What is Whistleblowing in Health and Social Care?
Whistleblowing is where staff report concerns about wrongdoing, most commonly seen at work. It is seen across all industry sectors and is gathering momentum as an increased emphasis on transparency sweeps through society. The following types of concerns can be classified as whistleblowing:
- Unsafe patient care
- Poor clinical practice
- Failure to properly safeguard patients
- Inadequate administration of medicines
- Untrained staff
- Unsafe working conditions
- Lack of policies
- Bullying at work
- Unwell or stressed staff who are not seeking help
These complaints differ from personal grievances as they have a public rather than private interest. Sometimes it can be difficult to know if a complaint classifies as whistleblowing or not. The NHS Whistleblowing Helpline can help to answer this type of question, for NHS and social care workers. Similarly, the charity Public Concern at Work can provide free and confidential legal advice. Whistleblowers can be employees, former employees, trainees, agency workers or members of an organisation.
Why is Whistleblowing Important in the Health and Social Care Sectors?
Those working in the health and social care sectors have a duty to put patients and the people they are working for first, as outlined in their professional code of conduct. Therefore, if an action is likely to cause harm to these people, there is a duty to report it. Essentially, whistleblowing is an early warning system that allows malpractice to be addressed before it results in serious harm. The nature of the health and social care sectors means that mistakes that would be considered minor in other sectors could have serious consequences for those involved. Patients are often at the receiving end of malpractice and require our protection accordingly.
The Bristol Royal Infirmary scandal highlights the atrocious damage that can be done by overlooking malpractice in the health and social care sectors. Around 35 babies tragically died from 1990 to 1995 at the hands of Bristol Royal Infirmary's cardiac surgeons, whilst numerous more suffered irreversible brain damage. The unit continued to carry out high-risk operations at the expense of children's safety, and in far too many cases their lives, in order to make the unit a centre of excellence. The practice continued until Steve Bolsin, a consultant cardiac anaesthetist, blew the whistle on the astoundingly high mortality rate in the unit. When Bolsin approached management with the shocking mortality figures he had compiled, he was turned away and ignored. The CEO of the trust nearly fired him for his persistence with the matter. Bristol has been described as having a "club culture" where a few people had far too much power, which essentially bred ignorance to these malpractices. Had Steve Bolsin not courageously stepped forward to blow the whistle, countless more young lives could have been lost.
The Whistleblowing Process
Many organisations have a whistleblowing policy which should guide you through the process, this can be accessed through your human resources department or trade union. Whilst they are not a legal requirement, it is beneficial for organisations to have a whistleblowing policy in place.
When reporting a complaint, it is widely recommended that you draw attention to your concern locally, for example by talking to your line manager or a more senior manager in your organisation. However, if you have tried doing so and not got anywhere or you would prefer to speak to someone removed from the situation, you have a number of other options, including NHS England and the General Medical Council (GMC).
The best way to make a whistleblowing complaint is confidentially. This means that the people you report your complaint to will know your identity, but they will try to conceal it for as long as possible. Your identity will not be revealed without your consent, unless the body is legally obliged to divulge it. Alternatively, reports can be made anonymously, meaning no one knows your identity. However, this may hinder or even halt the investigation as investigators will not be able to contact you for further information. Additionally, you will not be able to receive any updates on the progress of the investigation if you remain anonymous. Also, it is worth considering that making your report anonymously does not mean that your colleagues will not suspect you.
In order to make a valid whistleblowing complaint you must fulfil the following criteria: having a genuine concern in the public interest and being honest to the best of your knowledge. Whilst you need not have hard evidence to support your concerns, any evidence that you do have is useful. However, you must not start investigating the concerns for yourself. This risks tipping off the individual involved.
Whistleblowing in Primary Care
Primary care includes frontline services like GP surgeries, dentists, opticians and pharmacies. Most primary care organisations are relatively small. This can pose difficulties when it comes to whistleblowing as it raises employees' worries of being identified as the whistleblower. Staff in the primary care sector can choose to report their concerns to their appointed Freedom to Speak Up guardian or directly to NHS England. Since April 2016, NHS England has been classed as a prescribed person under the Public Interest Disclosure Act 1998. The act sought to protect whistleblowers.
You are legally protected from harassment and bullying following whistleblowing and your employer should take disciplinary action against anyone who victimises you as a result. Additionally, if you are victimised after blowing the whistle you have the rights to bring the matter to an employment tribunal. To receive full whistleblower protection you must be sure to follow whistleblowing protocol within your organisation - for instance, first filling in a critical incident form. Much of this process will be set out within the whistleblowing policy.
Due to limitations in the existing legal protection, junior doctors have been subjected to mistreatment after blowing the whistle. However, the British Medical Association (BMA) has now established a legally binding agreement with Health Education England (HEE) in order to protect junior doctors when blowing the whistle. This means that if junior doctors receive detrimental treatment by HEE as a result of whistleblowing then they now have legal protection.
Encouraging Whistleblowing in Health and Social Care Settings
Sir Robert Francis' report on the findings of the Mid Staffordshire NHS Foundation Trust's failings recommended whistleblowing training for staff members of all NHS organisations. The Mid Staffordshire NHS Foundation Trust came under scrutiny as multiple staff members reported poor care across the trust. Whilst staff eventually stepped forward to blow the whistle, many others avoiding doing so out of fear of persecution. It is estimated that malpractice led to the deaths of between 400 and 1100 patients from 2005 to 2009. This enquiry paved the way for a novel push on whistleblowing in health and social care. The NHS has developed a whistleblowing film to educate staff members. It can be used for induction, team development, board meetings, staff group meetings, appraisals and revalidation. Another respected way of educating people on whistleblowing is through training courses – eLearning, for example. Training is multifunctional in generating awareness of, promoting and educating staff on whistleblowing.