medical practitioners remains a constant possi- bility and we would agree with two of NevilleGoodman’s quotes in this journal that help todeﬁne the solution. Firstly ‘there is no perfect sol-ution’. Secondly there ‘must be systemsto supportand investigate suspicion rather than systems thatgo out looking with suspicion’.
Although thesolution proposed for the vexatious whistle blowing seen in the Stoke-on-Trent episoderelated to alleged research misconduct, such asystem in clinical and research practice wouldseem to be designed to deal adequately with justi-ﬁable and unnecessary concerns in both ﬁelds of professional practice.
Role of medical education
The medical profession is experienced and adeptat promoting bad behaviour around reportingpoor care, and can inﬂuence the behaviour of medical students during their training.
This be-haviour change has been attributed to the ‘infor-mal’ or ‘hidden’ curriculum of medicine and iswell described.
Of even more concern is the dis-tribution of ethical responses from the students atthe start of their undergraduate training (only 13%of students would consider reporting a senior col-league at the start of their training and
5% at theend).
In 1999, the Institute of Medicine, in a seminalpublication entitled
To Err is Human. Building aSafer Health System
, attributed $17–29 billion of healthcare spending annually to the effects of sys-temic healthcare error in the US, and there is noevidence that the NHS is a safer healthcare provi-der.
Consequently the failures, deterrents andobstructions faced by whistleblowers in the NHSmay be having a severe impact on the publicpurse as well as public safety. This year the Treas-ury has spent well over £3 million gagging whis-tleblowers, which will ensure that improvementsto patient care will not occur.
Martin Fletcher,Chief Executive at the National Patient SafetyAgency, has said: ‘Good reporting is the corner-stone of patient safety. Safety cannot be improvedwithout a range of valid reporting, analytical andinvestigative tools that identify the sources andcauses of risk in a way that leads to preventativeaction.’
The management side
The past failures of medical managers and the DHto show moral leadership and support for whistle- blowers, makes it unlikely they will be in the van-guard of change. The emphasis on ﬁnancial goals,thelackofeffectiveresponsibilityforthe outcomesof care and of any widely accepted code of ethicsfor medical managers makes it unlikely that theycan currently catalyse the necessary change.
The House of Commons Health Committee con-ﬁrms that the lack of achievement of the Depart-ment of Health in dealing with harmed patientsis ‘appalling’.
Need for change
Who can achieve the necessary change?
The medical schools will ﬁnd the role of ‘changeleader’ difﬁcult because they select, encourageand perpetuate these undesirable norms.
Whatis less obvious, but equally logical, is that themajority of the medical profession, who have been trained in medical schools, with these beha-viours and reﬂect that training, may also struggleto lead the change, although it may be possiblewith support.
This potentially sweeping exclu-sion of change leaders would automaticallyinclude the GMC, whose track record in this areais at best inconsistent, having attempted a com-plete U-turn in the last 21 years.In the absence of the professional groupsputting their heads together the problems of reporting poor care have not gone away but havepossibly multiplied, as predicted by the
atthe time of the GMC verdicts on the Bristoldoctors.
The prediction was inevitablewithout a serious change of attitudes at the topof the profession. In view of this professionalintransigence, we would add the British MedicalAssociation (BMA) Council to those from whomleadership in this area should not be expectedwithout some difﬁculty. Like the professionalmembers of the GMC, the BMA Council iselected by the profession and is therefore notlikely to support reporters of poor care.
Thelogic is two-fold. First, the BMA is representative
J R Soc Med 2011:
278–282. DOI 10.1258
Journal of the Royal Society of Medicine