Expertise with integrity

Blowing the Whistle on Whistle Blowing

Public questioning of the referee is on the up. More than ever, the general game plan is one of transparency and fairness. This relegates institutions like the church, the NHS, FIFA and even our old favourite auntie the BBC, to the shameful side-lines of the sin-bin. Surely it’s about time the General Dental Council (GDC) shook up its game play?

Playing off-side…and getting away with it

I’m nearing full time on my 40-year career in dentistry, yet at no point have I felt that whistle-blowers are given any meaningful protection as they try to protect the public. There is an enormous disconnect between policies that encourage whistle-blowers and what actually happens in practice. I’ve seen a lot of off-side play in my time, with bullying and intimidation the normal reaction to practitioners who seek to speak out.

Like Margaret Hodge MP, who chairs the Public Accounts Committee, I believe we should have real sanctions in place to support the whistle-blower against bullying, harassment and intimidation.

Yellow card, red card

Today, it’s rarely in the best interest of an associate dentist, hygienist or therapist to blow the whistle on a principal dentist. They risk scorn at best, and losing their position at worst. Either way, the mental stress in itself can see them off the team.

I find it morally challenging that a young consultant anaesthetist at the Bristol Royal Infirmary (BRI) found himself having to leave the UK for a foreign transfer to Australia after he persisted in reporting the death rate of the hospital’s paediatric heart patients. He had been told, in no uncertain terms, that his career in the UK was finished if he went public. Naturally, his report caused immediate public concern.

What happens in the chair stays in the chair

As a long-term expert witness, I found myself reporting to various instructing solicitors on a string of cases brought against one particular colleague of mine. This pattern continued for a concerning period of some six or seven years.

The clinician in question was a senior consultant in one of the surgical specialties, with hospital and private practices. I found the issues against him quite indefensible. His treatment deviated widely from established surgical protocols and repeatedly resulted in significant and permanent cosmetic, functional and peripheral neurological problems.

Watching from the sidelines

Casually and in confidence I asked a colleague who worked in the same hospital, if he had come across any problems working with Mr X. He quickly replied: “Oh yes, I’m always picking up the pieces of his debris”. Nothing more was said until yet another file landed on my desk for a case against the same defendant.

With escalating concern, I asked this same colleague – with whom I’d shared a London office during our junior hospital training – if he would support me in voicing my concerns to the Royal College of Surgeons. Specifically, I asked if he would contribute to and countersign a letter.

Taking sides

His response was an emphatic “No”. He didn’t want to “make waves”. Incidentally, my old friend was a highly ambitious young politician who had just been given the prodigious appointment of clinical lead at a very early age. His strategy was to join the board of the Royal College; an ambition which we both knew would have been swiftly dropped had he added his signature to my letter.

Personally, my only agenda was to avoid the public arena while questioning the fitness of a key player. Whatever happened to the ‘three wise men’ who worked highly effectively when I was a young surgical trainee in hospitals, who protected patients when colleagues went offside for whatever reason?

Moving the goal posts

In terms of this particular unsettling colleague and defendant, I found myself having to wait for him to retire before I could consider patients were safe. So, have things progressed?

Institutional gags that never amuse

GDC guidance 9.1.3 states: “You should not publish anything that could affect patients’ and the public’s confidence in you, or the dental profession, in any public media, unless this is done as part of raising a concern”.  Surely, though, any issues raised could lead to concern and a loss of public confidence? Who decides whether an issue undermines public confidence versus one which raises public awareness and has just cause for concern? I myself do not know where the boundaries are, so who gives the GDC the right to be the executive decision-makers? Let the public decide. In essence, I consider this guidance a gagging order.

Then there’s the issue of expert witnesses who are effectively gagged by their instructing solicitors, because even if the expert’s report contains major concerns about treatment provided by a colleague, the solicitors retain the intellectual property of that report. This was the case when I expressed my concerns about the number of times a particular colleague had to defend himself against legitimate malpractice suits. If I was to blow the whistle in these particular circumstances, I would become a defendant myself, losing all further referrals for report writing and the income that entails.

Scourge the scourgers and score

It’s about time we had real accountability from within the GDC, which has developed an almighty credibility issue. When the Professional Standards Authority (PSA) published its damning December 2015 report into GDC whistleblowing, the British Dental Association (BDA) immediately called for Bill Moyes’ resignation as GDC chair.

The report demonstrates an ongoing crisis of governance and oversight at the GDC, listing a catalogue of failings by the GDC chair and Investigating Committee. BDA chair Mick Armstrong said:

“The BDA has consistently argued that the GDC is out of control and unaccountable… The chair… has failed to grasp that a fundamental prerequisite for good regulation is accountability and transparency. As this report shows, he has a disregard for his peers and is not open to scrutiny by the council. This is a disservice to both the profession and the public.”

For the sake of profession and the public, I sincerely hope the GDC takes a stern look at the rules of the game.

A game-changer: punish the bullies

The sad truth of it is that the only way we can protect whistle blowers is to punish individuals and institutions found to be bullying or harassing them. Labour MP Margaret Hodge, who chairs the Public Accounts Committee, said: ‘I think it is really important that there are proper sanctions in place in an organisation so if someone does blow the whistle, they are properly supported, and if anyone dares bully or harass them, they are not only reprimanded but punished.’

The final whistle

At the minute, everyone seems to be playing the same game but with different rules. Maybe it’s time for a dental TMO? I’m blowing the whistle on this one.