Confessions of an NHS whistle-blower!

The Flight of the Black Necked Swans: 
The story of a Chilean surgeon who escaped fascism
Milton Pena Vásquez – ukbook publishing.com
Review: By Derek Pattison

In February 2013, the Prime Minister, David Cameron, announced in Parliament that Tameside Hospital Foundation Trust was to be one of five failing hospital Trusts that was to be investigated by a review team led by Professor Sir Bruce Keogh, NHS Medical Director for England. The other four Trusts, were – Blackpool, Basildon, Colchester and Burnley. What all these Trusts had in common, was a higher than expected average mortality ratio – death rate. The number of NHS Trusts that were investigated for the quality of care and treatment they were providing, was later increased to fourteen.

The findings of the Keogh review team which were published in a report in July 2013, led to the resignation of Christine Green, the Chief Executive of Tameside Hospital and Tariq Mahmood, the hospital Medical Director. Among its findings, the report stated that Tameside Hospital had the 7th highest rate of infection for MRSA of 141 Trusts nationally over the three years from 2010-2012 and had the second highest infection rate in the country for Clostridium difficile, over the same period. It also found that:

“The Trust’s clinical negligence payments have significantly exceeded contributions to the ‘risk sharing scheme’ over the last three-years, by a total of £21m over this period.” 

Yet, in spite of its appalling record for mortality, cleanliness and safety, Tameside Hospital managed to obtain foundation trust status in February 2008 (“supposedly the benchmark of excellence”) when death rates were 19% above the average and safety was the “sixth-worst in England” (Daily Mail 30/11/2009). Mrs Green also managed to secure a 17% pay rise which took her salary from £120,000 to £140,000 a year.

The Keogh report may well have delivered the coup de grâce that led to the fall of Tameside Hospital CEO, Christine Green and much of her hospital regime, but it also vindicated the painstaking efforts, of one man in particular, who for over a decade, strove to improve care for his patients at Tameside Hospital against considerable threats and opposition from hospital management. That man, was Milton Pena, a consultant orthopaedic surgeon who spent seventeen years working at Tameside Hospital before retiring in October 2014.

Milton Pena became an NHS whistle-blower in 2005, after speaking out publicly to Rebecca Camber of the Manchester Evening News about the lack of patient safety at Tameside Hospital. In his recently published account of his life as a refugee who fled Chile with his wife and children, following the CIA-backed military coup of the Chilean dictator, General Augusto Pinochet, on 9/11/1973, he says that what led him to become a whistle-blower and to risk his career as an NHS consultant, was “dangerous nursing staffing levels” at the hospital that had put one of his patients at great risk.

Part autobiography, travelogue and detailed diary of his life, working as a doctor at Tameside Hospital, “The Flight of the Black Necked Swans” is a fascinating account of how one young man, more than forty years ago, arrived in England as an asylum seeker and speaking very little English, managed with much difficulty, to obtain a position as a hospital doctor to do a ‘Clinical Attachment’ and eventually to work his way up to becoming a consultant orthopaedic surgeon in the NHS, where he worked for 40 years.

In 1966, aged 18-years old, Milton Pena joined a left-wing university student group called the MIR (Movement of the Revolutionary Left), while studying to become a doctor in the City of Concepcíón, Chile.  A supporter of Dr Salvador Allende, a founder of the Chilean Socialist Party, he participated in protest marches and wrote articles in support of Allende and the Socialist Party and worked as an activist in the coal mining and fishing town of Coronel. His political activities didn’t go unnoticed by the military junta and following the coup, he was detained in the Regional Football Stadium which was serving as a jail and then transported to the infamous Quiriquina Island in the bay of Concepcion, where like many others, he was beaten and tortured and accused of being part of a plan to run clandestine field hospitals, but was eventually released so he could continue working as a doctor. It was while working as a doctor in the town of Mulchén that he was tipped-off that he was about to be arrested and was wanted by the DINA, the National Intelligence Agency. Fearing for his life, he left Chile with his family and fled over the Andes into Argentina. After being interviewed at the UK Embassy in Buenos Aires, the family were granted asylum and entered England at Heathrow airport on 11 July 1974.

Official reports suggest that over 3,000 Chilean citizens were murdered during the Pinochet regime and over one thousand are classified as having disappeared. Some 36,948 were tortured for political reasons during the seventeen-years long   dictatorship and over 200,000 fled into exile.

During his forty- year career in the NHS, Milton Pena worked at various hospital’s - Ascot, Kent, Bedford, Epsom, London, Rochdale and Tameside. But the bulk of this book, deals with his experiences of working at Tameside Hospital in Greater Manchester, which he joined in 1997, after leaving Rochdale Hospital in March 1997.

He started to write to hospital management about understaffing in January 2002. At the time, some nurses were looking after 14 patients or more, which he believed, put patients at risk. He also highlighted the problem of understaffing at a coroner’s inquest in 2002. In September 2003, he wrote to the Commission for Health Improvement (CHI), about low medical and nurse staffing levels at the hospital and the high mortality rates that were one of the worst in the country. In May 2004, the CHI informed him that they had received the Trusts ‘Action Plan’ and would not be launching an investigation.

Although nurses were complaining at the time that observations were not being done on time or being done late, or medication, was not being given to patients on time or pressure wounds and catheters, were not being monitored properly, hospital management denied that there was any link between quality of care and patients dying at Tameside Hospital. Hospital mortality rates were dismissed as misleading - a consequence of how data was recorded, or it was put down to the high level of social and economic deprivation in the area, which ignored the fact that standardization of the figures, factored this in. It was even suggested that something called the “Shipman Factor”, might be the reason for the high death rate at Tameside Hospital as more people were being sent to die in hospital from care homes, following the conviction of the serial killer, Dr Harold Shipman, who practised in Hyde, Cheshire. Indeed, in February 2013, Mr Pena met with the Chairman of the Trust, Paul Connellan, to discuss high mortality rates at Tameside Hospital. The Chairman referred him to an investigation by an external professor in 2012 who he said, had found no links, between the quality of care and patients dying at Tameside Hospital. Mr Pena noted in his diary:

“I mentioned the case of a 70-year-old patient, critically ill with a life threatening condition, who was inappropriately sent from A&E to the Trauma Ward, where he died within six hours. He asked for more information which I will send tomorrow.”

In March 2010, Milton Pena appeared on the BBC Panorama programme to discuss failing hospital Trusts. He stated on the programme that Tameside Hospital did not have enough staff or beds to provide the necessary level of care for vulnerable patients and that one or two per cent of deaths at the hospital, were avoidable. He believed the hospital was in danger of becoming another Mid Staffs. Brian Jarman, Professor of Epidemiology and Public Health at Imperial College, London, told the programme that hospitals had been self-assessing for years and many of them had done so inaccurately. He also added, “Mortality rates should be considered a potential indicator of poor care, with the caveat that statistical errors can occur…”

The CEO of Tameside Hospital, Christine Green, was an ardent believer in “managing people’s perceptions”. Under her leadership which lasted fifteen years, she held to the view that propaganda techniques, vacuous platitudes, and crude publicity stunts such as the “Everyone Matters” campaign and “energising for excellence”, and “I’m writing to thank you”, could persuade people that all was well at ‘her’ hospital. But no matter how many photos appeared on the walls of Tameside Hospital, of happy smiling employees, she couldn’t bluff her way out of everything. One postgraduate medical student, described the hospital in a ‘Deanery Report’, as a “dangerous place” in terms of patient safety, because some locums were perceived as having “significant and clinical language barriers.”  When the hospital Medical Director, Tariq Mahmood, claimed that a recent improvement in the mortality rate at the hospital was due to improvements in care, a hospital ‘Team Brief’ report, claimed that documentation and coding, had played the largest part in the reduction seen. But if propaganda techniques and slick PR stunts, didn’t do the trick, management could always resort to threats and intimidation.

When the local coroner described care at Tameside Hospital as “despicable and chaotic”, the top brass complained to the Office of Judicial Standards, who dismissed the complaint. When the local health watchdog the ‘LINk’, wrote a critical report, the hospital threatened to take legal action against them.

It is clear from reading this book that many nurses and doctors at Tameside Hospital, were afraid to speak out because they feared they could lose their jobs or damage their medical careers, if they went off message or stepped out of line. And this fear of raising concerns and reprisals, wasn’t something confined to just Tameside Hospital.

Dr Stephen Bolsin, (who is referred to in the book), a consultant anaesthetist and whistle-blower, who raised concerns about the high mortality rate of children undergoing cardiac surgery at Bristol Royal Infirmary in the 1990s, maintains that he, “was virtually driven out of the UK by the reaction of some of his colleagues.” Although he knew that he risked being struck off for criticizing medical colleagues, he said:

“In the end, I just couldn’t go on putting those children to sleep, with their parents present in the anaesthetic room, knowing that it was almost certain to be the last time they would see their sons and daughters alive.”

A subsequent investigation found that 29 infants had died unnecessarily at Bristol and two surgeons were found guilty of serious professional misconduct. The hospital’s chief executive, Dr John Roylance, was struck off the medical register for covering up the surgeon’s inadequacies. After resigning his post at Bristol, Dr. Bolsin, applied for other jobs in Oxford, Nottingham and Southampton. After one interview, he was told by a panel member that he was probably not employable in England because people knew that he had raised concerns about mortality rates for paediatric cardiac surgery. Unable to work in the UK, he sought employment in Australia.

Although Milton Pena did not resign his post or lose his job, he certainly came close to it. After speaking to the Manchester Evening News in 2005, he was disciplined and told not to speak out publicly. Later, an investigation was launched into his personal conduct, which came to a sudden and abrupt end – without explanation - after 22 months, following the resignation of CEO, Christine Green, in June 2013. The external investigator, brought in to carry out the investigation, was paid by the hospital, £800 per day, plus expenses and VAT for his work. During this time, his marriage broke down and to cope with the stress and pressure, he took up mountaineering and trekking which is covered in the book.

Although this book is not without its faults, mainly in the editing, it ought to be compulsory reading for any young person intent on embarking on a career in the medical profession. Not only does it give a revealing and honest insight into the internal workings of an hospital and the interaction that takes place amongst the actors who work within it - from the point of view of a senior medical professional and a participant observer - but it is also rare for any medical professional to speak out as Milton Pena has done in this book. Those people, working in the NHS, who have spoken out in the public interest, at some risk to themselves, deserve our praise. I know that Milton Pena never liked being called a ‘whistle-blower' because he always felt that he was just doing his duty as a doctor to his patients. Moreover, while he was aware that understaffing of doctors and nurses on medical wards, put patients at risk, he also knew that this arose largely, because financial priorities, such as balancing the books, were put before the interest of patients. As he says of the NHS generally:

“Cost improvement programmes had to be implemented – which were invariably accompanied by only very perfunctory quality assessments. The internal market led to an increase of employees at every administrative level: business managers, purchasers and procurers as well as accountancy firms, trouble shooters, turn around directors, management consultants and advisers…”

And all this, and the army of senior managers and bureaucrats brought into the NHS by Margaret Thatcher’s reforms of the health service and the Blair, ‘New Labour’ government, had to be paid for by cutting nurses, doctors, salaries, and beds on the wards. The consequences of this, are that patients don’t get cared for properly. They lie in bed in their own urine and faeces, and post-operative observations are not done on time and they don’t get their medication. Likewise, a wrong patient might be put on an insulin drip or given amitriptyline by mistake, simply because of the pressure that medical staff are put under to cope.

Many hospital trusts are now in financial trouble because of PFI schemes and Tameside Hospital is one of them. After the Keogh review in 2014, the hospital was given a government cash injection if £14.3m to the balance the books. The regulator, MONITOR, also pronounced the hospital, “clinically and financially unsustainable.”