One element of this case is disturbingly predictable: the discovery that whistleblowers seem to have been stifled
Yet there have been more than 100 such investigations into NHS failures since the first modern healthcare inquiry in 1969. This equates to about two each year. They keep coming up with similar conclusions that expose the dangers of defensive management, dire communication, disempowered staff and patients, systemic inertia and silenced whistle-blowers – as seen again in this distressing case.
That inquiry 54 years ago – into abuse of people with learning disabilities held at Ely psychiatric hospital in Cardiff – stressed the need for staff to raise concerns “without fear of victimisation”. Health secretary Richard Crossman said the “odious and alarming” targeting of whistle-blowing nurses was “the biggest single deficiency” exposed by the probe.
Yet it is like Groundhog Day: nothing seems to change the toxic culture that corrodes the NHS with often fatal consequences. Victims tend to be elderly, disabled or women, reflecting blinkered attitudes that plague society. Last year saw publication of a damning final report into the Shrewsbury maternity scandal, where 201 babies and nine mothers may have needlessly died and many infants left with serious disabilities.
There has been protective legislation introduced for health whistle-blowers. There have been demands for more accountability from a succession of politicians; the longest-serving health minister Jeremy Hunt even wrote a book showing how trusts destroy those raising concerns in their dismal efforts to evade accountability. Yet the medical bureaucracy clings to hierarchies and fails to mimic sectors that put safety at their heart.
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