Doctors are being forced to choose between patient safety and their careers
I’ve always been proud to serve as a small but critical and enduring cog in an NHS machine once considered one of the best health services in the world. But for over a decade, I’ve seen standards of patient safety steadily crumble, and fear spread amongst doctors who dare to raise concerns over unacceptable and preventable harm. For some, their careers are over for trying to highlight such awful events.
Over that time, the BMA has repeatedly made the point that doctors and patients know the needs of the health system best. The voice of those who care for patients, day in and day out, should always have the keen ear of those who run our NHS. It’s such a simple concept, so why is this proving so difficult?
New data from the BMA show that nearly 60 per cent of the doctors who responded raised concerns about patient safety at their workplace within the past year. Fewer than 6 per cent felt their concerns were fully resolved satisfactorily, with the safety issues addressed. Almost 53 per cent said their concerns had not been resolved or the patient safety issues addressed.
This is a terrible place to be – that means over 800 doctors have spoken up and said, in some way or another, I am worried. They are saying: “Something is risking my patient’s safety.” The true number is most likely significantly higher.
The crux of the issue is the appalling persistence of the terrible way “whistleblowing” is regarded within our NHS.
Doctors are held to a high standard, and rightly so. The GMC states it is the duty of doctors to “take prompt action if patient safety is compromised”. So essentially being a whistleblower – someone who reveals information about activity within an organisation that is deemed illegal, immoral, illicit, unsafe or fraudulent – is a required part of our duty as doctors. I’ve heard firsthand too often from colleagues that enacting this duty is not welcomed by NHS management, with a strong sentiment that NHS trusts and senior managers are more concerned with protecting personal and organisational reputations than they are with protecting patients.
Doctors who take a brave stand and raise issues are often met with hostility and risk losing their careers, dismissed both figuratively and physically. I struggle with the secrecy and opaqueness repeatedly evident, given that the NHS is owned by the public for patients; openness and transparency should be givens.
It’s not just individual doctors who speak up about risks to patient care. The warnings of the Royal College of Emergency Medicine fall on deaf ears, with their evidence suggesting more than 260 patients a week – an average passenger planeload – die from long delays in getting patients out of emergency departments and on to hospital wards. This is a scandal being swept under the carpet.
To extend the flying metaphor, doctors are being over-ruled and instructed to take off every day often not quite knowing which bit of the plane may fall off next. No pilot takes off until they are completely satisfied that it is safe to do so – it is what their industry demands. It is right that health has learned from aviation too – be open, transparent, and welcome investigation of what goes wrong – so it’s anathema that this should be so readily dismissed by those in charge. The lack of proper accountability for non-medical NHS managers has materially contributed to this sorry state of affairs. Without accountability, doctors will continue to risk losing their jobs when raising safety concerns; the NHS can’t afford to lose any more doctors and as a society we should not allow preventable deaths of patients.
Despite this, data tell us that doctors continue to raise patient safety concerns, with the number of inquiries to the BMA nearly tripling over the past decade. It’s important to remember that doctors and our families are patients too and we’re personally invested in providing and having a health service that is safe.
The NHS must be an organisation that welcomes being told what is wrong so that it can put it right. Those who run and fund our health services must, like doctors, be accountable for their actions and for the decisions that they make. No doctors should ever have to choose between protecting patients or their careers.
We will continue to speak up and speak out – you need doctors’ expertise to treat patients and fly the NHS. We will continue to highlight risks to patient safety as the NHS plunges in turbulence until we can say: “This is your captain speaking, we’ve regained control of the aircraft”.
Professor Phil Banfield is chairman of the BMA Council
