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Little change in NHS culture on whistleblowing, warn campaigners


There is a “real and continuing problem” over the treatment of NHS staff who raise concerns about patient care, according to a report submitted to a national inquiry into whistleblowing.

The report, published by the whistleblowing campaign group Patients First, warned there was “little sign of the sea change” needed in NHS culture to improve safety levels and working conditions, despite the previous public inquiry into care failings at Mid Staffordshire Foundation Trust.

“There is a real and continuing problem over the treatment of those who raise concerns”

Patients First

In fact, the report (attached PDF, top-right) said the divergence between organisations that demonstrate best practice on supporting staff raise concerns and the remainder “appears to be getting greater”.

The document has been submitted to the Freedom to Speak Up review, which is currently being carried out by Sir Robert Francis QC, who also led the Mid Staffordshire inquiry.

Robert Francis

Robert Francis

The work, carried out for Patients First by a team of employment law experts, looked at common themes from 70 cases involving whistleblowers.

It concluded that failure to provide support and following policies on raising concerns appeared to be the “norm rather than the exception” among health service employers.

The report also noted that some NHS employers were working to a “fundamentally wrong” definition of what a whistleblower was.

Patients First insisted there should be no distinction between “raising concerns” and “whistleblowing”, and no distinction between whether concerns were raised internally or externally.

In addition, it claimed the employment processes adopted typically lead to the isolation of whistleblowers and the containing of their concerns – for example, via confidentiality imposed during internal investigations and through suspension.

A “very striking feature” of the case review, the report said, was the loss of trained talent to the NHS, through termination of employment, ill health or, in some cases, suspension on full pay for long periods.

It warned that there seemed “little doubt” that the experiences of those who had raised concerns operated as a “serious deterrent” to those who might wish to.

The report also said that the number of whistleblowers referred to professional bodies, such as the Nursing and Midwifery Council, was “striking”.

“An overwhelming number were dismissed by professional bodies at a preliminary stage on the basis that there was no case to answer – calling into question the basis and motive for employers having made such referrals,” the report stated.

Patients First said changes were required “as a matter of some urgency” to ensure the early support of whistleblowers became the expected norm in NHS employment and that those who raised concerns received more legal protection to avoid significant loss of earnings.

Among its recommendations, it called on employers to avoid being distracted into turning patient safety concerns into employment issues, and to prevent the “marginalisation and isolation” of whistleblowers.

Meanwhile, it called on the NMC and other regulators to play a “concrete and positive” role in supporting whistleblowers and be “astute to detect reactive or malicious referrals for professional misconduct”.

In March 2013, Nursing Times launched the Speak Out Safely campaign to raise awareness about the problems staff faced when raising concerns.




Readers' comments (22)

  • michael stone

    'Patients First insisted there should be no distinction between “raising concerns” and “whistleblowing”, and no distinction between whether concerns were raised internally or externally.'

    That is my position on this one, in essence: but it seems clear that until concerns can be raised 'anonymously' but also properly looked into, staff who raise concerns could be 'bullied' by bad employers.

    I'm sure Sir Robert understands the issues - how far he will go, in suggesting solutions, will be interesting to see. It will also be interesting to see, whether he formulates his conclusions/recommendations in the 'very hard to cherry-pick' way he did for the Mid Staffs report.

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  • So administrators and nursing staff want to really put 'patient's first'? Then start with safe nurse-to-patient ratios. A nurse forced to care for more patients than is safe for ANYONE to render safe, adequate care is jeopardizing patient safety, patient health and their own well-being, including their licenses. By inundating good nurses with humungous patient load assignments healthcare administrators are forcing these nurses to choose between their survival and the survival of their patients--and THAT is causing more and more nurses to leave the profession---or avoid getting into the profession altogether. Change MUST start at the top. Implement and make law limits on safe nurse-to-patient ratios.

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  • I kind of give up on this although I know I shouldn't, but in almost 30 years in the caring services I have 'raised concerns' numerous times and every time WITHOUT FAIL I have been left suffering and have seen the same with others. The fate of the concern raiser is not thought about enough or protected so I agree that failure to provide support is the norm rather than the exception sadly. There is a lack of common sense in general and not enough emphasis on education, responsibility, accountability, honesty, and courage. I read in the paper the other day about the girl in a mental health unit who has broken her back after jumping out of a first floor window when an aggressive inpatient threatened to rape and kill her. She was on duty alone. 1. That should never have happened, and 2. She should have been warned to ring in and refuse to work the shift if she was ever on her own. When managers become proactive with at the very least minimum standards but preferably higher respect will return to the services; disasters will be averted; and there will be hope for the future. Stop punishing those brave enough to speak up and look after them. Prevention is better than cure but if you have to cure: do it well.

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  • At the risk of sounding repetitive (but it needs to be said again and again as nothing appears to change), there needs to be a fundamental change in NHS management culture, right from the top, to allow for dissenting views, to allow the orthodoxy of those in power to be questioned, especially, but not exclusively, where this impacts on standards of care and safety.

    This did not exist at any point in my 30 years in nursing: all we had, as pointed out in comments about "lack of leadership", were a bunch of "yes people" dedicated to squashing any form of dissent and persecuting the dissenters.

    If this does not change then Francis is wasting his, and everyone else's, time.

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  • Spot on Basketpress 5.18pm. Nursing is a top-down, militaristic profession which still views any form of dissent as 'insubordination'. This bullying side of nursing culture is often hidden by the 'caring' mask that most of the leadership at all levels hide behind. The cases we of hear about are a manifestation of a complex and vast web of unspoken rules, subtle intimidation and pervasive fear. Nursing is sick. We need root and branch examination of these underlying attitudes and then radical reform, but it won't happen because the bullies are in charge! The only way is out.

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  • tinkerbell

    why deny the obvious? The management culture of the NHS is not receptive to nurses raising their concerns. Get shot of corrupt managers and we may, at long last, get some positive change for the better. They should not allow managers to destroy the trust of nurses and patients. This tortuous route of nothing changing needs to be changed once and for all and placed firmly at so called managements door.

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  • Gosh, really!! Has this culture not stopped!! Shame on you Trust Managers and CEO's? What are my taxes paying you for then? Why have I paid you any money at all in fact if you clearly cannot support your staff or actually do the job the Government is paying you?

    Who put these bullies in charge?

    When I come into hospital as a patient, I expect to be treated by a calm and happy nurse, not a bullied and terrified one!! If I see a Manager, Sister or Doctor bullying anyone, Trust me they will hear from me. It is the ultimate form of cowardice and frankly I am too long in the tooth to put up with it anymore.

    So Open Letter to all CEO's and Directors of Nursing and Matron's and Ward Sisters.

    Start doing the job you were trained to do. Start working for a living instead of jetting off on jollies to foreign countries and leaving people here in England to suffer.
    Stop sitting on your backsides expecting the world to do your job. You are paid a salary for a reason, so start earning it.
    When training a member of staff I ask you this question. When you go in for an operation, would you like to have your wound dressed or your post op care done by a staff nurse who has just got 40% for her training, who is bullied and demoralised, or by a dedicated nurse who has worked hard and trained hard and knows her stuff (70-80%er) and is not bullied or terrorised and does not stand for it and who is proud to be a nurse and has patients ask for her by name because they know they will be treated with kindness and respect.

    I guess what I am trying to say to you all is 'GROW UP!! YOU ALL LEFT THE PLAYGROUND A LONG TIME AGO'.
    I am fed up with reading comments like the ones above because no one has the right to bully you, so tell your bully to stop and treat you with respect and if they don't raise your voice and loudly tell them to stop bullying you and amazingly I can guarantee you they will. Be assertive because if you can't look after yourselves, how on earth can you tell me that you can look after me when I am a patient.

    So CEO's and Directors and Matrons and Sisters I address this to you all around the UK.
    Kindness, Care, Compassion, Trust and Respect. If none of you have any of these qualities left, GET OUT OF MY NHS!!

    Kind Regards

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  • This 'speak out safely' campaign has always been complete and utter nonsense. The clamour to sign-up was a clamour to silencing and whitewashing. You've three main camps: patient/relatives, clinical staff and managers.

    Management priorities are not the same as clinical staff or patients. Similarly, clinical staff's priorities are not the same as management or indeed patients and yes, you've guessed it, patients priorities are not the same as clinical staff or management.

    As managements priorities are completely different to those front-line staff, they [management] don't really want staff flagging concerns to them. Similarly, patient complaints aren't really welcome either.

    Things will never improve until all stakeholders want the same thing. When it becomes managements priority to provide quality food, enough staff, decent working conditions etcetera that's when things will improve.

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  • I agree with the person who stated that being able to raise concerns anonymously is forever going to be the "sticking point". Having been in this situation personally, I had to decide NOT to go any further with ANY of my concerns as my name would be put forward with them, leaving me in a situation that would be even more unbearable than it has been anyway. Where I work bullying and intimidation is inherent, it is not just one or two people, it is throughout. It is awful. Is patient care affected? Oh I would say so and have seen things that make my hair stand on end. Still, I will just have to carry on doing what I can do because I have bills to pay and by raising any concern I would lose my job, simple. Nothing is going to change from Mid Staffs, it breaks my heart. I want out.

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  • Anon @8.58am I so agree with you, BUT, it is not as simple as you seem to think it is. Every time I have raised concerns I have been bullied and harrassed then moved and I know colleagues who were also moved for raising a concern then getting upset and then moved for being honest when asked a direct question. That leaves those behind shrinking into their shells even more as the message is: Speak up and you're gone. Fact. People do need to put food on the table and I'm afraid that comes before being kicked out for being conscientious. Change the outcomes to these stories and we might see a more positive picture emerging. If not it will continue sadly. I would like to see Robert Francis devise a Raising Concerns course using his research and real life stories/cases and it being compulsory for ALL managers to take it. It should then be continually updated and audited. It's no good just highlighting these things unless it is personalised and affects every single manager who are supposed to be the role models we follow. At the very least departments should be fined for getting it wrong by an independent body. That would shift them.

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