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A ‘duty of care’ to speak out

17 October 2011

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Dawn Stott

Managing Director,
Association for Perioperative Practitioners

Dawn has worked in healthcare for more than 15 years. Currently, she runs the Association for Perioperative Practice, a membership organisation and charity promoting safer surgery. Previously she worked for a private hospital group and managed successful projects, including new hospital builds and IT implementations. Dawn recently completed volunteer training with the Prince’s Trust, mentoring young people embarking on new business ventures

The recent Mid Staffordshire NHS Trust scandal led the health secretary to announce, in June last year, a range of measures to “give teeth to” the current safeguards for whistleblowers in the Public Interest Disclosure Act 1998 (PIDA), including amendments to the NHS Constitution to make clear the rights and responsibilities of NHS staff.(1)

The PIDA is part of wider employment rights legislation, providing legal protection against detriment in the workplace to all workers (except volunteers) in England and Wales.

What exactly is ‘whistleblowing’?
‘Whistleblowing’ means making a disclosure in the public interest. If a person believes wrongdoing is taking place in their workplace, they can report this by following the correct process as laid out in their company’s policies and procedures. Part of this process should ensure that their employment rights are protected. Whistleblowers are protected for public interest to encourage people to speak out if they find malpractice in their workplace – ie, improper, illegal or negligent behaviour by anyone in their work environment.

GP practices are NHS-funded organisations; therefore, the practice has a duty of care to protect their staff and should support them should they feel it necessary to make a ‘qualifying disclosure’ – ie, a disclosure of any information they believe shows:

  • That a criminal offence has been committed, is being committed is or likely to be committed.
  • That a person has failed, is failing or is likely to fail within their duties.
  • That a miscarriage of justice has occurred, is occurring or is likely to occur.
  • That the health and safety of any individual has been, is being or is likely to be endangered.
  • That the environment has been, is being or is likely to be damaged.
  • That information relating to any of the above disclosures is being or is likely to be deliberately concealed.

Likewise, practice employees should feel confident enough to raise concerns about colleagues – clinical or non-clinical – following the relevant procedures without being bullied or unfairly dismissed as a result of identifying any wrongdoing in
the workplace.

Increasing responsibilities
Aligned with the government’s agenda to “move care closer to home” and provide a greater focus on local community services, including the development and enhancement of surgical procedures, GPs will be faced with numerous challenges and opportunities.

Many areas of the NHS have seen improved outcome statistics for patients. However, this is not across the board and, with the changes to the NHS continuing as they are, it will be important for GP practices that are providing minor surgery expertise within their surgery setting to develop processes and measures to manage any possible poor outcomes or issues that may be identified and disclosed under a whistleblowing regime.

Increasing awareness of how to raise concerns could result in more matters being reported, which, dependent on the outcome of the investigation, could lead to improvement in the provision of service within the community. Data keeping will enable enhanced knowledge and intelligence to manage future issues. It will also encourage sharing best practice to ensure that similar occurrences do not happen again or, if they do, information is available to help manage the issue effectively.

Concerns about what is happening at work are often easily resolved through the use of the most up-to-date policies and procedures to ensure quality of service offered is maintained and the chances of staff making incorrect decisions, which could compromise staff or patient safety, are reduced. It can, however, be more difficult to know what to do when concerns involve more serious issues such as:

  • Unlawful conduct.
  • Financial malpractice.
  • Breaches of codes of conduct.
  • Ill-treatment of patients/clients.
  • Abuse to clients.
  • Disregard of health and safety rules.
  • Dangers to the public or the environment.

Towards a more open culture
The Public Concern at Work (PCaW) charity is the independent authority on public interest whistleblowing (see Resource). It was established in 1993 following a series of scandals and disasters. PCaW has played a leading role in putting whistleblowing on the governance agenda and in developing legislation in the UK and abroad. In April 2008 it won a competitive tender to provide advice to all NHS staff and whistleblowing policy support across the NHS.

For years, many staff within the NHS have been too scared to raise concerns, fearing for their jobs. This has allowed scandals such as Mid Staffs, ‘Baby P’ and Harold Shipman to go unchecked.

Recognising this as a barrier to excellent care, the Department of Health went out to tender, seeking an organisation to provide whistleblowing support across the length and breadth of the NHS. Due to the support provided by PCaW, every member of staff working within the NHS should feel confident enough to raise any concerns and should be fully conversant with the correct channels to take.

PCaW recently published their findings from research undertaken about ‘what the whistleblowers say’. Cathy James, Acting Director of PCaW, said: “Our research demonstrates there are systemic deficiencies that prevent care workers from speaking up effectively to protect vulnerable adults.” Since the charity was established in 1993, PCaW has received 19,000 calls, of which 7,994 had a whistleblowing concern.(2)

With the massive and fast-moving change within the NHS in England, GPs may find themselves without the critical mass or resources to compete against private sector organisations, and shortcuts may be taken to ensure profits don’t leak out of the locality into the private sector. Those shortcuts may culminate in poor practice that in turn leads to disclosure and a formal inquiry into their outcomes.

The ultimate goal for GPs and their clinical commissioning groups will be to design health systems that translate their clinical skills into the requirements of their patient population. Their skills and competencies will need to be high to enable them to build a new healthcare system that meets the population’s requirements.

Healthcare professionals have a duty of care to ensure that the care provided is relevant and correct. It is important to understand how you would feel if something adverse were happening to a member of your family that you were unaware of, but a healthcare professional was privy to the wrongdoing and did nothing about it.

Local policy
Your practice should have a local policy outlining the procedures to follow should any member of staff identify an area of concern. It should include:

  • Types of concerns.
  • How to raise a concern.
  • Confidentiality.
  • External support.
  • Response to the concern raised – timelines and responsibilities.
  • The identity of the responsible person with whom you should raise your concern.
  • What to do if you are not satisfied with the outcome.

The Social Partnership Forum brings together NHS employers, trade unions and the Department of Health to discuss, debate and involve partners in the development and implementation of policy. It has produced a guide to support NHS organisations to promote best practice when devising, implementing and auditing their whistleblowing policies and procedures.(3)

It is essential that NHS organisations work with partnerships to embed good practice. This approach will help create an environment and climate of openess, where staff feel comfortable raising concerns about patient safety without the fear of exposure or suffering any detriment.

It is also important that all policies and supporting information are provided in a variety of accessible formats, ie, Braille, large print, audio and in languages other than English.

As the span of the GP commissioning role changes and the care landscape evolves, with a continuing demand for excellent health and social care services and getting the best value out of limited resources, it will be even more important to ensure all employees are protected, whatever their role.

All employees should feel comfortable in their environment and confident that they can raise issues they feel are unacceptable. Nobody should feel intimidated or bullied by fellow colleagues.

The responsibility lies with all employers to ensure correct policies and procedures are in place to allow employees and colleagues to raise their concerns in a controlled and confidential environment and feel comfortable that their issues will be dealt with appropriately. There should also be a form of recourse if they do not feel vindicated and need to take their concerns to a higher level.

Finally, nobody should be an onlooker to wrongdoing; they should speak up and raise concerns. Speak up loudly and coherently if and when you feel standards are slipping.

Your comments (terms and conditions apply):

“A lot of media attention has been given to this subject and it is clear that staff at all levels are still not confident to raise concerns. This excellent article should be used to support training and raising awareness of whistleblowing at practice level” – Siobhain O’Donnell, Kent