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'Disaster is just around the corner, unless we take action now'

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Joan believes that unless the culture of the NHS changes dramatically, and quickly, a scandal similar to the Mid staffs disaster is inevitable

Our beloved NHS is facing one of the most challenging times ahead.

At present we have a recipe for disaster. We have the perfect ingredients for another scandal to happen very soon unless there is a dramatic change of direction. In my opinion, it is not a question of if another Mid Staffs will happen again, but when.

  • 15 trusts are in special measures;
  • 71% of CQC inspected trusts are rated ‘requiring improvement’ or ‘inadequate’;
  • Monitor has rated 6% more trusts in danger of discontinuity of service;
  • 33 trusts’ CEO posts are vacant or interim-filled;
  • Nursing shortages are common;
  • The morale of frontline staff is low;
  • Workloads and pressures are increasing.

According to a recent Royal College of Nursing survey, 59% of nurses report they are too busy to provide the level of care that they would like. 43% reported an increase in the number of patients they were being asked to care for. 82% had worked when not feeling well enough to do so, of which 46% said the main reason was stress.

Almost a third of all respondents were seeking a new job, with almost a quarter looking to leave healthcare completely.

The commitment to deliver the same standard of care to patients amid rising demand has an understandable impact on the wellbeing of staff. For how long can we sustain this situation? Frontline services are at a breaking point.

“In my opinion, without extra funding our NHS will be unable to cope with winter pressures”

In my opinion, without extra funding our NHS will be unable to cope with winter pressures. With NHS hospitals unable to go bankrupt, the government will be forced to either intervene or accept a rapid decline in performance. I wonder which pathway the government will take?

In this dire situation, it is more important than ever to speak out about situations that need to change. We have a duty of candour but many people worry about pointing out poor care.

Whistleblowing can play a vital role in the early detection and prevention of harm.

Whistleblowers should be celebrated, applauded. They should be seen as an opportunity to improve and avoid further problems, an opportunity to get the care and services right and save a lot of money at same time.

“Whistleblowing can play a vital role in the early detection and prevention of harm”

Unfortunately, whistleblowing is often not seen this way.

I have heard anecdotes of managers protecting themselves rather than patients. But I don’t blame them, it’s a human instinct and middle management are also human at the end of the day. It’s the system that I blame.


At present, who should a would-be NHS whistleblower turn to?

The first person is the employee’s manager, but this has two problems: the manager may choose not to take action and may in fact be the cause of the problem.

Failing this, NHS organisations have policies for whistleblowing with named senior officers to handle complaints, but this still means an organisation investigating itself, facilitating the possibility of a cover up.

Things are shifting slowly but in my experience the management style adopted by the NHS doesn’t promote whistleblowing: you will do as you are told, you won’t make any noise, you will deliver the targets or else. If you question the decisions or try to get involved in change, you are quickly levelled as a troublemaker.

“If you question the decisions or try to get involved in change, you are quickly levelled as a troublemaker.”

Of course, this isn’t the management style adopted by all managers and many are very supportive of staff raising concerns. However, we cannot ignore that this is sometimes the case.

The Rose report unveiled a lack of basic training for leaders and managers on how to listen to people and an increased level of pressure on management to achieve targets at the expense of staff who are willing to raise issues.

If we want to protect the whistleblowers we need a complete overhaul of the NHS culture, not just the whistleblowing system.

“The NHS needs a value-based leadership culture instead of intense scrutiny”

The NHS needs a value-based leadership culture instead of intense scrutiny where too much is done based on a need to meet quantitative targets. In my opinion, if you get the culture right and create environments where staff feel valued, the targets will follow.

But to do that we need time and a long-term vision; something the NHS doesn’t have. Unless we find that time to overhaul the system, a Mid Staffordshire scandal will happen again. Soon. It’s time to whistleblow that the whistleblowing system is not working.

Joan Pons-Laplana is Telehealth FLO Clinical Lead at NHS Arden & Greater East Midlands Commissioning Support Unit. He is also Nursing Times’ Nurse Tweeter of the Year 2014.

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