The end of a challenge, or just the beginning?
BBC News
Was it worth it?
Back in June Alice Figueiredo’s parents were interviewed at the end of a 10 year battle to establish why their daughter had died in Hospital. Their immense pain was obvious. They had suffered personal, professional and financial loss - both had left their jobs to work full time on Alice’s case, and twice they had sold their home to fund litigation.
The trial of NE London NHS Foundation Trust (NELFT), and the Ward Manager Benjamin Aninakwa, lasted 7 months. The Trust and the Ward Manager were found guilty of health and safety failings, with the jury deciding that not enough was done by NELFT, or Aninakwa, to prevent Alice from killing herself. NELFT was cleared of the charge of corporate manslaughter, and Aninakwa was cleared of gross negligence manslaughter.
This week Judge Richard Marks KC handed out sentences to NELFT and to Mr Aninakwa. NELFT were fined £560,000 plus costs of £200,000. Aninakwa received a 6 month prison sentence, suspended for 12 months, and was ordered to undertake 300hrs unpaid work in the community. Judge Marks took into account the 10-year delay in the case in his decision to suspend Aninakwa's jail sentence.
Those like the Figueiredos who challenge the system experience career loss, financial instability, and psychological trauma. Alice’s mother Jane said ‘You can't underestimate or even find the words to say, the toll that that takes on you. It's profoundly re-traumatising’. No victory could have removed the pain that devastated Alice’s parents but the not guilty verdicts on the manslaughter charges must have been a bitter pill for them to swallow.
After the verdicts their focus was on the potential positive impact of Alice’s case, with Jane hoping for changes to psychiatric care. ‘You need to do far, far better to stop failing those people who you have a duty of care to’, she said.
Why do organisations resist challenge?
It is reasonable to think that concerns raised by employees and the families of patients would be investigated, and appropriate changes made to improve care and patient safety. However the default position of most organisations is to prioritise self-preservation. Employees who raise concerns are often dismissed, targeting the messenger whilst ignoring the message. Organisation leaders have anxieties about loss of control and Financial liabilities. It is easier for them to fight the challenger than to change the organisation.
NHS Trusts make accountability difficult. Complainants face delays, incomplete disclosure of information and inadequate internal processes which seek to justify individual and institutional failures. For those who persist, the calculation is relatively stark. Challenge rarely benefits the challenger but might improve the system and, in the NHS, the standard of care.
The Figueiredo family emphasised their fight was about ‘justice, truth, and accountability – not vengeance’. Many feel a compulsion to ‘prioritise truth over corruption’ even if that comes at considerable personal cost, and even if it brings little if any personal benefit.
Is challenge worth the trauma?
It clearly takes a special person to follow the path of the Figueredo family. But those who challenge also drive reforms, including improvements in hospital safety and corporate accountability. We should cherish and support those who persist; they benefit all of us.
In sentencing Aninakwa, Judge Marks said in relation to his failure to prevent her death by suicide in a communal toilet ‘I am in no doubt that there was a complete failure to adequately assess and manage the risk that this posed’. Aninakwa also failed to address ‘major concerns’ of Alice's mother which should have ‘rung major alarm bells’. He went on to comment ‘You knew that she was suicidal - she was the only patient on the ward that was. Your negligent breach of duty went on for weeks’.
Judge Marks concluded that ‘Whilst you regret Alice's death you have no real insight into what you did wrong. I find the fact you clearly remain in a state of denial very troubling’. What is particularly inexplicable in the Figueiredo case is that despite his criminal conviction Mr Aninakwa continued to work for NELFT. Aninakwa has said he plans to appeal against his conviction for failing to take reasonable care for the health and safety of patients. He had previously declined to give evidence in his defence at his trial.
During these past 10 years NELFT resisted the attempts of the Figueiredos to find out the truth. They obfuscated, delayed, provided incomplete information and conducted internal reviews that papered over their inadequacies. They finally subjected the Figueiredos to a trial, which they then defended at huge public expense rather than admitting guilt for their errors.
Today the reaction of Paul Calaminus, the new Chief executive of the trust was to say that NELFT was ‘deeply sorry, both Alice's untimely death and for everything that her family and friends have had to endure over the last decade’ but caveated this by saying that the fine imposed by the Court may impact on services. The ultimate irony in this statement is surely that engagement and dialogue 10 years ago would have had a much greater impact on patient services at much earlier time and with less personal and financial cost than a 7 month trial.
Conclusion
For those who put themselves in the crosshairs, the choice between bearing unsustainable personal costs or to walk away and allow harm to continue, is agonising. The case of Alice Figueiroa demonstrates the grim reality that systemic change often demands individual sacrifice. Even after these sentences, will there be any meaningful change?
It may be that in your professional life, you have felt it necessary to challenge the system, including becoming a whistleblower. If so you will probably feel unsupported, undervalued, and probably marginalised by your colleagues.
If you are at odds with your employers, and feeling unsupported, please seek help from an Executive Coach who can help you navigate thought these difficult times. You can book a free no obligation 30 minute on-line conversation with me here. If I am not the right Coach for you, I will recommend somebody else who might be.
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