Doctors have warned that a “culture of fear” in the NHS may prevent life-saving lessons being learned about Covid-19 after a leading hospital consultant emailed scores of staff saying those responsible for “leaks” would be found and fired. Dr Daniel Martin OBE, head of intensive care for serious infectious diseases at the Royal Free hospital, emailed a report to colleagues at the peak of the pandemic with a note claiming that the trust would “track any leaks to the media” and then “offer you the chance to post your P45 on Facebook for all to see.” The email, which described journalists at one respected newspaper as “parasites”, was sent to dozens of nurses and junior doctors. It has been examined by Liberty Investigates, the investigative journalism unit of the civil rights group Liberty, and the Guardian, after being shared by a recipient who said they found the language “intimidating”. WhistleblowersUK, the non-profit group, said it had been made aware of the email by a separate individual who was also concerned about its contents. The Royal Free London trust said the email was “badly worded” and did not reflect trust policy. However, the trust said it was an open and transparent organisation that “does everything it can to encourage our staff to raise concerns and, if necessary, whistleblow”. Campaigners have warned that communications like Martin’s could have a chilling effect, damaging the speaking-up culture, harming patients and limiting chances to learn lessons. The government has defended the right of NHS staff to speak out. Last year the health secretary, Matt Hancock, announced a ban on the use of non-disclosure agreements to gag workers and vowed to end the injustice of “making someone choose between the job they love and speaking the truth to keep patients safe.” Martin’s April email followed the sharing on social media of a memo written by him two weeks prior. Reported in the Financial Times, it summarised a conference call with 80 other doctors. The memo detailed equipment shortages at a time when hospitals feared intensive care units might be overwhelmed, and made recommendations for the best treatments as well as flagging potentially harmful practices. Following the FT report, an email from the Royal Free hospital’s chief medical officer, Dr Chris Streather, to a clinical team was widely forwarded around the hospital to groups of nurses and junior staff, pointing them to internal complaints procedures and warning them off sharing information on social media or with press. The email said this was “not the correct way to escalate concerns” and risked “alarming the public”. Some days later, on 18 April, Martin issued his own warning. “The usual rules apply and are important to point out again as many internal emails sent within the Trust have ended up on social media and in the hands of journalists. Please do not do any of the following: send this report to someone outside of the Trust, post it on a WhatsApp group, give it to one of the parasites at the Financial Times, or drop it in leaflet form from a low flying aircraft. The Trust will now track any leaks to the media and are then likely to offer you the opportunity to post your P45 on Facebook for all to see. This week’s rant is now over.” The recipient who passed the email to Liberty and the Guardian said Dr Martin is known for being “measured and calm”, and is widely respected by other staff. But, at a time when staff were frightened about Covid-19 and the issue of adequate PPE, they said that his email felt “bullying and intimidating”. “I didn’t take it as a joke and I don’t think others did … As soon as people feel they can’t speak up, that’s when serious concerns aren’t raised, and that’s when patients come to harm.” “Communications like this instil fear and are toxic,” said Dr Jenny Vaughan, law and policy officer at Doctors Association UK, said. “When things go wrong we have to make sure lessons are learned, and we have to feel able to speak up. It is always important to support staff who have concerns about safety and not make them feel they are working in a culture of fear.” “This once again evidences an ingrained culture within the NHS that deters people from speaking up at the earliest opportunity about potentially very serious life-threatening issues,” said WhistleblowersUK chief executive Georgina Halford-Hall. The health service has been dogged for years by reports of detriment to those who speak up. In 2015, a review commissioned by the government recommended health chiefs appoint Freedom to Speak Up Guardians, nominating a person in every NHS Trust to whom staff could raise concerns in confidence. The Royal Free London trust said it has 67 speaking up champions and a dedicated confidential helpline set up for staff during the pandemic. A spokesman for the trust said: “Although badly worded, and not reflecting trust policy, Dr Martin’s email was not about whistleblowing – it was urging people not to share unvalidated patient data for an important research study, prior to publication. Rather than seeking to dissuade people from raising concerns, Dr Streather’s email to a clinical team, explained the channels available to them were they to have any.”