An inconvenient truth

Over half of respondents to an MPS survey admitted to regret over their failure to raise concerns in the workplace. Gareth Gillespie looks at how obstacles to whistleblowing can be overcome.

In the healthcare profession, raising concerns about colleagues or other workplace issues – ‘blowing the whistle’ – is a vital duty to be carried out if patient safety is to be safeguarded and professionalism maintained. Not optional; a duty – the GMC says “all doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity is being compromised”.1

Potential whistleblowers may feel a sense of disloyalty – that they are landing colleagues in trouble, and ‘breaking rank’. Confidence in whistleblowing procedures – which the updated NHS Constitution says organisations must put in place – varies widely and many individuals have complained of ‘blame and shame’ cultures.

Perhaps unsurprisingly, would-be whistleblowers can also be deterred by fears that they will be ostracised by colleagues, or persecuted by senior management – their careers clandestinely derailed in an effort to secure their silence and cover up undesirable issues. For whistleblowers, the risks of encountering problems can be reduced by ensuring established processes and protocols are followed, which includes taking a step-by-step approach to escalating concerns.

You should be able to demonstrate that your concerns are legitimate and be sure your response is proportionate – and it is important to document each step you take in identifying and reporting your concern. Paragraphs 11-15 of the GMC’s Raising and Acting on Concerns about Patient Safety provide clear guidance on the correct approach.

In the line of fire

Protection exists in the form of the Public Interest Disclosure Act 1998 (PIDA), which states: “A worker has the right not to be subjected to any detriment by any act, or any deliberate failure to act, by his employer done on the ground that the worker has made a protected disclosure.”2According to the Act, a “protected disclosure” means any disclosure of information that reveals the following:

• "That a criminal offence has been committed, is being committed or is likely to be committed,
• That a person has failed, is failing or is likely to fail to comply with any legal obligation to which he is subject,
• That a miscarriage of justice has occurred, is occurring or is likely to occur,
• That the health or 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, or
• That information tending to show any matter falling within any one of the preceding paragraphs has been, is being or is likely to be deliberately concealed.”3

MPS carried out a survey on whistleblowing in April 2012, asking 20,000 GPs, consultants and non-consultant hospital doctors in the UK for their views and personal experiences. The survey found that only 18% of respondents were aware of, or understood, PIDA. Elsewhere, 67% of respondents agreed that more training on whistleblowing should be offered to staff.

Confidence in existing processes was very low, with 11% saying they had faith, while 52% of respondents were not even aware of their organisation’s policy on whistleblowing. The survey also uncovered signs of inertia when faced with situations that caused concern. Of all respondents, 53% said they had experienced such a situation that they now wish they had done more to address; while 49% said that current whistleblowing processes discouraged efforts because the fear of consequences was too great.

Confidence in existing processes was very low, with 11% saying they had faith

Barriers, either real or imagined, undoubtedly block the path to – and can ultimately discourage – raising concerns. GMC guidance acknowledges this4 but stresses that patient safety – and your duty to maintain and protect it – overrides any such fears held about one’s own interests. Likewise, it says that the fear of inaccurately reporting a concern should not be a disincentive, provided it is raised “honestly, on the basis of reasonable belief and through appropriate channels”.

Follow the leader

Strong leadership is essential, especially as it is more likely to be junior doctors who are fearful of the effects whistleblowing may have on their careers. It may be down to organisations to provide sufficiently robust whistleblowing policies and processes, but senior individuals need to provide support and mentorship to junior colleagues.

In MPS’s survey, 76% of respondents said that supportive management is the best source of encouragement to raise concerns. Dr Stephanie Bown, Director of Policy and Communications at MPS, said: “Doctors at all stages of their career need to be supported to speak up, but none more so than junior doctors who will be shaping our hospitals and practices of tomorrow. This is why strong and open leadership by example is so important.

It may be down to organisations to provide sufficiently robust whistleblowing policies and processes, but senior individuals need to provide support

“The starting point must be that executive boards take responsibility for creating a culture in which raising concerns is a normal and integral part of providing healthcare. In addition, doctors and other healthcare professionals have to know and understand the right process. They also need to have confidence that their managers will support and enable them to fulfil their professional obligations – and they certainly can’t do that if they work in a culture of blame and fear.”

How to report a concern

The GMC’s Raising and Acting on Concerns about Patient Safety outlines the steps you should take if you have a concern you wish to raise:

"Wherever possible, you should first raise your concern with your manager or an appropriate officer of the organisation you have a contract with or which employs you – such as the consultant in charge of the team, the clinical or medical director or a practice partner.

"If your concern is about a partner, it may be appropriate to raise it outside the practice – for example, with the medical director or clinical governance lead responsible for your organisation. If you are a doctor in training, it may be appropriate to raise your concerns with a named person in the deanery – for example, the postgraduate dean or director of postgraduate general practice education.

You must be clear, honest and objective about the reason for your concern

"You must be clear, honest and objective about the reason for your concern. You should acknowledge any personal grievance that may arise from the situation, but focus on the issue of patient safety.

"You should also keep a record of your concern and any steps that you have taken to deal with it."6

You can also disclose concerns anonymously, or in confidence, to the Care Quality Commission (CQC) on 03000 616161 Independent and confidential advice is available from:

• The Whistleblowing Helpline for NHS and Social Care – 08000 724725
• The charity, Public Concern at Work – 020 7404 6609

The bigger picture

MPS understands the anxieties and obstacles surrounding whistleblowing, and we have been active in seeking to influence organisations to do more to entrench a culture of openness across the healthcare profession.

In May, we held a seminar to discuss ways of identifying and removing these obstacles, and to improve patient safety – representatives from a range of organisations including the RCGP, NMC, GMC, RCN and BMA were in attendance – and we will continue to engage with policy-makers on taking further action. Patient safety is the ultimate goal for the healthcare profession, and this must be the deciding factor when facing a whistleblowing dilemma, as painful and difficult as it may be.

Strong leadership goes a long way to breaking down barriers; while leadership begins with executive boards, senior doctors can play their role by looking beyond their clinical specialty and taking responsibility for the wider interests of the patient. It is in leading by example that the necessary culture change can be brought about – and healthcare can begin to see a ‘normalising’ of the process.

Strong leadership goes a long way to breaking down barriers; while leadership begins with executive boards, senior doctors can play their role

People who have concerns in the workplace should ensure they follow the correct process. If they have any concerns about how to do this, contact MPS, but we would not normally become involved in any dispute surrounding whistleblowing.

References

1. GMC, Raising and Acting on Concerns about Patient Safety (2012), para 1
2. www.legislation.gov.uk/ukpga/1998/23
3. Ibid
4. GMC, Raising and Acting on Concerns about Patient Safety (2012), para 9
5. GMC, Raising and Acting on Concerns about Patient Safety (2012), para 10c
6. GMC, Raising and Acting on Concerns about Patient Safety (2012), paras 13-15

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