Thirty-five years ago, during the summer of 1984, my grandmother, Agnes MacDonald became unwell and after several hospital visits for blood transfusions, she passed away at the start of October aged 68 years. She died from acute myeloid leukaemia (AML) – an aggressive cancer of the bone marrow that results in a fatal abnormality of the white blood cells.
However, the true cause of death was a negligent mistake by the NHS. Over a decade before, she undergone a hysterectomy for ovarian cancer and been prescribed a course of cyclophosphamide – an immunosuppressant used in cancer care. The recommended course was 12-18 months, however a simple administrative error meant that course completion dates were not recorded or flagged and she remained on the drug for the next twelve years, unbeknown to her consultant and GP.
The overexposure to cyclophosphamide destroyed her bone marrow and was the cause of the AML – however, this was not reported to the family at the time and would have remained undiscovered, had it not been for another mistake by a hospital medical records department a few years later.
I’d only been qualified for a year when she died and worked at the same hospital as her consultant. When a patient sharing the same name of Agnes MacDonald came in for treatment one afternoon a few years later, the notes in the bundle of records I’d been sent were my grandmother’s; therein lay the truth of the matter.
It was clear from the consultant’s final entries and letter to the GP, that the cause of death was overexposure to the drug. But there was no explanation why this had happened, any admission of negligence or suggestions to prevent any similar cases happening again in the future.
At the time, there were few options to pursue enquiries regarding NHS treatment and care of relatives. Complaints managers or liaison services for patients didn’t exist back then and medical negligence litigation was extremely rare, not that any of these would have been a consideration anyway. Not in our family at least.
My grandmother’s view would have been quite simple. Everyone makes mistakes, the important thing is to learn and not cover them up for fear of punishment. That only compounds the problem. She had always been thankful and gracious with all the doctors and nurses that had looked after her over the years – and any notion of a complaint or legal action for negligence would not be something she would have wished for in any circumstance. But I still needed some answers.
I wrote about these events in an earlier essay, but it was not until relatively recently that I realised just how much of an impression they had made – and why the lessons they offered at the time are equally important today as they were back then.
Whistleblowing was unheard of in 1984 – unless you were familiar with the adventures of Winston Smith – and in the NHS particularly, the idea that an employee would seek to publicise through the media, mistakes made in patient care, would primarily be regarded as a betrayal and breach of trust of colleagues; a powerful inhibitor in any consideration. In practical terms, it may also prove counter-productive – negative publicity, loss of trust and respect, blame and punishment – rarely act as a prelude to a satisfactory outcome.
But that was thirty-five years ago and in the interim, the NHS has been politicised and weaponised by successive governments and an increasing number of external agencies with powerful vested interests. Professional bodies, private hospitals & commerce – such as the pharmaceutical industry, medical regulators and the legal profession – each one pursuing a different agenda – are all part of today’s working environment in the NHS.
Ostensibly, these agencies should compliment and enhance the function and performance within the NHS – and improve patient outcomes. In many aspects they do just that. But they also complicate and threaten professional responsibilities for health professionals within the NHS who raise concerns regarding risks to the general public.
When dangerous practice is created by the function or actions of one of these agencies, the risk to the health professional raising concerns becomes substantial. Sadly, over the last two decades, we have witnessed the persecution and victimisation of many individuals in the NHS – and other sectors – who have had their careers ended and reputations tarnished when their concerns implicate the very agencies and institutions whose principal responsibility is to ‘protect the public’.
Raj Mattu, David Drew, Narinder Kapur and Shamila Chowdry all had the misfortune of losing their careers after raising concerns about patient safety in the NHS. The conduct of the agencies involved in persecution of Dr Mattu and Dr Drew led directly to the Public Inquiry headed by Sir Robert Francis, whose condemnation of the conduct by the NHS Trusts and regulators involved in the cover-up of the scandal at Mid Staffs, compelled the Health Secretary, Jeremy Hunt, to make a formal apology in Parliament on 11 February 2015 in response to the publication of the Francis Report.
“Sir Robert confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed because they tried to do the right thing for patients: people losing their jobs; being financially ruined; brought to the brink of suicide; and family lives being shattered. Eminent and respected clinicians had their reputations maligned.
There are stories of fear, bullying, ostracisation, marginalisation as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny” with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers” and then blacklisted from future employment in the NHS as the system closed ranks.
But the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if doctors and nurses who have given their lives to patient care always feel listened to if they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which has no place in our NHS.”
Jeremy Hunt 11/2/2015
Whilst he was making this statement, I was standing in the dock at Hammersmith Magistrate’s Court being prosecuted for the second time by a health regulator. Hunt was aware of the case – my MP had written several times by then – but the Health Secretary remained silent and refused to intervene. Even after it became known that one of the UK’s worst paedophiles had exploited the loopholes in the legislation and had been practising as an unregistered podiatrist for over a decade until his arrest and conviction in 2016 – Jeremy Hunt refused to acknowledge the regulatory failings at the HPC.
Blatant hypocrisy from a Health Secretary who presided over a regime at the Department of Health that created its own ‘hostile environment’ in the NHS and Social Care with its continued persecution of whistleblowers. Dr Chris Day, the nurses at Gossport and Shrewsbury continue to have their lives blighted by malicious and sustained victimisation by the Department and its partners in the regulatory and legal agencies.
Earlier this month, Norman Lamb MP tabled a debate in the Commons regarding whistleblowing and highlighted the experience of Chris Day.
In recent months, medical and health regulators issued their own guidance on whistleblowing for their registrants. This included the Health Professions Council (HPC) and the Nursing and Midwifery Council (NMC), who jointly regulate over a million health professionals in the UK.
Readers of this blog will recall my own experience at the hands of the HPC after I raised concerns about public safety caused by deficiencies in their primary legislation regarding “protected titles”. Following two criminal prosecutions and fifteen separate hearings over four years – with legal costs for the HPC exceeding £300,000 – I am sadly unsurprised by Norman Lamb’s remarks in Parliament.
I suspect in due course, he will share a similar sentiment when he reads the following.
I am now in a position to advise readers that the legal proceeding have now concluded in my case with this regulator. In January last year, I submitted an application to the Criminal Cases Review Commission after my conviction was upheld by a perverse judgement at Preston Crown Court in June 2016.
The application to the CCRC was based on evidence that the HPC and Department of Health, wilfully and knowingly conspired to conceal the actual provisions governing use of title, thus compelling individuals to register with them when the legislation gave no such authority in law. The HPC – and NMC – fraudulently misrepresented the conditions for registration when they became statutory regulators in 2004 – and their failure to properly disclose the provisions formed the basis of my application to the Commission.
When submitting this in January 2018, I asked the CCRC to obtain the transcript of evidence heard at my Crown Appeal – together with the prosecution and defence papers. The Judge had contradicted herself a number of times in her summary judgement – whilst the prosecuting counsel for the HPC had misled the court regarding disclosure during my evidence. I provided new evidence that the regulator had deliberately concealed essential information from the professions, public and myself as a defendant in a criminal prosecution that had only one purpose: To silence an individual whose persistent defiance threatened to expose yet another scandal in the agencies associated with the NHS.
The CCRC agreed to obtain this material and estimated a conclusion by May 2018. In February 2019, they issued their provisional review – and upheld and reinforced the Appeal Judge’s findings. It was quickly apparent that the Commission had not examined the transcript evidence from the hearing – a fact confirmed in an email exchange on the day the review was received.
Hello Andrew
When I made my application to the CCRC last January, I asked whether the Commission would have access to the court transcripts of my hearings – particularly the Crown appeal. I was assured they would be available for consideration, if required.
From the Commission’s response, I suspect the transcript of the appeal was not considered. Can you confirm that is the case, please?
Hello Mr Russell,
I can confirm that you are correct – the Commission did not obtain a full transcript of the appeal proceedings, but instead relied upon the detailed judgment of the court that you provided to us in support of your application.
Regards,
I invited the CCRC to reconsider their decision and set out why their decision and that of the Appeal Court was fatally flawed. I asked them once again to obtain the transcript of the hearing and consider this in context with my submissions.
In May, I received a final decision from the CCRC not to refer the case to the Court of Appeal. They refused to obtain and consider the Appeal hearing transcript and then compounded matters by offering their own interpretation of the legislation, directly contradicting the findings of all the courts during this bizarre case. It was perhaps, given all that had gone before, a fitting conclusion – but not one, I suspect, the CCRC will be especially comfortable with in the very near future.
For transparency, I have uploaded the application and all other papers referred to here:
Application for review Jan 18 CCRC Provisional Review
Request to reconsider CCRC Final decision Closing correspondence
I had really hoped that there would at last, be a satisfactory outcome in this sorry saga – not least to provide some reassurance all the other health professionals who may, in future, be faced with a similar dilemma that I had a decade ago. Regrettably, I am unable to do that, but what I can do it to offer some advice for all registrant health professionals, doctors, nurses and dentists – who might consider voicing a concern regarding safeguarding but is worried about the implications and impact it may have, professionally and personally.
- Document everything; every meeting, conversation and all correspondence.
- Be honest, objective, accurate and truthful at all times. Don’t exaggerate any claims. Be concise.
- If your initial concerns are rejected or ignored, think carefully whether you wish to pursue the matter further. Consider what other interests might be affected by your claim and how that may impact in future action against you.
- Do not trust anyone in authority. Do not trust the institutions you expect to be honest, transparent and forthright – as if we didn’t know that by now.
- Do not expect any assistance from your professional body or any other agency you are affiliated with, particularly when they are implicated in the safeguarding issue you raise.
- Do expect to lose your livelihood, future career, reputation, home, savings and pension. Your relationships, with loved ones and friends, health, sanity, self-respect and dignity will also suffer detrimentally. At some stage, suicide will seem an attractive solution.
- Anticipate little satisfaction from political quarters. Pursuing whistleblowing concerns directly with government Ministers through constituency MPs is a complete waste of time and energy. Particularly when they are in the governing party.
- Do not assume any support from the media, unless your claim is sensational and can be summarised in just one sentence. The vast majority of journalists and editors in the media – and their readers – don’t understand complex cases where victimisation, cover-ups and NDAs all form part of the game.
- Confide only with close friends and seek the assistance and guidance of others who have experienced similar matters.
- Provide an account of your experience with documented evidence for the public and your colleagues to consider.
- Be resolute, determined and most of all, believe in yourself, particularly when all seems lost.
As the political chaos with Brexit engulfs Parliament and the country, I watch with a mixture of horror and disdain at the choices facing us for the future Prime Minister. On the one hand we have a fantasist buffoon who can barely string a sentence without contradicting himself – and on the other, a consummate liar; a Machiavellian character who has inflicted immeasurable damage on the NHS and many of the dedicated professionals who work in that sector. A Hobson’s Choice, if ever.
I’ve never considered myself a whistleblower before – just a podiatrist who raised a safeguarding concern through the appropriate channels – and discovered, to my cost, a quagmire of dishonesty, deceit and corruption. Never again. As another matter has exquisitely reinforced, no-one is listening.
The Health Professions Council spent over £300K prosecuting me to cover-up their dishonesty and fraudulent misrepresentation. I was fined £200. My costs including loss of earnings now amount to over £700K. I am now unemployed and in receipt of Universal Credit which provides me with a generous £3.85 per month to live on.
The pendulum always swings back, Mr Hunt. This time it carries more weight than you can ever imagine.