I would like to take this opportunity to share a blog with Chris Day and the other junior doctors to talk about ‘whistle blowing’ and what it means. Typically, it refers to people who “speak out of turn”, “wash the dirty linen in public”, “speak indiscreetly to the press”. The generation who feel so upset by such behaviour acquired their ‘values’ in post-war Britain when the poster campaign to stop loose talk was literally a matter of life and death.

Having a hierarchy of communication was important to prevent mis-understandings, to keep things in context and preventing unnecessary alarm in the wider community. But it requires honest people higher up the chain and what happens if the senior surgeon and the chief executive of the hospital are members of the same Masonic Lodge and the anaesthetist who realised there were too many deaths was palmed off? In the end he went to Private Eye and that was whistle blowing.

In 1985 I undertook a survey of British burns units. I visited every one and spent several days interviewing staff and looking at protocols and policies. I was a junior doctor, albeit in those days not a training grade; I was seven years post graduation with four years of plastic surgery under my belt. I presented my findings at the first meeting of the European Burns Association in Groningam, Holland, the same year. My conclusions were simple; the UK had too many burns units. Rationalisation was needed as the number of patients did not justify the current ‘dilution’ of experience and expertise. I must say that time has proved me right and that is exactly what has happened in the UK.

But there was a lady at my presentation. She was called Anne Sutherland. She was a powerful political figure, President of the British Association of Plastic surgeons and also the senior consultant in the Edinburgh Plastic Surgery Unit at Bangour. She wanted to open a new unit in the Edinburgh Royal Infirmary and was presenting figures to the Government to support more financial input into burns and plastic surgery. Also present at my talk, by complete chance I think, was a person from the Department of Health. I had definitely made a major political faux pas and Miss Sutherland quickly made it known to the British contingent that I was an ‘untouchable’. She phoned my boss at 1am saying that I was a disgrace to the UK. I must not be allowed to continue my training and that I had ruined the future of plastic surgery not only in Edinburgh, but also Scotland. (Of note the Bangour Unit did move, but not as Anne wanted, into the Infirmary but even further out of town to Livingstone). I was blackballed and sent into exile. I had no option but to go to America and spend three years as a Research Fellow in Pathology at Harvard University. Living on Joy Street in Beacon Hill. What a gift she gave me. Thank you, Anne.

Fast forward: Director of Burns Services at Frenchay Hospital, Bristol. This was a surgical specialty hospital with a major emphasis on trauma, in particular neurosurgery and burns and plastic surgery. I was putting Frenchay on the international map in the field of burns. We earned a lot of money for the hospital in the days of extra-contractual referrals but there was always a fight with the administration who were deep into ‘creative accounting’ to use ‘my’ money for other things. They were well intentioned, a one-stop breast clinic, for example, but it was the way it was done. I was a single-handed burns surgeon for seven years and we earned plenty enough to fund another colleague. Anyway, toward the late 1990s after exposure of the corrupt cardiac surgeon and his Masonic mate, and the nightmare of Shipman, the medical profession was not doing so well. The nursing profession saw this as an opportunity to exert their political and ideological influence in the management of the hospital and declared in this surgical specialty hospital that they wanted to introduce generic nursing.

I predicated a disaster and a disaster occurred. Even prior to this disaster the chief executive of the hospital had agreed to allow me to present my concerns to the Trust board. I was also targeting a specific manager, Jane Hopes. Days before my presentation to the Trust board I was summoned out of theatre, mid-operation, and taken to the office of the Medical Director, Peter Simpson, Now Sir Peter, and handed a letter of complaint. It was very strangely worded but essentially a student nurse, with no understanding of burns care had complained that I had put the life of a child at risk during a dressing change on the intensive care unit. Curiously, attached to this was a memo from Jane Hopes to the Chief Executive, Anne Lloyd, saying essentially that she had found someone to make a complaint. I do not know to this day if that was by mistake or Peter acting as a gentleman to let me know I was being stitched up. I left the hospital on that bizarre October day in 1998 never to work again in my burns centre.

The MDDUS accompanied me to the investigation of the complaint. Jim Rodgers told me they had nothing. They were, as he described it, fishing. But I was not re-instated. I was offered two years salary to resign but I refused. The months went by and the suspension morphed into gardening leave. I was not told if this was a personal issue or a professional issue so the BMA walked away and so did the MDDUS. After eight months I had to engage help from my own solicitors who wrote a brief note demanding that I be told why I was on gardening leave, threatening a judicial review.

So, with great reluctance, the Trust brought out this very serious complaint that on the night of (date) I was in serious dereliction of duty. A child on the mixed burns and neurosurgical ward became critically ill and the SHO was unable to contact me. As the ‘Consultant on Call’ this was a very serious matter. I was delighted to read this because it was so ludicrously simple to show this was a complete fraud. I had the rotas, there were six consultants and we did a one in six on call. Mr John Kenealy was on call that night but the juniors knew he would never come in, particularly for a burns case. I always told them to try my phone if the consultant on call would not help.

I was not in dereliction of duty but I was very angry. The child who died had all of the clinical manifestations of a child who had aspirated. The neurosurgical nurses gave her a bottle and put her in her mother’s bed and did not monitor her as a burns specialist nurse would have done. An inquest was rushed through whilst I was on gardening leave and unable to attend. Alex Manara, the Director of the ICU at Frenchay gave evidence. He is, or was, an excellent adult intensivist but he was dangerously arrogant. Despite my pleading to transfer Sigourny to the Level III PICU at the Children’s Hospital in Bristol he refused. It was his week on call and he called the shots. He was eventually overruled and the poor creature was transferred to die in someone else’s unit. Alex showed his capacity for self-delusion but saying that the death of this young girl was due to an infection she had brought into the hospital with her. He talked of toxic shock. But it was not the clinical picture and the staph. in her surveillance swabs were a non-toxin producing strain. Perjury would be one description for his dishonesty.

If I had gone to that inquest I would have told the truth and I would have been labelled a whistle blower.

I wonder if any ‘legislation’ can protect the adult equivalent of the little boy who observed that the emperor had no clothes on? When you look at the whistle blowers in the NHS you see a very mixed group of people who find themselves in extraordinary situations. Technically, I have not been a whistle blower but I have been sent into exile twice from the NHS.

Jane Hopes died of breast cancer. Anne Lloyd was promoted out of trouble to NHS Wales. The HR guy was demoted to a small hospital for arthritis in Bath, and so it went on. John Kenealy is, I believe, arrogantly calling shots in his native New Zealand. No barest murmur of a disciplinary action for him. I was replaced by four burns consultants and promised an apology (I received that five years later) and a fiercely negotiated settlement of £36,000, which I have never received. What I did receive was a big bill from my solicitors that the MDDUS should have paid.

I say this to Chris and Johann, do not let this whistle blower ‘protection’ become a divisive issue as it is, and always will be, an illusion.

Andrew Burd (Prof)

The Chinese University of Hong Kong.

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