Saturday, 1 June 2013

Whistleblowing isn’t always good for your healthcare

‘The press lives by disclosure,’ wrote John Delane, iconic editor of the London Times in the nineteenth century. 

It isn’t even any old disclosure. News is something we all want to know and someone else wants to keep quiet. Publishing it is journalism at its most effective.

The whistleblower has a key role in making it happen.

Not the least shameful aspect of many recent scandals has been the attempt by people in authority to silence potential whistleblowers, and much of the outcry has been over the failure to listen to them in the past it time to correct problems: it’s often the people at the coalface who know what’s going wrong and who could launch action to correct it if only they could gain a hearing.

So I’m keen on a campaigning, disclosing press, and I’m keen on whistleblowers having the opportunity to make themselves heard.

However, there needs to be some intelligence in the way information is handled as well. Otherwise, as much damage can be done by irresponsible disclosure, as would have been done by unprincipled concealment.

My local hospital, the Luton and Dunstable, has in place a well-resourced discharge planning department, putting it at the cutting edge of health service management today because it embodies a goal pursued across the NHS, to encourage collaboration between social workers and district nurses as well as nurses and managerial staff from the hospital. 

The aim is to prepare for the earliest possible discharge of patients, under the best possible conditions: there is nothing to be said for keeping patients in hospital any longer than necessary, if only because hospitals are dangerous places (full of sick people) with a high chance of infection, patients recover better in their own beds, and beds are at a premium for others impatiently awaiting their turn.

Most discharges are uneventful. But sometimes discharge planning has to make sure that
 patients have district nurse or social care support in place, that their medication is ready, that they are going home to an environment in which they can continue to recover, and so forth. It’s hard work, under great pressure, involving the coordination of many different agencies and their staff.

Now it’s impossible to do good work without occasionally getting it wrong. The only people who never make mistakes are those who never make anything. The trick is not to be put off by fear of making errors, but to recognise them quickly, take action to correct them and learn the lessons.

So the Luton and Dunstable hospital is to be congratulated for carrying out regular audits of its discharge planning work. It’s entirely right that the department should understand its shortcomings and plan how to make sure they don’t occur again. Audit is a key way of providing information to support appropriate action.

So what a pity it is that a reporter on the Herald and Post, perhaps seeing himself as a latter-day Bob Woodward, got an article on the front page of the paper denouncing the cases that went wrong, such as the two patients discharged with cannulas still in place, or the dementia patient sent home with no-one ready to receive him. These are highly regrettable incidents, but the journalist might have mentioned that the problem discharges are a tiny proportion of the total, less than one in a hundred, and that the hospital has an exemplary record of handling discharges.

The press lives by disclosure.
But sometimes that’s less than helpful
The publicity won’t produce an improvement in service: the hospital was working on that already. Instead, what we’ll see is an increased reluctance to make information available if it can be abused. That can only increase the difficulty of achieving improvement.

Whistleblowers are essential in a healthy society. And the press does indeed owe it to itself, and to us, to live by disclosure. But it would be useful if the press learned that the disclosure of information is a right that comes with an obligation to exercise it intelligently.

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