3 Whistleblowing

If you think there may be some form of wrongdoing or misconduct in your workplace, you need to raise your concerns about it: this is known as whistleblowing, or ‘raising concerns’ in the NHS. Under the Public Interest Disclosure Act (1998) workers have a right to ‘blow the whistle’ if management instructions are conflicting with their duty to act in the public interest.

Examples might include where you believe that healthcare practices or equipment are dangerously unsafe; where there is abuse of patients or staff; substance misuse (alcohol or drugs); violence or bullying; or there has been serious misuse of funds or resources (for example fraud or waste).

Next, Gail will describe her understanding of whistleblowing and how it might arise for a healthcare assistant working in a hospital setting.

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Transcript: Whistleblowing

Gail

My advice would be, that if you see something that you know is wrong you must report it. That is the only way that we can improve our practice. It’s not a case of, I don’t want to because they’re my friend – you have a duty as a healthcare professional to report anything that you see that is wrong. We then, again, have a look at it and see how it’s not going to happen again – we’ve put something in place to make sure it’s not going to happen again, But it’s very very important that we do that

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Whistleblowing

Every employer should have a whistleblowing procedure in place to facilitate the disclosure of this kind of sensitive information, which may be along the lines of the following process issued by the UNISON union:

If you are concerned about something and thinking of talking to someone about it, get support: this could be from your trade union, the appropriate person in your workplace or a ‘whistleblowing guardian’.

The following statements have been taken from healthcare assistants who are thinking about raising an issue within their workplace. While reading them, think about what you might do in each situation.

Figure 1 Raising issues in the workplace

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The diagram provides two examples of concerns which might be raised by a healthcare assistant, and suggestions with how each issue could be managed, as follows:

‘I do the night shift often as it is a little more money. I would like to continue doing it but am worried that the staffing levels are not high enough. I would like to raise a few things but I am really concerned that they will put me down as a troublemaker and maybe put me on an all-day shift.’

You should not be concerned about being labelled as a troublemaker as you have the responsibility of raising any concern, even if you don’t believe anything will happen. You should follow your employer’s procedure for raising concerns and put it in writing, and ask for a response with an update on what has been done.

‘I am really concerned that some of the equipment isn’t safe or fit for purpose. I raised it with my local manager but they didn’t seem to be able to do anything about it. A while later I tried to follow the internal process but never heard anything back.’

You did the right thing by raising your concern and it is the employer's responsibility to act upon it. You should go back to your local manager with your concerns in writing, requesting a response outlining what action is being taken, and seek trade union support where necessary.

Figure 1 Raising issues in the workplace

Activity 1

Timing: (allow about 45 minutes)

Health Education England have published a video on raising concerns in healthcare. Watch the video now and try to place yourself in the shoes of the people who had to report wrongdoing. Would you have the courage to report failures in the system where you work?

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Transcript: Raising concerns: speaking up about patient safety

NARRATOR

Working in health care is both rewarding and demanding. You'll work with many different people, and with countless systems and processes, all striving for the very best patient outcomes. But people under different demands and pressures can make errors, and even with good systems in place, things can go wrong, putting patients at risk.

If you see that happen, then raising your concerns can prevent immediate harm and is an essential part of improving care for patients in the future.

UMESH PRABHU

Patient safety is absolutely essential. I always say, patients must be at the heart of everything work we do. That's the only reason I became a doctor.

HELENE DONNELLY

I think patient safety in a health care setting is everybody's responsibility as a collective whole, right from the very top to all the wards or any clinical area.

STEPHEN MOSS

It's absolutely vital that we see our responsibility first and foremost towards safeguarding our patients and making sure that we deliver care safely, and with great compassion.

LISA BAYLISS-PRATT

From wards to boards, whatever your role is across the NHS, it's your job to raise a concern if you spot that a patient is not being cared for appropriately.

NARRATOR

However hard it may be, part of caring for patients is to raise concerns when appropriate, and to support and respond to the concerns of others in your team.

WENDY

That's looking really lovely there, Mrs. Baxter. It's lovely and dry. Can you see how the swelling's gone down in there, David?

DAVID

Yeah. Sure.

WENDY

Yeah. I'm just going to leave that dressing on, all right? And if it's all right with you, I'll come back on Wednesday and check it then. OK?

MRS. BAXTER

Oh, that's lovely, Wendy.

WENDY

OK.

MRS. BAXTER

Thank you. Thank you.

WENDY

No problem.

MRS. BAXTER

And thank you, David.

DAVID

No worries.

MRS. BAXTER

How long are you with Wendy?

DAVID

Just a few weeks, then I'm on another placement.

MRS. BAXTER

Oh, well, you'll learn a lot from Wendy.

WENDY

All right. So we're going to get away, but I'll see you Wednesday.

MRS. BAXTER

Yes.

WENDY

So you take care.

MRS. BAXTER

I will.

WENDY

Okie doke. Thanks now. Bye

DAVID

See you.

MRS. BAXTER

Bye bye.

DAVID

Want some gel?

WENDY

Oh, no, your'e fine, thanks. Say, that one's looking really good. Should be able to get the dressing off next week.

DAVID

Wendy. Can I just check? It's just, well, I've noticed you've not washed your hands or used cleaning gel yet today. It's just, we're told at uni, we should wash our hands before and after every visit. You know, what with the big push to reduce infection.

MRS. BAXTER

I've only checked a few dressings today. Well, you've had a long day, so go and get yourselves home and I'll see you tomorrow.

DAVID

Sure.

WENDY

Okie doke. Night night.

DAVID

Bye bye.

NARRATOR

Tricky, isn't it, when you know someone's doing something wrong, but your attempts to encourage them to change aren't working. Challenging a colleague can be hard. It might be that they're in a position to influence your career. Maybe they're someone who gets 99% of the job right, but in this case, Wendy is putting he patients at risk.

[MUSIC PLAYING]

DAVID

Hi, Anita. I need a bit of advice. It's Wendy. I don't want her to get into trouble, but I don't think it's safe.

NARRATOR

Talking to your supervisor-- in David's case, his tutor-- is always a good first port of call if you have concerns. David may feel disloyal to Wendy, but changing her behaviour can only be good for patients.

LISA BAYLISS-PRATT

Students are so important in this process, as they provide a real opportunity to put fresh eyes onto a situation, so I really urge all of our students to not hesitate to raise a concern if they see something that doesn't look right.

NARRATOR

Nurse Helene Donnelly was so concerned about the quality of patient care in Mid Staffordshire that, having had little success with her supervisor, she went to her board, and eventually her MP to help bring about change.

HELENE DONNELLY

Although it has to be acknowledged that it's very daunting prospect to have to raise concerns, particularly if you have to go above and beyond your immediate line management structure, for me, the way I nurse is always that I treat patients as I'd wish to be treated myself or a member of my family to be treated. And where that's not happening, we need to address it and improve it, and that was all I was ever trained to do.

NARRATOR

Of course, while many concerns relate to the behaviour of an individual or individuals, sometimes you may have to challenge systemic problems.

MARK

So how can I help?

MRS. JONES

Well, I'm still feeling breathless, and it's getting worse. I'm sick, and generally a bit off colour, really.

MARK

Right. And we're waiting on an appointment with the cardiologist for you.

MRS. JONES

No. That was three weeks ago.

MARK

Oh.

MRS. JONES

Yes. And I wondered if it was the new medication they're given me. To be honest, they said you would have been in touch with me by now about some blood tests last week.

MARK

New medication. There's nothing showing on the system. I don't suppose you happen to have the drugs with you.

MRS. JONES

Yeah. They're in here.

MARK

Right. I think we need to get you those blood tests straightaway. Just to check your kidneys. Bear with me.

FATIMA

Hi, Mark.

MARK

Fatima. Mrs. Jones. We should have had a letter about her new medication from the hospital. She needs blood tests now. Who's free to do them?

FATIMA

Uh, OK. Bear with me.

SALLY

No letter today either.

MARK

It's Cardiology. It's always Cardiology. They just don't tell us what's going on.

FATIMA

Uh, Jane is in room three to do blood.

MARK

Right. Can you organize that now? Thanks.

SALLY

That happened last week, you know. One of Dr. Mighton's patients. It's just certain departments at the hospital, but it's just not good enough

FATIMA

Sally, it's always been like that. Some departments are great at getting their letters to us, and others are always slow.

SALLY

We need to do something about it as a practise. I'm going to raise it at the staff meeting tonight to see if we can do anything about it.

FATIMA

Good luck.

NARRATOR

Sometimes, like Fatima, we accept failures in the system because they feel normal, or because we feel we can't change them. Figures show that many people don't raise their concerns, because they feel they won't have an impact. But change can only happen if people like Sally both speak up and then follow through their concerns.

UMESH PRABHU

If you make sure each and every staff feels happy to come to work, feels supported, they will be there to raise concerns. They will do their best for their patients.

NARRATOR

So how should you raise your concerns? In the first instance, it's always best to speak to you immediate supervisor. If you don't feel you're being listened to, then check your local protocol, which should be available on your employees intranet to see how you might escalate your concerns.

But there are also independent sources of advice. Your regulatory body or union should offer guidance and direction on their own website. And if you want to talk to someone, there are now several phone lines available which offer independent, legally-backed advice for anyone with concerns. Details of all these organisations can be found here.

LISA BAYLISS-PRATT

In order to change the culture on raising concerns, it's important that we weave it into everything that we do. But appraisal provides a fantastic opportunity to reflect with your line manager on a concern that you might have had throughout the year.

NARRATOR

Any concern you do raise should be valued and listened to, and it could start a process of change.

AHMED

Hello.

HELEN JARVIS

Ahmed, hi. It's, uh, Helen Jarvis here.

AHMED:

Hi Ms. Jarvis.

HELEN JARVIS

Um, look. The ward round's running over here. It's just manic. I'm aware that the list is incredibly busy, so take the briefing, will you? It's Mrs. Saunders, followed by Mr. Venables, and then Mrs. Kay, I think.

AHMED

Uh, yes, of course, Ms. Jarvis. No problem.

HELEN JARVIS

Thank you. Bye.

[BEEPING]

WOMAN

Dr. Massey you must've seen a few of these before, then.

DR. MASSEY

Yes. I'm getting to know how it all works.

SURGEON

Good morning, everybody. Sorry for the delay. Where's Ahmed?

DR. MASSEY

He's just nipped out. He'll be back in a few minutes.

SURGEON

I'm sure he's told you how busy we are today.

DR. MASSEY

Yes.

SURGEON

OK let's crack on.

DR. MASSEY

Should we do the WHO check list?

SURGEON

OK. Valerie Saunders, arthroplasty of the left knee. No critical or unexpected steps. Tourniquet up?

WOMAN

Yeah.

SURGEON

Happy with the equipment?

WOMAN

Mhmm. Yeah.

SURGEON

OK, scalpel, please.

DR. MASSEY

No! This is Mrs. Kay. arthrodesis of the left ankle.

SURGEON

I-- I thought Mrs. Saunders was first up. Ahmed. I thought Mrs. Saunders was first up.

AHMED

She was, but the list changed. This is Mrs. Kay. She has a latex allergy, so she was moved to the top of the list. Didn't you know?

SURGEON

No.

AHMED

Look. I know we're busy, but I suggest we call this to a halt and do the briefing again.

SURGEON

Thank goodness you spoke up.

NARRATOR

This team is clearly under pressure. The surgeon should have been at the briefing. They haven't done their safety checklist properly. But because someone spoke up, this was a near miss and not a never event. And if you do speak up, you should expect a course of action to begin.

SURGEON

Thank you very much, again, for today, guys. Before you do go, I think it's quite important that we have a discussion about the near miss that happened early today. We need to make sure it doesn't happen again, OK?

HELENE DONNELLY

Raising concerns can feel very daunting, and obviously, it's normal to feel very apprehensive about the process.

STEPHEN MOSS

At the end of the day, your prime responsibility is to your patients, and bullying can be an indicator that things are very wrong.

HELENE DONNELLY

Things have changed, and the processes are improving, especially in terms of education and training, so that people feel able and knowledgeable about the process.

STEPHEN MOSS

I think there's been some significant changes happening over the last couple of years in the NHS, and boards really do desperately want to listen to what you have to say now if you're worried about anything, whether that's poor practise or inappropriate behaviour. And our role is to make sure that you feel supported and able to speak out, because boards will want to act on what you have to say.

NARRATOR

Wherever you work in the NHS, if you see anything that puts patients at risk, you have a responsibility to raise your concerns.

[MUSIC PLAYING]

End transcript: Raising concerns: speaking up about patient safety

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Raising concerns: speaking up about patient safety

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The film you have just seen was made with the purpose of supporting healthcare professionals at all levels, ensuring they feel empowered to both raise and respond to concerns. In it you saw a range of scenarios that you could encounter where patient safety may be put at risk. Challenging behaviours or seeking advice may not always be easy, but it is important that you know who you would speak to in order to raise your concerns. The film also signposts to regulatory bodies, unions and independent advice websites where you can find more information on speaking out.