NHS managers who silence and scapegoat whistleblowers will be banned from working in the service, the shadow health secretary has said, as part of a determined drive by Labour to eradicate a culture of cover-ups.
In an interview with the Guardian, Wes Streeting pledged to push through the formal regulation of NHS managers and warned the Care Quality Commission (CQC) that its inspectors must get much better at exposing risks to patients’ safety in order to regain the confidence of frontline staff.
“I think the only way in which we genuinely protect whistleblowers and create a culture of honesty and openness is if you have tough enforcement,” he said.
“I’m deadly serious when I say NHS managers who silence whistleblowers will be out and will never work in the NHS again. It is the number one priority for the system. And I want people to have the confidence to speak out and come forward.”
With days to go before Streeting potentially replaces Victoria Atkins as health secretary, he said one of his biggest fears was that he would uncover further patient safety scandals, especially in maternity care. Inquiries over the last decade into childbirth care scandals at the Morecambe Bay, East Kent and Shrewsbury and Telford NHS trusts have painted a grim picture of babies and mothers being left injured, brain-damaged or dying after receiving inadequate care.
Further reviews are examining appalling risks to mothers and babies at more hospitals where there were preventable deaths and injuries, including in Nottingham.
Streeting said: “I’m extremely anxious about maternity services. And what frightens me is the issues we’ve seen raised in relation to Nottingham and Kent – I think [they] are a risk factor right across the NHS, and it’s one of the big reasons why we are losing midwives faster than we can recruit them in some cases.”
Three reviews on serious patient safety failings have recommended the regulation of NHS senior managers, to allow them to be disbarred if they silence whistleblowers. Streeting accused Conservative health secretaries of repeatedly failing to implement that change.
This week Ian Trenholm, the boss of CQC, unexpectedly resigned. In a subsequent internal memo leaked to the Health Service Journal, Kate Terroni, who has been named as CQC’s interim chief executive, admitted that it was failing to keep patients safe and losing the confidence of the NHS and of ministers. The memo reportedly said: “The way we work is not working and we are not consistently keeping people who use services safe.”
Streeting said the instinct to protect the reputation of the NHS “at all costs” had to change.
He said: “You have doctors who are afraid to speak up because they think ‘if I speak up, will I be shipped out?’. You get actually a lot of frontline staff who are trying really hard to either formally blow the whistle or to raise the alarm about patient safety and the pressures of the system and feeling silenced, scapegoated, in some cases bullied out and this has got to stop.”
Senior NHS staff and whistleblowers have long argued that the regulator is not fit for purpose and inept at rooting out cover-ups. On Thursday the chief executive of NHS Providers, Sir Julian Hartley, said the CQC memo “confirmed what trust leaders have long known: the regulator is in urgent need of reform”.
Streeting said he agreed that the CQC was losing the confidence of concerned NHS staff and said they were begging for a stricter inspection regime.
“When I was shadow schools minister I can’t recall a single occasion where I went into any school and the teacher said ‘what we really want are longer Ofsted inspections, more Ofsted, please’,” he said. “And yet I have been very struck as the shadow health secretary by frontline staff, often nurses, saying actually we don’t feel that we get listened to. And we don’t feel that they asked the right questions and if they did, we can tell them where the challenges are on patient safety.
“So I do think the CQC has got to look at making sure the inspectors ask the right questions of the right people and get under the bonnet of things, especially on patient safety to the extent that staff have greater confidence in it.”
Streeting said hearing the experience of the Guardian senior editor Merope Mills had been a “wake-up call” as she described watching her 13-year-old daughter Martha die a preventable death from sepsis in hospital because of a refusal by senior doctors to listen when she raised the alarm. He said the health service should “go further” than Martha’s rule, which gives patients the right to demand a second opinion on their condition.
The British Medical Association, the main doctors union, welcomed Labour’s plan to regulate managers. Prof Philip Banfield, its chair of council, said: “Those who run NHS organisations must, like doctors, be accountable for their actions and for the decisions that they have made, instead of being quietly transferred to another senior post in what’s akin to a disgraceful revolving door of ineptitude.
“As long as this culture of protectionism, rather than accountability, holds sway, doctors will continue to face appalling victimisation and I fear that the pandora’s box about to be thrown wide open is far bigger than the Post Office scandal.”
Growing numbers of doctors were approaching the BMA “desperate to highlight cover-ups but also desperately afraid for themselves and colleagues if they do”, he said.
The patient safety campaigner James Titcombe, whose son Joshua died in the Morecambe Bay maternity scandal, said subsequent events showed that the government’s decision in 2014 not to regulate NHS managers, against the advice of the official inquiry into the Mid Staffordshire care scandal, was a mistake.
“Too often we have seen a culture in the NHS where reputation has been put above the interests of patient safety,” he said.
Streeting said he was also determined to address diversity in the NHS and the bullying that black staff often experience within the health service. “I look at the fact black women are four times more likely to die in childbirth, black men are twice as likely to die of prostate cancer than white men. And I think those issues are linked,” he said.
He added: “There is a particular challenge experienced by black staff in the NHS when it comes to bullying and I’ve heard that time and time again. It speaks directly to patient safety. It also speaks to whether or not we’re going to succeed in our ambitions to close the health inequalities that lie our society.”
If Labour wins the election, Streeting will inherit a department with some of the toughest challenges in government: strikes; NHS funding predicted to fall £38bn short by the end of the parliament; and almost 10 million people on waiting lists. Strikes will be the main focus of his attention in the short-term.
“I can’t abide the thought of patients suffering more misery through further strikes or the NHS putting good money after bad paying for the costs of strikes rather than solving them,” he said.
Streeting said the party’s ambitions started with the pledge for 40,000 more appointments a week, and he repeatedly talked up the last Labour government’s achievement in ending waiting altogether.
“The one advantage I would have, which none of my opponents have, is that I have every Labour health secretary, from Andy Burnham to Alan Milburn, in my corner, at the end of the phone,” he said. “These are people with a track record of turning the NHS and delivering the shortest waiting times and the highest patient satisfaction in the history of the NHS. We did it before and we can do it again.”
