Where’s the care?

The care of doctors-in-training needs change from the top

The BBC adaptation of Adam Kay’s “This Is Going To Hurt” has reignited a key question raised by the case of Dr Bawa-Garba. Who in authority actually cares for doctors-in-training?

Health Education England (HEE) is a key agency responsible for doctors-in-training. Unfortunately, its conduct in the case of whistleblowing junior doctor, Chris Day, doesn’t inspire confidence that it cares for the doctors it’s training.

“Working or partying?” has become a much ridiculed symbol of the technicalities used by powerful interests in order to evade responsibility. But Health Education England has used similar technicalities in Dr Day’s case, not once but twice.

When Dr Day claimed HEE were partly responsible for the derailment of his career, HEE denied liability arguing neither he nor any other junior doctor was technically working for them. HEE lost to Dr Day in the Court of Appeal, later paying him substantial costs when it emerged HEE probably knew junior doctors were working (not partying) with them.

Having failed on that technicality, HEE completed a legal path with similarities to Prince Andrew’s (denial, technicality defences, settlement) by next settling with Dr Day, without admitting liability. Like Prince Andrew, HEE’s key witnesses never took the stand on the most serious issues to do with whistleblowing and safety.

But Dr Day had to bring a further claim after he learnt of covert briefings against him by his former hospital – with the alleged involvement of HEE. Again HEE went for the technicality, asking a judge first to decide: working or partying? In other words, when Dr Frankel wrote the briefings about Dr Day was he partying alone (in recent retirement from HEE) or was he working together (still as HEE’s agent)?

At the recent preliminary hearing (Jan 2022), the judge read how Professor Reid (HEE Medical Director) insisted Dr Frankel was still part of the HEE family, even after he’d left. The tribunal also noted Dr Frankel’s admission to behaving deceitfully. Of particular concern, Dr Frankel tried to dig around Dr Day’s training information to then brief about him. Such information is meant to be held confidentially by HEE, raising serious questions about how Dr Frankel intended to obtain it, if not with the knowing cooperation of current HEE staff.

Given this apparent murkiness, it’s hard to credit the tribunal’s decision that Dr Frankel was partying alone, and not working with HEE. This decision allows HEE to slip liability, as the alleged hit to Dr Day was delivered not strictly by their worker, but by a senior member of the HEE family.

This judgment may yet be appealed by Dr Day’s team. But even as things stand, this isn’t a good look for HEE. It appears they don’t follow the rules they expect doctors-in-training to follow. The latter are expected to show candour, insight and learning, in the face of difficulty. But HEE seems to exhibit a recurring pattern of denial and defensiveness. As with Prince Andrew, one wonders about the outcomes if HEE hadn’t had inexhaustible funds to prop up litigation.

The bigger picture matters. First, is HEE’s the sort of behaviour we would want our doctors to emulate? Dr Day seeks justice for a lost career, but families can find themselves seeking truth after loss of a child. Their suffering is only compounded if doctors copy the denial and defensiveness that’s been shown by HEE.

Second, is HEE caring for doctors in ways we’d expect doctors to care for us? It seems not to have shown great care to either Dr Day or Dr Frankel. For one, his career’s ended before it started. For the other, it’s spiraled toward embarrassment. As compassionate colleagues were Professor Reid and others at HEE too busy or blind to detect what the judge readily found? Namely that Dr Frankel took Dr Day’s case “very personally” leading him (Dr F) to misconduct himself in ways criticised as “foolhardiness” and “wholly inappropriate”.

If, with all its resources, HEE can’t even keep its own family, like Dr Frankel, from inappropriate behaviour, what confidence can we have that it can care for doctors-in-training or the public they care for? Looked at in the cold light of Day, HEE now needs a full, open and independent review of this case. It’s a real opportunity for HEE to learn lessons with humility and to rebuild trust with both the public and doctors-in-training. Done properly, this could be a credible way for HEE’s leaders to show they care.