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Offline: Lessons in whistleblowing
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Offline: Lessons in whistleblowing
* An urgent safety review was initiated. Contrary to the alarming reports Keogh had received, it found no “clear blue water” in outcomes between Leeds and other centres. The review found no evidence of significant safety concerns at Leeds. It recommended that children’s heart surgery could resume, which it did on April 10. On April 13, The Lancet wrote that this “debate has confused parents of children needing surgery and the public as a whole”. However, we also said that Keogh’s “proactive response was the safest course of action”. But were we wrong? Last week, after publication of a definitive review about the events in Leeds, some paediatric cardiologists might feel that the report supports allegations of very poor behaviour by those involved in the closure of the Leeds unit. I know, for example, that several paediatric cardiologists have felt briefed against at the highest level. www.thelancet.com Vol 384 November 8, 2014
So what really did precipitate the closure of a perfectly safe and effective surgical unit for children with heart disease? *
Christopher Furlong/Getty images
Peter Macdiarmid/Getty images
The report on the actions of Keogh and others concludes that, “the advice offered to Leeds about suspending surgery while a safety and data review took place was reasonable”. Given the evidence available at that time, albeit incomplete and unvalidated, the issues reported to Keogh could not be ignored. But the concerns raised by families did not give a complete perspective on the quality of services offered at Leeds. Indeed, these events show that full and accurate data are essential for making reliable judgments about service “reconfiguration”. Leeds did not make the submission of its data to national databases a sufficiently high priority. But, in some instances, descriptions of individual cases, which contained factual inaccuracies, were used as a tool for political campaigning to support one paediatric cardiac surgery unit over another. The result was that doctors in Leeds suffered “the burden of unproven allegations of serious professional misconduct”. Doctors working at centres in Newcastle and Leeds became bitter enemies. The independent review puts it more politely—”we found evidence of a strained relationship between clinicians”, “antipathy”, and “a high level of upset by Newcastle professionals about Leeds professionals”. Indeed, the behaviour of some senior medical staff in Newcastle suggested that “they compressed the period of their concerns in a way that put Leeds in an unfairly poor light”. The review continues, “Reporting the unchecked allegations of others is not whistleblowing... Newcastle should have carried out basic checks before they passed on the stories of these families.” What is the larger lesson? In the NHS today, and in the name of improving quality and reducing costs, conditions have been created for a kind of extreme competition between hospitals, and even between individual doctors, which too often fosters rivalries that help no-one—certainly not patients, their families, and the reputation of the medical profession itself. If you want to be a whistleblower, be sure of your facts.
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
On Friday, March 29, 2013, Bruce Keogh, Medical Director of the NHS, said this: “There had been rumblings in the cardiac surgical community for some time that all was not well at Leeds and on Tuesday I had two phone calls which I found disturbing, both from highly respected, temperate surgeons who commenced the conversations by saying that they had to speak out...then I had a call from an extremely agitated senior cardiologist who had a preliminary cut of some mortality data... which showed that...there was clear blue water between the Leeds mortality rate and other units, so as medical director I couldn’t do nothing.” The whistleblowing from paediatric cardiac surgeons in Newcastle and Birmingham contributed substantially last year to the suspension of surgery for children with congenital heart disease at Leeds. Families faced the prospect of their children being re-routed to other hospitals in England. These events took place on a background of efforts to “reconfigure” paediatric congenital cardiac services—to reduce the number of centres nationally from 11 to 7. In the North of England, 3 centres (Liverpool, Newcastle, and Leeds) had to be cut to 2. In 2012, a decision was taken to shut down Leeds. A campaign ensued to reverse this decision on the grounds that the consultation was unfair. The Royal Courts of Justice agreed the process was flawed. But with Keogh’s intervention, the Leeds unit was forced, finally, to close.
Richard Horton [email protected]
1655
Offline: Lessons in whistleblowing
* An urgent safety review was initiated. Contrary to the alarming reports Keogh had received, it found no “clear blue water” in outcomes between Leeds and other centres. The review found no evidence of significant safety concerns at Leeds. It recommended that children’s heart surgery could resume, which it did on April 10. On April 13, The Lancet wrote that this “debate has confused parents of children needing surgery and the public as a whole”. However, we also said that Keogh’s “proactive response was the safest course of action”. But were we wrong? Last week, after publication of a definitive review about the events in Leeds, some paediatric cardiologists might feel that the report supports allegations of very poor behaviour by those involved in the closure of the Leeds unit. I know, for example, that several paediatric cardiologists have felt briefed against at the highest level. www.thelancet.com Vol 384 November 8, 2014
So what really did precipitate the closure of a perfectly safe and effective surgical unit for children with heart disease? *
Christopher Furlong/Getty images
Peter Macdiarmid/Getty images
The report on the actions of Keogh and others concludes that, “the advice offered to Leeds about suspending surgery while a safety and data review took place was reasonable”. Given the evidence available at that time, albeit incomplete and unvalidated, the issues reported to Keogh could not be ignored. But the concerns raised by families did not give a complete perspective on the quality of services offered at Leeds. Indeed, these events show that full and accurate data are essential for making reliable judgments about service “reconfiguration”. Leeds did not make the submission of its data to national databases a sufficiently high priority. But, in some instances, descriptions of individual cases, which contained factual inaccuracies, were used as a tool for political campaigning to support one paediatric cardiac surgery unit over another. The result was that doctors in Leeds suffered “the burden of unproven allegations of serious professional misconduct”. Doctors working at centres in Newcastle and Leeds became bitter enemies. The independent review puts it more politely—”we found evidence of a strained relationship between clinicians”, “antipathy”, and “a high level of upset by Newcastle professionals about Leeds professionals”. Indeed, the behaviour of some senior medical staff in Newcastle suggested that “they compressed the period of their concerns in a way that put Leeds in an unfairly poor light”. The review continues, “Reporting the unchecked allegations of others is not whistleblowing... Newcastle should have carried out basic checks before they passed on the stories of these families.” What is the larger lesson? In the NHS today, and in the name of improving quality and reducing costs, conditions have been created for a kind of extreme competition between hospitals, and even between individual doctors, which too often fosters rivalries that help no-one—certainly not patients, their families, and the reputation of the medical profession itself. If you want to be a whistleblower, be sure of your facts.
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
On Friday, March 29, 2013, Bruce Keogh, Medical Director of the NHS, said this: “There had been rumblings in the cardiac surgical community for some time that all was not well at Leeds and on Tuesday I had two phone calls which I found disturbing, both from highly respected, temperate surgeons who commenced the conversations by saying that they had to speak out...then I had a call from an extremely agitated senior cardiologist who had a preliminary cut of some mortality data... which showed that...there was clear blue water between the Leeds mortality rate and other units, so as medical director I couldn’t do nothing.” The whistleblowing from paediatric cardiac surgeons in Newcastle and Birmingham contributed substantially last year to the suspension of surgery for children with congenital heart disease at Leeds. Families faced the prospect of their children being re-routed to other hospitals in England. These events took place on a background of efforts to “reconfigure” paediatric congenital cardiac services—to reduce the number of centres nationally from 11 to 7. In the North of England, 3 centres (Liverpool, Newcastle, and Leeds) had to be cut to 2. In 2012, a decision was taken to shut down Leeds. A campaign ensued to reverse this decision on the grounds that the consultation was unfair. The Royal Courts of Justice agreed the process was flawed. But with Keogh’s intervention, the Leeds unit was forced, finally, to close.
Richard Horton [email protected]
1655