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Blowing the whistle on bad practice

Delilah Hesling, the UK’s first patient safety ombudsman, says she found supporting staff a struggle, despite having her chief executive’s support. Managers could be obstructive and staff were initially reluctant to come forward. The new guardian roles being introduced need to have ‘teeth’ if they are to be effective, she warns.

In her five years as patient safety ombudsman at Brighton and Sussex University Hospitals NHS Trust, Delilah Hesling saw the best and the worst of the NHS.

Her role involved listening to and acting on concerns raised by staff– who frequently wanted to remain anonymous – and responding to patients and their families who had concerns about their care.

Ms Hesling, who has just retired, was appointed after being a whistleblower and spending a year suspended from her job as a nurse in emergency care in Brighton. Eventually she was reinstated with an apology. The trust was also under scrutiny when a nurse who filmed poor care of older people was struck offbut reinstated after a public outcry.

The case prompted the incoming chief executive Duncan Selbie to set up Ms Hesling’s role. She then continued under Matthew Kershaw, who took over in 2013. She praises both men for their support for her role. ‘Matthew and I have had a professional relationship – often challenging each other. But I never felt that he did not listen to me,’ she says. They had regular one-to-one meetings, she adds.

Delilah Hesling found that staff became more willing to approach her with concerns about care

But while she had support from the chief executive, she found other managers less willing to act on concerns and staff members reluctant to come forward with worries about care. Often they were afraid to talk to their line manager – or frustrated to see nothing done when they did.

Her first whistleblower case was a consultant who ended up leaving the trust.

‘The concerns raised by staff were a broad church, from serious patient harm or human errors, to physical/sexual/psychological abuse, safeguarding and drug/alcohol abuse, never events, and bullying and discrimination.’

There were two underlying themes, she reveals: ‘Poor leadership and poor staffing levels.’

She says: ‘Towards the end, people were more willing to come forward. But it was always an uphill struggle. Many people agonised in my office in floods of tears.’

Whistleblowers can end up in trouble themselves, she says. ‘They shine a light on a problem and that light is twisted on them,’ she says. ‘There is a lack of accountability – problems are just passed around.’

A vital source of support for Ms Hesling was Aidan Halligan, chief of safety at the Brighton trust from 2008 to 13. He was in contact with her after he left until his death earlier this year. ‘Without him, I did not feel I had any power,’ she says.

Reputations

The trust is one of the south east’s largest, with more than 7,000 staff. ‘Miracles happen here every day,’ she says. ‘There are thousands of fantastic, committed staff.’

It has had well-documented problems over the past few years – with waiting times and capacity in A&E, and deaths among patients treated in its acute medical unit.

The trust also had a nurse who worked in its children’s department for nine years who was found to be a paedophile. No criminal activity occurred at the hospital but the trust faced the dilemma of whether to tell parents of patients he had treated. Ms Hesling argued for openness and parents were informed, but only just before a Nursing and Midwifery Council hearing where the man was struck offand his connection with the trust was made public.

Other concerns included the poor care of dementia patients.

So what was she able to achieve? ‘Lessons were learned but I felt the problem was not with the trust but also with the regulatory system.’

She is critical of the Care Quality Commission (CQC). ‘I have visited the CQC many times with evidence of patient harm. It took them so long to respond.’ She was also unimpressed by the Parliamentary and Health Service Ombudsman.

Roles like Ms Hesling’s and Helene Donnelly’s, the Mid-Staffs whistleblower who is now a cultural change ambassador, may become more common. The whistleblowing review, by Sir Robert Francis, recommended the creation of local Freedom to Speak Up guardians as well as a national guardian.

Reputations are destroyed when things are swept under the carpet and then come out later’

Several trusts have appointed guardians and the CQC is overseeing the national role. Ms Hesling is concerned that local guardians will report to the chief executive of the organisation they work in. She is concerned that others may not get the support that she had – and there are obvious conflicts of interest if whistleblowers come forward with problems with the chief executive.

She argues that the NHS still needs to be tougher in dealing with people who harm patients or show a lack of care as all too often they are simply recycled into different roles.

New patient guardians should be given more power, says Delilah Hesling, and the NHS should be tougher on staff who show a lack of care

Picture credit: Lisa Payne

‘I have no faith in the current proposals for guardians,’ she says. ‘They need teeth. I feel that the CQC, Department of Health, Jeremy Hunt and the other powers-that-be have a different agenda,’ she says.

She fears that some guardians could be cherry-picked and be too junior to deal with senior staff. Her role was band 8 – senior enough to be respected. Guardians on lower bands may not have the seniority and resilience to have difficult conversations with people such as directors of nursing, she says.

‘You do get a grudging respect after a while. But the guardian cannot think of organisational reputation before patient safety. You can engender change without destroying reputation. Reputations are destroyed when things are swept under the carpet and then come out later.’

There may be an argument for guardians to report to other organisations – perhaps by presenting an annual or quarterly report to HealthWatch. Ms Hesling produced quarterly reports in Brighton but they were not included in public board papers.

‘I would even say that the guardian should be a member of the board,’ she says. ‘Whistleblowers are ideal candidates’.

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