Amid the horror over babies’ deaths at the Countess of Chester Hospital, Marilyn Eveleigh questions the effectiveness of whistleblowing in the face of NHS managers who seem to prioritise budgets and reputation
Like most nurses, I felt horror and concern as I followed the judicial revelations and extensive media commentary on the case of Lucy Letby. It has really affected me because she was one of us. Nurses have rightly been quick to point out that she is an exception, but she has momentarily tarnished the reputation of a highly trusted profession.
It is an historic case, up there with those of Beverley Allitt and Harold Shipman. Lady Thirlwall’s public inquiry will expose nursing and health services to deeper scrutiny. Like previous inquiries, it will identify failures and recommend wider changes to reduce the risk of recurrence, not just at the Countess of Chester Hospital.
Have past recommendations been effective? Successive inquiries have highlighted that an understaffed and poorly supported workforce lies behind many cases of harm and negligence. In the Letby case, medical and nursing shortages appear not to have been a significant factor, with the focus instead on hospital management.
Though Letby was an individual perpetrator, the media have rushed to allocate blame to NHS managers for not listening to concerned doctors.
Over the years, management and executive boards have increasingly come under the spotlight, accused of blocking safer clinical care. Organisational leaders are being called to account for decisions to ignore concerns, for example. In the latest case, managers could potentially face corporate manslaughter charges.
At Nottingham University Hospitals NHS Trust, despite earlier maternity negligence settlements, past cases are now being elevated to criminal status, with police investigating alleged management cover-up and silencing of whistleblowers.
After the 2013 Mid Staffs NHS inquiry report into the unnecessary deaths of hundreds of patients through poor care under a toxic organisational culture, Freedom to Speak Up Guardians were established at healthcare providers. They have regular direct dialogue with chief executives to report concerns and risks that could affect patient safety and organisational decision making.
Whistleblowing is now acceptable, and indeed expected, where concerns raised via the normal channels have not been followed up.
Yet NHS whistleblowing processes and scrutiny did not stop Letby’s actions, despite four consultant paediatricians reporting concerns over babies dying for more than a year. This has exposed a situation whereby regulated clinicians are set against management decision makers who appear to prioritise targets, budgets and reputation. Interestingly, a third of NHS managers are regulated clinicians.
So are effective whistleblowing mechanisms in place across the NHS? What happens in primary care? What if concerns do get ignored? In the Letby case, the hospital’s nursing director and possibly other nurse managers are now subject to NMC fitness-to-practise investigations. Watch this space.
The Thirlwall review is intended to restore the trust in healthcare services and staff that the public has a right to expect. Let’s hope it concludes speedily and helps give closure to the families and communities that have suffered pain and loss.
Marilyn Eveleigh is a nurse adviser and independent trainer in East Sussex