CQC boss encourages whistle-blowing
Tuesday 22nd October 2013, 7:20PM BST.
The new leadership of England’s health watchdog are calling on doctors and nurses to trigger inspections of their hospitals by coming to them with concerns about patient safety.
The chairman of the Care Quality Commission, David Prior, told MPs that many clinicians – including “alpha male” surgeons at the top of their profession – were “frightened” to voice concerns because of the damage it could do to their careers.
And he said there was a “tribal” culture in hospitals and other healthcare organisations which discouraged potential whistle-blowers from breaking ranks.
Mr Prior and chief executive David Behan were appointed over the past year to lead a shake-up of the CQC after it came in for harsh criticism over its response to scandals including Mid-Staffordshire and Morecambe Bay.
They told the House of Commons Health Committee that they were bringing in a new regime of specialist inspections of hospitals, care homes and surgeries, which will eventually see ratings published not only for each service but also for individual departments within hospitals.
In between inspections, a sophisticated surveillance tool will keep track of 150 indicators – including mortality and complication rates and surveys of patients and staff – which could trigger additional checks, said Mr Prior.
He told MPs that the CQC wants clinical staff to have the confidence to come direct to the watchdog with any concerns about standards where they work.
“To be a whistle-blower you have got to be very, very brave,” said Mr Prior. “I have spoken to a couple of surgeons whose careers have been severely limited because they expressed concerns about what was going on at their hospitals.
“I think how we enable people to raise concerns with us at a much earlier stage in confidence is incredibly important.
“We need to get a continuous flow of information from staff and residents and patients and carers. That’s our best source of information.”
Mr Prior said he found it “chilling” to hear a senior clinician ask why doctors did not raise concerns about unusually high mortality rates and poor care of patients at the Mid-Staffordshire NHS Trust.
“Where were the doctors?” he asked. “For years, this dreadful care went on and no doctor put his head above the parapet. Why is that? One part of the answer is that they are frightened. Even if you are an alpha male surgeon, you are frightened. We might feel that’s not good enough, but that is the situation.
“What we have got to do is to be absolutely sure when we do an inspection that hospitals have got proper whistle-blowing, concern-raising, procedures within the hospital and that there is real clinical engagement. And we have got to be a safety net and be available to these people at a much earlier stage so they can ring us up, get in touch with us and that can precipitate an inspection.”
Committee member David Tredinnick said that NHS trusts operated a mafia-style “omerta” code of silence under which employees were expected not to speak about problems.
“It is about organisations closing ranks so tightly that if anyone steps out of line they are finished,” said the Conservative MP. “It is a kind of mafia code, an omerta, where you do anything against the status quo of the organisation and you are finished. That is something that surely needs to be broken.”
Mr Prior agreed, adding: “I think we have to recognise that we are all tribal people. We all have our tribes – clinicians have their tribes, hospitals have their tribes, the CQC has its tribe and the House of Commons has its tribe. We tend to be quite defensive about that but we need to break those walls down.”
Mr Prior acknowledged that the CQC’s new inspection regime was “very much a work in progress”, but said the first 18 inspections carried out under the system would be completed by Christmas, with reports published by February. Details of the monitoring system to keep track of hospitals between inspections will be released on Thursday.
The CQC bosses were challenged over their decision to clear head of media Anna Jefferson of any wrong-doing in relation to a report into the watchdog’s handling of complaints about a series of maternity unit deaths at Morecambe Bay.
An independent report by Grant Thornton suggested that Ms Jefferson was involved in preventing the publication of the results of an internal inquiry because of fears it would damage the watchdog’s reputation. But the CQC announced earlier this month that she had “no case to answer”.
Labour committee member Barbara Keeley told the CQC bosses: “This is an important issue because it’s about a situation in a hospital where babies had died and mothers had died.
“How can members of the public affected by what was in the report have confidence in it when effectively a part of it you have now said wasn’t right.
“If you looked into this and found it wasn’t true in the case of one particular person, how can you say that the substance of the report isn’t queried in any way and you have got confidence in it? It doesn’t stack up.”
Mr Prior insisted that Grant Thornton had raised issues about CQC officials’ actions over Morecambe Bay, but had not come to the conclusion that any individual was guilty.
Disciplinary proceedings undertaken by the new management found that allegations against Ms Jefferson were “not valid” because there was no contemporaneous evidence against her, he said.