'Whistleblowing in the NHS should be a routine duty - there has to be change'

Video report by ITV News UK Editor Paul Brand

Writing his personal account for ITV News, Dr Ravi Jayaram, a consultant paediatrician at the Countess of Chester hospital, discusses why NHS medics who have concerns must be listened to. 

Over the past few weeks, I’ve been filming for an episode of Tonight with the programme’s team at ITV News.

I first met presenter Paul Brand in August. He interviewed me after the verdict came in on the Lucy Letby case - I am one of the doctors who warned managers at Chester Hospital about her behaviour, but were told to stop.

I wanted to know how many other medics are having their warnings ignored, so Paul and I have been on a journey talking to others who have felt silenced.

I still struggle to comprehend why any NHS manager, when made aware of issues potentially affecting patient safety, would react in any other way than to investigate those issues and work with their teams to improve things.

Everything in healthcare should be based around providing safe, effective, and timely care.

When areas for improvement are flagged up, they need to be addressed not ignored.

It appears that there is an NHS management culture that believes if concerns are raised about the service then this will reflect badly on their abilities. The reality is (or should be) that good managers should work to address concerns, and if areas for improvement are identified, then do just that.

Since August, I have heard from dozens of people from across the NHS who have raised concerns about risks to patients.

All of them have been met with initial refusals to acknowledge any issues and then, when they have persisted and tried to escalate things, have been met with accusations of bullying, weaponising of GMC referrals, and gaslighting to create narratives that portray them as being the problem.

Many of the concerns raised have not led to actual patient harm because much of the time the concerns raised are about reducing the risk of harm.

However, in situations where serious harm has occurred, there is a recurring theme that senior managers have ignored frontline staff.

What has become clear to me is that whistleblowing and the highlighting of patient safety issues should be a routine duty and not something that puts the individual raising concerns at risk.

So many are destroyed professionally and personally. I have heard from people driven into early retirement, prolonged sick leave, career changes or even moving to work in other countries.

Managers in the NHS work in very difficult circumstances, having to balance the need for the best quality of care with financial restraints over which they have no control.

I know that most do their best in these impossible circumstances and work well with frontline staff.

However, when clinical staff feel that their concerns have not been listened to and try to escalate things, they all too often feel like there is nowhere else for them to go.

In my view, the things that need to change are as follows.

• There needs to be statutory systems in place whereby patient safety concerns that have not been resolved at a local level can be assessed independently, openly and transparently by experts who have no vested interests.

• If local NHS managers want to institute disciplinary procedures against clinical staff in response to whistleblowing, this same body needs to assess the circumstances before this line can be pursued. This, I believe, will be a deterrent to the use of the GMC, NMC or employment tribunals as a means to gag staff.

• There needs to be a cultural shift in the NHS so that collaborative working towards common goals is facilitated, including mandatory input from patients.

• As part of this, the selection processes and qualifications for senior executive level NHS managers need to be reviewed and revised, and there needs to be greater accountability in terms of their appraisal, development, and performance.

• A statutory organisation akin to the GMC or NMC needs to exist to set standards for senior NHS managers and to whom concerns could be escalated about those who fall short of these standards.

For the sake and safety of every NHS patient (which at the drop of a hat could be any one of us), there has to be change.

Dr Jayaram will appear with Paul Brand in this week's episode of the 'Tonight' programme: 

'After Lucy Letby: Silence on the Wards?' on Thursday 9 November at 8.30pm on ITV1 and ITVX. 

Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know...