This is a short piece written by Dr Kim Holt on the paediatric service failing and running into the ground before Baby P’s death. She talks about the experience and gives advice to other doctors who may have concerns in the modern NHS.
I was asked to write something about how I feel about the past four years (see the shoot the messenger special in Private Eye for the detail). My main sentiment is one of “disbelief”, a sense of being in some parallel universe where normal rules no longer apply.
My eyes have been opened to what happens behind closed doors in the NHS and its very, very bad at times. It’s like growing up and realising that your parents are not who you thought they were.
Anyone who has read the NHS London report will know that my problems started, in Haringey, astoundingly in 2006, when four paediatricians felt so concerned about our increasing caseloads and the lack of capacity within the community paediatric team that we wrote a strong warning letter to senior managers within Haringey and Great Ormond Street. We challenged the proposed cuts to the service which led to the loss of a key paediatric post; the “named doctor”, as well as cutbacks in admin support and some therapy time.
It was inconceivable that a few years after Victoria Climbié died, the named doctor post for child protection was lost to the Haringey team – one paediatric post lost out of four. How was that supposed to work? What on earth was the logic to that?
Who else will speak up for vulnerable children apart from paediatricians and other social care professionals? Having seen first hand the real life experiences of many children living in poverty and particularly those of children within the care system – it was my responsibility to develop services – I could not stay quiet about the impact of the cuts. It was evident to me that by the end of 2006 the service had reached a stage that was no longer tenable and we were failing children.
It was as if we had lost our humanity, and children were reduced to numbers on a waiting list rather than real people. The community paediatric service had been reduced to a meeting of targets and ensuring that the budget was not overspent. Of course we live in that reality, but there comes a situation where we can no longer pretend to be providing a safe clinical service and there needs to be much more honesty and transparency for safety to be reached. We were unable to have a dialogue with management about the clinical risks and what short term measures could be put in place to ensure that child protection was prioritised.
I have committed myself to working in the NHS with disadvantaged children and for me the NHS should provide a safety net to the most vulnerable – it is an indicator that we are a civilised society. If that safety net is not in place then it is the weakest who suffer.
When I first told my MP Lynn Featherstone of my concerns we agreed that we thought that this was an issue with the Haringey management of the community team. The problems were the low staffing on the medical side and admin which had direct implications for what had happened to Peter Connelly (Baby P). I was quaking at the implications of taking my concerns externally.
I remember Lynn saying to me once, “You care about this”. An interesting observation. When I first shared my worries with Lynn Featherstone, in 2008, I never expected to be here; three years later, knocking at the doors of the Dept of Health.
There are a few things which I want other clinical staff to be aware of. Firstly, if you have concerns about clinical risk, document everything, keep every email and follow up any verbal discussion with a written note and save it. Check out your Trust whistleblowing policy and follow it step by step; going through every level, and ensuring that before you go external to a Trust you have taken it to Board level, Chair and or Chief Executive. If there seems to be no response to your concerns or a negative or hostile one then consult with your Union, but whistleblowing legislation states that if we have concerns regarding clinical risk, systems or resources that impact upon patient care, or corruption then we will have right to redress that through the courts if we suffer detriment or are dismissed for bringing those into the public domain. That means talking to the press about your concerns if no-one within the NHS will listen.
This is where the trouble really starts because there is not a level playing field with regard to trying to protecting yourself legally. NHS trusts use their funds to pay for legal advice and it seems that lawyers advise looking for other reasons apart from whistleblowing to engineer a dismissal, rather than defend a whistleblowing claim. We however as individuals fund our own legal costs unless represented by our unions. Fortunately for me at the moment I am represented by the BMA, but you will see from other stories how costly legal defence can be. Many people end up giving up and being advised to accept a financial settlement, often not what they want but because there are no other options. This brings me to the most important issue. Gagging clauses.
The Department of Health has provided guidance to the NHS that gagging clauses should not be used in severance agreements. If they are used, it means that health service failings can be covered up. Now I know that the proposed compromise agreement sent to me when the Trust offered me 120,000 was in fact a “supergag” that meant that I couldn’t even have talked about its existence. In order to accept compensation I had to sign a document that my concerns had been addressed, which was clearly impossible as I had been blocked from returning to my post. It would have been a lie.
If doctors are expected to raise concerns but actually it’s unwelcome and you are branded ‘mad’ or a troublemaker, how are you actually supposed to do it? And why would you do it?
It has felt at times as if this is a burden that I am carrying for others less able or willing to speak about this. There are others in similar and much worse situations than me who are not able to go public. Why are we so scared? How can highly trained professionals end up shaking in a corner when all they want to do is ensure that patients get the health care they deserve. This should not even be an issue.
There is a kind of madness that has crept in to the NHS, and no-one seems able to stop it.
We know that in Mid Staffs doctors were criticised for not raising concerns or whistleblowing about the dire state of affairs, but my guess is that some did try to speak and suffered. Others watching them stayed quiet. Hopefully, the inquiry will help to tease this out.
I was also asked about how this has impacted upon my family. That is hard to say because they have stood by me and they would not have wanted me to back down from my position, but they have been affected. What is important for the family is to have this resolved, and for them to see that I feel comfortable with having done the right thing.
I always thought that it was enough to be a good doctor. Not it seems in today’s NHS. What is needed is courage, resilience, support and a hardworking and concerned MP as well as a free press.
Dr Kim Holt