There will be more avoidable death until NHS leaders learn to welcome whistleblowers

Editorial: Time and again, warnings are ignored because managers or doctors are worried about the damage to their personal reputation or to that of the trust

In many cases, whistleblowers had to go to journalists in order to get their complaints investigated (Getty)

Most employees of the National Health Service believe their managers would ignore someone expressing concerns about patient safety, according to the latest NHS staff survey. This supports The Independent’s view that the Lucy Letby case was not a one-off: it is merely the most shocking and most recent example of a fundamental problem of the culture of the health service.

As we reported this week, the NHS bosses at the Countess of Chester Hospital who stand accused of failing to act on complaints about Letby were the very same people who were nominated to receive and act on whistleblowers’ concerns. Thus the NHS tries to open itself up to whistleblowing, but succeeds only in putting people in charge of investigating themselves. That might work in a leadership culture that welcomes and rewards self-criticism, but this is, sadly, not the culture in large parts of the NHS.

We have seen the same pattern repeat itself time and again in the scandals that The Independent has reported. In recent years we have exposed failings in maternity care in Shrewsbury, East Kent and Nottingham; we have forced the closure of a mental health hospital in the Huntercombe group. Longer ago we reported on the poor patient care in Staffordshire, which may have contributed to the deaths of 1,200 people in one of the largest healthcare scandals in the UK.

In every case, warnings were ignored because managers or doctors were worried about the damage to their personal reputation or to that of the institution for which they worked. In many cases, whistleblowers had to go to journalists in order to get their complaints investigated – which was almost always regarded by NHS leaders as a hostile and aggressive act.

As Ann Lloyd Keen, chair of the Patients Association, told The Independent, an open culture where staff can actively raise concerns is “critical” for patient safety – but too many NHS trusts have a “defensive culture”. She said that trusts sometimes regard patient complaints as an “annoyance or a threat”, and that “closing ranks, denying, and defending” are a “common feature throughout the long and shameful list of NHS safety scandals”.

She is right that the features of a safe and successful healthcare culture are well known. Many of them involve the kind of airline-style safety protocols that prevent mistakes, negligence or malign actions in the first place. Indeed, it could be argued that whistleblowing, important though it may be, is something that can only happen after things have gone wrong and is therefore too late. Which is true, but an effective safety culture needs a backstop: an openness that welcomes warnings of unsafe practice, as part of an early warning system in case the first line of defence fails.

Psychologically, that is the hard part of changing the culture of any large organisation: ensuring that mistakes are quickly identified, acknowledged and learned from, without blame. As many investigations into avoidable deaths have revealed, warning signs were often not acted on because subordinate managers were afraid of negative responses from senior managers. That has to change. Which means changing the incentives operating on NHS leaders, so that they are rewarded, recognised and promoted for acting promptly on warnings of serious threats to patient safety.

In other words, the reflex response to whistleblowers must be to welcome them rather than to try to shut them down. Until that becomes the NHS’s default setting, there will be more avoidable deaths.