Category Archives: Guest

Whistleblowing and gagging update

If Scotland accept the proposals there will be another area of Post Code differential. Peter Gregson in Scotland posts as a guest, and NHSreality hopes that other Regional Health Services will follow (but it will take more than this to change the culture):


I wanted to let you know that the Scottish Parliamentary Petitions Committee will be discussing petition PE1605 this Thursday the 9th February at 9.15am. It will  take evidence from:

·         Laura Callender, Governance and Compliance Manager and Kirsty-Louise Campbell, Head of Strategy (interim), City of Edinburgh Council;

·         Cathy James, Chief Executive and Andrew Pepper-Parsons, Head of Policy, Public Concern at Work;

·         Tam Hiddleston, Secretary, Scottish Healthcare Branch, UNISON Scotland

 The agenda can be downloaded at

I’ll be there, but I won’t get to speak. If you want to attend, book your ticket at

You will also be able to watch it live on Parliament TV here

I’ll circulate the official report and link to the video in about 10 days’ time. (NHSreality will give a link in an update to this page)

 Here’s hoping for a revealing discussion. I think the Petition will be continued after Thursday – the clerk tells me that the Chief Exec of NHS Scotland is due to attend to discuss this but was not free on Thursday – he thinks Paul Gray will likely attend on the 2nd March.


File on 4: Speaking Up – Whistleblowing in the NHS (BBC iPlayer 7th Feb 2017)

…Two years ago the first independent report into the treatment of whistle…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by…

…Two years ago the first independent report into the treatment of whistle-blowers in the NHS was published. The Freedom to Speak Up report was commissioned by the government amid concerns not enough progress had been made to create a more…

Whistleblower Bullying hotline – proposed by petition for Scotland – could be rolled out across the UK

Peter Gregson, who works for the Scottish Health Service (NHS Scotland) has proposed that the Scottish Parliament cover the costs of a Whistleblower Bullying hotline in his i-petition. If accepted then this should be rolled out across the UK. But barriers to acceptance include the trade unions. Peter was asked to leave a meeting in which he was handing out leaflets (see below) recently. ( Peter Gregsons press release. )

whistleblower cartoon

So if we do stay together this could be one area where we improve the culture together. The current system of relying on line managers to back you up, is not good enough.

Whistleblower HotlineHealth workers in Scotland are being blocked from debating whether to support a Parliamentary Petition calling for a whistleblower hotline. It would allow NHS staff to report mismanagement, bullying, perceived negligence, malpractice or ill treatment of a patient by a member of staff.

The Petition PE1605 is shortly to go before MSPs and union support is crucial to seeing it implemented. But all four big health sector unions either won’t support (or won’t allow their members to discuss) the Petition, which calls upon the Scottish Government to establish an independent national whistleblower hotline for NHS staff to replace the current helpline. It would differ in that it would investigate reports about mismanagement and malpractice, often without recourse to NHS managers.

The reason why the unions oppose the measure is because they say they are tied into partnership arrangements with NHS Boards and will do nothing that might undermine that. But it is clear that they have not even discussed the scheme with NHS Management; they have rather instinctively chosen to side with what they think managers will say.

It is unreasonable of them to assume that NHS bosses will oppose a hotline. When a similar approach was made by the same petitioner to Edinburgh Council in 2013 the Corporate Management Team initially opposed it, but now pay tribute to its success. The hotline has been in place since May 2014 and was recently lauded by the Council in its Whistleblowing Annual Report : “Many of the recommendations that have resulted from investigations have led to amendments to policy, improvements to procedures and processes, the development and sharing of best practice and improved service delivery.”


Whistleblower reports are taken by the Council’s Governance Risk And Best Value (GRBV) Committee and have led to numerous improvements at the Council.

The Petition to the Scottish Parliament has been signed by politicians from right across the spectrum. Supporters include MSPs Kezia Dugdale (Scottish Labour Leader); Jeremy Balfour (Conservative Shadow Minister for Childcare & Early Years- who also helms Edinburgh’s GRBV Committee) and Green MSPs Alison Johnstone and Andy Wightman.

It is supported by The UK Patients Association, by Action for a Safe and Accountable People’s NHS (ASAPNHS), the Scotland Patients Association, the NHS Lothian Branch of Unite and Accountability Scotland.

The only agencies refusing to support the scheme are the unions and staff associations…..

Whistleblowing cartoons, Whistleblowing cartoon, funny, Whistleblowing picture, Whistleblowing pictures, Whistleblowing image, Whistleblowing images, Whistleblowing illustration, Whistleblowing illustrations

'And this is Mr Proctor, he manages the hospitals whistleblowing support team.'..


1 in 20 Welsh voters wants to abolish Welsh Assembly Government – and the “One party state”

Wales is funded and founded differently to Scotland. The monies available for Health and Education in particular are less, and this is because of the structure. The Nuffield Trust commented earlier this year. In effect more money would be available for Health and Education under the former regime with a Welsh office. If 1 in 20 want abolition without publicity and media coverage, how many more will vote next time? Turnout was just over 50%.. When will the dying “one party state” of Wales change?

How will abolishing the welsh Assembly benefit the people of Wales ? If readers consider that £350 m is equivalent to one fully staffed new hospital per annum. From waiting times, mortality and morbidity, life expectancy and general standards overall it looks to the professions as if Devolution of Health in Wales was a mistake. How much worse must it get before the voters realise this?


James Cole writes in Walesonline Letters Tuesday 10th May 2016: ‘Abolish’ Party is proving worthy

Thank you one and all who voted for the Abolish the Assembly Party.More than 44,286 votes! Abolish is now the largest party in Wales (in terms of votes) that doesn’t have a seat in the Senedd.

Making a huge gain first time out was clearly beyond reality. However, we got 44,286 votes despite the fact that perhaps most voters were either still unaware of our existence or were, at least, taken by surprise at the last moment. It seemed at times that, apart from the BBC, the Welsh media boycotted our campaign. This, despite the fact that the “No, to a Welsh Assembly” vote in the 1997 referendum received 552,698 votes.

That was 49.7% of the votes cast when only half the Welsh electorate actually voted. So, only a quarter of us actually voted Yes to the Assembly. Hardly a mandate for fundamental change.

I urge everyone to consider the possibility that the Welsh Assembly was not designed for the benefit of the Welsh people, but for the benefit of the career politicians.

They get big salaries, expenses and pensions. What do we get? The bill.

Issues that are perhaps best devolved can be made the responsibility of our local authorities and their 1,265 councillors. That really would be power closer to the people.

We think the Assembly just gets in the way while costing far more than it would take to keep Port Talbot steelworks operating.

We consider our result in this election to be a foundation stone for the fightback. We have drawn a line in the sand.

We will keep this movement going.

James Cole, St Thomas, Swansea


A campaign to abolish the Welsh Assembly will continue

Spokesman David Bevan claimed the assembly benefitted “career politicians”, not the Welsh people.

He said the election result was “a foundation stone for the fight-back”.

The Abolish the Welsh Assembly Party put up candidates on the regional lists, claiming abolition would save the taxpayer £500m a year.

Further info below from the party website

“The cost of running The Assembly is very difficult to estimate. We are tempted to think this is deliberate as the figure would, no doubt, be truly shocking. Now we find that Welsh Assembly members are going to see their salaries increased to £64,000 in 2016. Assembly Cabinet ministers will get £100,000 p.a. The First Minister’s salary is due to increase to near the level of Prime Minister David Cameron, £140,000 pa. The First Minister is only in charge of devolved issues covering Wales.” from the abolishthewelshassembly website

Welsh Assembly Final Budget 2016-17


Components of the Welsh Budget £000s
Departmental Expenditure Limits Resource Capital Total
Health and Social Services      £7,004,269
Local Government  £3,370,622
Communities and Tackling Poverty  £ 707,323
Economy, Science and Transport  £988,747
Education and Skills £ 1,756,578
Natural Resources £ 376,575
Central Services and Administration  £311,897
Total Welsh Government MEG Allocations

Resource 13,159,112 Capital 1,356,899  TOTAL £14,516,011

The amount of funding allocated to Welsh Government Main Expenditure Groups (MEGs) for 2016-17 is £15bn.

Abolish the Welsh Assembly Party

Seats0 Net change in seats Votes 44,286 Vote Share4.4%  




On a turnout of 45.3% Letters Walesonline May 10th  , but no candidates fielded in the constituencies.

The Abolish the Welsh Assembly Party put up candidates on the regional lists, claiming abolition would save the taxpayer £500m a year.

Devolution of health to Wales was a mistake?

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

Patients and the professions are ready to ration health care strategically, without devolution. It’s the politicians and the managers who won’t hear of it because the strategy might mention rationing.

The State of Wales: we should all rage against it dying

Trainee’s portfolio ‘used as evidence against them’ in legal case

The real man smiles in trouble, gathers strength from distress, and grows brave by reflection. Thomas Paine
Article from Pulse magazine once again the opportunity to learn from mistakes will be lost in order to satisfy the thirst for cash for claims bonanza that is going on in the UK. Good luck retaining doctors with this  sort of thing  going on …. We will become the dumping ground for the worlds worst practitioners , man can only learn through experience. LINK TO FULL ARTICLE BELOW

“If you want a vision of the future, imagine a boot stamping on a human face – forever.”  Could be a quote from any tory politician …. but alas not their actions speak far louder than words …


Trainee’s portfolio ‘used as evidence against them’ in legal case
|15 April 2016 |By Alex Matthews-King

GPs must provide ‘honest explanation’ to patients if something goes wrong, says GMC
03 Nov 2014
A trainee’s ‘written reflections’ on an incident in their training development portfolio was used against them in a legal case, which GP leaders have said illustrates the medico-legal ‘minefield’ that GPs are having to operate in.

Health Education England bosses in London and the South East have warned that a recent legal challenge saw a trainee release their reflections – a vital part of a trainee’s portfolio – which ‘was subsequently used against the trainee in court’.

But in a letter to postgraduate deans and training supervisors, HEE said trainees should continue to make particular note of cases where ‘things do not go well’.

It highlights that for trainees the reflection process is exactly the same as for GP appraisal, and that these should avoid patient-identifiable information and focus on the positive lessons learned.

RCGP’s guide to revalidationGP leaders warned that GPs need to take all precautions to not incriminate themselves

The letter from HEE, which was shared by doctor and medical educator Dan Furmedge on Twitter, said: ‘Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in questions about whether trainees should still provide reflection about incidents in their portfolios.

Some words from the USA that strike a chord with Doctors in the UK

Link to original full article below

“The doctor’s autonomy is now nonexistent,” one doctor lamented. “We are being dictated to by insurance companies, hospital administrators, national medical boards, and state medical boards. We are being recurrently credentialed by the same entities. All of this constrains our ability to perform as physicians. We are cogs in a system designed for the maximum profitability. There is no continuity of care, and younger doctors are perfectly happy to work from 9 to 5. Mindfulness training and yoga can’t cure those problems. There has to be mass action to get insurance companies, politicians, and government out of the practice of medicine, and physicians need to take back their responsibilities.”

……… a physician wrote. “The problem is a crisis of professional identity, work overload, powerlessness, and job insecurity. We are responsible for the operational capacity of the system [and] are held accountable for all the outcomes, but have little say in how decisions are made and the direction in which things are going. The only effective treatment is physician independence! The employment model is bad for patients and bad for healthcare costs. Worst of all, it is destroying physicians. Burnout is a symptom, not the problem. We are not suffering burnout. We are suffering because of feelings of helplessness and deep dissatisfaction.”

This applies in  the NHS but with different titles to each of the factors implicated above substitute NICE / NHSE / Jeremy hunt and the DOH / LHB/GMC /    etc etc





Samir Dawlatly: The countdown to the 2020 GP conundrum

31 Dec, 15 | by BMJ

There can be no doubt that the problems facing general practice are complex and interconnected, and that the answers have proved elusive for many. GPs and the organisations that represent them have been very vocal about the obstacles hampering the ability of grassroots GPs to do their jobs safely and effectively: from increasing workload from hospitals (due to increasing patient expectations and demands) to the strain of excessive regulation. These problems and, some would argue, the way that they are discussed openly are probably contributing to the decreased recruitment and retention of GPs…………………

Link above to full article


Non-executive director appointments to NHS Improvement

From the DOH more appointees with little interest in real reform of the health service and probably just a nod towards a gong and a life peerage drawing down expenses from the taxpayer ?

April 2016

Non-executive director appointments to NHS Improvement

Professor Dame Glynis Breakwell, Laura Carstensen and Richard Douglas have been appointed as non-executive directors of NHS Improvement for 4 years from 1 April 2016. Richard Douglas will also have responsibility for chairing the Audit and Risk Committee, a joint committee of Monitor and the NHS Trust Development Authority (NHS TDA).

NHS Improvement brings together Monitor, the NHS TDA and patient safety and improvement functions from across the NHS framework, under one single leadership and operating model, and a single board.

These appointments will involve a time commitment of 2 to 3 days per month. Remuneration for the roles will be at a rate of £7,883 per annum, with the chair of the Audit and Risk Committee receiving £13,137 per annum.

Following changes to regulations (which came into force on 1st April 2016), NHS Improvement non-executive directors have been formally appointed to both Monitor and the NHS TDA boards. As a result, from the 1 April 2016, the following people will also be appointed as non-executives of both Monitor and the NHS TDA, with their time commitment and remuneration for both roles combined remaining the same:

  • Lord Ara Darzi, Lord Patrick Carter and Sigurd Reinton, currently Monitor non-executive directors, will also be appointed to the NHS TDA
  • Sarah Harkness and Caroline Thomson, currently NHS TDA non-executive directors, will also be appointed to Monitor.

These appointments are made in accordance with the Code of Practice for Ministerial Appointments to Public Bodies, issued by the Commissioner for Public Appointments. The appointments are made on merit and political activity played no part in the selection process. However, in accordance with the original Nolan recommendations, there is a requirement for appointees’ political activity (if any declared) to be made public. Professor Breakwell, Laura Carstensen, Richard Douglas, Sigurd Reinton, Sarah Harkness and Caroline Thomson have not declared any political activity. Lord Carter is a Labour Peer. Professor Lord Ara Darzi of Denham is a Labour peer and former Labour Minister.

Professor Breakwell is also a non-executive director of the Student Loans Company and a non-executive director of the Economic and Social Research Council. Laura Carstensen is also a commissioner of the Equality & Human Rights Commission and a trustee of the National Museums Liverpool. Lord Carter is also chair of the Property Advisory Panel and a member of the cross-government Efficiency and Reform Board.

Letter to the Profession from the GMC regarding Junior doctors strikes


Dear Doctor,


The British Medical Association has asked doctors in training in England to take further industrial action later this month, including the withdrawal of emergency cover. The GMC’s Chair, Professor Terence Stephenson, issued a statement on 11 April setting out the GMC’s position. In this he said: ‘Many doctors in training feel alienated, unvalued and deeply frustrated and this extends far beyond the current contractual dispute. There is a pressing need to address these deep-seated concerns.’


Today we have set out the latest GMC advice for junior doctors. This should be read alongside the advice issued on 4 November 2015 and 5 January 2016. We are also making this advice available to all other doctors in the UK as we recognise that there is interest across the profession.


The GMC recognises that there is anger and frustration among doctors in training following the breakdown of negotiations and the decision of the government to introduce a new contract. We have no role in contract negotiations and it would be inappropriate for us to comment, other than to observe that everyone must regret the current situation.


For every doctor affected these are difficult and worrying times and feelings are understandably running high. This advice, which sets out doctors’ continuing professional obligations, is intended to be helpful and sets out the various challenges facing doctors with leadership responsibilities, employers, doctors in training and senior doctors as well as those in non-training roles. We know all doctors will want to do their utmost to reduce the risk of harm to patients and this advice is designed to help them achieve that.


Advice for doctors contemplating industrial action

We ask every doctor contemplating further and escalated industrial action to pause and consider again the possible implications for patients, not only in terms of the immediate action but also in terms of the cumulative impact on patients and the additional risk posed by the withdrawal of emergency cover.


The GMC cannot second guess the situation facing each doctor in training in England – that must be a matter for individual judgement. But given the scale and repeated nature of what is proposed, we believe that, despite everyone’s best efforts, some hospitals may struggle to cope. In these cases where local circumstances are particularly acute, the right option may be not to take action that results in the withdrawal of services for patients.


Any doctor taking action should take reasonable steps to satisfy themselves about the arrangements being made during the period when they are withdrawing their labour. They should engage constructively and at an early stage with those planning for the care of patients during industrial action to make sure that patients are protected. They have a responsibility for continuity and coordination of care, and for the safe transfer of patients between different teams.


If, during the industrial action, it becomes clear that patients are at risk in a local area because of inadequate medical cover, and doctors in training are asked in good faith to return to work by employers, we expect they would fulfil this request. In the event of an emergency, we know doctors in training will always come forward. Where contingency plans are overwhelmed, it is vital that doctors taking action can be contacted and are available to help.


Advice for doctors in leadership roles

Doctors in leadership positions should do everything possible to organise services during the industrial action to make sure that patients are protected, as they have done during the action to date. They should assist employers who will have been preparing for this action and putting in place other options for emergency care.


Although hospitals will inevitably face increased pressure during any period of industrial action, doctors in leadership positions should only call doctors in training back to work where there are genuine and significant concerns about the ability of the hospital to provide safe care to patients.


Doctors who have a management role or responsibility must support their organisations in acting immediately on any patient safety concerns.


Advice for senior doctors and those not in training

Senior doctors and those not involved in the dispute should continue to provide medical care during the industrial action and, as far as is possible, make sure that patients are protected, where necessary providing cover in place of those taking action. They should assist employers and clinical managers who will have been preparing for this action and putting in place other options for emergency care.


Advice for employers

The GMC does not regulate employers but we would expect them to engage with their medical workforce to develop robust plans that protect emergency services and minimise the impact on patients. Where there are concerns about the capacity of the organisation to cope, these concerns should be raised at the earliest opportunity with doctors, including those taking action.


Employers are required to meet our standards in relation to doctors in training. In particular, they should make sure that doctors are supported in the learning environment and given appropriate clinical supervision.


During the industrial action, concerns have been expressed about the design of rotas for doctors in training. We would therefore remind employers, who will be working hard to make sure patients continue to receive safe high quality care during the action, that our new standards for medical education and training – Promoting excellence – require organisations to design rotas that make sure doctors in training have appropriate clinical supervision and minimise the adverse effects of fatigue and workload. Where there are concerns, we expect postgraduate deans to address these with their local NHS Trusts or GP surgeries.





Niall Dickson



Chief Executive and Registrar

General Medical Council



Further information


  • The GMC’s core guidance, Good medical practice, sets out what is expected of all doctors registered with the GMC and makes clear that doctors must use their judgement in applying its principles to the situations they face.
  • The GMC was established by Parliament to act as the independent regulator of the medical profession. As such its statutory role is to set – and ultimately, enforce – standards that protect patients and support medical professionalism. Where doctors are placed in unsafe environments or the support for doctors in training is inadequate, it has a duty to step in to protect them and the patients they serve. This applies whatever the contractual arrangements in place between doctors in training and their employers.
  • The GMC introduced new standards for medical education and training – Promoting excellence – in January 2016. These standards place a range of important obligations on those employing doctors in training including the following requirement:

    ‘Organisations must make sure there are enough staff members who are suitably qualified, so that learners have appropriate clinical supervision, working patterns and workload, for patients to receive care that is safe and of a good standard, while creating the required learning opportunities’.
  • There may be situations where there is a tension between the right to take industrial action, especially when it involves withdrawing emergency cover, and the professional obligation on every doctor to make the care of their patient their first concern and not to do anything which may harm patients. This is the standard that the GMC sets for all doctors through its powers under the Medical Act.
  • There has been widespread commentary on the industrial action through social media. The GMC published guidance for doctors using social media in March 2013. This sets out the need to treat colleagues fairly and with respect, and that the same standards apply to doctors using social media as in any other form of interaction.
  • Following a number of queries via social media, we have issued guidance to doctors who might be asked to cover rota gaps which they feel they cannot safely cover.




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GP trainees up as training acceptances fall

Some good news for General Practice or the realisation by trainees that GP training represents the fastest way to exit the UK’s failing medical education system ?

Link below to full article at Doctorsnet

GP trainees up as training acceptances fall 12 01/04/2016

The exodus of trainees from general practice may have been reversed, according to figures published yesterday.

Mid-year figures, released for the first time, show a very slight increase in take-up of specialist training places in general practice.

A year ago 69% of GP places were filled in the first round of specialty recruitment. This year 70% of places have been filled by 2,296 doctors – a total increase of 152 extra doctors taking up places.

The Health Education England figures show that psychiatry is the specialism that struggles most to attract trainee – just 67% of places have been accepted by 280 doctors. This is also a slight increase of two percentage points on last year.

Emergency medicine also shows a decline in acceptances from 325 doctors last year to 298 this year in round one – a three percentage point reduction in the acceptance rate.

Overall the figures show a small decline in doctors taking up specialty places in round one – some 89 fewer than last year or a three percentage point reduction in acceptances.



By the end of my first year as a doctor, I was ready to kill myself

Link below to another article on physician suicide by the Guardian the author is anonymous ( probably because going public would result in  terminating their career ! )

The UK  what a lovely place to be a Doctor , my advice never let your children become doctors not until there is drastic and wholesale reform of regulation and working practices. (Nudge them into safer careers ).

link below to full article


By the end of my first year as a doctor, I was ready to kill myself

Doctor suicide is the medical profession’s grubby secret – but it’s unclear why some of those dedicated to preserving life silently plot their own deaths