Charlotte Monro case proves nothing has been learned from Mid Staffs

The comments of Health Secretary Jeremy Hunt following the revelations over patient abuse at Mid Staffordshire Foundation Health Trust sounded good.

"We will foster a climate of openness, where staff are supported to do the right thing and where we put people first at all times," he declared.
The sad thing is that as hospital trusts are squeezed across the country, often at the behest of paying huge private finance initiative (PFI) debts, it seems exactly the opposite is taking place.
Indeed some would argue that what is happening now makes the chances of another Mid Staffordshire situation all the more likely to recur.
Take the case of Charlotte Monro, a union rep who worked at Whipps Cross hospital in east London for the past 26 years.
An occupational therapist and moving and handling co-ordinator, who four years ago received a special award, Monro was dismissed on October 30.
The dismissal followed an investigation that began after she addressed the local Waltham Forest scrutiny committee for Whipps Cross hospital in east London.
The scrutiny committee is a body made up of local representatives such as councillors and other concerned individuals charged with ensuring that local citizens receive the services to which they are entitled.
Monro addressed the scrutiny committee on June 26 2013, only to be told on July 2 that she was being investigated.
The final dismissal was justified on the grounds of bringing the Barts Health Trust into disrepute by speaking to the scrutiny committee and of speaking to staff she worked with prior to the official opening of a consultation on their service.
The trust also dredged up a charge of failing to disclose previous convictions relating to protest activities that occurred back in the 1970s. Monro had been involved in protests against apartheid and for peace in Ireland. This was never regarded as an issue over her previous 26 years of exemplary service.
Upon appeal, the charge of bringing the trust into disrepute was dropped, while breach of confidentiality and the failure to disclose the convictions were upheld. Monro is now planning to take her case to an employment tribunal.
The whole attack on Monro came about after the formation of Barts Health Trust in 2012. In a reorganisation, Whipps Cross, Newham General Hospital, St Bartholomews Hospital, the Royal London and Mile End hospitals were brought together under one body.
Monro tells how when she was dealing with the hospital management at Whipps Cross there was a good constructive working relationship based on respect.
This all changed when Barts Health Trust became involved.
"They were clearly out to get me as a union rep," says Monro, who sees her case as part of a wider effort to destabilise staff generally by creating an atmosphere of insecurity.
At a time when there have been job losses and posts are being down-graded, an action like this warns others who might think about putting their heads above the parapet as to what might happen.
The neutering of union activity in the NHS will also make it less likely that people will speak out. The union is a source of security and support to workers, allowing them when necessary to have the confidence and support to speak out about wrongdoing.
The unions themselves also represent a crucial element of any effective regulation or monitoring process across the NHS.
The role of a union is crucial to any ideas the government may have of fostering a "climate of openness" when people will not be afraid to speak out.
What seems certain is that the staff at Barts Health Trust need that voice. The latest report from the Care Quality Commission on Barts Health Trust says: "Morale across the trust is low, with staff being uncertain of their future with the trust and a perception of a closed culture and bullying.
"Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied. Many only agreed to speak with us if they could be anonymous.
"In the 2013 staff survey 32 per cent of staff reported being bullied. The average score for trusts in England was 24 per cent.
"Staff told us they felt stressed at work and said there were not equal opportunities for career development. This must be addressed urgently if the trust's vision is to be realised."
Of course in the background of this process are the ongoing deficits caused by PFI.
Big trusts like Barts have been created so that there can be economies of scale, making cuts as and when possible.
These cuts are bound to hit patient care somewhere down the line.
Under section 118 of the care Bill going through Parliament, trust special administrators (TSAs) will be free to close, merge or privatise hospitals regardless of doctors, patients or the public.
In the light of the Monro case and other recent developments, maybe Hunt should go back and reread Robert Francis's report into Mid-Staffordshire Foundation Health Trust.
Francis referred to a story of "the appalling and unnecessary suffering of hundreds of people.
"They were failed by the system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety."
The question then is what has changed. Beyond the rhetoric of compassion, the market is being allowed to run riot in the NHS to the cost of staff and patients alike.
The potential whistleblowers who ensured that scandals like Mid Staffs were exposed are being forced out amid a growing atmosphere of fear and retribution.

  * Morning Star - 21/1/2014
* Tribune - 24/1/2014