Monday, 8 August 2011

NHS - who should be the whistle blowers?

The recent scandals surrounding abuses by staff in care homes has sent the subject of whistle-blowing in healthcare up the agenda again. The shocking images in the BBC left no doubt that vulnerable patients were being treated terribly. This sparked the obvious debate – surely someone must have known this was going on and why didn’t they speak up?

Whistle blowing in any organisation is fraught with major pitfalls. The whistle blower can face bullying, loss of employment and huge emotional turmoil. There is a danger that innocent colleagues can be accused of bad behaviour by a jealous or spiteful associate and often the ‘crime’ for which they are being accused is difficult to prove. Although anonymity can afford the accuser some protection, this can mean less opportunity for the accused to clear their name.

Andrew Lansley, UK Secretary of State for Health launched a new whistle blowing guide last year saying ‘the publication of this guide is an important step to developing a culture of patient safety. NHS staff need to be free to raise patient concerns and shielded from any backlash…’ The department of health have spent around half a million pounds on this initiative over the past three years, working with the Charity, Public Concern at Work, and I have no doubt that some important inroads are being made into encouraging staff to report bad clinical practice or inappropriate treatment of patients.

But what about staff who are probably clinically sound but demonstrate actions that are mildly incompetent, rude or just plain mean? This is where patients and their carers must take the lead.

A friend (I’ll call her Jane) witnessed an unacceptable level of care this weekend. Jane’s elderly mother had a fall on Friday evening. Suffering from an ongoing back problem, the fall caused her severe back pain and she had also banged her head. The accident was complicated by the fact that this lady she had been drinking heavily, sadly a daily occurrence.  Jane called an ambulance, which attended the scene quickly.

The paramedics were kind and understanding and recommended that the lady should be taken to hospital. Jane followed a few minutes later in her car. When she arrived in the emergency department of the local hospital, Jane found her mother sitting in a wheelchair quietly waiting to see the doctor following triage by the nurse on arrival. So far so good.

Some time later a doctor came through the doors to the emergency department waiting room and ‘spat out a name’. (Jane’s words) Jane wasn’t sure if it was her mother’s name so waited until the name was shouted out again. Yes it was. She lifted her hand and said ‘over here’. The doctor said nothing, stayed where he was and held the door open, waiting for the patient to enter the clinical area. ‘She can’t walk’ said Jane. ‘Bring the chair’ was the reply. Jane replied that she didn’t know how to take the brake off and she was also concerned that as her mother kept slumping forward she may slip and injure herself. With a loud sigh and rolling of eyes, the doctor grudgingly came into the waiting room and wheeled the patient into the assessment area. Jane quietly told the doctor that her mother had been drinking and that she had an ongoing back problem. Twice the doctor replied but his command of the English language was so poor that Jane had to ask him to repeat every sentence. ‘She’s drunk’ he said loudly. ‘Yes’ said Jane ‘I have advised you that she has been drinking heavily, but her back is causing her considerable pain’

Get up on the couch’ – he snapped. Jane had to advise the doctor that her mother had difficulty standing and had to ask the doctor to help her mother get into the couch. At that point– and these are Jane’s precise words ‘the doctor poked my mother’s back with one finger. Mum yelped in pain. He didn’t say a word. Then one more time, yet again with just one finger he poked her again – to produce another yelp’

End of consultation. Diagnosis – back in spasm.  Sent home with a prescription for a painkiller that the paramedics had advised Jane that her mother could not take while she was under the influence. Yes, her mother was drunk, but she was also a vulnerable, confused old lady in considerable pain. She wasn’t being a nuisance, just sitting in her wheelchair, whimpering quietly.

Forgive the length of this fairly uninteresting story. But that’s the point. Jane’s mother received the right treatment. Fast access to an ambulance, Speedy admission to an emergency department. Acceptable wait for assessment by a doctor. But the doctor was rude, unintelligible and mean. Not a case for whistle blowing by a colleague. But a case for complaint by the patient’s carer.

As discussion surrounding NHS reform, restructure and cost cutting occupy everyone’s thoughts there is a danger that we are losing sight of the core values that makes this organisation so special. One of the issues the NHS faces today among staff is bad attitude, bad manners and poor service which are becoming acceptable and unchecked. The majority of staff are caring, efficient and kind but as stress levels rise and anxiety about the future build, there appears to be are a growing number of cases of bad behaviour going unchecked.  I am not advocating a patient revolt. But please, if you experience unkind treatment, rudeness or mean behaviour by a member of staff, complain in writing to the hospital chief executive, senior partner or head of whichever establishment you are attending. The bad eggs are giving the good eggs a bad name. if you see what I mean.

If I had been Jane, very early on in the event, I would have asked the doctor’s name. If he refused to give it, I would find it out anyway. I would then note down in detail, every word and action that caused me concern and then write a measured, unemotional letter of complaint.

Patients must and should expect better.


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