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Christina McAnea: 'The Colchester case shows the huge struggle to change culture'

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Having to rely on whistleblowers to highlight problems or mistakes is wrong, says Christina McAnea

It takes a lot of strength and courage to speak out about bad practice in the NHS. The history of what has happened to whistleblowers doesn’t inspire confidence. If you’re a junior member of staff and your manager is saying it’s nothing to do with you, and you should just get on with your job, or even worse, bullying you, it can start to feel like David fighting Goliath.

That’s precisely what Unison members at Colchester Hospital University Foundation Trust faced when they were instructed to change data relating to patient treatment and referrals. As the Care Quality Commission reported, staff provided examples where “they felt they had been pressured, bullied or harassed to change the data on the cancer pathways”. These staff also raised their concerns in writing to managers and, in one case, directly to the chief executive of the trust. In a previous internal investigation, our members have told us they were not interviewed over these issues.

‘We are calling for additional protection for whistleblowers’

There appears to have been a number of areas where the process failed in Colchester and opportunities to change things were either missed or possibly even deliberately ignored. No doubt, this will become apparent in the ongoing investigation.

What the Colchester case has highlighted is that, despite the revelations from Mid Staffs and the Francis report, there is still a huge, uphill struggle to change the culture in some parts of the NHS.

In our response to Francis, Unison has called for a designated trust board member to be responsible for addressing concerns and complaints from patients and staff, and for ensuring these are investigated properly and action taken.

We are also calling for additional protection for whistleblowers, to allow groups of staff who raise issues to have the same protection as individuals. We also believe there is merit in looking further at the recommendation from Francis to ensure there is adequate time for union representatives to do their job. Although this recommendation is said in the context of nursing, it must be extended to all staff.

The case in Colchester demonstrates that highlighting patient safety concerns is the responsibility of all groups of staff. It could be argued that for junior or lower graded staff, being able to go to your union representative and having the confidence to raise issues safely and without fear of retribution is even more crucial. As has happened in other areas, if those complaining are relatively low down in the NHS hierarchy, for example, administrative staff or healthcare assistants, it can be difficult to be heard, or to have concerns treated seriously.

So we are calling for further investigation into the role of the trade union representative who would have specific responsibility to raise staff concerns, including professional, clinical and patient safety issues with management, and who could be involved in the governance of risk within trusts.

Initiatives, such as the Nursing Times Speak Our Safely campaign, are influential in encouraging staff to feel they have the right to speak out and also in getting employers to put in place systems that enable openness and transparency. At Unison, in response to the original Francis report, we developed our Be Safe programme for training. This is designed to train our representatives and full-time staff on how to highlight concerns and, more importantly, how to support members who are raising concerns. We are rolling this out across the NHS and are working with NHS employers nationally to deliver the training to all staff.

Having to rely on whistleblowers to highlight problems or mistakes is wrong - we need a culture where staff at all levels can speak out and, importantly, be heard.

Christina McAnea is head of health at Unison

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Readers' comments (1)

  • To tackle culure change, you will need to understand the psychology of organisational hierarchies and why people, even in senior positions adopt a herd blindness in the face of authority and the compulsion the comply and fit in.

    No report, no government, no union have suggested anything that will have any effect on the NHS culture. In spite of the huge media fallout from the Francis Report, the CQC (itself a deeply flawed and ineffective organisation) has reported that Mid Staffs continues to fail in its ability to monitor care. Hundreds have died and nothing has been done. Why does no one see this? The latest 'scandal of the week' is focusing on Colchester. There are many more that we don't know about.

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