How the NHS locks away its secrets

Secrecy image Those working in the NHS believe it is not as open and transparent as it should be

On setting up the NHS, its founder Nye Bevan is reported to have said if a bedpan was dropped on a ward of a hospital, the noise would reverberate all the way to the corridors of power in Westminster.

That may be so, but the level of control and secrecy in the NHS means the clanging sound is muffled from the public.

Ministers talk a lot about making the NHS transparent and open.

But it appears nothing could be further from the truth - as the debate over gagging orders prompted by the Gary Walker case demonstrates.

Mr Walker has told the BBC he had no choice but to sign an agreement linked to a confidentiality clause in April 2011 after being sacked as chief executive of the United Lincolnshire Hospitals Trust

This issue is nothing new. It has been going on for years.

In 1998, the government of the day tried to stamp it out through the Public Interest Disclosure Act.

It is known as the UK's whistle-blowing law as it gives employees protection if they raise concerns.

'Isolated and fearful'

But as the years have gone by it has become apparent that within the health service it has not quite had the intended effect as the culture of secrecy has continued.

Staff who worked at Stafford Hospital, the trust at the centre of the scandal subject to a public inquiry, have complained of being bullied and silenced after trying to raise the alarm.

Another high-profile case involved the nurse, Margaret Haywood, who was struck off in 2009, after filming examples of neglect at Brighton's Royal Sussex Hospital for a BBC Panorama programme.

She too complained of a lack of support from bosses.

Evidence from the British Medical Journal from 2010 showed that while most trusts do have whistle-blowing policies, many were written in a way that did not do enough to encourage staff to come forward.

Start Quote

Lawyers may be involved and they are facing this big organisation and feel they can't speak out. We have to change that”

End Quote Dr Mark Porter British Medical Association

Some stressed the threat of disciplinary action, while others did not even mention that staff would be protected if they came forward.

On top of that there is the issue of gagging clauses. By their very nature it is impossible to know just how many are in place.

British Medical Association leader Dr Mark Porter says part of the problem is that while the law is clear, in practice people can feel isolated and fearful.

"Lawyers may be involved and they are facing this big organisation and feel they can't speak out. We have to change that."

Stephen Dorrell, a former health secretary and the current chairman of the House of Commons' Health Select Committee, agrees there is a "core problem" which shows the "culture of the health service is wrong".

To be fair, the Department of Health has attempted to counter such secrecy.

Just over a year ago a free helpline for whistleblowers was launched, while the need for staff to report concerns and employers to act on them was written into the NHS Constitution.

And, of course, last week the public inquiry into the Stafford Hospital failings recommended a duty of candour to get staff to be open about mistakes, while with-holding information from regulators should become a criminal offence.

But it goes much wider than this.

Many compare the openness - or lack of it - in the NHS with what happens in local government.

The power devolved to councils and the presence of councillors willing to talk out means much more uncomfortable information tends to leak out of the system.

Over the years ministers have often talked about making the NHS more transparent by publishing more and more information.

And, yes, a whole mountain of statistics are now published on the NHS each month from waiting times to how many patients are kept on mixed-sex wards.

But the complex nature of the NHS means only half the picture emerges.

For example, while each hospital submits how it is doing against the four-hour A&E target that masks what is happening around the emergency department.

Ambulances can be queuing outside and delays can be experienced once a patient is admitted into the hospital. But none of this is properly reflected in the official statistics.

All this helps create a system that encourages silence rather than noise.

Nick Triggle Article written by Nick Triggle Nick Triggle Health correspondent

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  • rate this

    Comment number 26.

    Our NHS, Education system, Police - key elements of our society - are being ripped to pieces by a misguided attempt to run these organisations as 'for profit' businesses.Targets are for double glazing salemen.
    If these organisations must have targets they should be:
    The NHS: cure the sick
    The education system: Educate all to the best of each child's maximum ability
    The police: nick criminals.

  • rate this

    Comment number 25.

    When bosses or leaders are scared of the truth coming out, they must be hiding something that shows they have screwed up... or worse.

  • rate this

    Comment number 24.

    As a carer of a user of NHS provided services, I can testify first hand about the pressure exerted by those in charge. Those at the coal face are brilliant but their managers have obviously been installed in their positions precisely for the bull xxxxxxxx that they are. They even speak a 'different language', english words but they make no sense! Same in fire service & other govt depts.

  • rate this

    Comment number 23.

    I'm surprised gagging orders are even legal, surely it amounts to extortion? "Keep your mouth shut and we'll pay you a large amount of money."

    Very dodgy. Wonder how much money is being spent on gagging orders that could otherwise be spent fixing the problems they're trying to hide.

  • rate this

    Comment number 22.

    They seem to have forgotten that it is the National Health SERVICE, it is not supposed to make a profit or meet targets, it is supposed to care for the sick. WE pay for it. Disband all the NHS "trusts" (misnomer?) Make gagging orders illegal, and replace the "managers" with doctors and nurses. Gas and electrical engineers are legally responsible for the work they do, make this apply in the NHS!

  • rate this

    Comment number 21.

    Margaret Haywood wasn't struck off for being a Whistleblower but because she covertly filmed patients without their knowledge for the BBC to broadcast on prime time. Whatever her motives that was a line no medic or nurse should cross.

  • rate this

    Comment number 20.

    There is a clear lack of governance covering whistle-blowers. Gagging clauses should be banned by the Department of Health where public interest is concerned. They serve no purpose for the public good and their very presence in contracts infers that there is something to hide.

  • rate this

    Comment number 19.

    Bullying of whistleblowers is all part of the plot to denigrate the NHS, and then privatise it.

  • rate this

    Comment number 18.

    There should be no such thing as a "gagging order" in any business.

  • rate this

    Comment number 17.

    The politicains who set targets (often to catch headlines) do not understand the law of unintended consequences.

    Take any target and think "how can I subvert this"? Is the target sufficiently worthwhile to risk the consequences of being subverted?

    Simple targets are usually simply subverted. Good managers starved of resources become subversives.

  • rate this

    Comment number 16.

    As usual, statistics are compiled by statistitians. These people are paid by bodies that want the stats to read in a 'certain way' and clearly if they want any more similar work, they will be inclined to comply. Result? A misleading bunch of rubbish that could later be argued as " no, we meant this . . . " I believe the quote goes "there's lies, there's absolute lies, and then, there's statistics"

  • rate this

    Comment number 15.

    It's not just the NHS but all Public Service organisations, Secrecy, incompetence, old boys network for jobs, no blame culture and a distinct way of stopping the public knowing how their money is being wasted. Lets have publically disclosed family trees for ALL organisations funded by taxpayers money, then we can all see the way they are run.

  • rate this

    Comment number 14.

    The NHS cheif Gary Walker who was gagged still readily accepted his £500,000 payoff.
    If he was really one of the good guys he would have stood up to the bullies.
    Now he is taking a risk by talking after having the money in his pocket and expecting us to be on his side.
    Money talks and he is probably after more.

  • rate this

    Comment number 13.

    This seems to be part of a broader culture seeking to silence those prepared to speak out against 'the rules'.

  • rate this

    Comment number 12.

    re 1 "what is the government trying hide"
    Think we neeed to define 'government'. A lot of events (and all the Nortth Staffs stuff) happened under Labour, not the current government. This is more about an NHS culture of untouchability (supported by the uncritical support of a large % of the public who regard the NHS as a modern deity) and less about party politics.

  • rate this

    Comment number 11.

    Free care? Rubbish. It's taxpayer funded. We all pay for it during our entire lives, just not all at once at the actual time we receive it. And it's got nothing to do with "the Tories" - the nasty stuff at mid Staffs happened during the rpevious Government's time in office No, it isn't down to them, either).

  • rate this

    Comment number 10.

    The law needs to be changed so that whistlblower truely are protected. And those who gag, bully, or suppress whistleblowers are the ones who face disciplinary action.

  • rate this

    Comment number 9.

    I've said this before and I'll say it again : Jeremy Hunt and the Tories cannot be trusted with the NHS.

  • rate this

    Comment number 8.

    Gagging orders are driven by the compensation culture and ambulance chasing lawyers. This is the canker in so much of life. As far as the NHS goes it should be illegal to get any money out of it for errors at all. Consider, they will pick up all the medical needs anyway. Further if we take free care, there is no place to get cash for errors. Errors can then be admitted and the system corrected.

  • rate this

    Comment number 7.

    Believe it or not the organisations that were best at proctecting staff and thereby patients and confronting dodgy managers were the Trade Unions. They played a major role in maintaining NHS standards.


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