Category Archives: Gagging

Don’t believe we are rationing? Do you believe in transparency and honesty? Why not use the correct word?

Just in the last few days these news items reveal the truth. Despite this the “R” word can never be acknowledged by politicians. None since Enoch Powell has embraced the truth. (Described by Richard Smith, former BMJ editor as “the best book written on the NHS”. A new look at medicine and politics: 1975 and after. Pitman Medical 1976. 2nd edition. ) 

Link to his book published by the Socialist Health Association

Why do you think we had no PET scanners until 20 years late! Why are there waiting lists longer than any other G7 country (and the results to match)? Why have the two countries that emulated the original NHS reconsidered? (NZ and Scandinavia). Why are we only appointing 1 doctor for every 10 who apply and have been encouraged to do so by their careers officers? Why are botched operations so commonplace?  Why does the NHS Ombudsman produce reports which have no notice taken? Do the politicians read these reports?

If you believe in honesty and transparency why not use the correct word? We will never win the hearts and minds of the health service staff if politicians and media and public collude in the language of denial.

Henry Bodkin in the Telegraph 14th September 2019: NHS bosses tried to “gag” father of boy whose life was ruined in botched operation

In The Guardian 30th August 2019 Dennis Campbell: ‘Crumbling’ hospitals putting lives at risk, say NHS chiefs  –  Four in five NHS trust bosses in England fear Tory squeeze on capital funding poses safety threat

Why cannot Cheshire recruit enough GPs? Pulse reported by Lea Legraien 14th September

Why do we still get fraudulent managers promoted (The Independent 19th December 2018)

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

This is particularly important for Pembrokeshire and West Wales as we have a long distance over difficult roads to travel to Swansea at present. Our planned new Hospital, wherever it is, needs Radiotherapy, Radio Isotope Investigations, and STENT treatment for Coronary Heart Disease if our options are to be the same as those in more favoured areas. I reproduce the article at the bottom of this post.

Adam Shaw for the Harrow Times reports 13th September 2019: North-West London CCGs dismiss claims of “rationing” services.

Kat Hopps September 13th in the Express reports: IVF: How NHS IVF treatment is unfair postcode lottery and keeps couples childless

A disgrace and a shame on politicians: “Surge in patients raising own cash for amputations”. Rationig by waiting and by incompetence.

Pembrokeshire Oncology cancer services in crisis

There is a “need to put doctors in charge and force them to take account of patients’ views. Cancer survival rates are (just) one of the prime examples of NHS mediocrity.”

Desperate NHS needs a desperate remedy – care is already rationed

The 3 myths of the NHS…..& …No learning from other countries – no co-payments, and more scandals..

Britain ranked last (out of 20 rich countries) by a wide margin in the number of CT and MRI scanners per head of population. Australia has six times as many CT scanners per head, and spends roughly the same as Britain on healthcare overall as a share of GDP.

Why are half of the 4 health services’ trusts using out of date radiotherapy equipment? ( Andrew Gregory in The Sunday times 15th September 2019 )

Almost half of NHS trusts are using outdated radiotherapy machines that are far less effective at killing cancer cells to treat patients.

The revelation comes days after the UK came bottom of an international league for cancer survival rates in The Lancet Oncology journal.

In 2016 the NHS said it was investing £130m in upgrading radiotherapy equipment but the figures, revealed via freedom of information requests, found 46% of trusts are still using outdated linear accelerator (Linac) machines beyond their recommended 10-year lifespan.

Dr Jeanette Dickson, president of the Royal College of Radiologists, said more advanced radiotherapy techniques enable “greater precision when targeting specific tumours and have been shown to be less harmful to surrounding tissue than older types of radiotherapy, depending on the complexities of the cancer being treated”.

Rose Gray, policy manager of Cancer Research UK, said it was “deeply concerning” to hear outdated radiotherapy machines were being used.

She said: “The NHS has grappled with the question of how best to replace outdated equipment for many years, and the government has repeatedly been urged to put a long-term plan in place.

“But . . . that still hasn’t happened. These investigation findings prove the urgent need for a solution to this persistent problem.”

In total, 57 of the 272 Linac machines used this year are 10 or more years old. One of them that is still in operation has been used for 17 years.

Dr Peter Kirkbride, the former chairman of the government’s radiotherapy clinical reference group and spokesman for the Radiotherapy4Life campaign, said: “That radiotherapy has been put on a lower footing than other cancer treatments — such as chemotherapy — by successive governments is an open secret within the NHS.”

The Liberal Democrat MP Tim Farron, chairman of the all-party parliamentary group on radiotherapy, described the figures as “shocking”.

He said they proved the investment in 2016 had been a “drop in the ocean” when compared with what is required to meet soaring demand.

Saffron Cordery, deputy chief executive of NHS Providers, which represents hospitals, added: “What we do know is that for year after year, money earmarked for capital investment has been siphoned off just to keep services running.”

An NHS spokeswoman said 80 radiotherapy machines had been upgraded since 2016 and patients were benefiting from “a range of improvements” to cancer services.

Enoch Powell 4 Supply and Demand – Rationing

 

GPs told to stop closing for half-days . Corporate bullying and breaking contracts unilaterally will not “gag” self employed GPs.

The contract between an independent GP as a self employed practitioner, and the state is a written one negotiated by the BMA. Some practices are large enough for there to be no half day closures, but some are not. This “instruction” is illegal, and should be ignored and challenged in court. (By the BMA). However, there is a problem with single handed practices, usually either in distant rural locations, or in city centres. GPs, mainly female appointments since 2000, are NOT an emergency service any longer, and their contract states this. Many GPs work part time to accommodate family commitments. The idea of the instruction is to free up appointments; I know of no GP who is not exceeding his contractual commitment, but it is very possible that corporate bullying of this nature will mean they start working to rule. It is not the professions fault that there are too few bodies at the coal face. Even today, when Medical Schools are trying to train more, there are 10 applicants for every place. Why not appoint on criteria rather than competitively…. Overcapacity might result in rather more appointments but it will take a decade. It is the perverse incentive to save money and plan for only the next four years, rather than empower good manpower planning, which has led to this situation. Government has been in denial of it’s own part in the mess that is General Practice today for at least 6 years… The corporate culture of Hospital bullying will not work in General Practice.

Exclusive: Doctors are ordered to stop halfday closing at surgeries …
Daily Mail19 Aug 2019

Anviksha Patel reports in Pulse 0n 19th August: GPs told to stop closing for half-days or risk losing £40k in funding

GP practices have been warned to stop closing for half-days or risk losing £40,000 in funding, according to new plans by NHS England.

The plans to withhold funding come as figures show over 700 practices in England regularly close for part of the working week, according to findings from the Daily Mail…..

….Figures show in 2018/19, 722 practices were shut for part of the week, 197 of which initially did not declare they were closed for a half-day. Additionally, 38 practices reported their total opening hours amounted to fewer than 45 hours per week, lower than the contracted 52.5 hours per week.

The BMA has said instead for ‘threatening’ GPs by reducing their funding, NHS England must address the GP recruitment and retention crisis as a solution to ‘lasting improvement to patient care.’

BMA GP committee chair Dr Richard Vautrey said: ‘It is disingenuous for NHS England to be so categorical in claiming they know exactly how many more appointments would be available if practices changed their opening arrangements….

Richard Ault in Stoke on Trent live 23rd August reports “North \Staffordshire GPs ordered to end half-day closing.

Orders issued to GPs to end the practice of half-day closing have been slammed as ‘political nit-picking’ by a leading North Staffordshire doctor.

NHS England says more than a quarter of a million GP appointments will be available when surgeries end the practice of shutting midway through the day…

In future, as part of the NHS Long Term plan, practices will have to seek permission from local health authorities to shut during working hours or risk losing funding worth more than £40,000 per business……

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Pulse 29th September 2017: Extended GP opening has ‘no immediate correlation’ to A&E … –

Sofia Lind in Pulse 27th October 2013: Longer opening hours needed

 

 

Whistleblowing Champions – in Scotland only (for now). Apply through NHSreality, or Holyrood.

With permission (I assume) from Peter Gregson in Scotland, I can publicise the new Whistleblowing Champion, in Scotland only for now, then apply for the job through the link below. The other 3 UK dispensations may follow suit, but you never know: after all there is no National Health Service any more, except for emergencies. Congratulations to Pete for getting this success… Now we need to measure outcomes, especially longevity in post and unemployment rates..

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This is Pete’s e-mail to me:

Here is the video of the event at Holyrood  –  www.tinyurl.com/blastvid

It lasts 90 minutes, but I think it’s good stuff.

The PA to the Health minister Jeane Freeman has asked for the link and says he’ll send it onto Jeane. I’d be impressed if she watches it.

I will send the link to the members of the Health Committee.

One of them, Alex Cole-Hamilton (LibDem) has asked to meet Rab and I. That should happen before the end of July.

Would any of you be interested in a new job? These are paid Whistleblower Champion posts.

https://applications.appointed-for-scotland.org/pages/job_search_view.aspx?jobId=1674&JobIndex=1&categoryList=&minsal=0&maxsal=150000&workingPatternList=&keywords=&PageIndex=1&Number=4

Finally, if you know of anybody who wants to log a whistleblowing concern with us, give them this link www.tinyurl.com/scottishNHSwhistleblowers  We’ll make sure the new Independent National Whistleblowing Officer, Rosemary Agnew, takes note.

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NHS Scotland must tackle bullying problems ‘head-on’ – Dr Lewis Morrison for the BBC News 25th June

Third high-level resignation from NHS Highland board in as many .. NHSH vice-chairwoman Melanie Newdick .Press and Journal 16th July

Surge in calls to Scotland’s NHS whistleblowing hotline – 19th April

Holyrood: NHS Whistleblowing champions ‘can come straight to me’, says Jean Freeman October 2018

Non-executive Whistleblowing Champions – NHSScotland – Apply here

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Tere is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

GP list sizes in England can be found here. 

Standards are falling in most areas because of the pressure of work both in Hospital and General Practice. Occasional well respected and popular training practices are the least under pressure. In social care standards are also falling, and one inspector (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission. He should be listened to, as there is a toxic culture, and disengagement everywhere in Health and Social Care. Of course there will always be examples of individuals who break the mould, but in general NHSreality says it as it is. The Times report is below..

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Mary MacCarthy in Pulse December 2018: Cappling GP lists would make GPs and patients safer: 

Nick Bostock in GPonline 12th December 2018 reports that since 2004, there has been a 50% increase in GP list sizes.

and earlier that year, he reported with Teni Oluwunmi  that the number of GP practices had declined by 263!!

and last year, according to the Mail by 138

Emma Bower for GPonline 5th June 2019 also suggests that Scotland needs a new target for the GP workforce. With increasingly elderly population with multiple pathologies and complexity, 15 minute appointments are also needed. (BBC News)

Anal Carcinoma needs prevention with HPV vaccine? A nurse comments on her own illness…in Healthonline

Research in the US has discovered what the drug manufacturers should have found: drugs for shrinking enlarged prostates cause delay in the diagnosis if the prostate goes malignant. Another case of Big Pharma and overtreatment.

Barry Stanley-Wilkinson gives his exit interview from the CQC. (Greg Hurst reports in the Times 13th June 2019) has quit citing a toxic culture in the Care Quality Commission.

Waiting lists are getting longer, even for cancer diagnosis and treatment. Nick MacDermott in the Sun12th June 2019 so keep up the private insurance payments as long as you can, especially if you live in Wales.

An inspector whose report highlighting failings at a scandal-hit hospital was never published resigned from the regulator, protesting that some of its staff were too close to the private company that ran the hospital.

Barry Stanley-Wilkinson also complained of a “toxic” culture at the Care Quality Commission and said many of its inspectors felt that they worked in a “bullying, hostile environment”.

Mr Stanley-Wilkinson resigned six months after he led an inspection in 2015 of Whorlton Hall, a private hospital in Co Durham for adults with learning disabilities or autism. Police arrested ten carers at the hospital last month after Panorama on the BBC broadcast footage of staff appearing to mock and intimidate patients.

The inspector reported in 2015 that some patients had accused staff of bullying and inappropriate behaviour. He said patients did not know how to protect themselves from abuse and recommended that the hospital should be given a rating of “requires improvement”.

His report was never published and a new CQC team that inspected Whorlton Hall in 2016 gave it a “good” rating. Mr Stanley-Wilkinson’s resignation email, sent to the CQC in January 2016, was published yesterday by parliament’s joint committee on human rights, which took evidence from two CQC executives. He expressed frustration that his report on Whorlton Hall had not been published “despite significant findings that compromised the safety, care and welfare of patients”.

He referred to a complaint about his report by the hospital, which was then run by the healthcare company Danshell, and pointed out that it had previously been run by Castlebeck, which ran Winterbourne View, a care home where there had been an abuse scandal in 2011. Whorlton Hall was taken over by Cygnet Health Care this year.

“I am concerned about the relationship managers have had with the service,” Mr Stanley-Wilkinson wrote. “Discussions had taken place without my involvement despite me being the inspector.”

Paul Lelliott, deputy chief executive of the CQC, said the 2015 report had had inconsistencies and lacked evidence. Ian Trenholm, its chief executive, said the CQC planned to develop a new way to monitor institutions.

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Scottish Highlands: Bullying continues as endemic

 “Last year, a group of senior clinicians claimed there had been a culture of “fear and intimidation” at the board for at least a decade.” What is needed is exit interviews on all staff, in all four dispensations. Hundreds of staff may have been harmed by bullying and harassment in NHS Highland BMJ 2019;365:l2166

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BBC News reported 9th May: ‘Hundreds’ faced bullying at NHS Highland

The review led by John Sturrock QC said staff had described suffering “fear, intimidation and inappropriate behaviour at work”.

Concerns raised by a group of clinicians prompted the review.

Health Secretary Jeane Freeman apologised and said other health boards should learn lessons.

At Holyrood, Ms Freeman said the culture at the health board had been unacceptable, and she supported the review’s recommendations.

These include educating all staff on the effects of bullying and providing a “properly functioning, clear, safe and respected wholly independent and confidential whistleblowing” mechanism.

NHS Highland runs services in Argyll and Bute, and another recommendation was that a separate review be done of the “functioning of management” in this area, partly because of its geography……..

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Peter Gregson in an email to me asks “if only the BBC could take it up” and it has but it wont be sustained:

The Minister has not changed position on anything relating to whistleblowing apart from in one regard. In future she will choose the whistleblowing champions in each board herself. Therefore if any particular champion is getting nowhere with any particular board they just go to her for help. Simples!

She rejects the idea of a whistleblowing hotline again, but gives no indication as to how any whistleblower might be assured that somebody somewhere will register their concerns. “We believe that it is right that Boards, as employers, have the responsibility to initially respond to a concern and that this is key in improving local culture. Where a whistleblower remains concerned about a Board’s approach they will have the ability to raise the issue with the INWO”. [Independent National Whistleblowing Officer].

So we continue to be lumbered with the useless PCAW helpline, the use of which continues to fall. (I calculated in my last email to MacDonald that our helpline sees one-twentieth of what we should be seeing, if conditions in hospitals here can be compared to England [if you missed that, see www.kidsnotsuits.com/nhs-staff-whistleblower-hotline-parliamentary-petition])

How will she know when whistles are blown? Through annual “Duty of Candour” reports from each Board. Which at the moment are not standardised, so for at least the next year, Boards can say as little as they like.

It feels to me that she and her Dept have learnt little from the recent Tayside and Highland shenanigans.

If only we could get the BBC to take up this matter.. Any other ideas?

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Whistleblowing protection is important, but exit interviews that prevent the need for whistleblowing are more important.

Whistleblowing protection is important, but exit interviews that prevent the need for whistleblowing are more important.

Clare Dywer in the The BMJ reports Whistleblowing: Government tries again to ban “gagging clauses” in NHS BMJ 2019;365:l2052

England’s health secretary has revived the government’s unfulfilled 2013 promise to ban non-disclosure agreements in the NHS. Clare Dyer considers the legal implications and hears why NHS whistleblowers are often still fearful of recriminations

Matt Hancock is “determined” to end the use of gagging clauses that stop NHS staff speaking out. The health and social care secretary for England told the Daily Telegraph last week that whistleblowers provided “a vital and courageous service” for the NHS.1 “Settlement agreements that infringe on an individual’s right to speak out for the benefit of patients are completely inappropriate,” he added.

The determination to end the use of non-disclosure agreements that ban staff from airing patient safety issues is not a new one. Back in 2013 Hancock’s predecessor, Jeremy Hunt, announced that the “era of gagging NHS staff from raising their real worries about patient care” would end,2 after Robert Francis QC called for such a ban in his report on widespread failings at Mid Staffordshire NHS Foundation Trust.3

Yet only days before Hancock spoke, lawyers for Sue Allison, a radiographer who signed a settlement agreement after raising concerns about missed cancer diagnoses and standards of care in a breast cancer unit, were arguing that her agreement should not prevent her bringing a whistleblowing claim. A judge ruled that the agreement, which she signed in 2015 without legal advice, was invalid. Her case that she suffered a detriment as a result of blowing the whistle will now go ahead.

In the wake of a series of scandals over poor care in which staff failed to blow the whistle for fear of reprisal, the NHS has been aiming for a culture of greater openness. Guidance on the duty of candour requires trusts to explain honestly to patients when something has gone wrong with their care, and the Care Quality Commission now inspects providers on their compliance with the duty of candour, as well as other aspects of their care.

Every trust is required to appoint a “freedom to speak up guardian,” and the National Guardian’s Office said in its first report in November 2018 that more than 7000 workers had contacted the local guardians.4

Gagging clauses still widespread

But use of settlement agreements with non-disclosure clauses is still widespread, says Arpita Dutt, an employment solicitor who has acted for several NHS doctors. The law makes it clear that a settlement is unenforceable unless the worker has had legal advice and that a gagging clause cannot stop an employee making a “protected disclosure”—passing on information, for example, revealing a criminal offence or danger to someone’s health or safety.

Guidance from NHS Employers, updated in February 2019,5 recommends a clause making it clear that nothing in a non-disclosure agreement will prevent a worker speaking up about concerns relating to the quality or safety of care. “This includes, but is not limited to, matters relating to patient safety, bullying and harassment, and cultural issues that may affect quality of care or the wellbeing of workers,” says the guidance.

Dutt, a partner in the law firm BDBF, told The BMJ that almost every settlement agreement she had seen in whistleblowing cases contained some form of confidentiality clause. Although the law allows whistleblowers to speak about a protected disclosure, they may be barred from talking about their treatment by the trust after their disclosure and therefore be unable to tell the real story of what happened to them as a result, she noted. “Because of that blurry line, once employees have settled they’re too afraid to jeopardise it by saying the wrong thing in the wrong way.”

Andrew Pepper-Parsons, head of policy at the whistleblowing charity Protect (formerly Public Concern at Work), echoed Dutt’s comments. “When it comes to public interest issues, such as a patient safety concern, no agreement can prevent a whistleblower from escalating concerns to a regulator, their MP, or the media. Where it’s less clear is when a whistleblower wants to raise their own treatment in the workplace as a worrying example of workplace culture. This could be seen as falling foul of a non-disclosure agreement, as it reveals details about the potential claim that is being settled.”

Protect is not in favour of an outright ban on non-disclosure agreements. NHS trust leaders argue that sometimes they need non-disclosure clauses, not to prevent staff speaking out about patient safety but where they are balancing the rights of different staff members who may be in conflict with each other and the trust has a duty of care to staff members whom it still employs.

Dutt acknowledged that settlement agreements with non-disclosure clauses may be appropriate in some cases—for example, if both parties genuinely agree and want to put things behind them and move on. But she said that NHS trust lawyers told her it was difficult to settle whistleblowing cases because “we won’t get authority to settle a whistleblowing case unless there’s a public hearing and we get a judgment.” She added that whistleblowers’ lawyers were told, “If your client can withdraw the whistleblowing element, we can settle the rest of it.”

Dutt doubts that the duty of candour has made any difference to the way whistleblowers are treated, “because the culture of most organisations is still quite toxic against whistleblowers.”

She added, “The first thing trusts try to establish is that you are not a whistleblower at all. Most trusts I’ve dealt with don’t operate whistleblowing policies effectively.”

References

Halfhearted support from Scotland. English Whistleblowers: “promises of protection are repeatedly broken”, meeting hears.

In Scotland the “whistleblower blast” is on 19th June, but there is no funding for the room Peter Gregson needs. For fundraising go here

He ends his message: “Please chuck in a few £. Then I’ll be able to afford to feed my children this month”. The petition is here

and the Scots are also looking at the Independent Contractor Model (GPs) after it has been cleaned out by understaffing and underfunding.

The health services are too proud and mean to contract out their human resources, but this is what is needed, along with a whole dose of repeated honesty, exit interviews, removal of targets, and giving the profession more powers over their own destiny..

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The BMJ opines: Whistleblowers: promises of protection are repeatedly broken, meeting hears BMJ 2019;364:l1482

There has never been a more dangerous time for frontline NHS staff to consider speaking up in defence of patients, a consultant surgeon who lost his job after reporting concerns about an avoidable death has told a meeting on whistleblowing at the Royal Society of Medicine.

All three levels of supposed protection—the NHS itself, regulators, and the law—are failing whistleblowers, Peter Duffy said.

Duffy, who reported his worries to the Care Quality Commission in 2015, won his case for unfair constructive dismissal at an employment tribunal last July. He was awarded £102 000 (€120 000; $135 000), which related to a dispute over pay, not his disclosures.

He told the meeting, opened by the RSM’s president, Simon Wessely, that he had been forced to resign from University Hospitals of Morecambe Bay NHS Foundation Trust in 2016 “for my own protection” and was “unemployed and, it seemed, unemployable.”

Since 2017 he has worked outside the NHS as a consultant surgeon at a hospital on the Isle of Man, living alone, while his wife, family, and friends still live in the Morecambe Bay area. “It really does feel like being two years into a 10 year prison sentence,” he said.

His case showed, he added, that “we have NHS promises of whistleblower protection repeatedly broken, leaders who don’t show leadership, regulators who don’t regulate, guardians who don’t hold organisations to account, and a law which simply exposes whistleblowers to more hate, threats, intimidation, and allegations.”

He said that the law failed whistleblowers in at least three critical areas. First, the whistleblower was the one on trial, not the NHS trust and managers. Second, whistleblowers were “threatened with costs if they don’t drop the case.” Finally, for success in a claim of sacking on the ground of whistleblowing the law demanded an evidential link or “smoking gun” to link the whistleblowing and the sacking. “This evidential link is an almost impossible task, particularly with the NHS conducting a scorched earth policy to evidence right from the start,” said Duffy.

He advised potential whistleblowers, “If you speak up as a group, you are infinitely more powerful. My mistake was to go it alone.”

David Nicholl, consultant neurologist with Sandwell and West Birmingham Hospitals NHS Trust, asked how far the NHS had come since the report of Robert Francis’s Freedom to Speak Up review in 2015.1 “Not very far,” he answered.

Nicholl said that one hopeful sign was that the CQC had fined Bradford Teaching Hospitals NHS Foundation Trust in January for breach of the duty of candour because it had failed to tell a family within a reasonable time that there had been delays and missed opportunities in treating their baby, who had died.2

Peter Wilmshurst, consultant cardiologist at Royal Stoke University Hospital and a whistleblower who has reported several research misconduct cases to the General Medical Council, said that there was an inequality of arms because “the individual can never match the resources of the trust.” He added, “There are no effective sanctions for those who treat whistleblowers badly.”

Several speakers and delegates called for reform of the whistleblowing legislation the Public Interest Disclosure Act, which Duffy described as “full of loopholes.”

Nicholl said, “There are fundamental problems with the legislation. If there’s anything we can do to press on that, it’s absolutely vital.”

David Walker, medical director of the Morecambe Bay trust, said in a statement, “We strongly encourage staff to come forward if they think patients may be in any way at risk, so we can investigate and learn from any mistakes. He added that the concerns raised by Duffy had been thoroughly investigated at the time and that “the employment tribunal found there was no evidence that he was ill treated or suffered a detriment for raising those concerns.”

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