OPINION

'It’s your responsibility to report patient safety concerns'

17 January, 2012

Try to nip problems in the bud before they get serious, says the CQC’s Cynthia Bower

In some cases a degree of resolve, if not courage, is needed to blow the whistle at work. As the industry regulator, it is key that the Care Quality Commission provides clear guidance to workers about how to express any concerns they may have.

The CQC has just produced updated guidance on whistleblowing, for which it has had support and suggestions from other organisations, including the Royal College of Nursing, the Nursing and Midwifery Council, the Royal College of Midwives and NHS Employers.

In an ideal world, there wouldn’t be a need for whistleblowing. Employers should ensure care is of the highest standard and their staff need not go outside their own organisation to have their concerns addressed. Good standards of care usually go hand in hand with an open management culture that encourages staff to make their views known without fear of reprisals. If their worries are properly dealt with, every-one will benefit. To underline this the CQC has also produced a providers’ guide to whistleblowing to help employers understand the benefits of a positive approach.

“After the alleged abuse of people with learning disabilities at Winterbourne View private hospital, the CQC admitted there had been fault on its part in failing to follow up the concerns of a whistleblower”

My plea to you is: don’t wait until a problem becomes serious - try to nip it in the bud. I know some, especially junior staff, may lack the confidence to approach their manager. However, it is their professional responsibility to report any concerns they have that the welfare or safety of patients is being adversely affected. If they have tried unsuccessfully to get their organisation to resolve a problem, or are not confident it will be dealt with properly, they should report their concerns to the CQC or the Department of Health via its whistleblowing hotline.

After the alleged abuse of people with learning disabilities at Winterbourne View private hospital, the CQC admitted there had been fault on its part in failing to follow up the concerns of a whistleblower. After reviewing its systems and processes, it set up a special team at its national customer service centre in Newcastle to ensure all whistleblowing concerns that come to the CQC are logged and the follow-up action is tracked until it reaches a conclusion.

Each matter is passed to the local inspector for that particular registered service, who decides what action is necessary. Depending on the concerns, there could be an inspection by the CQC or a referral to the local authority under the multiagency safeguarding procedures.

In the last six months, the CQC received nearly 2,500 concerns from whistleblowers from the NHS, independent healthcare providers, social care services and even dental practices. Among the concerns raised about NHS services were: inadequate staffing levels, bullying, errors in drug administration, cases of misdiagnosis, delays in patients being examined and a lack of follow-up appointments.

I won’t pretend whistleblowers are never adversely affected as a result of their actions, but under the Public Interest Disclosure Act 1998, those who suffer dismissal, victimisation or any other detriment can take a compensation claim to an employment tribunal.

The CQC values information from whistleblowers. Anyone who is thinking about blowing the whistle, but worried about it, should seek confidential advice by ringing the DH’s hotline; contacting Public Concern at Work; or talking to their trade union or professional body. Employers can also get advice from these sources.

The CQC’s guidance can be found at: tinyurl.com/cqc-guidance. You can contact the CQC by emailing: enquiries@cqc.org.uk or telephoning: 03000 616161. The DH whistleblowing hotline is 0800 0724 725. Public Concern at Work can be contacted on 020 7404 6609.

Cynthia Bower is chief executive of the Care Quality Commission

Readers' comments (4)

Sarah Stanley | 20-Jan-2012 3:02 pm
What a bunch of hypocrites! Healthcare staff DO report concerns often at huge cost to themselves, only for the CQC to do sweet fanny adams!
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roger kline | 22-Jan-2012 4:57 pm
Dear Cynthia

I am afraid your article completely misses the point.

Overwhelmingly, NHS staff know they should report concerns. Overwhelmingly, NHS staff know they have a duty of care.

Employers are aware of the evidence that an open, collegial, working environment is good for patient care. If they haven't read the meticulous work by Carol Borrill and colleagues (funded by the DH) , for example, they certainly should do. There are requirements (widely not met) to report all near misses.

All NHS Trusts have whistleblowinbg policies, though whether they do more in most cases than tick the box for having a policy is debateable. Your own advice, largly cut and pasted from that of others, sets out the obvious things staff should do.

But most staff know that their NMC and other Codes of Conduct require them to "act without delay if you believe that you, a colleague or anyone else may be putting someone at risk", "inform someone in authority if you experience problems that prevent you working within this code", and "you must report your concerns in writing if problems in the environment of care are putting people at risk".

What your article completely fails to address is the failure of employers and the CQC itself to ensure a safe environment in which staff are able to raise concerns in a timely and effective manner without fear of reprisal. Survey after survey, including by Nursing Times, shows that many staff fear the consequences of raising concerns. They especially fear the consequences if such concerns are not addressed locally and they need to take the matter further.

The NHS is littered with examples of staff who have been bullied, ostracised, or dismissed on trumped up charges as a result of raising concerns. It is a tribute to the likes of Shamila Chowdhray, Kim Holt and Margaret Heywood that despite, the real risks, staff continue to raise concerns. You will have followed in detail the evidence to Mid Staffs NHS Trust from those Mid Staffs nurses who did raise concerns and were harassed for doing so.

You write "I won’t pretend whistleblowers are never adversely affected as a result of their actions, but under the Public Interest Disclosure Act 1998, those who suffer dismissal, victimisation or any other detriment can take a compensation claim to an employment tribunal."

You well know - or should do - that whilst PIDA is a helpful piece of legislation it has not proved a deterrent to the victimisation of many whistleblowers in health and social care. You well know - or should do - that too many NHS trusts respond to the raising of concerns is a challenge to which they respond with a closing of senior ranks. rather than seeing such an eventas an opportunity to improve patient care.

There are excepotion and they should the standard for all employers but they are certainly not the rule.

I am not aware - and you will correct me if I am wrong - of any long list of cases where the CQC has stepped in to protect a whistleblower and prevent their dismissal or victimisation. I am not aware - and you will correct me if I am wrong- of any NHS Trust where the CQC has called for action to remove Board members whose organisations permit the victimisation of whistleblowers.

What the NHS - patients, nurses and indeed social care staff - need from the CQC is more than advice on how to raise concerns. It needs an assurance that the CQC will vigorously and publicly create an environment where those who raise concerns can do so safely and effectively and where those who prevent staff raising concerns, or who victimise them are held to account in a manner that is a warning to others.

My criticism of the CQC is not about your own well publicised failures in the past. My concern is that without unremitting and remorselessly creating that safe environment, you only address the symptoms of a desperately serious problem, not its causes.

Perhaps you can tell us what you hope the Francis Inquiry into Mid Staffs will recommend that will assist you in that job, and what steps you or your successor intend to take to address the concerns I have raised and which I am confident are widely shared.

Roger Kline
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CQC spokesman | 24-Jan-2012 5:46 pm
Roger is absolutely right that what is needed is an environment where those who raise concerns can do so safely and effectively and where those who prevent staff raising concerns, or who victimise them, are held to account in a manner that is a warning to others. However, CQC alone cannot create this environment – while we can play a part, we don't have the means of doing it single-handedly. It requires all players in the health and social care sector to contribute.

CQC's regulatory powers enable us to take action to protect people who use services, and to force providers to improve if we find that standards of care are inadequate. We investigate concerns raised by whistleblowers and use this information to inform our judgements about whether the provider is compliant with essential standards of quality and safety. But we don't have powers to directly protect members of staff who blow the whistle, and we cannot in practice ensure that they do not face reprisals. That is why PIDA and other employment legislation are vital.

In our guidance for employers, we emphasise their responsibility to encourage an open culture where staff can raise concerns without worrying about the consequences, and we set out how CQC will act on information from a whistleblower. We have worked with partners including the GMC, RCN and the Patients Association to develop the guidance, and taken advice from Public Concern at Work. We will continue to do as much as we can to raise the importance of this issue.
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Anonymous | 27-Jan-2012 0:55 am
I wonder if this article is worth the attention of Cynthia Bower and any other people contemplating Whistle Blowing.....

http://www.pcaw.co.uk/files/fecitt-press-release.pdf

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