20/08/2014 13:13 BST | Updated 20/10/2014 06:59 BST

The Whistleblower Reality Check.

The NHS cannot solely wait for ad hoc complaints/litigation from patients or whistleblowers to trigger improvements. An overhaul in the culture is required so raising concerns is part of the job description for every healthcare professional.

The Bristol Inquiry and Steve Bolsin's work led to the implementation of UK's clinical governance reforms. Instead of employing him to improve patient safety, the NHS accepted his exile in Australia. The system then bemoans the failure of patient safety and whistleblowing in this country. The fact is, if you don't have good people running the NHS, progress to an open culture of error reporting will never be made.

Finely micromanaged inquiries give health workers a false sense of security. Despite numerous reviews and conclusions outlined in the Bristol, Shipman and Mid Staffordshire Inquiries, the current Freedom to Speak Up Review appears to be yet another platform where "stories" sent to the review are not verified. Numerous questions on "cherry picking" evidence, failure of cross examination and poor methodology have been raised in relation to the Mid Staffordshire Inquiry.

No doubt similar criticisms will be made of the current whistleblowing review run by Sir Robert Francis and his team. Having billed it as an "independent" inquiry in various media outlets, all has gone silent from the Francis camp now that his lead medical adviser has been found to be partying with Freemasons. The influence of freemasonry was a hotly debated subject in the Bristol Inquiry. Again, the government's safe pairs of hands appear to be constructing documents for public consumption and electoral benefit. I suspect addressing the realities of whistleblowing would sink all mainstream political parties. In the meantime, the Pied Piper in the form of Robert Francis QC and his team of famous whistleblowers attempt to tempt us all to raise concerns. Is it safe though? That is the question.

While Robert Francis QC encourages whistleblowing, one must examine the reality away from his legal rose tinted spectacles. Having naively believed in the Bristol hype, I raised concerns about patient safety. The ward concerned was like many others in the NHS. What followed was a paper mountain, successful court cases, reviews, strained apologies but my concerns were never investigated properly by any authority. While senior figures responsible enjoyed the status, pensions and merit awards, my fragile medical career was over before it has started. Having struggled my way through a myriad of frivolous allegations instigated by my regulatory body, I slowly discovered trickles of evidence that eventually led to my vindication. While repeated investigations by the regulatory body focused on silencing/discrediting my concerns, no one glanced at the system failures. No wider audit was done and no patient/relative was informed of the damning reports. Essentially, no lessons were learned by the system. This isn't just one isolated story. It is a common pattern of failures of accountability in the NHS resulting in widespread patient safety failures. Of course, this evidence was conveniently set aside in the Mid Staffordshire Inquiry. Perhaps it become too hot to handle in the government's "safe pair of hands".

Patients deserve good care and NHS staff deserve good management. The NHS has no accountability systems for management failures. Patient safety and the public purse have to be protected. This means balancing the interests between patients, the NHS and the whistleblower. It also means addressing the prevalence of vexatious whistleblowers especially in an era of opportunistic litigation.

While attention has been focused on employment contracts and gagging clauses, very little has been said about indirect silencers. Anyone raising concerns should understand that the romantic idea of whistleblowing - admiration, bravery and fame - is essentially only saved for the select few. The average whistleblower will experience long term unemployment leading to poverty, homelessness, long term unemployability, endless job centre waits, satellite harassment, endless litigation and the Pariah effect. The stigma of being labeled mad, bad or sad and a troublemaker isn't easy to handle.

Healthcare whistleblowers face a myriad of problems post whistleblowing. They include a destruction of employment references affecting employability in the medical and non medical sectors, referral to their regulatory bodies on spurious charges, mobbing by the profession, sham peer reviews, failures in representation by trade unions and defence unions, and your MP's reluctance in resolving difficult issues. Pro-Bono legal support or even legal aid is negligible for doctors. Handling whistleblowing repercussions and reprisals in an ineffective system is difficult even for the toughest. The gravity of personal losses can only be understood by those who have walked this turbulent path. The tragedy of many cases is that this high price paid does not in turn improve patient safety.

The NHS cannot solely wait for ad hoc complaints/litigation from patients or whistleblowers to trigger improvements. An overhaul in the culture is required so raising concerns is part of the job description for every healthcare professional. Normalising error reporting appears to be the only way to improve patient safety and reducing litigation in the long term. It is probably the only way forward in a country where inquiries are tainted while political and establishment interests are protected. The power of the state will always be used to silence those who shake the foundations of such an establishment.

Dr Rita Pal

Co-Author of Whistleblowing and Patient Safety - Whistleblowing and patient safety: the patient's or the profession's interests at stake? Journal of the Royal Society of Medicine.