In the patient safety module that I teach my second-year medical students, I spend a lot of time whistleblowing and speaking up. I explain why it is important. The need for medicine as a profession to learn from mistakes and improve healthcare. I review the mechanisms for speaking up and reporting.
the Guardians of the freedom to express yourself they were introduced to all trusts in 2016, after the horrors of the Mid-Staffs scandal, to ensure that employees always have someone they can safely approach to voice concerns about security or the practice they have witnessed.
I’m even down with the kids. To show the normality of speech, even humor, I read them a passage from Adam Kay’s brilliant book, This is going to hurtabout a wayward pair of forceps and the importance of admitting when you, the doctor, have been wrong.
I detail in every way how the system has been designed to avoid a blame culture and protect the whistleblower. I even have my students role-play talking about a security incident so that they learn the language, get experience of how people can be a bit defensive, even angry, when talking about mistakes made.
My entire course is designed to develop your skills in calmly and rationally identifying security issues, bringing them to the attention of someone who can resolve the issues, and in doing so upholding the high levels of best practice that NHS patients expect and deserve.
And once I’ve done all that, I tell you how it really works.
I’m talking about the archaic hierarchies that still exist in many trusts. Difficulties junior staff members have (either because of seniority or perceived rank, such as outdated notions that doctors know more than nurses) in speaking up about mistakes or accidents they see senior staff making.
I warn you that as keen medical students you are actually more likely to spot errors or oddities in practice than those who have been doing the work for years, because they are a fresh pair of eyes attached to a brain crammed full of up-to-date of medical knowledge.
Finally, I tell you that the odds are against you. Those years of austerity and under-resourced NHS have led us to a nightmare scenario of understaffing, maintenance delays and a job void of over 100,000 openings, which means that one day, very soon, you won’t just see a mistake, but they will be the ones to make that mistake.
I end the session by telling them that I wish I were wrong. I wish the system was better, that the policies worked like they’re supposed to. That talking was something as normal and blameless as filling out the neighborhood files. He had no idea how close to home that would be until last night.
It was with resignation and fear that I heard about the difficulties that University Hospitals of Birmingham (UHB) staff have found trying to work securely in the trust. Dread, because my students work in that trust. They are learning clinical and team skills in that environment. I have taught them how to speak in that same environment that I have now learned can be hostile, even enemy territory.
He resigns because without significant investment, the NHS, whatever it trusts, is increasingly in danger of only being able to deliver the best possible care, not best clinical practice, considered the gold standard of medicine. And that means that more than ever, speaking is becoming a vital part of the future of medicine.
As the NHS is forced into a position where it can no longer provide best clinical practice to its patients, reporting needs to be embraced positively by the entire institution as the new normal of medical practice. This starts with the active promotion of psychological safety, the belief that you can speak up about a concern without being punished, within your ranks.
With the increasing likelihood that best practice is not always carried out, NHS staff must feel empowered to identify problems without retaliation. They need to feel that upper management wants to hear problems openly so they can fix them.
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The alleged use of weapons of GMC references by senior UHB staff is exactly the kind of useless retribution that, if true, will get in the way of keeping the NHS safe in its darkest hour. Rather than stubbornly closing ranks, now is the time for the NHS to own up and own up to its failures at a national level: face its problems head-on, speaking out to the public about the restrictions it is currently operating under and the consequences those restrictions have on their ability to provide a high level of care.
As I teach my students, the NHS must now show that it has the honesty, integrity and strength to stand up for patient safety, not turn its back or, worse, try to silence and discredit those who wish to identify failures. It’s time to talk.
Dr Alexis Paton is Professor of Social Epidemiology and Health Sociology and Co-Director of the Center for Health and Society at Aston University. Dr Paton is also Chairman of the Royal College of Physicians Committee on Ethical Issues in Medicine and a Trustee of the Institute of Medical Ethics.
