Interview with Helen Fernandes

As part of our 'Humanising the Learn Not Blame process' Dr Simran Mann talks with prior Learn Not Blame Lead and current DAUK Co-Chair Helen Fernandes

As part of our Learn Not Blame campaign, we are launching a new article series led by Dr Simran Mann, focusing on the lived experiences of doctors who have undergone mistreatment in the workplace.Through in-depth interviews, the series aims to humanise the processes doctors are subjected to and shed light on the real impact of blame cultures.

“I do think that the health secretary is listening so, if we could be coherent about what we think good looks like for all parts of the NHS, then I think we do have a unique opportunity for change”

Helen Fernandes has been advocating for other doctors throughout her career, as a consultant neurosurgeon in Addenbrooke’s Hospital, as chair of Women in Surgery and more recently, in her role within DAUK. In October she sat down for a conversation about her path, the lessons she has learned throughout her work and the key issues facing doctors in the NHS.

Helen first became involved with DAUK as part of the Learn Not Blame campaign, an initiative aimed at promoting a culture of learning from adverse events. The campaign was launched in 2018 following a series of high-profile cases in which individual doctors were held responsible for patient harm, sometimes with no regard for the systemic failures contributing to these outcomes. As a neurosurgical consultant, Helen has experience with complex cases such as these. Prior to joining DAUK, Helen had also chaired the Women in Surgery Committee for six years during which time she developed her skills in putting together campaigns and research. This background gave her the tools she needed to be a strong advocate for doctors in need of support.

“You’ve got to understand the issues first before you can speak out and help others. Knowing the people that you’re representing and having good data is the strongest way of advocating for change.”

When providing support for doctors under investigation, it is helpful to be able to understand a situation from the perspective of the NHS trust or relevant governing body. This concept became more relevant to Helen during the covid pandemic, when her daughter was in the process of completing an online law conversion degree: Helen found herself perusing the lecture material and her interest was piqued. She decided that she would do a law conversion herself and quickly realised that a deeper understanding of the law would allow her to better support doctors. Beyond refining her knowledge, the qualification taught her how to advocate on behalf of others by closely examining the systems in which they work. She speaks passionately about the importance of context when considering events leading up to poor outcomes in healthcare and refers to the relevance of the ‘Swiss Cheese model’:

“You pick out an individual who might have made, let’s say, the final mistake that has led to patient harm. Rather than unpick the context and perhaps look at the staffing on the ward, the number of patients being covered by the resident doctor on call, how much sleep they had, whether they had a list of 150 tasks to do and this was task number 149… it’s much easier for an institution to blame that individual.”

GMC investigation committees are obligated take the actions of a doctor in the context of where and how they were working, but many doctors who have faced disciplinary procedure do not feel this the case. Furthermore, doctors under investigation often feel isolated due to the stigma surrounding mistakes in medicine. The GMC has recognised the level of stress induced by contact with them and they do refer individuals to the BMA-run Wellbeing Support Service for mental health support. However, many still insist that GMC complaints or referrals are used as a detrimental tool in a blame culture which hinders learning from mistakes. Helen suggests that more could be done to support doctors, including addressing some of the systemic reasons for GMC referrals.

“many institutions or trusts will think about their reputation first and foremost before they’ll think of the doctor that they’re dealing with or the patients that they’re trying to protect”

According to GMC data, doctors of BAME origin are twice as likely as their non-BAME counterparts to face a GMC referral. Whilst it is fundamental that medical staff feel empowered to raise concerns, Helen suggests that we should be investigating the reasons for disproportionate referrals, which should ideally begin with tailored outreach to individual hospital trusts.

Despite feeling positive about DAUK campaigns and the impact that we make, Helen acknowledges that our messages do not always reach their intended audience. DAUK lobbies for improved monitoring of wellbeing in physicians and supports individual physicians facing difficulty, but many doctors are still unaware of the support that we can provide.

“There is a lot of noise out there… [we are] competing with everyone that wants to say something and change something, but also perhaps try to bring solutions at the same time”

At a time when the NHS is an increasingly divisive topic in politics, getting positive messages out to the physician body as well as the wider public can be a struggle. Furthermore, Helen suggests that media reporting on issues facing doctors has been detrimental to public trust in doctors. Any mention of the NHS in news articles tends to skew negative and opinion polls indicate falling satisfaction rates in the NHS. In recent years, Helen has been disappointed by the language used by the press, particularly regarding the reporting on resident doctor strikes.

“I think it’s destructive… it fuels the public perception that those that are working in the NHS are not working hard enough which I know – we all know – is not the case.”

The financial cost to the NHS of doctor or nursing strikes is heavily reported on in the media, but in contrast Helen suggests that key decision-makers within the NHS are relatively protected from blame, despite worsening inefficiencies within trusts. When it comes to the purpose of blame within human nature, Helen speaks passionately about treating a negative experience as an opportunity for accountability and reflection. She explains that when a doctor is facing investigation, DAUK not only advocates for them but also empowers doctors to examine their own mistakes and grow from them.

“We get the doctors that we deal with to be very reflective about how they may have contributed to the situation they find themselves in: if someone is in the right mindset they could do that very effectively and most people do. It’s a shame that the institutions that they’re battling with don’t do the same.”

A greater level of local accountability, particularly at trust-level, would potentially allow the NHS to more closely assess spending plans and staff management. However, Helen appreciates that in order to support trust-level issues with staff shortages, there needs to be a national change in workforce planning for doctors. Whilst hospitals across the country are reporting rota gaps, increasing numbers of doctors are struggling to find work and competition ratios for training posts are inflating each year. DAUK has recently spoken out about the crisis in specialty training.

“When it comes to messaging from the government, do you think the general public fully appreciates that this country is creating new medical school places without having the actual jobs for the graduates who come out of these medical schools?”

“I don’t think even the government knows.”

According to the BMA, this year there were 10,000 specialty jobs for 30,000 applicants, leaving around 50% of FY2s without a specialty post starting in August 2025. Before national recruitment systems were established, resident doctors would apply locally for training posts. Helen says that when she reached the end of her equivalent of FY2 she can’t remember any of her peers struggling to get a job. National recruitment systems aim to eliminate nepotism and provide an even playing field, but many are sceptical about the validity of using a points-based scoring system to measure doctors’ careers against each other.

“[regarding national recruitment for specialty training] it’s clunky and very formulaic. It is difficult for those that don’t quite fit into these little boxes that have been created”

Many doctors with years of clinical experience are struggling with specialty training applications. Their ‘score’ on the national system for their respective specialty, which may determine whether or not they are even offered an interview for a job, relies on the number of points they can score based on extra qualifications or experiences. Each year, the rules behind these systems may change, with certain qualifications being worth more one year than they are worth the next. This uneasy precedent of moving goalposts within medical careers is not well understood by the general public. The undersupply of NHS jobs available for doctors out of training is also downplayed in the media as much of the general public is led to believe that there simply are not enough doctors available to meet the health needs of the country.

DAUK echo the BMA’s call for expansion of training posts to meet the demand for jobs from growing numbers of UK medical graduates and resolve the difficulties around overseas graduates with clear plans for them and the NHS. Resident doctor strikes have prompted a series of government talks and our health secretary, Wes Streeting, has committed to expansion of training positions but a clear timeframe for this is yet to be seen.