Hospitals are cynically burying evidence of poor care in a ‘cover-up culture’ leading to avoidable deaths, and families are being denied the truth about their loved ones, the NHS Ombudsman has warned.
Ministers, NHS leaders and hospital boards are doing too little to end the health service’s entrenched ‘cover-up culture’ and the victimization of staff who become whistleblowers, he added.
In an interview with the Guardian, as he prepares to step down after seven years in the role, Rob Behrens claimed that many parts of the NHS still value ‘reputation management’ over openness to relatives who have lost a loved one through medical negligence.
England’s ombudsman said that although the NHS was staffed by “brilliant people” working under immense pressure, his investigation into patients’ complaints had too often uncovered cover-ups, “including changing care plans and disappearing of crucial documents after patients die and robust denial in light of documentary evidence.”
Behrens urged ministers to review the way the NHS handles complaints and the way the range of regulators investigate them.
His concerns include that:
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Preventable deaths occurred too often, especially in maternity care, mental health care and cases of sepsis (blood poisoning).
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The NHS sometimes did ‘terrible’ and ‘cynical’ things by preventing families from finding out the full facts about a death, including lying and withholding evidence.
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The agency’s legal “duty of candor” did not force hospitals to be open if something went wrong.
although Martha’s Reignallowing families to urgently seek a second opinion if a patient’s condition worsens was a major step forward; relatives were still struggling to overcome trusts’ reluctance to admit mistakes, he added.
In a plea to Health Secretary Victoria Atkins and NHS England boss Amanda Pritchard, Behrens said: “NHS leaders, including ministers, set the tone for the whole organisation. Time and again we hear that patient safety is a priority, but all too often actions suggest otherwise.
“We urgently need significant, concerted intervention to accelerate improvements in culture and leadership, not just in trusts or primary care, but also in NHS England and government.
“Culture is not only determined by the core of an organization, but also by its top leadership.”
The ombudsman expressed alarm at the recurring pattern of hospitals intimidating whistleblowers rather than taking their concerns seriously. He cited the University Hospitals Trust in Birmingham for referring 26 of its doctors over 10 years to the General Medical Council, which oversees doctors, for alleged misconduct in an apparent attempt to punish them for raising concerns . No one appeared to have committed a violation.
The trust’s board and regulators should have acted sooner to tackle the “disgraceful” behavior of the trust management, which was well known across the NHS, Behrens said.
The Health Journal reported last week how North Tees and Hartlepool NHS Trust were told to pay surgeon Manuf Kassem £431,768 in damages for racial discrimination and harassment he faced after he told bosses of his fears that patients had ‘suffered complications, negligence, delayed treatment and avoidable deaths”.
Last year the same trust was forced to pay £472,600 in compensation for unfair dismissal to another whistleblower – a nurse – who warned that a patient had died as a result of the heavy workload.
Patient Safety Watch CEO James Titcombe, who was denied a full explanation for 17 months after his son Joshua died of sepsis at nine days old in 2008, said he echoed Behrens’ concerns.
He said research has shown that tens of thousands of avoidable deaths occur in Britain every year because safety standards are lower than in other countries.
Paul Whiteing, the chief executive of patient safety charity Action Against Medical Accidents, said the Countess of Chester NHS Trust’s failure to act on doctors’ concerns about serial killer Lucy Letby – including forcing them to join to apologize for questioning her integrity. – was an example of Behrens’ task of “reputation management”.
Last year, a third of NHS staff saw mistakes, near misses or incidents in the course of their work that could have harmed staff or patients, the latest annual NHS staff survey found, he added.
Responding to Behrens, an NHS spokesperson said it was “absolutely essential that everyone working in the NHS feels they can speak out and have their concerns acted upon.
“The NHS has updated its freedom to speak out (and) introduced additional background checks for board members to prevent directors involved in serious mismanagement from joining another NHS organisation.
“As the Ombudsman is aware, great efforts have been made in England to prioritize patient safety and progress has been made in creating a more positive safety culture within the workforce, leading to a higher level of reporting of patient safety incidents than ever before and a widespread focus on improvement, also through the new framework for responding to patient safety incidents.
A spokesperson for the Department of Health and Social Care said: “The safety of all patients is vital, and we have made significant improvements to strengthen patient protection, including publishing the first NHS Patient Safety Strategy.
“We are committed to making healthcare faster, simpler and fairer. We are investing record levels in the NHS, training and retaining staff through the Long Term Workforce Plan to keep our NHS adequately resourced for decades to come.”