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RCN general secretary Peter Carter talks to NT about the Britten case

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RCN chief executive, and former chief executive of Central and North West London NHS trust, Peter Carter talks to NT about the case of disgraced nurse David Britten, who had inappropriate sexual relationships with 23 vulnerable women over a 20-year period, and how he uncovered what was really happening.

How did the case come to light and the trust find out what was happening at the Peter Dally clinic?

Within a year of taking over as chief executive of the newly merged trust in 1999 we uncovered a pretty bad situation at the clinic. Although there was no hard evidence at this stage there was a raft of circumstantial evidence.

I became suspicious that there were no incidents reports for the clinic given the nature of the vulnerable patients being treated there for serious eating disorders. The now former manager said that the clinic was well managed and therefore did not have any incidents but that did not ring true to me.

I had a feeling that things were not right, when a psychologist who worked there left because he was unhappy with the way things worked at the clinic I started an internal investigation.

What happened following the initial investigation?

During the internal investigation it came to light that two patients have previously complained about David Britten. I decided to try and speak to them, one of them had unfortunately died but the other was furious about what had happened and how the case had been handled-Mr Britten had been investigated but the investigator had concluded that without independent evidence or witnesses there was not case to answer which is an incorrect assumption.

While our internal investigation was taking place Mr Britten was redeployed and we faced deputations from patients and former patients and we lobbied by MPs against sacking him, however during this time another patient also got in touch with me and gave me an account of what life was really like at the clinic, it was obvious that we were dealing with a terrifying individual.

We referred the case to the NMC to have him struck off and to get an external investigation started.

What lessons should the NHS learn from this case?

Managers need to walk the job, have a presence and create an atmosphere that people feel that they can be whistle blowers. There also need to be systematic staff appraisals and exit interviews. In this case there were none.

I spoke to former staff at the clinic who were terrified of speaking out about this, because they thought David Britten would find them - it was something out of the movies. If exit interviews and appraisals had been carried out systematically at some stage it would have come out about what Mr Britten was doing and what was happening.

The NHS also needs to be very careful that when patients raise issues and complain they are not pathologised, we must work on a basis that patients are telling the truth and that allegations should be looked into if only to exonerate staff.

What should the Nursing and Midwifery Council learn from this?

I can't believe it took two years for the NMC to suspend him that is outrageous given that he had already been sacked and reported and NMC suspension and a hearing of the case should have been relatively quick. The NMC failed to protect the public in this case as the CHRE review has also highlighted.

Do you think this could happen again?

Yes, I think it probably will. I believe the vast majority of people that work in the NHS are good decent people but from time to time you get these kinds of events and I am under no illusion that something like this won't pop up again. Policies and procedures can only take you so far, people need to walk the job, talk to staff and create a climate where a predator like Mr Britten does not feel able to act with impunity.

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