NHS ombudsman Rob Behrens: ‘There are serious concerns’

“TIt has been a cathartic experience,” says Rob Behrens. The NHS Ombudsman for England is reflecting on his seven years in the soon-to-end role, during which he has acted as arbiter of last resort for people who have exhausted the health service’s complaints system. Chastisement? How?

“Dealing with people who have experienced trauma and grief as a result of preventable death in the NHS requires empathy and compassion alongside impartiality and fairness.

“Second, confronting the duality of an NHS funded by brilliant people who kept it running during the Covid pandemic, but at the same time having to cope with a culture of cover-up, including changes to care plans and the disappearance of crucial documents afterwards . Patients have died and there is vehement denial despite the evidence,” he says.

While sipping tea from a mug depicting his beloved Manchester City, Behrens speaks softly. But when asked what he has learned about the NHS, his assessment is harsh. “That it is a very complex organisation, full of brilliant people, from porters to nurses, midwives, doctors and managers, who have performed brilliantly in dealing with multiple crises: Covid, massive staff shortages, financial pressure, demand, (staff) stress , the fragility of buildings, which makes life very difficult.”

But – and it’s a big but – despite the everyday miracles that the NHS performs, he has discovered that “there are serious problems within that brilliant environment, particularly when it comes to aspects of the culture of the NHS”.

“The harm people experience is significant and should not happen. In key areas – maternity care, mental health, preventable deaths, sepsis, eating disorders – I have come across stories again and again of people who just want to know the truth about what happened to their loved one and who have found it very difficult to do so. to find out. It.

“That is my job: to find out the truth.”

It is also his job, he adds, to highlight when the NHS is making the same mistake worryingly often, to assess the response when shortcomings are identified and to suggest ways to change things. Medical care is never without risk. But the most important test of a good system, Behrens argues, is whether lessons are learned after something goes wrong and whether changes are made to prevent recurrence. His experience, based on investigating thousands of complaints, is that too often that doesn’t happen in the NHS. And also that far too many employees who are brave enough to highlight bad practices subsequently become victims.

To illustrate, he mentions Dr Rosalind Ranson, the former medical director of the Isle of Man’s NHS. Last year she was awarded £3.2 million in compensation after an employment tribunal heard how she was unfairly dismissed after raising concerns about the government’s response to Covid-19.

“I have had doctors on the phone telling me too many times what has happened over the past seven years. They say they tried to file a complaint, raising patient safety issues, and were warned about it. And they told me, ‘If I continue with this, my career is over.’ Good doctors have lost their careers because of the way that is done.”

The Countess of Chester Hospital’s decision to ignore paediatricians’ concerns about Lucy Letby – at one point forcing doctors to apologize to her for their suspicions – illustrates his point.

He also refers to the rotten culture and scandalous treatment of whistleblowing staff by university hospitals in Birmingham (UHB) NHS Trust, which BBC Newsnight exposed in 2022. “What shocked me most about UHB is that management handled patient safety reports by sending people to the General Medical Council and threatening them with misbehaving. That is shameful,” says Behrens.

In the past decade, UHB has reported no fewer than 26 of its medics to the GMC, which can suspend or expel doctors found guilty of misconduct. UHB referred eye surgeon Tristan Reuser after he warned there were too few nurses to ensure the safety of operations. Reuser said that in his experience, whistleblowers at the trust suffered “victimization and retaliation through GMC referrals. If you criticize senior management, they will get you.”

The GMC took no action against any of the 26 doctors. But it did issue a formal warning to Dr David Rosser, who was the trust’s medical director at the time and later became its chief executive, for failing to tell them Reuser was a whistleblower. Rosser later left the trust. An employment tribunal later ruled that Reuser had been wrongfully dismissed.

An ombudsman must be forensic, fair and impartial. But, Behrens says, medical negligence investigations and hospitals’ attempts to downplay or bury the truth, and helping families whose losses have been compounded by secrecy get the facts out, can be emotionally taxing. Some have angered him about what he found. He quotes Bristol Children’s Hospital Refusal to tell Ally Condon for seven years exactly the reason why his eight-week-old son Ben died in April 2015. The staff failed to give him antibiotics quickly enough to fight a virus, it turned out.

“They withheld test results, they told us tests that were never administered were negative, they deleted documents from the medical notes – it’s endless,” Ally Condon said.

In Behrens’ seven years in office, steps have been taken to improve patient safety: the upcoming rollout of Martha’s Rule, which will give patients and family members the right to demand a second opinion if they are unhappy with someone’s care; the creation of the Institute for Healthcare Safety Research; and the NHS gets its first ever patient safety commissioner, adding to a raft of regulators that also includes the Care Quality Commission and GMC.

But, the ombudsman says, there are now “too many healthcare regulators – too many agencies doing roughly the same thing – (and) they are not sufficiently aligned, meaning no decisive action can be taken. taken because ministers do not get one vote on what should be done.” Legislation is needed to make things less confusing, he adds.

He wants his successor to have ‘own initiative powers’ – the ability to investigate things even if no formal complaint has been made, because sometimes scandals unfold in the NHS where insiders know but nothing is done about it, such as deaths of mental health patients. . Too often, he adds, “the people least likely to complain are those who need the ombudsman most: people with mental health problems, the elderly, people from ethnic minorities or the poor.”

Ministers have told him that such power would effectively lead to the ombudsman sticking his nose into too many cases, creating an even greater workload. Complaints against the NHS have already increased by 15-20% since Covid. The experience of his colleagues elsewhere who already have that right, including Wales and Northern Ireland, does not bear out that fear, he says.

How can the ‘cover-up culture’ end? “First, you have to acknowledge that it exists, and second, you have to make leaders accountable for how the culture works,” he says. Ministers, NHS bosses and the boards of NHS trusts need to be much more proactive, he adds.

Behrens, who retires at the end of the month, returns again and again to the fear families have experienced as they tried, often for years, to find out what happened to their loved one. He quotes Nye Bevan’s words from his book In Place of Fear that “silent pain provokes no response” to capture how that suffering, despite being worryingly common, does not lead to the necessary cultural change. “In modern parlance, if you say nothing, injustice and service failures will continue unchanged,” he adds.

He is referring to whistleblowers, many of whom pay a high price for their candor. But his words apply to him too, given his accuracy, independence and willingness to speak truth to power.

Is healthcare safer and the NHS more responsible than when it started? He pauses. “There are still too many examples where healthcare is not safe and healthcare institutions are too slow to deal with this. It shows that we have not yet gotten to the heart of the problem. My successor will face major problems.”