Sunday's report in
The Independent online.
Exclusive: NHS targets and secrecy are hurting patients, doctor warns
Consultant warned that patients
were being lied to by hospital officials. But health managers responded with
false accusations about his competence. Clearing his name cost him dear
A leading surgeon at the centre
of a NHS whistleblowing scandal has warned that hundreds of doctors and nurses
face persecution if they speak out about NHS cuts that jeopardise patient
safety.
Ramon Niekrash, in his first
interview since winning a landmark case to salvage his reputation, said health
professionals needed to think "
very hard" before standing up against
poor patient care, because it is "
potential professional suicide".
"
Your employer won't thank you; the law won't protect you. You're on your
own," he says.
His story, which saw him
suspended and his reputation in tatters after repeatedly raising concerns about
the treatment and safety of patients following cuts at a London hospital, has
raised disturbing questions about the legal protection of whistleblowers, 10
years after legislation was brought in by the Labour government.
As political parties canvas in
the closest fought election in almost two decades, the NHS is the second most
important issue for voters in the latest polls. This case is one of the most
vivid and disturbing instances of what critics claim is a target-obsessed and
secretive system. Following soon after last
year's scandal at Mid Staffordshire Hospital, where hundreds of patients died
because of poor care in a results-driven management culture Mr Niekrash's case
raises questions which to which politicians of all parties will need to find
answers.
The Conservatives say they
will, for the first time, give NHS staff the contractual right to report
failings anonymously to the health regulator, which would protect them from
bullying and disciplinary action and put the onus on the regulator to
investigate. The Lib Dem health spokesman
yesterday pledged to revisit the existing legislation and "
give it more
teeth", as well as making more accountable managers who wasted public
money bullying and harassing whistleblowers. Until that happens, says Mr
Niekrash, money and targets will come always first, and clinicians with a
conscience should not feel protected. "
Management can investigate you;
they can suspend you; they can do pretty much anything they want to you. But as
an individual, all you can do is write to people, to your seniors, to the
managers, the regulators, telling them what your concerns are. And that's all I
did. It cost me £180,000, my reputation, and two years of my life."
Mr Niekrash, 50, is a surgeon
at Queen Elizabeth Hospital in Woolwich, south London. He is a urologist, an
expert in diseases of the bladder, kidney and prostrate. His story is
extraordinary but not unique. He joined the urology department at the newly built
QEH in 2000, a year after he moved here from his native Australia.
In 2005, the
trust was in dire financial straits. It had a deficit of more than £20m and a
cash shortfall of nearly £50m, mainly as a result of the high fixed costs from
the private finance initiative scheme used to build the hospital.Mr Niekrash started raising
concerns about patient care that same year. The urology ward was closed to save
£1m, so patients were spread across the whole hospital. With too few specialist
nurses and doctors spending so much time going from ward to ward,
post-operative complications were sometimes being missed. Outpatient clinics
were bursting at the seams. New patients were prioritised which meant existing
cancer patients sometimes had appointments cancelled several times, according
to Dr Niekrash, something the trust has always denied.
Mr Niekrash gives an example:
"
A patient came to see me with blood in his urine. He'd had an ultrasound
scan in our hospital six months earlier, which showed a tumour, but his
follow-up appointment had been cancelled. I wrote to management to express my
concern. They denied the appointment had been cancelled. By the time the
patient was scheduled in for surgery eight weeks later, his cancer had advanced
and his life expectancy reduced. So I wrote again about unacceptable delays.
Nothing happened." A fellow surgeon, Roy Isworth,
recalls: "
Patients would come in and ask me how I was feeling, or how my
holiday had been, because that's what they'd been told when their appointment was
postponed." After seeing one patient who
had his appointment cancelled seven times, and failing to get an adequate
response from the hospital managers, Mr Niekrash sent letters which detailed
cancelled appointments for about 20 cancer patients to the Strategic Health
Authority. "
I got no response, nothing." he said. "
I could just
come to work, keep my head down, but it's my job and it's my responsibility. If
I don't report it and someone dies and there is an inquiry, then I'm nailed."
He eventually got a response
but it wasn't what he had expected. He was suspended on 9 April 2008 for
"excessive" letter writing and because two senior managers from the
surgical department had complained, in writing, on the same day, about his
conduct, attitude and, most worryingly, his clinical competence. Dr David Robson, medical
director and future chief executive, and Sally Storey, head of human resources,
claimed they were forced to suspend him to protect the interest of patients and
staff. They also claimed that the National Clinical Assessment Service – an NHS
organisation set up to help to resolve performance concerns – approved the
suspension during a phone call on 26 March 2008.
The decision to exclude him
was made, at the very latest, on that day. So a senior doctor with an
unblemished record was suspended on full pay for 10 weeks while an
"
independent investigator" was brought in. A locum surgeon was hired –
all at the taxpayer's expense.Several local GPs wrote letters
to management to express their shock, but private correspondence shows Tory
councillor and trust chairman Colin Campbell suggested these should be
"
ignored and filed".
He was reinstated only after senior doctors
threatened a vote of no confidence in the trust. On his return, Mr Niekrash sought
an apology from management and recoup the money he'd lost from his private
practice. The trust refused to budge.In an attempt to rescue his
reputation, he took his case to an employment tribunal. "
There was a
conspiracy to get rid of me. It was rotten as could be, right to the top. It
was so wrong that I had to vindicate myself and take the huge costs on the
chin. Obviously lots of people, people with kids, porters, nurses, couldn't do
that." He won.
The accusatory letters,
from Anneliese Weichart and Dr Sharon Power, were dismissed as defamatory by
the judge. Mr Niekrash asked the General Medical Council to investigate Dr
Powers and Dr Robson for failing to act within the medical code of conduct. No
case to answer, said the GMC, but it has since been asked to reconsider. A court will decide how much
compensation the NHS must pay him next month. It may not cover his legal bill
which his trade union, the British Medical Association, would not fund.
The
final bill for the hospital – now part of the much bigger South London NHS
Trust – could reach £500,000 of taxpayers' money. None of the managers involved
has faced financial or professional hardship as a result. The trust refused to
comment on what action had been taken since the tribunal.This story may become a
familiar one as the NHS tries to find £20bn in "
efficiency savings".
Cuts do not necessarily lead to bad care. But fewer nurses, doctors, clinics
and wards will mean some patients will not get the best treatment as quickly as
they should. There is a fear, among some, that those known for raising
concerns, the "
troublemakers", will be the first to face redundancy.
The Public Disclosure Act 2000 is meant to protect whistleblowers from
bullying, suspension, dismissal and financial losses as long as concerns are
raised in the proper manner. But there is widespread agreement that, however
well intentioned, the legislation is failing people like Mr Niekrash. The
Department of Health doesn't agree. Mr Niekrash said, "
If you
think what happened in the Mid Staffordshire Trust is unique, you've got to be
joking; it just got caught. There are lots of trusts out there with dirty
laundry but people are too afraid to speak out." Andrew Lansley, shadow Health
spokesman, said yesterday, "
I am determined to fight this closed culture
in the NHS. It should never again be possible for managers to put a box marked
'target met' while patients are pushed off to a ward and left to die." The experience has made Mr
Niekrash more cynical, less confident, and practically, he fears, unemployable.
"
Who wants a whistleblower, a troublemaker? Do I have faith in the NHS?
No. Do I believe this will happen to other individuals? Yes. Do I believe there
is any accountability for managers? No. It's too late for me, but whoever is in
government must change the law so whistleblowers are protected."
The fate of the
whistleblower
Margaret Haywood was struck off
the nursing register last year after being found guilty of misconduct for
secretly filming the neglect of elderly patients where she worked in Royal
Sussex Hospital for a television documentary. The decision was overturned by a
High Court judge.
Professor Stephen Bolsin was
the anaesthetist who helped to lift the lid on the appalling death rate at
Bristol Royal Infirmary in the 1990s. Ostracised by many of his colleagues for
speaking out, he persisted for eight years in order to bring the Bristol babies
scandal to light. He left to work in Australia, unable to get work in the UK.
Paediatrician Dr Kim Holt
repeatedly told managers that children's services were unsafe at St Ann's
Hospital in Haringey, northeast London, more than year before the death of Baby
Peter in 2007. Her employer, Great Ormond Street Hospital, offered her £120,000
to stay silent but she refused. She has been off work, on full pay, for more
than two years and is still waiting to be reinstated.
Timeline
2000 Joins Queen Elizabeth Hospital as consultant urologist
2005 Mr Niekrash starts raising concerns about ward closure
and long delays for cancer outpatients
2007 Mr Niekrash instigates a complaint of harassment
against two managers
2008 Suspended as "independent investigation" is
carried out; reinstated after 10 weeks
2010 Employment tribunal rules the suspension was unjust
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