NHS 'openness' faces first test

THE FIRST test of the Government's call for openness in the National Health Service starts this week when a consultant haematologist begins an appeal against what her health authority said was redundancy and what she describes as the sack.

Helen Zeitlin says the real reason for her dismissal by the West Midlands Regional Health Authority from her post at the Alexandra Hospital, Redditch, in February was managerial irritation over her 'whistle-blowing' on nurse staffing levels.

As a consultant, Dr Zeitlin is entitled to appeal to Virginia Bottomley, the Secretary of State for Health, who in June said that 'staff should have no hesitation at all about coming forward and management must convey the impression that they want to listen'.

On Wednesday Dr Zeitlin, who has worked in the NHS for 20 years, appears with legal representatives before a Professional Committee of the Department of Health. The hearing will be public, at her request, and department lawyers will then make their recommendations to Mrs Bottomley.

Brian Raymond, Dr Zeitlin's solicitor, believes she has a strong case. Witness statements have been exchanged and, as a result of the appeal process, 'a large quantity of hitherto secret memoranda and internal health authority correspondence has been disclosed', Mr Raymond said. Dr Zeitlin will test the validity of her redundancy against this information.

At the time of her redundancy, Dr Zeitlin, who had previously been faced with disciplinary charges, later dropped, was initially given 24 hours to leave the hospital.

Despite Mrs Bottomley's assertions and promise that guidelines would be produced for a procedure by which staff could take their concerns straight to the top of the NHS management executive, the worry is growing that there is more secrecy in hospitals since the changes in the service began in April 1990.

The Royal College of Nursing has taken a stand against 'gagging' clauses in employment contracts preventing staff from going public over their concerns. NHS observers say that the atmosphere of secrecy necessary to provide patient confidentiality has in some places been too readily adopted by new-style hospital managers.

The RCN is receiving 50 letters a month from nurses worried about conditions in their wards or hospitals and too frightened to speak out. These have been sent in response to the RCN Whistleblow campaign and report. 'Usually nurses beg us not to use their names because they are afraid they will lose their jobs,' an RCN spokesman said.

Until the NHS changes, the majority of major decisions were made in public. By law, health authority meetings were open under the Public Bodies Admissions to Meetings Act 1960. Members had to vote to exclude the public and the press.

But the new NHS trusts, which now make up a third of health service capacity, are not subject to the Act. Instead they are required only to hold a public annual general meeting.

The health authorities, the purchasers of hospital and health services on behalf of their local populations, are still required to meet openly.

But Toby Harris, director of the Association of Community Health Councils of England and Wales, said: 'Many are finding their business much reduced and meeting quarterly instead of monthly, or devolving many duties to consortia who make the real decisions - they do not have to meet in public. It is the purchasing, how the authorities decide to apportion money which are the interesting issues and which should be decided in public.'