By Narinder Kapur, University College London
I lost my job in 2010 after raising concerns about staff shortages and patient safety in the NHS. But despite the NHS Chief Executive's promise to intervene for whistleblowers and a tribunal in my favour, I wasn't reinstated.
So I was saddened to note that the word "whistleblowing" only appeared once in Sir Bruce Keogh's report into 14 failing hospital trusts.
The report lays bare the failings of 14 hospital trusts which between them have had up to 13,000 "needless deaths" since 2005. The political blaming has started and the majority of the trusts will be placed under special measures.
Culture of silence
It's stories like mine that put NHS staff off saying anything when things go wrong in hospitals.
Just a year before I blew the whistle, the UK House of Commons Health Select Committee noted:
The NHS remains largely unsupportive of whistleblowing, with many staff fearful about the consequences of going outside official channels to bring unsafe care to light.
There should be major reform of how whistleblowing is handled in the NHS - investigation of whistleblowing allegations should always include some independent, external scrutiny; consideration should be given to establishing a National Whistleblowing Centre along the lines of the one in the US, and the appointment of a National Director for NHS Whistleblowing.
Staff have 360° view
If we start from the premise that the people who often know best about poor standards of care on the ground are dedicated NHS staff themselves, then we should be looking extremely carefully as to how they are treated.
NHS staff who have genuinely raised concerns relating to patient care or staff bullying, and who consider themselves as whistleblowers, should be protected from unfair treatment. Only under the most exceptional of circumstances relating to conduct or performance should they be subject to disciplinary, exclusion or dismissal procedures.
In such cases, there needs to be completely independent scrutiny of the procedures used, since they can easily be manipulated by management to become "show trials", with lip service paid to professional guidelines or expert opinion.
Bringing your employer into disrepute
Whistleblowers are particularly susceptible to being punished on the basis of a charge of bringing their employer into disrepute. There should be clear guidelines as to when this charge can be laid. And where it is brought against a genuine whistleblower, it should again be subject to external scrutiny.
Employers should not be allowed to use the legal cloak of "some other substantial reason" for the dismissal of NHS staff who have raised concerns. Any such NHS staff who have in the past been dismissed for this reason, and who have won a case for unfair dismissal at an employment tribunal, should be offered automatic reinstatement if that's their wish.
Unfair legal advantage
Whether at a trust level or in a legal setting, it can be very difficult for such staff who get victimised or dismissed to prove that their ill-treatment was due to them raising concerns. In my case it was claimed that the relationship had broken down because of my management style and working methods.
People who are dismissed for an alleged breakdown in relationships with a senior manager can easily find themselves at the wrong end of a clever and vicious trust barrister who is difficult to go up against. Trusts have unlimited funds to fight dismissed staff, and this unfair advantage needs to be put right.
Most NHS whistleblowers who leave their employer, and also other unfairly dismissed staff, are sadly treated like lepers, branded "troublemakers" and find it difficult or impossible to get jobs again in the NHS. There may even be collusion between managers across differing trusts but this is hard to prove.
Such exclusion from jobs can be disastrous and extremely distressing for individuals and their families, and is a form of blatant discrimination. Specific measures should be introduced to ensure that whistleblowers aren't put to any disadvantage. Employers who refuse to employ whistleblowers or unfairly dismissed staff should be penalised.
A striking omission
Whistleblowers in the NHS are often the key to improving patient safety and consideration should be given to an award scheme to reward genuine whistleblowers who have shown courage and self-sacrifice.
This government is to be congratulated on setting up a number of inquiries after the Francis Report into Mid-Staffs; for providing an initial response to it; and for promising a final definitive response. But it sadly omitted to set up an inquiry into how NHS whistleblowers are treated, even though whistleblowing is repeatedly mentioned in all four Francis report volumes.
Such an inquiry should now be set up as a matter of urgency, and it should be wide-ranging to include how staff who raise concerns are treated at every stage, in trusts and in legal settings.
Until then, campaigns and hunger strikes won't be enough to protect patients.
Narinder Kapur set up A Better NHS, a website dedicated to whistleblowing in the NHS.