Nina Lakhani: The message is clear - speak up, but be ready to pay the price

Recent scandals at Mid Staffordshire, Winterbourne View and Royal Sussex Hospital have made the department of health and Care Quality Commission stress the importance of whistleblowers in raising standards of patient care, emphasising the legal protection in place for all those who raise their heads above the parapet.

Yet the long and inglorious history of NHS whistleblowers suffering serious detriment as a result of their determination not to turn a blind eye as patients or the taxpayer suffers has continued at a pace since Steve Boslin’s NHS career was destroyed as a result of exposing the Bristol babies’ scandal in 1995.

NHS staff who raise concerns about patient safety or financial wrongdoing or bullying can still face unsubstantiated accusations of incompetence, harassment and mental illness. As Kay Sheldon’s case shows, no-one is considered too big to oust.

The Independent newspapers have reported story after story of nurses, doctors, radiologists, and chief executives losing their jobs after refusing to stay quiet.

Two recent examples illustrate the enormity of the problem - that is the gap between what was intended by the Public Interest Disclosures Act and promises under the NHS Constitution, and the reality on the ground.

Gary Walker was bought in as the chief executive of United Lincolnshire Hospitals NHS Trust in 2006 with a 17 year unblemished NHS career behind him. The trust had been through nine CEOs in the preceding six years and had serious problems with overspend, top-down bullying and gaming of waiting time targets.

Mr Walker and the new chairman David Bowles tried to instil a culture of safety first. During their first two years, hospital acquired infections and waiting times were cut by half, and the Trust started to meet national targets for the first time. It cleared its historic debts and even made a small surplus.

Things went wrong for Walker after he refused to keep meeting non-urgent government targets because the hospitals were dangerously full with emergency patients; senior doctors and nurses were telling the Board that patient safety was in danger. Internal strategic health authority (SHA) documents show that the risks to healthcare associated infections from overcrowding were known.

But the SHA refused to budge, and began pressuring ULHT to meet the targets “regardless of demand”. Mr Walker made several prima facie 'protected disclosures' to the board and NHS chief executive, stating that he was being bullied into putting targets before patient safety.

He was suspended while off-sick - accused of bullying and harassment. He was eventually sacked for allegedly swearing during staff meetings.

His employment tribunal claim was settled on the first day of the scheduled hearing last October with a 15 page gagging clause attached. Gagging clauses that try to stop issues of public interest being exposed are “void”. Despite this, the six-figure severance payment and compromise agreement passed through the Department of Health and Treasury.

In April 2010, Mr Walker wrote to the CQC after six ULHT employees came to him with evidence of patients being harmed as a result of targets being put first.

They conducted a spot check two months later and reported no serious concern after meeting with staff and patients. They found minor breaches which did not present any “immediate safety risks.”

However the inspectors did not speak to any of the clinicians or board members who had evidence of the clinical incidents. They did not approach Walker for further information.

Mr Walker wrote to Andrew Lansley and the Prime Minister to alert them to what he feared could become the next big scandal, but felt fobbed off.

Yet less than a year later, the CQC launched a full investigation into the Trust and threatened service closures and even prosecution if urgent improvements were not made to improve patient safety. It continues to monitor the trust.

Walker doesn’t think he will ever be employed again in the NHS.

Two paediatric surgeons at Alder Hey Children’s hospital have raised concerns about a systematic failure to learn lessons from deaths and near misses for several years. The concerns were repeatedly raised internally before the doctors went to the department of health and regulator, which accepted reassurances from the trust.

The Independent on Sunday published an investigation in January 2010 detailing patient safety concerns and bullying within the department – again the Trust rejected all the allegations. The subsequent review by Royal College of Surgeons found serious problems and said Alder Hey’s surgical department was no longer “world class”.

It was only then that the CQC appeared to take notice. A CQC inspection in March 2012 and found the trust to be compliant.

One of the surgeons, Shiban Ahmed, was suspended twice, once for a whole year, and accused of being mentally unwell and suicidal. No concerns were ever raised about his clinical skills. He is currently off sick with stress.

The second recently won a High Court battle to stop the Trust holding a meeting where he could have been dismissed – because of a breakdown in relations with his colleagues. Dr Edwin Jesudason is fighting to stay employed.

The trust has always denied targeting the doctors because of whistleblowing.