The Conversation Blog

Dr Narinder Kapur

As we await the report of the Thirlwall Inquiry into the crimes of Lucy Letby, I have found myself reflecting on our work over the past fifteen years supporting one of the NHS’s most persistent reform campaigners, Dr Narinder Kapur.

The issues now being examined by the Thirlwall inquiry – failures to listen to clinicians, the suppression of concerns and the institutional instinct to close ranks – are themes that Dr Kapur has been raising, often at great personal cost, for well over a decade.

I first met The Good Doctor in 2010. At the time he was in the middle of an Employment Tribunal, fighting what he believed was an unjust dismissal from his post as Head of Neuropsychology at Addenbrooke’s Hospital in Cambridge.

From our very first meeting he struck me as a gentle man – and a gentleman. But beneath the calm exterior there was visible frustration. He had spent years raising concerns about falling standards of safety and care that he believed were linked to NHS cost-cutting and staffing decisions. He warned hospital management that unqualified or inadequately supervised staff were being used in clinical settings, potentially putting patients at risk. Instead of being listened to, he found himself facing investigations, false accusations and ultimately dismissal in December 2010.

The saga that followed was bruising. During the tribunal process it emerged that hospital managers had secretly searched his office and cloned his computer hard drive while he was away at a conference. In July 2012 the Employment Tribunal ruled that Dr Kapur had indeed been unfairly dismissed, describing the conduct of the Trust as unreasonable and condemning unfounded allegations made against him.

But the personal toll had already been immense. The case left him with serious financial losses and significant strain on his family life. Looking back now, he speaks openly about the psychological impact of that period. Like many whistleblowers, he experienced profound isolation and depression and even suicidal thoughts. Thankfully he survived that ordeal – and instead of retreating from public life, he threw himself into campaigning for reform.

From whistleblower to campaigner

In October 2012, just months after the tribunal ruling, Dr Kapur staged a five-day hunger strike outside the Department of Health in Westminster to protest against the treatment of NHS whistleblowers. It was an early sign of the persistence that would come to define his activism.

A few years later, in November 2015, he staged another hunger strike in Parliament Square with fellow doctor Shiban Ahmed, drawing attention to what they described as widespread victimisation of whistleblowers – particularly those from ethnic minority backgrounds.

The campaigns were sometimes theatrical, but they were never empty gestures. Dr Kapur consistently backed them up with detailed policy proposals on reforming the NHS disciplinary system.

In 2017 the British Psychological Society awarded him a Lifetime Achievement Award, recognising both his distinguished neuropsychology career and his wider contributions to healthcare and patient safety. Characteristically, he dedicated the award not to himself but to “all sacked NHS whistleblowers”, especially those from Black and minority ethnic backgrounds who he believes face even greater retaliation when raising concerns.

The Amin Abdullah campaign

One of the most moving episodes in his campaigning came after the death of NHS nurse Amin Abdullah in 2016. Abdullah, who had been dismissed after a disciplinary process he believed was unjust, died by suicide after setting himself alight outside Kensington Palace.

Dr Kapur helped campaign for an independent inquiry into the case. In a powerful protest outside the Department of Health he joined Abdullah’s partner carrying a coffin bearing the nurse’s image, symbolising what he argued was the deadly cost of toxic disciplinary processes.

I invited Dr Kapur to look back and identify the turning points that helped transform how his campaigning was received. He highlighted three:

- first, securing the independent inquiry into Amin Abdullah’s case and the subsequent apology from Imperial College Healthcare NHS Trust,

- second, his contribution to the formal recommendations issued to NHS Trusts by NHS Improvement one to two years after the Amin inquiry, addressing concerns about disciplinary processes,

- and third, more recently, winning the engagement of senior NHS leadership, particularly Jim Mackey, whose willingness to examine proposals for reform has opened the door to potential systemic change.

He agrees that PR has been an important element in his long journey from outlier to respected reform advocate whose views policymakers are prepared to hear. Perseverance is also key, he says - as is luck in making contact with the right people.

Influencing national policy

Over time, Dr Kapur’s ideas have increasingly moved from the margins into the policy mainstream. Many of the cultural issues he highlighted were later acknowledged in the Freedom to Speak Up Review led by Robert Francis in 2015, which called for a safer environment for NHS staff to raise concerns.

More recently Dr Kapur has been advocating for “Amin’s Rule”, a proposal that healthcare professionals facing dismissal should be entitled to an independent external second opinion before a final decision is taken.

The unfinished work

Over the past two decades the UK has introduced several legal protections for whistleblowers – from the Public Interest Disclosure Act to regulatory reforms following the Shipman Inquiry and the Freedom to Speak Up framework. Yet Dr Kapur argues that the fundamental problem is not simply legal protection but culture. “Too often”, he says, “the NHS still defaults to defensive institutional behaviour – closing ranks, discrediting critics and protecting reputations rather than confronting problems.”

Dr Kapur also points to a particularly troubling structural weakness within whistleblowing law itself. If an organisation claims it has “investigated” and found no wrongdoing, the procedural box is often considered ticked, whether or not that investigation addressed the concerns properly. When the whistleblower persists – because the underlying patient-safety issues remain unresolved – that persistence can be reframed as vexatious behaviour or misconduct. This is how the system can end up protecting institutional process and branding individual complainants as "difficult", embroiling whistleblowers in disciplinary processes instead of focussing on the patient safety issues. This, Dr Kapur would argue, is precisely the cultural problem that still needs fixing.

In his evidence to the Thirlwall Inquiry, Dr Kapur majored on what happened to those who raised concerns about Lucy Letby and how failings here contributed to the tragedy that unfolded. In conclusion, he makes the case for a further Inquiry focussed on the NHS disciplinary system.

“The current Freedom to Speak Up Guardian system has clearly failed”, he says. “Freedom to Speak Up Guardians are invariably Trust employees, and they face a clear conflict of interest if they try to stand up to management. Every NHS Trust will state that they support the Freedom to Speak Up system, when in reality this is not the case. Whistleblowers are often silenced through hollow speak-up processes, and then face a high risk within a disciplinary structure which has left them with an environment that has grave implications for patient safety.” Amongst the 10 specific points for reform he identifies in his Inquiry witness statement, two stand out as particularly self-evident: “Freedom to Speak Up Guardians’ should not be Trust employees. Further, referral of any member of staff to a regulatory body, suspension of a member of staff, or a disciplinary hearing for a member of staff who in the past raised patient safety concerns, should always require the approval of an external advisor – this could be a GMC employment liaison officer or a member of the SCQC.”

Let's hope the Letby Inquiry Report will help shift the cultural block towards NHS Whistleblowers. If it does, it will owe something to campaigners like Dr Narinder Kapur – a man who refused to stop speaking up, even when the system tried to silence him.