SPEAK OUT SAFELY WEEK
David Drew: ‘Every professional needs to fight for a better NHS culture’
I have just received some bad news. Three years after being dismissed by my NHS trust for “gross misconduct and insubordination”, my appeal against dismissal at the tribunal has failed.
I’ve put a lot of time and effort into getting justice. I’ve lost a huge amount of income and spent a small fortune in legal fees. Stress has been my daily diet.
Yet I do not have a single regret. The same goes for my wife and family who have born the emotional brunt of these difficult years.
In the week I received my news, the Commons health select committee, in its response to the Francis report, advised:
“Disciplinary procedures, professional standards hearings and employment tribunals are not appropriate forums for constructive airings of honestly held concerns about patient safety and care quality.”
From 2008 to 2010, as the senior paediatrician in my trust, having been clinical director for seven years, I raised honestly held, serious concerns about patient safety and care quality. I was dismissed by a disciplinary procedure. I turned to lawyers and the employment tribunal as my only way of getting redress. The General Medical Council was not involved. My employer described me as an excellent doctor.
It’s a relief to hear that, although I have been forced down the wrong road by my trust, there is hope others may avoid this in future.
The committee also reaffirmed its previously expressed view that:
“The effective exercise of professional responsibility is the bedrock on which high standards of patient care are built. It also continues to believe that there is an essential public interest in ensuring that professionals are protected against punitive action when they raise concerns about professional standards at their place of work.”
The explanation for this punishment-based culture is found in Robert Francis QC’s report, in which he delivers a typically polite but damning criticism of some NHS management:
“A greater priority is instinctively given by managers to issues surrounding the behaviour of the complainant, rather than the implications for patient safety raised by his complaint.”
In my case this was true of the trust chief executive, chair, medical director and clinical director responsible for my dismissal. Framing my own story as an employment dispute rather than a senior, experienced doctor advocating for his patients was the work of the trust solicitor, whose professional responsibility is to the trust, not to patients. As at Mid Staffs, this poses a threat to patient safety.
The mistreatment of whistleblowers is an abuse of power and results from a clash of cultures. Management has a business to run. Whistleblowers rock the boat and are seen as troublemakers. On the other side of the divide, the whistleblowers represent a minority of professionals prepared to stand up when they see patient harm and refuse to be bullied into silence. David Morgan – a psychoanalyst with experience in caring for NHS whistleblowers – explained this behaviour in a recent talk. “The whistleblower is more likely to be concerned about moral security than personal security,” he said.
My chief executive offered me a choice; accept a six-figure severance payment and sign a gag or we will dismiss you by disciplinary procedure. At least three other professionals involved in my case were gagged. Everything about this is contrary to the transparency that current wisdom demands for safe patient care. I refused the offer, knowing this would trigger disciplinary action against me. “All I need for a happy retirement is a clear conscience,” I wrote to my CEO.
It’s over for me now. I will not work as a paediatrician again. After three years’ absence from work, I am deskilled. I firmly believe that the Francis report and Don Berwick’s response to it offer a kinder culture and a better future in which professionals will be able to Speak Out Safely for patients.
But this will not be achieved without a fight. Every professional has a responsibility to engage. I intend to be there cheering you all on.
David Drew is a retired consultant paediatrician