the case. Dr Stephen Bolsin, a consultant anaesthetist at Bristol Royal Infirmary,
spent five years trying to draw attention to the problems with the paediatric cardiac
surger ydeliver y. In light of such concerns the 1998 Public Interest Disclosure Act
was passed to enable employees to raise concerns about dangerous or poor
practice without endangering their careers, protecting whistle-blowers from
sacking or victimisation.
Even with legal safeguards in place staff members could feel threatened by
having to report mistakes and accidents to the risk manager [21]. The NHS
Executive has stated that `the results of the risk management process should not be
used for punitive or disciplinar ypurposes' [22]. It also states that the information
given should be kept confidential and that the informant should remain anon-
ymous. Such confidentiality could ensure that the near-miss reporting scheme
could effectivel ycarr yout the stated aims. This would be beneficial to both staff
and patients and would ensure that the ethical aims of CRM schemes could be
realised. As long as the possible fears of the staff are borne in mind b yemplo yers, a
culture of trust could be fostered and non-punitive mechanisms developed for
addressing the concerns of employees.
11.14.2 The bad doctor
Aspecific problem clearl yarises when a health carer is reporting a colleague who is
allegedl yincompetent. This issue has been brought to the fore of public debate b y
the events at the Bristol Royal Infirmary and the consequent inquiry. The GMC's
longest running disciplinar yhearing recorded verdicts of professional misconduct
against three senior doctors. The press reporting of these cases was emotive and
largel yhostile and exemplified the reduced public confidence in the abilit yof the
medical profession to police itself [23].
The General Medical Council stipulates that it is a doctor's dut yto inform the
appropriate authorit yabout a colleague whose performance is questionable:
`You must protect patients when you believe that a colleague's conduct,
performance or health is a threat to them... if necessar y you must tell someone
from the employing authority or from a regulatory body.' [19]The Tavistock Group's statement on Shared ethical principles for everyone in health care' says that all health carers have a responsibility for improving the qualit yof health care [24]. The UKCC also has requirements in their code of conduct that nurses should,report to an appropriate person or authorit yan y
circumstances in which safe and appropriate care for patients cannot be provided'.
The appropriate response to an allegation of incompetence clearl ydepends on
the type of accident or incompetence that is reported. Serious misconduct or
wilfull ydisregarding the welfare of the patient should merit disciplinar yaction.
The issue that is of more concern here is a genuine accident or mistake that the
practitioner did not wilfull ycause. Whether the accident was caused b ya lack of
skill or an inadequate process, these factors should be able to be addressed
without the practitioner facing an yform of disciplinar yprocedure.
One mechanism introduced b yclinical governance schemes to improve and
monitor health care professionals' performance is professional self-regulation.
Clinical Governance 249