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EDITOR’S COMMENT

'Staff need to know it’s safe to speak out'

Health commentator Roy Lilley told delegates at the Florence Nightingale Foundation annual conference last week that he didn’t know why managers didn’t crawl on bended knee and beg their staff to tell them when there were problems in their organisations.

He said he couldn’t fathom why directors wouldn’t want to be told when things were going wrong. We couldn’t agree more Mr Lilley.

This week is the anniversary of the Speak Out Safety campaign launch. Last year, in the wake of the Francis report into care failings at Mid Staffordshire Foundation Trust, we heard of several NHS staff who felt terrified to speak out. Helene Donnelly, the nurse whistleblower from Mid Staffs A&E, had been held up in the Francis report as a paragon, but was ignored, bullied and threatened at her trust. But she wasn’t alone. Former United Lincolnshire Hospitals Trust chief executive Gary Walker broke his gag to disclose allegations of how he’d felt pressured to put targets before patients. His speaking out created a watershed - and other health workers flooded our inbox with their tales of raising concerns that had gone wrong.

The campaign was launched to encourage trusts to say they will listen to staff who raise genuine safety concerns, treat them with respect and try and resolve them

Speak Out Safely was launched to encourage trusts to say that they will listen to staff who raise genuine patient safety concerns, treat them with respect and try and resolve them. That’s the sort of NHS Berwick, Keogh, Francis, and surely everyone, wants.

And yet a year on, just over 70 trusts out of the 300 or so that could sign up, have. Universities and private companies have been encouraged to join the ranks of organisations who seek out staff intelligence and act on it, but few have pledged their support.

Comedian, journalist and GP Dr Phil Hammond asked delegates at the Florence Nightingale Foundation conference to raise their hands if their trust had signed up to Speak Out Safely. Very few did.

I am delighted those organisations who have sighted up are supporting SOS, but Dr Hammond highlights the importance of this SOS anniversary week - in getting the message out there and encouraging more trusts to sign up. I cannot understand why any trust wouldn’t sign up and tell its staff it’s safe to raise concerns.

If your trust is signed up, you can see it on the roll of SOS glory at nursingtimes.net/sos. If it isn’t, then you need to ask why.

As Ms Donnelly told the conference, she just knew “something wasn’t right”. Staff often do. If you want to avoid your trust becoming the next scandal-hit hospital, you need to make sure people will and can speak out when something isn’t right. No one should have to face the horrors that Ms Donnelly experienced. And definitely no patient or relative should have to face them.

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (18)

  • Richard White

    Not only managers can benefit from such information, all clinicians will gain from 'constructive comments' on their attitudes and practices. Far to often we are too precious to react appropriately to this.

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  • I think most directors of nursing were quite aware of the problems. Nursing directors went unchallenged for so long they probably assumed what they were doing was correct.

    The culture of nursing dictates orders come from the top, no one is allowed to question those orders. So, basically it is possible for a director to think she/he is running a top notch establishment. Despite the fact that life on a ward is hell.

    Another factor, a big one, is the type of person who tends to get into positions of power. Nursing does breed a rather egotistical type who quickly manage to get into senior positions. Many have delusions of ability, and cover up their weaknesses with arrogance and aggression.

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  • Anonymous | 4-Mar-2014 12:42 pm

    Very true.

    Quite a few nurses are Chief Executives now. I'm not saying it is just nurses who abuse that position and there are those who do a good job BUT, but lets face it, dangle the thought of a CBE under their noses and the bidding of those above will be done.

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  • I'm posting anoymousley because the issue is on going and is unlikely to be resolved for several months at least.

    Almost 6 months ago I was a whistleblower at a location where vulnerable elderly people were living. After having notified the regulatory authority my concerns were upheld and a moratorium was placed on admissions

    However the manager and staff at the location retaliated by colluding to try and destroy me by making serious allegations against me.

    Next time I'll think twice.

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  • All this SOS nonsense does is allow managers to continue doing what they're doing: putting patients and staff at risk until some lowly member of staff 'snaps' and blows the whistle.

    Ignorance is bliss: "we would've done something sooner if only someone had told us about it."

    It is naive in the extreme to think that managers and CEOs don't know what's going on in their organisations, of course they know: the amount of information that is recorded and the number of meetings held they would have to be deaf, dumb and illiterate not to know.

    SOS does nothing for whistleblowers and it's 'protections' do not extend beyond the confines of the organisation. Yeah, they'll not sack you - immediately - as long as you keep your concerns in-house, but go off to the CQC or the newspapers, then the gloves are off.

    A link to a Nursing Times webpage is not a policy, so what are these Trusts really signing up to? Nothing.

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  • Further to the above, I can now see SOS being used as a weapon against staff who don't 'shop' all and sundry.

    A member of staff being persuaded by a more senior member of staff into doing questionable things in order to increase patient flow.

    Managers find out: member of staff being pressurised, is disciplined under the new SOS policy for not speaking out.

    SOS (saving our salaries, in the case of managers) is a godsend to Trusts - hence the clamour to sign up - as it now puts the onus on staff members to speak-up rather organisations and it's management, having to be diligent and accountable.

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  • 'Speaking out safely' may be the ideal but unfortunately, it's still far from a consistent reality. The very 'hit and miss' nature of speaking out makes it an ongoing risk for nurses.

    It great if is works, but if it goes badly; a career is ruined, a livelihood is lost and a brave nurse/carer is eliminated by a 'system' that closes in and destroys them.

    The way the law is structured with the Protected Interest Disclosure Act, only those with thousands of pounds can take their whistleblowing claims to court, in order to have their whistleblowing upheld and obtain compensation. Impossible for the majority.

    Thus, nurses should be very careful with escalation of risk. Yes, it is important to speak out and raise quality issues, its part of our professional duty to do so, but until the law and culture changes, perhaps the safest way is to 'speak out' is using the protection of anonymity. Write a letter, write the Quality /Safety, Audit or Clinical Governance Committee, the CEO, DON, the Chair, all anonymously or contact your MP or the CQC.

    There are other ways to 'speaking out safely' other than verbal, which offer much more protection to those brave enough to do the right thing.


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  • tinkerbell

    Sometimes you just can't win. Having raised concerns about a unit I worked at many years ago over a period of 5 years no action was taken. Then an 'anonymous' sent in concerns, most of which were the ones I had raised in person. They suspended the manager and I was told to take over the unit in his absence. I was asked about the anonymous concerns and agreed they were mostly valid.

    I was then taken to the cleaners for not raising concerns sooner by the very manager to whom I had raised concerns but he denied I had ever done so. I understand he didn't want to lose his job by admitting I had but even so I was sent to Coventry.

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  • Tinkerbell , I am sorry to hear about your situation because you raised concerns. Nurse whistle-blowers have suffered horrible results at times but ruthless managers, HR and DONs.

    Would you have also raised it or followed it up in an email, if you had to do it again?

    Also, having gone through your experiences, would you recommend junior nurses to speak out or write anonymously with the 'hit and miss' responses that still occur from NHS, private healthcare management and a Protect Interest Disclosure Law that is unaffordable to take advantage of for most nurses?

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  • tinkerbell

    Anonymous | 7-Mar-2014 1:58 pm

    I was naive back then and learned the hard way. I thought managers would want to know patients were being abused in mental health. Now I would put all my concerns in writing and send them to every tom dick and harry.

    I still think though that an anonymous concern raised is better than doing nothing otherwise nothing will ever change. for myself I would still raise concerns but in writing now and face to face wherever possible backed up in writing.

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  • dikod1

    My fitness to practice has just been found to be impaired by the NMC and guilty of misconduct requiring practice conditions and training around patient confidentiality. This followed complaints about victims of various abuses within a forensic hospital and naming them which resulted in two internal inquiries and the eventual written thanks of the Trust CEO. However, managements hawks decided upon a witch hunt. Fired me over cobbled allegations involving huge Trust-wide investment and a proven referral of lies that suggested dated practices as my unique practice contribution was acknowledged in the second inquiry but nevertheless eagerly taken up by the NMC and pursued despite explanations for all allegations. Crucial defence evidence was deemed inadmissible and email evidence as hearsay when it was clearly genuine. I am subject to 18 months practice conditions having already been subject to 18 months interim practice conditions but now involving personal development plans and explaining how I am learning the importance of confidentiality. How can you check abuses if it is deemed misconduct for the victim to be identified (even with Trust permission as in my case)?

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  • dikod1

    'Whilst the panel had no doubt that it is commendable for for any nurse who identifies concerns relating to patient care to raise and escalate those concerns, the panel concluded that throughout this hearing you have sought to use this as an blanket excuse for your own unjustifiable failures to follow the very policies, procedures and professional standards which are designed to protect patients". (NMC Conduct and Competency panel decision, 3.3.14) "Dear Mr Dickinson, REPORT INTO CONCERNS ABOUT USE OF SECLUSION I enclose a copy of a report that I have received from the Review Group that I established following my meeting with you in July 2011 in which you raised concerns about the use of seclusion. You will see that a number of recommendations have been made for improvement, which will be acted upon. Thank you for bringing these matters to my attention, Yours sincerely, Martin Barkley, Chief Executive, Tees Esk & Wear Valleys NHS Foundation Trust. 3.2.12.
    (I was fired just after for accessing normally the adjacent ward seclusion victims file, initially for breaching confidentiality then following persistent argument for "accessing for too long" when I 'could have been completing a better nursing task'). Three other accessings alleged, all justifiable including one short genuine error due to no accessing protection. Afterwards a traffic lights protection tool quickly brought in following the fuss. NMC external private lawyer returned a year later and spent a fortune working out a new allegation ..complaining about and naming (with trust permission) a severe LD patient-victim ..without his permission ..and resurrecting all the original "evidence" long since dumped even by an extremely hawkish health service management determined to fire me only to dump it again two years later. Apparently I have an attitudinal problem ..I won't tolerate patient abuse.

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  • tinkerbell

    David, all credit to you for remaining sane throughout this skulduggery and treacherous corrupt culture that shoots the messenger who is trying to prevent patient abuse.

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  • In 1992 I raised concerns regarding Health ans Safety issues, guess what management re-organization and I lost my job, thankfully I got compensation at the tribunal, but I applied for over a thousand jobs (excluding agency work) before I was successful. Regrettable I again raised my concerns regarding fraudulent activities, this time I was made to retire, a couple of days before the new law came into force. i had a good professional record and no sickness, and was the only person in the trust to loose their job on the grounds of age. Two colleagues were bullied and lost their jobs for refusing to undertake fraudulent activities I have just heard that the trust is now investigating fraud. Guess many people will be a little too scared to speak out.

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  • dikod1

    3.2.12
    Dear Mr Dickinson,
    REPORT INTO CONCERNS ABOUT THE USE OF SECLUSION
    I enclose a copy of a report that I have received from the review group that I established following my meeting with you in July 2011 in which you raised concerns about the use of seclusion. You will see that a number of recommendations have been made for improvement, which will be acted upon. Thank you for bringing these matters to my attention.
    Yours sincerely
    Martin Barkley
    Chief Executive
    Tees Esk & Wear Valleys NHS Trust

    The dismissing operational director swore under NMC oath that he had never read, seen or aware of the contents of the 27 page report (and therefore was unaware of the single finding of practice excellence) although the report states that it was read and noted by LD forensic operation directors. Where does the NMC place this on the continuum that includes complaining about and stopping patient abuses by identifying the victim?

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  • dikod1

    I went to the Garden of Love
    And saw what I never had seen.
    A chapel was placed in the midst
    Where I used to play on the green
    And the gates of the chapel were shut with "Though Shalt Not" writ o'er the door
    So I turned to the Garden of Love
    That so many sweet flowers bore
    And I saw it was filled with graves
    And tombstones where flowers should be.
    Priests in black gowns were walking their rounds
    Binding with briars my joys and desires.
    Blake

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  • David Dickinson | 8-Mar-2014 6:38 pm

    beautiful and immensely moving. thank you for posting it.

    your positive attitude, protection of your patients and speaking up when things go wrong and your perseverance, where many would have understandably given up and been put of wanting to carry on nursing for life, will pull you through.
    all the very best of luck for your future successes

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  • dikod1

    TEWV NHS Annual Report and Financial Statement 2011/12..
    ..However, we know that we do not always get it right for all of our service users and their carers. For example, the Care Quality Commission (CQC) inspections of our learning disability services in 2011/12 highlighted a number of concerns. These concerns relate mainly to specific policy and procedures that may impact on the experience of our service users and carers rather than highlighting any significant risk to the safety of patients or the effectiveness of the care they receive. We know we cannot afford to be complacent and we recognise that we need to remain focused on driving up standards across the whole Trust. That is why we continue to listen, to learn and to focus on what more we can do to make sure that everyone who uses our services receives high quality care all of the time.

    Martin Barkley
    Chief Executive
    Tees Esk & Wear NHS Trust

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