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 146.

    Well it is the patients who in the end pay the price

  • rate this

    Comment number 145.

    How the NHS keeps its secrets? start with the club of senior NHS bluffers and bullies both in and outside hospitals, who keep each others jobs secure;

    Those who dish out the budgets/targets and will not hear that they impact services, plus those in the hospitals who go along with them for the sake of their own career (ie a new job/project conveniently pops up, just before the **** hits the fan).

  • rate this

    Comment number 144.

    How could the NHS ever be made better when the minister of health is Jeremy Hunt, a man who believes in magical fairy healing known as homeopathy. He even believes in funding it on the NHS! The man is an embarrassment to our country.

  • rate this

    Comment number 143.

    I absolutely agree Gwyneth 142.. It's ridiculous that managers do not spend time on the shop floor - should be made compulsory!

  • rate this

    Comment number 142.

    The NHS is run by people with an over inflated sense of their importance. Most are non clinical & have no idea of the work done by their staff.I spent my whole career in the NHS & feel qualified to say that until these people descend from their offices and see what is going on on the shop floor nothing will improve. They have forgotten that without the patient they would have no work .

  • rate this

    Comment number 141.

    How can anyone report a problem when the only people they can report to are the ones causing the problems in the first place?

  • rate this

    Comment number 140.

    Strange, when there is a problem in any business; all those who see it - discuss it, agree with eachother, say what they think needs doing, and yet when some brave soul decides to act, the supporters slip into the background and point their fingers, secretly relishing the benefits they will reap.
    It takes courage to stand up for what you believe in - they are the heros in the history books!

  • rate this

    Comment number 139.

    The targets are set by the politicians and I agree 100%. Change needs to come from the top and that means Ministers who have no experience should stay out of it. For example, the Minister in charge of health now used to be the Culture Secretary for goodness sake and look how that turned out. The problem is with Whitehall and number 10 pretending they know better than qualified NHS staff.

  • rate this

    Comment number 138.

    There are good staff in the NHS, and lots of hopeless staff who shouldn't be there. They are not being effectively managed by target driven manager. There is little time for quality or safety and senior medical staff who see the problems and can find solutions are excluded from decision making. Change must come from the top. Let's get more clinicians to lead and less managers to manage!

  • rate this

    Comment number 137.

    In 1983 The Griffiths' Report on the NHS, commented that "if Florence Nightingale walked the corridors and asked "who was in charge ?" , she would have difficulty in finding such a person." General Management was introduced . She would now have no difficulty in finding amongst the "Dames" and "Sirs" people who claim to be in charge - but if she was now to ask "who is responsible ?".....

  • rate this

    Comment number 136.

    Your telling me!. I discovered that I hadn't been receiving the medication I needed from my doctor for 10 years because on my medical records there was a error written in there saying I had suicidal tenancies, it was only discovered by me when I applied to join the army that it was discovered on my medical records by the army

  • rate this

    Comment number 135.

    Also though I have been telling the BBC for several years now about awful atrocious care, lies and denials regarding the NHS, you have not done anything to bring this to the publics attention until thousands have suffered unnecessarily.....

  • rate this

    Comment number 134.

    Are a lot of folk still dumb enough to think that ANY government or it's activities is/are transparent? Just try looking through a lead sheet and that is about as transparent the governments are! LIES are their foundation and EVERYTHING is built on them!

  • rate this

    Comment number 133.

    There is already a fair amount of transparency. But, if you think the current situation is bad, just wait until the Tories get their way and have most of the service privately run. You won't get any private company to disclose the profits it makes for it's Directors and shareholders. The Government will spin some legislation to say it isn't public interest to protect the figures from the FOI act.

  • rate this

    Comment number 132.

    I wonder what our Chinese ambassadors say when this is drawn to their attention as an example of our much-talked-about "freedom of speech"? Dictatorial regimes of the world must love having something like this to throw back in our faces.

  • rate this

    Comment number 131.

    If Gary Walker is being honest, it looks like Nicolae Ceauşescu would have been at home running the NHS. This has got to stop. We need complete transparency. All NHS data must be placed in the public domain, with the exclusion of personal medical information.

  • rate this

    Comment number 130.

    Too many chiefs and not enough Indians is what your struggling for!

    Also box ticking and absolute conformance for audit is looked on as being more important than experience and skill.

  • rate this

    Comment number 129.

    Being a culture of nepotism and jobs for the boys the incompetence at the top end of the NHS is GINORMOUS and because of this those working on the front line and coal face are feared by the management as allowing them access to the meetings would completely blow the lid off a sham that is mostly about high paid management roles and very little about patient care.

  • rate this

    Comment number 128.

    #120 Most NHS grades and their associated salaries are in the public domain. Mysteriously, all directors are employed on a separate salary structure, which is not published anywhere and is kept very secret.
    I was a department head, one below director level. Imagine my shock when I discovered by accident that my director was earning nearly three times as much as me. Ouch !

  • rate this

    Comment number 127.

    The entire NHS is about chasing targets thanks to years of government interference and meddling. They have targets for everything which means more admin staff to collate those numbers. This drives costs up when the government is reducing funds. That leads to lack of frontline staff, equipment and wards.

    Managers have to toe statistics so frontline staff get pressured. The result is as you see


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