Moreover, there is little understanding or comprehension of the issues involved in whistleblowing. Moreover, there is no accountability for those who fail to uphold proper standards of patient safety hence no deterrent exists. This is part of the reason why the same management failures recurs throughout the National Health Service.

I hope the above is useful to you. I enclose a number of articles and research collected by me over the years. This is to provide evidence for our views listed above. The views are also based on my personal experiences of most organisations in the NHS. No organisation was concerned about maintaining patient safety at any point. The onus has always been left upon the complainant to keep investigating and unearthing more evidence to push investigations forward. This element and feature of the NHS can currently be seen by the case Gosport Campaigners v Dr Jane Barton. All whistleblowers have had similar experiences ie the one who raises the concerns is expected to force accountability.

We hope that Ara Darzi will agree to a Health Select Committee Review of Whistleblowing in the interests of Patient Safety in the NHS. I hope you will find it acceptable to have a open and transparent discussion about the important subjects raised by you. It is in the interests of public safety to combine the ideas of policy makers and health staff who have had first hand experiences of whistleblowing.

Please contact me if you have any further questions.


Regards

Rita Pal and Dr M Al Ruby



Appendix 1

Editorials
Protecting whistleblowers

BMJ 2000;320:70-71 ( 8 January )
http://www.bmj.com/cgi/content/full/320/7227/70

Employers should respond to the message, not shoot the messenger

Whistleblowers have been likened to bees [1]: a whistleblowing employee has only one sting to use, and using it may well lead to career suicide. In a survey of 87 American whistleblowers from both public service and private industry all but one experienced retaliation, with those employed longer experiencing more.[2] Whistleblowers face economic and emotional deprivation, victimisation, and personal abuse and they receive little help from statutory authorities.[3 ].Last month the BMJ held a conference to consider how medicine and its institutions should change to protect and empower whistleblowers.

Dr David Edwards, a general practitioner from Merseyside, gave a personal testimony of the dire consequences he suffered when he blew the whistle on his senior partner, Dr Geoffrey Fairhurst. Dr Fairhurst was funded by the pharmaceutical industry to conduct research on antihypertensive medication, but he was submitting forged consent forms and falsified electrocardiograms. When Dr Edwards challenged him about this misconduct, Dr Fairhurst launched a campaign to discredit Dr Edwards' concerns. In March 1996 the General Medical Council found Dr Fairhurst guilty of professional misconduct.[4]David Edwards was left with damaged morale, half a practice, and a huge bank loan to pay off singlehandedly.

There are many reasons why doctors remain silent in similar situations, though two in particular have impeded openness in the past. Firstly, the culture of medicine has been one in which you shouldn't let the side down, and in which whistleblowing is seen as "sneaking" on your colleagues. Secondly, confidentiality clauses in NHS trust contracts effectively gagged employees.[5]But the culture and the law are changing.

The president of the General Medical Council, Sir Donald Irvine, told the conference that the council's recent policies signal "a very fundamental change in medicine." Continuing professional development will focus on attitudes, interpersonal relationships, and managerial skills. Doctors will be regularly asked to demonstrate their competence, so that they are fit to practise throughout their lives. "Clarity about our professional values and standards," said Sir Donald, "offers the public by far the best chance of safepractice."

Another key safety valve is the obligation to report dangerous colleagues. In a landmark determination in March 1994, Dr Sean Dunn was found guilty of misconduct because he wrote a reference for a colleague whose practice he knew was dangerous.[6] The council has made its position clear: whistleblowing is a core duty of doctors.

This cultural change has been strengthened legally by the Public Interest Disclosure Act 1998, which came into effect last July. The act has been described by United States legal campaigners as "the most far-reaching whistleblower law in the world."[7] It provides individuals in the workplace with full protection from victimisation when they raise genuine concerns about malpractice. Disclosures to the employer, to regulatory bodies such as theHealth and Safety Executive, and even to the media are protected.

The independent charity Public Concern at Work, which offers free legal advice to concerned employees, believes that the act offers all doctors the opportunity to blow the whistle without endangering their careers.8 Crucially, when a whistleblower is victimised or dismissed in breach of the act he or she canbring a claim to an employment tribunal for financial compensation. All awards will be uncapped and based on the losses suffered, including future loss of earnings. Though the act does not require organisations to set up whistleblowing procedures, its existence will encourage them to do so. NHS gagging clauses should become obsolete.

If whistleblowing is now encouraged and protected, should we as doctors have no hesitation in speaking out? The key to this is whether we are acting in good faith. Acts motivated by personal gain or vendetta are unlikely to succeed. Guy Dehn, director of Public Concern at Work, suggested that we should apply the "family test" before deciding whether to proceed. If we would not subject a family member to a particular colleague or service, then we have a duty to act. We should firstly raise the matter internally if possible. If this is unsuccessful in resolving concerns we should then discuss it with a senior colleague or an appropriate regulatory organisation. We do not need to invest enormous timeand energy in gathering a mass of data to support our concerns. The whistleblower's role is to raise the matter, not resolve it.


Will whistleblowing still be necessary in a modernised NHS with its focus on quality and accountability? All the stakeholders---public, professionals, and regulators---hope not. Stephen Bolsin, the anaesthetist who raised concerns about paediatric heart surgery at Bristol Royal Infirmary, said that all doctors should receive regular, anonymous feedback on their individual performance so that they can "blow the whistle on themselves" before serious errors occur.9 Professor Liam Donaldson, chief medical officer for England, gave his vision of a high quality NHS with built in mechanisms for the early recognition and open handling of problems. We should "applaud heroes, and hope they are among us, but to base our hope of remedy in ordinary systems on the existence of extraordinary courage is insufficient."[10 ]


Gavin Yamey, editorial registrar.

BMJ


1. Vinten G. Whistle while you work in the health-related professions? J Roy Soc Health 1994; 114: 256-262.
2. Soeken K, Soeken D. A survey of whistleblowers: their stressors and coping strategies. Laurel, Maryland: Association of Mental Health Specialities, 1987.
3. Lennane KJ. "Whistleblowing": a health issue. BMJ 1993; 307: 667-670.
4. Dyer O. GP struckoff for fraud in drug trials. BMJ 1996; 312: 798[Free Full Text].
5. Craft N. Secrecy in the NHS. BMJ 1994; 309: 1640-1643[Free Full Text].
6. Dyer C. Consultant found guilty of failing to act on colleague. BMJ 1994; 308: 809[Free Full Text].
7. Dyer C. UK introduces far reaching law to protect whistleblowers. BMJ1999; 319: 7[Free Full Text].
8. Public Concern at Work. Public Interest Disclosure Act 1998. An introduction to the legislation with authoritative notes on its provisions, section by section. London: Sweet and Maxwell, 1998(www.pcaw.demon.co.uk)
9. Yamey G. Whistleblower in Bristol case describes his vision of professional monitoring. www.bmj.com/cgi/content/full/319/7225/1592/g
10. Berwick DM. You cannot expect people to be heroes. BMJ 1998; 316: 1738.



----- Original Message -----

From: Jarman, Brian

To: Rita Pal

Sent: Saturday, March 13, 2010 1:34 PM

Subject: Robert Francis' Mid Staffs Inquiry report regarding the role of the Royal Colleges and PMETB



Rita,



Have you heard any response to some of the comments in Robert Francis’ Mid Staffs Inquiry report regarding the role of the Royal Colleges and PMETB, e.g. in the section on External Organisations.:-

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113068.pdf



72. I received a set of comments about the lack of any system requiring regular monitoring or approval visits by the various clinical Royal Colleges or the general medical and nursing councils.

73. In a letter to the Inquiry the Royal College of Obstetricians and Gynaecologists said that it had had no involvement in the Trust since its visit in 2002. Responsibility for visiting and approving hospitals for training passed in 2006 to the Postgraduate Medical Education Training Board.

74. In another letter, the Royal College of Physicians referred to representations it had made to the Health Select Committee about the loss of regular visits to trusts in the early 2000s. These were linked to medical training but “were a valuable source of intelligence about clinical issues locally”. The letter also said that “[the] Royal Colleges’ professional networks are invaluable” in cases falling between those resolved locally and those that are reported to regulators.

75. Royal Colleges do continue to operate an invited review system. The Royal College of Surgeons conducted reviews at the Trust in 2007 and 2009.



These remind me of the comments in the Bristol Inquiry report.



Do you think there should there be a structured system whereby doctors who are concerned with the care being provided in their hospital [and the Inquiry covered hospital care] have a safe place where they could report their concerns to their professional representative organisation, if they haven’t been able to resolve them locally, in the knowledge that their reports could, if they wish, be confidential (but no doubt ‘discoverable’ in law)? The current organisations would not have the resources necessary to investigate properly the reporting doctors’ concerns, but they would be able to collate them and formally report them, to the CQC. The ideal may be a medical organisation, independent of government and the Department of Health, with the capacity to carry out on-site inspections in response to concerns regarding quality of care reported by doctors. We have seen that the system of monitoring the quality of hospital care in England was considered to be deficient by the three independent US organisations that reported to Ara Darzi in 2008 (e.g. the Joint Commission “Quality today does not drive or even influence commissioning decisions”), that they depend very largely on self-reporting rather than on-site inspections. Apparently “A Department of Health spokesman maintained that the three reports were never intended for “wider circulation” and said they were extensively discussed by experts advising Darzi on the production of his report.” (http://www.timesonline.co.uk/tol/news/uk/health/article7052606.ece) but the CQC has stated that it will continue to rely on self-reporting (see extracts below).



Extracts from CQC reports:-

The future regulation of health and adult social care in England: response to consultation

http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_063286



3.24 The Care Quality Commission will develop and consult on compliance criteria for assessment of compliance with registration requirements, which will be linked to the secondary legislation. It will take an intelligent, risk-based approach to this by wherever possible using existing data sources, self-assessment methods and feedback from service users so that on-site inspections are only used where visits are necessary to ensure compliance.



Care Quality Commission registration 2010-11 (Essential standards of quality and safety)

http://www.hmr.nhs.uk/userfiles/documents/Board%20Papers/2010/JAN/PAPER%20Q%20CQC%20registration%202010.11.pdf



2. The registration system

From 1st April 2010, PCT, Acute, Mental Health and Ambulance service providers are required to register with the CQC. The registration process will be based upon self assessment and will ensure that providers are compliant with the following regulations:

• Health & Social Care Act 2008 (Regulated activities) Regulations 2009

• Care Quality Commission (Registration) Regulations 2009.



Brian.

**********************************

Professor Brian Jarman

Imperial College Dr Foster Unit

Support Raj Mattu. Sign the Petition

The Petition is available here.

Bangladesh v England. Go Bengal Tigers

England invented the game of cricket so the rest of the world could beat them. I developed the habit of watching cricket as a teenager due to the influence of my guy friends in Bury. Everyone including the goldfish had the surname Khan. When I became a doctor, I watched cricket with the boys while waiting for my bleep to go off while munching on Bengali takeaway with all my mates also called Khan.

I am of course half Bangladeshi therefore I have been glued to the TV watching Bangladesh v England this weekend. The BBC stated "After the Bangladesh tail frustrated the bowlers to rack up their third highest Test total of 419, England's hopes of a 2-0 series victory hang in the balance". Further coverage is in the Telegraph.

Sure I support Bangladesh...... so Go Bengal Tigers, eat those rasgullas and take Bangladesh to victory. It is time to make history.

NHSBLOGDOC. Dr John Crippen

Crippen Retires

Of course, few people remember it but I was the first person to set up a blog/website related to radical medicine in the year 2001. Crippen came after me and we both ended up in the Times listings. Here they are

CYNICS’ WEBSITES: TOP FOUR

Quackwatch Witness the systematic destruction of some of the outrageous claims that are made by some alternative practitioners.

NHS Exposed Investigative website allegedly exposing dozens of abuses to staff and patients, and the cover-up campaigns to suppress the truth.

NHS Blog Doctor A doctor tells it how it really, really is.

The Skeptic’s Dictionary The alternative health section is informative, but very unconvincing.

At the time we beat Crippen to the post by coming in second.

Now Crippen has decided to retire and leave the blogsphere. He has decided to remove the flash template designed for him by the Devil. I am not really sure why Crippen had to take down his historical website but there we go. At least the GMC won't be creeping around downloading it. Crippen is to be credited as being one of the most influential grassroots bloggers this side of the century. He is also to be credited with exposing the injustices regarding the MMC.

Anyone looking on the internet will spot Crippen in the internet archives here. Crippen leaves two recommendations, one of Jobbing Doctor and one of Dr Grumble. I on the other hand am of the view that Badmed.net is the one who will ultimately take over from Dr Crippen. Despite being the new kid on the blog his writing is of a high standard, his wit matches that of Dr Crippen from the early days and his style and intelligence is probably more in tune to the current medico-political climate. The next one on my recommendation list is the most intelligent of all bloggers - The Witchdoctor. I believe that Badmedicine and Witchdoctor are instrumental in engaging the public in investigating medicine today.

All that is left is to wish Dr John Crippen the best of luck for the future. I should also thank him for supporting Ward 87 and recommend that he leave his blog as an archive at the British Library's Internet Project. All history is important.

Foreign Doctor's English.

Following the GMC's Lead

Ferret's tone on foreign doctors makes us all wonder what planet he is on these days. No doubt, he has progressed up the greasy pole of the medical hierarchy and is treating several illiterate English hospital attenders and even more foreign speakers of the English Language. His latest spate of complimentary messages regarding the General Medical Council shows us that he is indeed progressing quite well to sidle with the dark side. Ferret refers to several high profile deaths where foreigners have been involved. In reality there have been two high profile deaths by foreign doctors and several even higher profile deaths by English speaking doctors. In addition, there is no current study that links foreign doctors English ability to patient safety. Ferret has hand cramp each time Jane Barton is mentioned. A high profile case with hundreds of deaths that Ferret remains silent on. Perhaps it messes up his usual world view that foreign doctors = patient deaths.

If Ferret had done his homework, he would have found out about the following in a 1981 piece. The GMC has therefore been aware of this issue from 1981-2009.

"The Overseas Doctors Association is upset that non-English speaking EEC doctors should not have to pass an English exam to register. It is also upset that-even if they have full registration in Britain-overseas qualified doctors will not be allowed automatically to practise in EEC countries. Both of these objections are more symbolic than practical. Although EEC doctors will be able to register without taking a formal English test, those few who want to practise in Britain (449 have registered since 1977) will probably not be able to get a job in the NHS (nor in the English-speaking private sector, presumably) unless they have a good command of colloquial
English"

That is part of the problem with Ferret, he has this broad brush stroke approach to his blogging. As time has proceeded on, I have noticed that Ferret's ability to dissect issues properly is failing. Long gone are the days when he criticized the media for their stance, outlined their poor knowledge in medicine and their prejudiced view of doctors. Ferret is now victim of the media he once criticized. He is following the GMC's and the media's lead like a large fat puppy, wagging its tail and agreeing to the status quo without observing the agenda there. I believe Ferret is currently the first victim of the success on Doctors.net.uk - to suppress a doctors ability to think laterally or inquisitively. Ferret indeed is no longer the blogger he used to be. His demise is indeed a sad loss to the usually vibrant blogsphere. For Ferret's sake, it is important to make him understand that the GMC are currently fighting for their reputation and are capitalizing on the David Gray story. Niall Dickson is former journalist. Journalists never change their spots. It is now politically advantageous to the GMC to jump on the foreign doctors bashing bandwagon. The fact is changes could have been made in 1981. The GMC failed to do so. Even if they had done, it would not have prevented the death of David Gray.

This is what he says on his recent blog

"Essentially European law means that the GMC cannot test EU doctors competence or ability to speak English, despite the fact that many have a rather limited command of English and that some of their medical degrees are not the most rigorous of "qualificiations"

Firstly, it would be nice if Ferret could spell "qualifications". When criticizing others with that kind of tone, it is always worth using blogger's spell checker before ex foreigners like me point it out with my grubby finger.

Secondly, his sentence is not based on any kind of research or evidence in science. Ferret just thinks" many have a rather limited command of English". In reality, we have no idea what the standard of English is like in foreign doctors.

Shame Ferret cannot spell. I mean it is really rather embarrassing when you go through his entire blog spotting the typos. Then perhaps he wants to use the "in haste" defense developed by the Guardian. Of course, Ferret won't like my tone but then I don't like his so we are equal.

Niall Dickson "Our starting position is that we have nothing to hide and want to be as open and transparent as possible"

"Transparency was like a greenhouse - you could look in but not enter the room"
Finlay Scott GMC Ex CEO

Niall Dickson wrote a missive today trying his best to sidle up to the Gosport Campaigners. It is rather amusing to watch the entire issue unfold. A Gosport Campaigner today told the GMC

"Do any of you know what you are doing"?

Now that is a good question because I have spent quite a number of years asking that question.

Bad Medicine is of the view that the GMC could not investigate a cornflake packet. That is of course true. I find Niall's stance fascinating because of their recent efforts to conceal the links between a GMC panelist and Scientology. The GMC's efforts to conceal documents related to Scientology was embarrassingly overturned by the Information Commissioner Tribunal. In short, the GMC lost. It is laughable that a body with a bottomless pit of subscription money was unable to win against a litigant in person.

To remind Niall of his team's efforts at concealing issues, we don't have to go far. We simply have to observe the GMC's antics when I requested the entire 2001 Report relating to Ward 87. I am entitled to the report because I was the whistleblower. Anyhow, according to the GMC, I am not allowed a full copy.

This game is called pass the parcel. The GMC were sent the unredacted copy. The GMC's actions here are interesting. This is Toni Smerdon's brainchild of course. Smerdon is one of the GMC's half witted lawyers. She assumes she is clever but we all know better.

Anyhow, Niall continues to make a spectacular fool of himself. That is nothing new because it is very very difficult to defend the actions of a body who last year allowed a doctor to slip the net of the conduct proceedings. They had not noticed that he was administratively erased. Niall is currently suffering from foot in mouth syndrome. He may seek solace in the Oxford Leadership Prize where he sits as judge.

"The impetus for it came from leaders attending the Oxford Strategic Leadership Programme, who were interested to know what new ideas were emerging amongst a cadre of younger future leaders"."For anyone wanting to put their energy and leadership experience to work in society, this programme offers both inspiration and practical first steps. Delivered in partnership with Common Purpose, the programme provides an opportunity to rethink individual values and explore the risks and challenges of non-executive roles through the insight of our experienced advisors and in the company of a supportive peer group".

Anyhow, back to the GMC's antics in the case of Ward 87. This game was fun. I played it for a while then got bored. They currently have the parcel and I have become the mocking bird.

Date	From	To	Comment
24/04/2005	Dr Pal	Steven Hardy	Email requesting the GMC's reasons for withholding Professor Griffiths' final submissions before passing them to the Case Examiners
09/06/2005	Jackie Smith	Dr Pal	Email confirming that the GMC is requesting a copy of the Creamer Report from the Trust
24/07/2005	Dr Pal	Jackie Smith	Email requesting a delay in her submissions until Dr Pal has access to the Creamer Report as she wishes to rely upon it and both the Trust and the DoH have refused her access
09/09/2005	Dr Pal	Jackie Smith	Email acknowledging the GMC's intention to obtain a copy of the Creamer Report from the Trust and speculating that the Trust would resist the request
17/10/2005	Dr Pat Chipping	Jackie Smith	Letter enclosing unredacted report from the Trust, confirming that a redacted version has been sent to Dr Pal, and stressing that the unredacted copy is for the sole use of the GMC and is not to be released to Dr Pal.
07/11/2005	Toni Smerdon	Dr Pat Chipping	Letter acknowledging reciept of unredacted report with letter dated 17th Oct 2005 and requesting a copy of the redacted version supplied to Dr Pal. ALREADY DETERMINED that GMC would use redacted version
09/11/2005	Jackie Smith	Dr Pal	Email confirming that the GMC now has an unredacted copy of the Creamer Report, and that it was obtained from the Trust on the understanding that it would not be disclosed to Dr Pal
11/11/2005	Ro Vaughn	Toni Smerdon	Letter from Trust Human Resources enclosing redacted version of the Creamer Report as supplied to Dr Pal
28/11/2005	Toni Smerdon	Dr Pal	Letter confirming that the GMC has copies of both redacted and unredacted copies of the Creamer Report
20/12/2005	Dr Pal	Toni Smerdon	Email querying the GMC's legal grounds for withholding the unredacted copy of the Creamer Report (letter 28 Nov 2005), confirming that she has made an FOI request for the document from the GMC
10/01/2006	Toni Smerdon	Dr Pal	Letter confirming that the GMC had agreed not to disclose the unredacted Creamer Report to Dr Pal, not a GMC document, will not correspond further on this matter
20/01/2006	Dr Pal	Jackie Smith	Email requesting update on the Griffiths matter, enclosing several documents as adenda to complaint and stating Dr Pal is still awaiting an unredacted copy of the Creamer Report from the Trust. Needed as Professor Griffiths has had access to it, which is unfair.
31/01/2006	Dr Pal	Jackie Smith and Toni Smerdon	Email requesting date at which the Trust and the GMC agreed not to disclose the unredacted report to Dr Pal
06/02/2006	Toni Smerdon	Dr Pal	Email and letter asserting that the Trust and GMC did not come an agreement not to disclose the unredacted Creamer Report to Dr Pal (contradicts other letters), or "brokered a deal" in any way. Confirms redacted report was sent to Prof Griffiths 22 Dec 2005. Denies GMC have attempted to conceal any documents from Dr Pal
08/02/2006	Helen Hardy	Dr Pat Chipping	Letter confirming that the GMC did not intend to use the unredacted report, and were returning it with the letter
13/02/2006	Dr Pat Chipping	Toni Smerdon	Letter confirming receipt of the unredacted version of the Creamer Report, returned to the Trust by Ms Smerdon by letter 8th Feb. Trust have filed the report
14/02/2006	Prity Vaja	Dr Pal	Letter claiming Griffiths did not see the Creamer Report until 2005, noting Dr Pal has a redacted copy of the report from the Trust, claiming both she and Dr Pal are using a redacted copy provided by the GMC
17/02/2006	Prity Vaja	Helen Hardy	Letter claiming Griffiths did not see the Creamer until it was "disclosed to us by the Trust at the end of last year (2005)"
27/02/2006	Dr Pal	Jackie Smith	Email requesting a copy of the Creamer Report identical to that provided to the Dept of Health (for Professor Griffiths)
28/02/2006	Helen Hardy	Dr Pal	Letter confirming the GMC does not have the correspondence referred to in Appendix 4 of the Creamer Report
28/02/2006	Prity Vaja	Dr Pal	Letter confirming that the GMC have returned the unredacted version of the Creamer Report to the Trust, and, because they have done so, she has done the same. Ergo, she has had sight of the unredacted copy of the Creamer Report
01/03/2006	Toni Smerdon	Dr Pal	Letter confirming that the GMC does not know what version of the Creamer Report is available to Prof Griffiths, and that the unredacted version has been sent back to the Trust.
10/03/2006	Dr Pal	Toni Smerdon	Email requesting confirmation that the unredacted Creamer Report has been returned to the Trust, and whether a copy has been retained as previously requested
13/03/2006	Dr Pal	Toni Smerdon	Email querying the dates on which the GMC received redacted and unredacted copies of the Creamer report and what happened to them
13/03/2006	Prity Vaja	Dr Pal	Email confirming that Ms Vaja received a copy of the unredacted Creamer Report from the GMC, NOT from the Trust or the Department of Health, and that the decision to return the report to the Trust was hers and not at the GMC's request
16/03/2006	Dr Pal	Jackie Smith	Email requesting JS confirm the accuracy of attached document (copy of letter from Helen Hardy / Toni Smerdon to Dr Pal
16/03/2006	Helen Hardy	Dr Pal	Letter and Email confirming that the unredacted copy of the Creamer Report was obtained from the Trust 26 Oct 2005 and returned it to them 8 Feb 2006 without keeping a copy.
30/04/2007	Juliet Oliver	Dr Pal	Letter confirming that the Trust and DoH together refused permission for Dr Pal to have access to the unredacted Creamer Report, claiming Data Protection and Professional Legal Privilege, and stating that the unredacted copy of the report was returned to "the Department" (DoH?) as it was their only unredacted copy. Contradicts previous statements that it was returned to the Trust.