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OPINION

'Don’t just stand by – blow the whistle on poor care'

Last week brought yet more bad news for those in the caring professions.

Following the Care Quality Commission (CQC) reports on hospitals failing to meet older patients’ essential needs, the regulator found itself in the spotlight in the Panorama programme aired on Tuesday 31 May. The CQC was forced to admit that its failure to act on a whistleblower’s reports of abuse at Winterbourne View residential hospital had prolonged the suffering of its vulnerable residents.

Senior nurse Terry Bryan tried to tell Winterbourne bosses and the CQC about the appalling abuse he saw dished out by healthcare support workers to residents with learning disabilities. These included restraint - or rather physical assaults, bullying and administration of drugs by force. And worse. The exposé showed healthcare support workers showering a patient fully clothed, pouring mouthwash over her so it went into her eyes, beating her and forcing her outside in temperatures barely above zero then throwing cold water over her.

Two charge nurses witnessed some of the abuse that bordered on torture. Those nurses ignored it. Thank goodness Mr Bryan had the courage to put his career on the line and tell the BBC.

The programme proves that the BBC has achieved what the CQC couldn’t - investigating and exposing weaknesses in the system. As a result, there have been four arrests, staff suspensions and Castlebeck, the hospital’s operator, has set up a whistleblower hotline, is reviewing its 56 facilities and patient records. The CQC has also responded quickly, and is inspecting this provider, and is to carry out a series of unannounced visits to the 150 hospitals caring for people with learning disabilities.

Winterbourne proves the need for whistleblowing. But why don’t more nurses feel able to raise concerns? Fear of retribution? A cultural no-no? Those are hard to contend with, but not as hard as standing idly by. Nurses are responsible for safeguarding adults against abuse - and should act to stop it. Always.

Readers' comments (17)

  • Easier said than done Jenni.

    As I, and many others have debated many many times on here, if we do 'whistleblow' or raise concerns, at the very BEST, we will get simple apathetic inaction from an impotent system, prompting many people not to bother. At worst, we will paint a target on our backs for the ingrained system of bullying and witch hunting from management and above, we will be putting our jobs, our careers and even our pins at risk.

    I'm not saying these are excuses not to, I am simply saying these are just two of the problems we face (and many others in between), that prompt many people not to even try.

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  • "But why don’t more nurses feel able to raise concerns? Fear of retribution? A cultural no-no? Those are hard to contend with, but not as hard as standing idly by. Nurses are responsible for safeguarding adults against abuse - and should act to stop it. Always."

    These same questions have been answered time and time again.

    The question is why aren't such complaints handled correctly and promptly acted upon to safeguard patients and without detriment to the nurse or their career.

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  • In view of all the time and money wasted on investigations, research and report writing, perhaps constructive research could be carried out on the type and nature of the complaints themselves and how they dealt with. follow them from the time of the complaint through the system to their conclusion to see if they are being correctly processed to protect patients as intended or fall by the wayside or are used as a weapon against the complainant and their careeer. This is a lengthy process but could, on a large enough sample of a cross section of nurses, carried out by independent researchers without vested interests, throw up some important answers.

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  • complaints should be handled by clinical managers i.e. with clinical qualifications and this and all hospital management related to patient care must be evidence based in the same way as quality clinical care!

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  • Currently a patient can write a letter of innumerable falseness and it will be fully investigated by your trust with their word given precedent over yours.
    A great deal of complaints are written by patients whose conduct is far short of a minimum standard of acceptability,however lacking in anyone to write to yourself - other than the widely derided incident form which unless it concerns falls or violent acts is rarely acted on.
    (I personally photocopy mine as i have had three disappear into the bin)

    Often your statement, with which you are obliged to give a factual account of the event will be afforded a lesser weight with your managers as despite the fact that you are beholden to a code of conduct and unable to embelish or diminish such statements. IF a patient wrote that i appeared to them in a dream i would be subject to an interview.
    You must insist on a union member to be present in every meeting that involves a complaint everytime. Don't think of it as fussing or being bitchy. That's the behaviour we have all been indoctrinated into.
    'Nursey should never act above her station or create the faintest glimmer of shame in a person - no matter what they do'.

    example A. patient cancelled for theatre 4 days in a row. No complaint but the patient did suffer.

    example B. extremely ill patient not given a shave but currently on a general ward with TPN, PCA, Hum02, IVI, IVABS, IVfluid/replace', xiphisternum to umbilical open wound with VAC dressing etc etc. patient declines shave, wife insists, nurses uphold patients wishes wife writes a complaint letter.


    The ones that complain about attitudes are usually create the conditions that they say they hate.
    I've yet to have a complaint about my attitude that did not come about from someone who i had not already documented about in the first instance.
    So another tip would be to beat them in the paper race and document first. The earlier the better.
    And finally if it is witnessed by another RN they have a duty to countersign or document their observations as soon as they occur, not via some statement days later.
    Have fun and protect yourself. Because your managers will not protect you, they have created and allowed the pattern of 'the letter writer must be sincere as they've wrote a letter'.

    On the other hand we have no evidence that they have written letters to anybody about the state of the crummy dumps many of us work in today. So does that mean they are not sincere?





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  • From Anonymous | 7-Jun-2011 10:19 am,

    Anonymous | 7-Jun-2011 10:30 am, and

    Anonymous | 7-Jun-2011 10:49 am

    In addition to my comments in these three posts above, if this is not already the case, there should be separate handling procedures for complaints issuing from patients and those issuing from healthcare professionals and nurses all of which must be heard and given equal weight but they are of a different nature. Those of patients are usually based on their own observed experiences and those of nurses and other healthcare professionals are based on defined standards of care and ethics, local policy and EXPERT PROFESSIONAL OPINION! They are also the direct observers and witnesses on the front line of what is below acceptable professional standards of practice, care and respect for their patients and their colleagues and not those in office management. Ideally, a complainant should always have a qualified professional as a witness to back up their report of poor care or abuse.

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  • Who do you whistle blow to? I ask this question becuse the usual advice given if you want to raise concerns is to talk to your manager/line manager and steadily go up the ladder bearing in mind the manager maybe the one giving poor care who happen by chance to have friends in high places. Personally I think the way the system is set up to deal with complaints, whistle blowing etc needs to be looked at. Things that could be dealt with at ward level between a manager and staff is usually escalted to HR etc and yet the big issues such as poor care etc is often allowed to continue, very confusing to me.

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  • I notice a lot of anonymous comments written above!!!!
    Yes one often doesnt know where to whistle blow for effective change.
    0ne risks so much and its scary to do this.
    bullying, job risk, loss of pin, future livelihood,
    But bottom line, we are in caring profession and if we do care we must find way to deal with this we cant pretend we havnt seen
    Very confusing to know HOW to respond but this cannot be allowed to go on.
    The DESPAIR FACTOR is THIS IS NOT NEW.
    DO WE NOT HAVE CARE AND COMPASSION

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  • just out of interest, the concise oxford english dictionary of whistleblower which i consider the ultimate authority on meanings of words in the english language

    whistle-blower
    n noun informal a person who informs on someone engaged in an illicit activity.

    i am surprised that people need to ask the question of where to whistle blow in their organisations as i had understood that large organisations in the UK such as all NHS facilities, were obliged by law to have a whistle blowing policy in place with strict procedures to follow with guidelines for their staff as well as the guidelines which were issued to all nurses on the nmc register. it is obvious, however, that in many areas this system is not effective and is not standardised across the nhs and all care homes as it should be.

    as i see it, this should be used for cases of serious negligence, poor care and abuse. if it is used for too many more minor complaints the system becomes flooded and there may not be enough staff to deal with the numbers, which leaves a backlog of untreated case files piling up on their desks.

    in my view, anyone who witnesses poor practice or unwanted behaviour from another staff member at whatever level should first point this out, tactfully, to the person concerned. if this is not effective, they should be made even more aware that it is unacceptable. if this is still to no avail the person should be informed that their misconduct will be reported to the manager and all the individuals concerned, if possible, should be present for further discussion. if there are no changes in behaviour then the complaints need to go progressively up the ladder of authority according to their nature and seriousness until action is taken. In nursing I have too often seen examples of people make genuine mistakes or remaining ignorant about what they are expected to know and do and instead of telling them this is reported or worse still discussed behind their back. this is nonconstructive and can lead to mistrust, poor working relations, bullying and even ostracism of the individual.

    to my mind ' whistle blowing' is not, and should not be, reporting someone behind their backs or 'telling tales' so they may be unaware of the effects of their actions on others. they should be given a fair chance to change their behaviour unless it is dangerous or totally unacceptable in which case it obviously needs to be handled as a matter of urgency.

    in answer to Valerie Thomson above, yes I agree that the very reason we wish not to tolerate poor care and need an effective reporting system is proof of our care and compassion, and hopefully there will be rapid improvements in this system.

    on a final note - once again this is an example of how general management of our services by non-clinicians is running our health services (introduced as an attempt to manage what the then government perceived as 'unbusinesslike' clinical staff, who were losing money running the nhs with the efficiency of staff from the industry sector on a production line!).

    large organisations with customer services now have customer complaints departments - a message in itself. as an example of this,
    twice recently statements from two financial institutions sent by post did not reached me. on each occasion, when i queried this, i received a reply saying that my request had been passed to the complaints department even though i had not complained, but merely requested replacement statements. this, however, involved lengthy procedures and generated a pile of correspondence with apologies, informing me that my case was being investigated and roughly when I could expect a reply, and follow up letters to inform me of their progress. several weeks lapsed before I finally managed to obtain several copies of each statement all sent separately over a period of several more weeks. i cannot help thinking of all the staff this involved, salaries, work space, equipment, time, materials and postage when it would have been far simpler just to have put copies of the requested statements directly in the post which i would have received within a few days!

    I am sure everybody can relate endless similar stories. i imagine that a system similar system to this is used in the nhs for complaints about patient care!



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  • In response to the title of this piece, I think there would be much less a need for whistleblowing if there was safe staffing, the incident forms were acted on and CQC did a more comprehensive job. However that does depend on the CQC not being subject to job freeze and post cutting by this government!!
    I'm wondering how Cameron and Lansley will wriggle out of this as a negligence case.

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  • Anonymous | 10-Jun-2011 3:54 pm

    in an ideal world...

    if only...

    I think this is what we all think, but how to make it happen?

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  • I recently attended a complaints management forum and related my own experiences of staff behaviour which fell well short of what can be described as acceptable. I was visiting my daughter in hospital over a period of about a month and noted a number of incidents which I related to the group. One of the responses I received was realy surprising. I was told that I only noticed these events because I was not busy and had time to watch what was going on. I tried to get it into the thick skull of the Complaints Management Adviser that was surely not the point. Regardless as to whether or not I was busy, these events were in fact happening and if they were not happening I would not have noticed them. The theme of the forum seemed to be a cost saving exercise. It was spelled out how much complaints cost and how to discourage complaints. So one can imagine the attitude management has towards whistle blowers, they cost money, get rid of them.

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  • From the comment above

    "I was told that I only noticed these events because I was not busy and had time to watch what was going on."

    this attitude is totally gobsmaking from those in senior positions paid to handle the complaints, who blatantly show that they prefer to sweep them under the carpet than deal with them directly for the safety and protection of the patients. such an attitude will infiltrate through the culture of the organisation at all levels and sets no example to the staff guilty of such failures who have patients in their care.

    "The theme of the forum seemed to be a cost saving exercise. It was spelled out how much complaints cost and how to discourage complaints. So one can imagine the attitude management has towards whistle blowers, they cost money, get rid of them."

    if I am not mistaken, the cheapest way would be to change the current culture and get rid of the sources of the complaints in the first place.

    fortunately I practiced in a culture in Europe where complaints were unusual except in cases of gross professional negligence which was usually medical and not nursing related, even though public and private patients were paying for their care through costly insurance. they expected high standards and this was delivered as the norm. this worked fine until the new management concept of 'customer as king' was translated in our 1,000 bedded uni hospital to 'patient as king'. suddenly all patients were issued with brochures to orientate them in the hospital and inform them of their rights. it caused outrage amongst the staff when posts and salaries started being cut and money was spent on paper napkins which appeared on every meal tray with a picture of a frog king, the slogan and a new hospital logo, which doubtless also cost money to design and produce. with these innovations, each patient was invited to fill in a questionnaire about their hospital experience. a good idea we thought, but then discovered after a long period that only the negative ones criticising our care and our ward reached us from management. fortunately these were few, and we knew who they came from but although some provided us with some constructive criticism and room for improvements which we did our best to implement, others were highly destructive and had a negative and highly stressful effect on our whole team. one resulted in a legal enquiry which involved a considerable amount of our time in defending our case. eventually it had to be withdrawn and management had to accept our stand that the patient had a severe mental health disorder, and although we had bent over backwards and spent a lot of extra time with her trying to help her and trying and meet some of her more reasonable demands, she would have been better cared for in psychiatry with specialized nursing care than on a hectic acute and chronic general medical ward. We were accused by her of being rude and uncooperative in meeting her demands and providing very poor care, which was clearly far from the facts. Although we found her very difficult she never expressed any complaints to us directly where we might have been in a better position to clear any difficulties, and the feedback from her questionnaire came to us out of the blue some considerable time later from management forcing us to recall any of the events which could have led to her complaints. we never go to see her original responses on the questionnaire. We came to the conclusion that for some reason management took pleasure in bullying us in this fashion.

    Sadly the quality of care did start to deteriorate after this event and the era of customer satisfaction questionnaires, which were later dropped, for other new fangled management concepts, as our staff was massively reduced, wards closed, and our workload rapidly increased until it more than doubled for each nurse on duty at any given time.

    The rest of the story is the same as it is everywhere else, and even in the best European healthcare systems, although here, where I am living, they still maintain very high standards, and thanks also to the excellent attitudes of their staff. Those who are bad are immediately reprimanded and shown how they may improve with a deadline for a further meeting. if there are no improvements they are shown straight to the door with no arguments and with bad references.

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  • Isn't is sad when nurses regard patients' family as the enemy? I can understand the need to speak out for one's family but they should back off when politely informed the rationale for doing or not doing something for their loved one. A shave for goodness sake?! Would they demand that the patient be given a cigarette because that is what they normally do at home?!

    Did this start with the Patient's Charter? Yes, patients have rights, of course they do, but so do us nurses! We have the right to be treated with good manners. If families think they know better than the medical and nursing team then they ought to take the patient home and get on with it!

    Fair enough, if the patient was being obviously mistreated or neglected then the family would have the right to complain and I would sincerely hope they would do so. But to interfere with the process of nursing itself is just not acceptable.

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  • Hi all

    Highlight the link below in your web browser
    and hopfully you will learn what is the CHRE
    and maybeif everyone with a concern about the way 'whistleblowing and doing the right thing' can be the wrong thing in terms of your career prospects then change can happen, Drop a coin and chat to CHRE they Could bring about change to NMC.



    http://www.chre.org.uk/_img/pics/library/110622_Who_regulates_health_and_social_care_professionals.pdf

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  • michael stone

    Anonymous | 13-Jun-2011 12:27 pm

    'if the patient was being obviously mistreated or neglected'

    Who decides, whether that is obvious ? The patient, his relatives, or nurses ? What may be 'obviously true' to me. may not be 'obviously true' to you !

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  • When I complained to both nursing staff and the 'ward doctor' responsible for my care, I was totally ignored. The icident concerned my medication, which was heparin injctions. These injections had been prescribed 12hrly, and following my admission into th medical ward, had been given regularly, at the prescribed time.
    Until, one day the trained staff nurse, wouldn't give it, making lame excuses for 'putting it off'. Eventually, I confronted her, reminding her that it was important for me to have the medication, to prevent my blood clotting. She disclosed to me that the dose of medication written on the medicine card wasn't correct, and thatn was why she was felaying giving it to me. She wanted to discuss the matter with the ward doctor when he arrived on the ward. Eventually, a dopctor came and asked me what the problem was, and after listening to me, went off to check the medicine card. Next thing I heard, was that he'd simply 'discontinued the medication'. No explanation, no apology, nothing!
    God Help the poor sods left on the ward! The mind is still boggling.

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