08/08/2012 13:05 BST | Updated 07/10/2012 06:12 BST

Whistleblowing and Patient Safety : The Patient's or the profession's interests at stake?

Medical whistleblowing has featured in countless newspaper headlines. The stories are usually victim-focused, implying that if you blow the whistle, your life is automatically destroyed. While that may be true in some cases, the stereotypical "victim" imagery is not constructive, helping neither the psychology of the individual whistleblower, nor the system that spawned them.

Most genuine whistleblowers have provided a public service to be proud of, and should not allow themselves to be, or feel like "victims" of the state. Even where they encounter repercussions, as is often the case, their "suffering" is, relatively speaking, far less than that experienced by patients and their families - the true victims of the negligence and misconduct that whistleblowers seek to expose.

It seems that many medical whistleblowers resort to litigation while alleging "work stress" and parading every detail of their "suffering" in the media. The emphasis has shifted to the subject of legal non-disclosure clauses (gagging clauses), instead of exposing bona fide flaws in medical culture. This is a misguided distraction from the whistleblower's primary objective of improving patient care.

That objective is difficult enough to achieve without additional diversions. It is widely understood that patient safety is compromised because potential whistleblowers are wary of coming forward for fear of reprisals, but there is no clear consensus on what to do about the problem.

A public inquiry that took account of the experiences of actual whistleblowers would help, as would a stable body of academic research into the situation. Many of the papers published to date take a falsely upbeat stance, overlooking serious problems and proposing solutions that have little basis in reality.

Despite its belief to the contrary, the British Government is similarly devoid of viable, evidence-based solutions. The recently held Whistleblower Summit didn't include any whistleblowers, and when the Health Select Committee held talks on whistleblowing , whistleblowers were again excluded. In both cases, however, official bodies frequently implicated in creating an environment hostile to whistleblowers were asked to provide solutions. Rather than calling on experienced whistleblowers to give evidence with the intention of finding practical and workable solutions, there seems to be an insatiable Governmental appetite for more of the same old problems.

For these reasons, Professor Steve Bolsin and I decided to develop a research paper that showed the reality of the system and outlined the flaws in the culture of medicine. This was a difficult challenge, as was finding a publisher.

Medical journals are often owned by those who are implicated in these cultural deficiencies, and are naturally unwilling to bite the hand that feeds them. One such journal felt we spent too long in apportioning blame and did not outline solutions, conveniently overlooking the need to identify problems before solutions can be found. It is no secret that I felt pressurised into developing a paper that was broadly in agreement with the establishment's line of thought.

Our paper, Whistleblowing and patient safety: the patient's or the profession's interests at stake? [Stephen Bolsin, Rita Pal, Peter Wilmshurst, and Milton Pena J R Soc Med July 2011 104:278--282] was eventually published by the Journal of the Royal Society of Medicine. As editor of this journal, Kamran Abassi should be praised for his courage in publishing a paper critical of the medical establishment. His excellent introduction, "A way forward for whistleblowing" is well worth a read.

Having examined the issues in some depth, the paper made three recommendations as to the way forward:

"Firstly that the profession, through the GMC or BMA Council, should commission a Consultation Group on Reporting Poor Care. This Group will examine the consequences to all parties from incidents of reported poor care. Second, the Government should consider establishing a Health Select Committee Review of Whistleblowing that would make impartial recommendations to Government and the profession. Third, the Government should consider setting up and resourcing a National Whistleblowing Centre similar to that in the US. We believe that only by open public scrutiny will constructive change be cemented into exemplary clinical practice."

Following publication, and a helpful mention in the Independent , I set up a Whistleblowing and Patient Safety Petition to further raise public awareness of the issues. Mary Foord Brown, a prominent patient campaigner said:

"This refreshing paper and petition has come to represent modern change for many. Both sides of the fence meeting in the middle. The blatant lack of respect for both patients and medical professionals is often polarised into a similar position with either whistleblowing or formal complaint - an equal trashing from DoH or medical regulators or perhaps both - an institutional scalding The DoH is wasting our money daily due to their outdated culture!"

Mr John Brace, a leading whistleblower said:

"Without whistleblowers the public wouldn't hear about what really goes on, yet organisations too often have a 'shoot the messenger' approach to whistleblowing as they focus on the person rather than their message. For those that have been brave enough to raise concerns in good faith, expecting change, being subjected to disciplinary procedures for raising a grievance can be personally upsetting."

Patient mortality rates are unacceptably high in the UK with a litigation bill of £15.7 billion. At present, clinicians face disciplinary action whether or not they blow the whistle on poor care. This is unacceptable. Surely, in the interests of patient safety, the time has come for the Government to devise a coherent policy on whistleblowing, based on the experiences of those who know the situation best - whistleblowers themselves!

Related Links

1. New Whistleblowing Petition

2. Guidance for Journalists Working With Whistleblowers

3. Whistleblowing and Patient Safety: The Patient's or the profession's interests at stake?

4. Medical Whistleblowing. Is it safe?

5. Vexatious Whistleblowing

6. Medical Mobbing.