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'The more people stand together, the less likely concerns can be ignored'


I was on holiday last week and it was with an element of dread that I started to see the name Gosport War Memorial Hospital mentioned in the national media and then, on checking my emails, a wave of press releases coming through about it.

The inquiry panel that looked into over 800 deaths at the hospital between 1989 and 2000 concluded the organisation had a “culture of shortening the lives of a large number of patients”.

It highlighted that nurses were involved in the inappropriate prescribing and administration of opioids over many years, despite having a “responsibility to intervene and challenge the prevailing practice on the wards”.

“The panel also found that nursing staff were the first to raise the alarm”

However, at the same time, the panel also found that nursing staff were the first to raise the alarm – although unsuccessfully.

A staff nurse called Anita Tubbritt was one of the first to express her disquiet about the use of diamorphine and syringe drivers in 1991, raising it with the local branch of the Royal College of Nursing.

Ten nurses went on to attend a meeting where they raised various concerns including the fact that not all patients prescribed diamorphine were in pain, that no milder painkillers appeared to be considered and that “patients’ deaths are sometimes hastened unnecessarily”.

Yet records of this and subsequent meetings, conversations and correspondence show that the nurses’ concerns were by and large swept under the carpet by hospital management. The documents reviewed by the panel “tell a story of missed opportunity and unheeded warnings”, states the report.

The Gosport case has obvious echoes of past scandals such as Mid Staffs and Morecambe Bay, but also those before them. Once again, it raises the question of how this was allowed to happen – and it could have been ignored for so long.

Why were the concerns of some nurses and other clinicians ignored? Why did others feel they could not raise any concerns at all? And why was it left to a staff nurse to try to act on behalf of patients, while more senior nurses seemingly stood by?

These issues are precisely why Nursing Times launched the Speak Out Safely campaign in 2013, with a call to employers “to encourage any staff member who has a genuine patient safety concern to raise this at the earliest opportunity”.

“I really hope the NHS and healthcare more widely are in a different place now”

Nearly 100 NHS providers signed up to support a pledge backing this aim, as did many other NHS and independent healthcare organisations.

The only solace I can take from the Gosport report is that most of the events documented in it took place 20 years ago or more and I really hope the NHS and healthcare more widely are in a different place now.

My fear, however, is that they are not and that, a few years down the line, I will once again read a similar report with a similar feeling of sadness.

While the report highlights the “bravery” of individuals like Ms Tubbritt for coming forward with their concerns, strength often comes from togetherness. The more people stand together and support each other, the less likely it is that their concerns can be dismissed or ignored.


Readers' comments (4)

  • It all comes down to power structures, and who has the power. It is always in the hands of doctors. While it is true that the vast majority of doctors are highly caring and act in the best interests of patients, there must always be a small proportion who are otherwise (eg Shipton), as in any large population of unique individuals).
    So, as I mentioned above, it is power. Nurses have little, and so challenging medical staff is for us always somewhat embarrassing and difficult. How to fix it? Nurses need to be respected in reality, and not just by lip service of doctors, managers and the public at large. I note that the groups who have the most power and respect also command the highest salaries. So when nurses are paid on a par with other professions, we may then have more influence and be listened to. Personally, I don't think the situation will ever change.

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  • tinkerbell

    Until nurses start to get more assertive as a group nothing will change. Thinking that the RCN is going to do something for them is laughable, especially after what happened in the Mid Staff scandal. Time for nurses to unite alongside one another rather than just doing something individually colleagues should shout loudly as a united voice, not just one nurse raising any concerns alone but a group of nurses on the same ward, in the same workplace, about whatever it is they are concerned about.

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  • Nurses are as much to blame, they are all 'paper chasing' and afraid to speak out, no matter how wrong things may be. Doctors are over rated and assume they cannot be wrong, when things that are wrong are highlighted, they refuse to amend records.
    When you complain through the right channels, they support the doctors, at southend hospital they claim they cannot manage the volume of complaints they receive, so things that are wrong continue.

    At Southend hospital Philipino nurses talk to each other in their own language and address patients as 'sweet-pea' even though the patients name is on a board above their bed ... nurses can only have power if they make sure they do their own job properly, that they abide by the rules and remain professional at all times .... nurses can make a difference but they need to make sure they remain professional at all times.

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  • Emily Montgomery

    It always saddens me when nurses fear to speak out or are ignored when they have the courage to do so but are then ignored.
    However, the question has to be put about where is the official response from management to the concerns raised, which should include an audit of records in this particular case, to prove or disprove the concerns.
    What is needed is a process for external scrutiny. If there is a lack of response internally, as nurses, we are accountable to raise it again and have the Commissioners, Health Watch, NHSI and CQC to escalate to if need be. Most NHS Trusts have a Freedom to Speak Up Guardian but how well are these individuals known and how much faith do staff have in them is questionable?

    Stronger together is true but professional responsibility, even if anonymous, is essential for a safer patient care environment and quality assurance.
    My plea to nurses is don't give up if you are not heard, keep going until you have a formal response that you are assured about, if in doubt speak up to your Freedom to Speak Up Guardian (in your organisation) , Commissioners, Health Watch, NHSI, CQC or union representative. You have a PIN number for a reason, you are the patient's advocate and they rely on you.

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