The excess number of deaths in Stafford and the descriptions of unacceptable care of some patients depicted by Julie Bailey
in her book should be a wake-up call for all health professionals about the importance of speaking up.
Raising concerns constitutes a spectrum ranging from the fi rst verbal mention of a worry to writing it down and completing clinical incident forms, then escalating it to board level. Successive governments have emphasised how staff are protected by the Public Interest Disclosure Act; it is clear now, however, that this is notthe case.
It is entirely possible to frighten and disadvantage a member of staff, and to make their life completely miserable while they are still employed. As soon as anyone raises a concern, they will learn all about the culture within that ward, department or health trust - but their card may already be marked, depending on the seriousness of the concern.
Patients First is trying to raise awareness about the cultural issues that can deter health professionals from speaking out so we can really understand what will make the difference, and how nurses in particular can be empowered.
In his report, Robert Francis QC has shown how a number of clinicians had been trying to alert management to patient safety issues but that the board did not consider these in any systematic way. Helene Donelly, an A&E staff nurse, completed over 100 clinical incident forms, and yet no change occurred. Having been threatened, she became frightened and, having exhausted all of the options that she felt were available to her, she eventually left her post.
Ms Donnelly is now vindicated but those who ignored her concerns or bullied her carry the responsibility of having allowed standards fall to unacceptable
levels. How in the current context can I encourage others that speaking out is theright thing to do?
My argument for speaking up is that we all want to do our best for patients and it is only by raising standards in an incremental way that we can do so. Staying quiet may allow situations to develop like Mid Staffs.
Last week a Nursing Times survey highlightedthat in 15% of cases, the threat of bullying deters nurses from raising concerns that they have. If a nurse works in this type of hostile environment, it is likely that the care patients receive will be more of a concern and, as such, the importance of raising concerns is even more urgent. In such workplaces, however, Patients First would advise speaking with colleagues who are trusted, taking advice from unions or groups like ours and ensuring careful records are kept of the concerns that are raised.
In a hearing of the Health Select Committee on 5 March 2013, Sir David Nicholson was asked about the culture of fear and blame that many talk about. What concerns Patients First is a continuing denial of the real fears that many health professionals have about the potential risks they might be taking when raising concerns. If the bullying culture is not acknowledged, how can strategies be put in place to tackle it?
This is why I am so pleased that Nursing Times has launched its Speak Out Safely campaign. This will keep the issue alive and try and help empower nurses who are not only faced with almost impossible situations on a daily basis, but also have to deal with the fear of bullying if they try to say anything.
This culture must change - if it doesn’t, we have all failed in fulfi lling the duty we have to our patients.
Dr Kim Holt is founder of Patients First
Sign our Speak Out Safely petition to support a transparent and open NHS. We are calling on the government to implement recommendations from the Francis report that will increase protection for staff who raise concerns about patient care.
Visit our Speak out Safely page to find out more.