Healthcare reporting: how to investigate the NHS

The UK's National Health Service is loved by many but it also has its fair share of problems.

One of the major problems is the scale of avoidable harm within the institution, said Shaun Lintern, bureau chief of Health Service Journal, speaking at the CIJ Summer Conference yesterday (4 July 2019).

"The NHS has huge levels of difficulty and I believe it's important for journalists to expose that and nudge the system to a better place," he said.

A House of Commons Select Committee in 2015 reported that there were 12,000 avoidable hospital deaths every year. In 2014, unsafe care costs were estimated to be worth up to £2.5bn of UK government funds. Even the two million incident reports sent by NHS staff in 2018 do not paint the full picture.

For journalists, health stories represent a potential treasure trove of public interest and human stories waiting to be untapped, investigated and published.

One example was the landmark Mid Staffordshire Hospital scandal in 2009, where many patients died as a result of clinical negligence which resulted in a public inquiry. One of the key journalists in breaking this story was Lintern, then of Express & Star.

He explained there are correct ways to go about health reporting and some very damaging, common errors too. Here are some of his best tips.

Get the knowledge

"One of the best decisions I ever made was to download the Inquiries Act 2005 and sit down and read it one night.

"It wasn’t a big piece of legislation but within the act was this wonderful bit about the power a journalist has in an inquiry and our ability to get hold of documents and introduce into evidence."

Many journalists are unaware of the power they have to request documents. This knowledge proved crucial in the Mid Staffordshire investigation, as Lintern recognised there was an opportunity to access reports that the surgery department had submitted to the inquiry.

"That would have never become known if I hadn’t taken the time to read up on my rights," he said.

Chase up all leads

Even though journalists traditionally look out for breaking news stories, health journalists must not rule out the importance of more dated events too as some families are overdue justice.

The inquiry into the death of Lizzie Dixon, a baby girl, in 2001, was dropped by NHS England. Cases like these highlight important regulatory gaps and are priceless leads for journalists to chase up when given the opportunity.

As in this example, HSF’s article prompted Secretary of Health Jeremy Hunt to launch a fresh inquiry, with the outcome still pending more than a decade later.

"Patients and harmed families have an incredible struggle to get answers and it’s up to us as journalists to get those answers, especially when it raises systemic questions."

"There was proven clinical negligence in the case of Lizzie but the system wasn’t able to investigate and provide the family with answers or to assure the system that it had learned."

Include solutions

When reporting on difficult topics like maternity deaths, which often lead from one negative story to the next, it can be useful to look actively for useful outliers. Solutions-orientated case studies have been well received as positive afterthoughts in articles.

"People bought into the narrative of a problem, exploring it and understanding the issue, and then the possible solutions, especially for our readers who deliver these services. It’s a potential model for how to craft an investigation which works for healthcare audiences.

"These days journalists get told off for looking after the negative stories, in fact a good side of investigations shows not only how it’s bad, but where it’s good. That’s just as much a part of a journalist’s job."

Working with whistleblowers

Health Service Journal relied on inside tips and whistleblowers for many of their investigations.

But whistleblowers have very real concerns around being identified post-publication, so journalists need to work especially hard to win their trust and give them practical advice on how to stay safe.

"I spoke with a lot of people about how they can share their information with me in a way that would protect them, how we would display it and misdirect some of the sources.

"Sometimes I see journalists make mistakes by immediately slipping into interview mode and trying to suck out information. I genuinely think the best way is to develop a relationship and understand where [the sources] are coming from.

"They are acting in the public interest but they are genuinely afraid. They need reassurance and that’s our responsibility."

Follow-ups are key

A series of stories around how NHS England tried to bury reports around poor cancer services for children highlights the importance of moving with each story.

"This was about cover-ups at the very highest level of the NHS," Lintern said.

From an initial report in the Guardian, he began stitching interviews with families together, until a former NHS medical director went on the record to call out the cover-up, prompting a clinician body to go on the record as well.

"We used each story to open up doors to the next story. Think about where your story goes after the first story - it can be tempted to get articles out but if you don’t build on it you lose impact.

"That's an example of how follow-ups work, you can build a campaign without thinking about it by pulling the threads."

Going beyond the coroner's report

The temptation for a lot of journalist is to simply churn out what is stated in the press release because it is there in black and white, and publicly available.

While reports can be useful sparks into a potential investigation, as they can shed light on unusual deaths and future concerns, journalists should use the information to find the families of the deceased to find out more.

"I go to great lengths to try and find those families. This isn’t just to get a heartfelt quote for a story, though that does add a lot, but families know a lot more about what happened."

He explained that he has experienced that local newspapers have published coroner's reports without concern for, or speaking to, families he had been speaking with.

"This massively upset the family, they had a breakdown and they felt like I'd given them the information, and it broke all levels of trust," he said.

"The frustrating thing for me is that I know there is more to what is in the coroner's report, and if the local newspaper did the same thing as I did, I'd be quite happy for them to scoop me. But they didn't bother, they ran a story because it was quick, easy and cheap. But that's not good journalism."

Developing contacts

"Our journalists do get the time to meet people and visit hospital. We do say 'you're not under any pressure to file stories today'."

Contacts are key, and they go hand-in-hand with knowledge. But sources need to see expertise and a common cause.

"If you ring up and are obviously out to criticise, you won't get anywhere.

"Whether you are a harmed patient or hard-pressed doctor or nurse, they all want improvement. As a journalist, if you align yourself to that position, quite rightly, you'll get somewhere."

Reaching out

"Some stories, I've just cold-called every department, and most slam the phone down, but the one that slammed the phone down emails you privately later that night to say 'I couldn't speak then, but now I can'," he said.

It is normal for people to be terrified of being found out, so you can expect rejections and people to respond in different ways.

"Nine times out ten, they'll say no, but you only need the one," Lintern concluded.

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