Posts Categorized: NHS
To Discipline or Not?
April 30 2019
The recent decision of the Solicitors’ Regulatory Authority to strike off Emily Scott, a junior solicitor, for being involved in misconduct while a trainee, only belatedly raising her concerns as a whistleblower after she left, raises, albeit tangentially, the difficult question of when – or if – it is ever right to discipline an employee for misconduct if they are also a whistleblower about that misconduct.
In this case, Ms Scott felt unable to report clients being defrauded by her firm while she was a trainee. She was involved in perpetrating the frauds on the instructions of the partners, the Disciplinary Tribunal finding her conduct to have been “deliberate, calculated and repeated”. It was only after she had left, some two years after the conduct in question, that she reported the fraud to the SRA who then took action against the partners of her firm and, controversially, her. The Tribunal reached its decision on Ms Scott despite accepting that she had been young, a trainee and had been “deceived, pressured, bullied and manipulated” by the partners into both carrying out the fraud and covering it up. The fact that she did not use the confidential route open to her by reporting the matter to the SRA was a factor, as was the fact that part of the conduct involved misleading the regulator when it sought answers.
Ms Scott feels that she has been punished for – eventually – doing the right thing, with the Tribunal refusing to accept her mitigation, even while expressing sympathy for her. It is easy to feel sorry for her: in her first job, anxious to impress, worried about her prospects if she refused or left and feeling bullied. In such circumstances, it is not hard to see how someone can justify to themselves what they are doing and convince themselves that they are still an honest person despite doing dishonest things.
Still, the SRA took the view that a solicitor, even a trainee one, is rightly held to a very high standard and there can be no excuse for dishonesty. Our system of justice depends on its practitioners being utterly trustworthy.
Will such a decision nonetheless lead to unintended consequences? Misconduct is often perpetrated by the most junior employees being made to do something wrong by superiors who seek to keep their hands clean. So it will often be those most involved who have the best knowledge of misconduct which should be reported and stopped. If their own careers will be lost – as Ms Scott’s has been – will this encourage those with the relevant knowledge to speak up? The SRA is, understandably, reviewing its rules in light of this case in order to ensure that it gets that balance right.
Ms Scott was not retaliated against by her employers for being a whistleblower. She was disciplined by a regulatory authority, which has different and wider concerns. Nonetheless, all employers will likely come across whistleblowers who have themselves been involved in bad behaviour and who may seek to protect themselves from the consequences of such bad behaviour by blowing the whistle, sometimes at a late stage when an investigation has already started – or is about to. Ensuring that a whistleblower is not retaliated for speaking up but is not also given a free pass against being disciplined for misconduct requires the most careful of judgments.
But the moral – however harsh it may seem – is that, ultimately, a professional – or someone aspiring to be one – is responsible for their own actions, that they need to do the right thing even if this prejudices their personal position and that acting dishonestly but saying to yourself “I’m not a dishonest person” may be comforting but is still a dangerous self-deception. It is our actions that make us what we are.
Similar considerations arose in the case of Dr Bawa-Garba, a paediatrician convicted of manslaughter over the death of a young child from sepsis, suspended from practice, then struck off and recently reinstated. There are, however, some obvious differences between the two cases:-
- The doctor was open about – and admitted – her mistakes immediately and was convicted in court. The initial medical disciplinary panel felt, however, that it was not just her mistakes which led to the child’s death and that these wider failures were a reason why her additional punishment should be suspension, during which she could do the necessary training to learn from those mistakes and improve her professional competence.
- It was the General Medical Council which sought to strike her off on the basis that her standards as a doctor were so far below those to be expected that she should not be allowed to practise.
- The concern within the medical community at this decision was that this would lead to the wrong consequences, both for doctors and patients. Criminalising individual mistakes would be more likely to lead to cover ups and a failure to learn from problems. It would have a chilling effect on health professionals’ willingness to be candid about errors and thereby learn what to do better next time. There was also significant concern that the wider failings which had been identified – lack of staff, poor supervision, inadequate resources, poor note-keeping by others – were being ignored in favour of placing the blame, unfairly, all on one individual.
- Most obviously, the consequences of the wrongful behaviour were much more serious in the doctor’s case than in Ms Scott’s. Yet it is Ms Scott who has lost her career and the doctor who will continue to practice.
Unfair? Superficially maybe. Is gross incompetence in a doctor less bad than dishonesty in a lawyer? Whatever the doctor’s failings, she was not dishonest; indeed, her very openness about her failings made it easier for her to be convicted and disciplined. A lack of knowledge or competence is something which is capable of being remedied.
Whereas integrity and honesty and the courage to say no when asked to do the wrong thing go to the heart of what it means to be a lawyer. If they are missing or capable of being so easily subverted, what else is there?
And while the work culture in which a person operates matters, often significantly, and frequently needs improving, it should never be an excuse for behaving without integrity.
What Whistleblowers Really Want
June 21 2018
”The real scandal is not that no-one knows. It’s that everyone knows.”
Not said, as you might imagine, about the events at Gosport War Memorial Hospital but about the childrens heart unit at the Bristol Royal Infirmary 30 years ago. And yet, as applicable today as then, despite all the lessons learned (or not) over the years.
There are many aspects of this which will be wearily familiar to those involved in previous NHS scandals (Morecambe Bay, Stafford) and those in other sectors:-
– warnings or concerns raised by junior staff were ignored or hidden away
– senior staff and colleagues were aware but turned a blind eye
– complainants, both internal and external, were treated as troublemakers
– a tendency to close ranks against those raising concerns
– missed opportunities: all too many moments when something could have been said, should have been said but was left unsaid
– retaliation (or threats of it) against staff. They were warned that if people continued to speak out, it could undermine the good work being done. Some staff highlighting concerns faced “a certain amount of ostracisation”
– a culture of deference: both to senior staff and to the institution
– viewing the protection of the institution’s perceived reputation as more important than dealing with its failings.
Sound familiar? The fact that an institution consistently admired by the public could develop a culture quite as bad and – in its effects on people – worse than in less admired sectors (such as banking or the press) shows how widespread these problems are. Unsurprising really. Most people are not heroes and find it easier to take their cues from those around them.
But the most shocking (and, so far, least commented on) aspect of this story is that even 12 different sorts of investigations over 27 years failed to uncover the full facts or lead to effective action. How can this be? Well, different bodies with different agendas, powers, without access to all the information and sometimes lacking the relevant skillset do not result in the ideal investigative set up. But in truth, institutions – like most people – do not really want to know about their failings.
So it is all too easy – and sometimes unfair – to criticise individuals for not speaking up (see here a nurse describe her shame at not having done more) and to think that training them to have the courage to do so is all that’s needed. Necessary as this may be, it places too great a burden on them. And lets others off the hook.
Too often the focus is on those who knew but did nothing and on the lessons to be learned but not on the critical bit in the middle – the integrity and thoroughness of the investigation. Without it no-one will come forward and “lessons learned” will be seen as lessons which are never learned by those who need to do so.
“Freedom to speak” guardians (the NHS’s most recent attempt to create a better culture) are a nice idea. But what, really, can they do? What those who raise concerns want is not just the freedom to speak but the knowledge that action will be taken once they have spoken.
What they need above all are trustworthy, fearless, independent and tenacious investigators who will really listen to them and investigate properly. And an institution humble enough from the top down to realise – and really mean it this time – that it is only by understanding its failings and mistakes and learning from them that it can improve for the benefit of those it is there to serve.
Only then can individuals have the confidence to know that speaking up is not just the right – but the professional – thing to do. And that it will not be in vain.