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Whistleblowing hits record high

  • 37 Comments

The Care Quality Commission has seen a record rise in whistleblowing calls, but there are mounting fears that it lacks the “teeth” and resources to properly investigate nurses’ concerns.

Over the past two months, the CQC has received more than 200 phone calls highlighting problems with services, compared with fewer than 100 during the whole of last year, suggesting it is heading for a threefold year-on-year increase.

Speaking to the House of Commons health committee last week, CQC chair Dame Jo Williams attributed the rise to the publicity created by the abuse scandal at Winterbourne View nursing home in Bristol.

She added: “It’s very important that we respond well…because we know that for individuals putting their head above the parapet is very difficult and there have been situations where whistleblowers have lost their jobs.”

But she admitted the embattled regulator has had to ask the Department of Health for an extra £15m to ensure concerns were followed up with inspections. The CQC carries out around 600 inspections a month but Dame Jo said there was a need to “double that, at the very least”.

In May, the regulator stated in board papers that a shortage of resources had left it in a position where it would “almost certainly” risk “fail[ing] effectively to identify or deal with non-compliance, leading to persistent poor quality care for users and reputational damage”.

Royal College of Nursing director of policy Howard Catton said: “We would like an effective regulator with teeth. Given the scope of the CQC’s responsibilities, there are questions about whether it’s sufficiently resourced to do the job.”

More unannounced inspections and a greater focus on staffing levels were needed, he said.

The committee also raised the latter issue, questioning how whistleblowers were supposed to tell the CQC when staffing levels were too low given there was no “clear standard”, or staffing ratio, to judge this against.

University of Southampton professor of health sciences Peter Griffiths said it would be useful to have “some clear point of reference that can clearly distinguish general disgruntlement from something that says objectively there’s an issue of concern here”.

Ratios would not necessarily be right for every ward, and care needed to be taken to ensure minimum levels were not treated as targets, he added.

Concerns have also been raised about the CQC’s 350 vacancies, of which around 121 are for inspectors.  About 70 job offers had been made in the past few weeks.

And the regulator has come under repeated fire during the ongoing public inquiry into Mid Staffordshire Foundation Trust.

National Patient Safety Agency director of patient safety Suzette Woodward said: “Mid Staffs shows us there are people who tried to speak out and weren’t heard, just as Winterbourne View has demonstrated.

“The CQC is trying to make lots of changes while the system is constantly changing around it. It needs to get it right during the transition, for patients and staff.”

In written evidence to the inquiry, Nursing and Midwifery Council chief executive and registrar Dickon Weir-Hughes criticised the CQC for lacking a director of nursing and carrying out inspections with only the “loose involvement” of a nurse or midwife.

At the moment nurses and midwives are invited to accompany non-clinically trained CQC  inspectors on visits but are not involved in the process from the start.

Giving the example of the CQC’s current programme of dignity and nutrition inspections in acute trusts, Professor Weir-Hughes said this led to criticisms of the process from nurse directors.

A CQC spokeswoman said: “We have reviewed our whistleblowing policy and are actively promoting it online – we want and are getting more calls and the last two months have seen a record number. Our national advisors support CQC to make sure we understand issues in their profession that might inhibit whistleblowing.”

  • 37 Comments

Readers' comments (37)

  • Damn right it lacks the teeth, at the moment it is absolutely unfit for purpose!

    I have raised concerns with the CQC myself, only to be told straight out that there was nothing they could do because there was no legal mandate for staffing levels. Others I know have contacted them, only to be told similar things. Even when they do make 'recommendations', they are only ever that, they do not have the teeth to enforce them.

    Apart from the whole bullying and witch hunting culture in Nursing, this is another large reason that Nurses do not whistle blow, because why should they risk their necks when absolutely nothing will happen? When all we will get is a few platitudes and a target on our backs?

    This whole process needs a massive overhaul from the ground up.

    We NEED a legalised Nurse patient ratio so that the CQC and we as Nurses have a powerful legal redress when standards are not met. The "clear standards" for staffing ratios are there, in clinical evidence; other countries such as Australia use them. So it isn't that they aren't there, it's just that the CQC and trusts choose to ignore them.

    And Peter Griffiths is wrong on this. The study that he did a while back led him to some very odd conclusions that I remember debating with him about on here. There NEEDS to be a minimum staff/patient ratio everywhere.

    Also, Staff Nurses and Senior Nurses NEED to be part of the CQC from the start. It is absolutely ridiculous to assess clinical care with untrained non clinical staff.

    The NMC need scrapping and starting again, the RCN are useless and needs to be thrown out and a new one put in it's place, and now the CQC needs a ground up overhaul too. Is it any wonder we find it impossible to do our work sometimes?

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  • tinkerbell

    hear hear mike

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  • michael stone

    mike | 5-Jul-2011 10:36 am

    'Also, Staff Nurses and Senior Nurses NEED to be part of the CQC from the start. It is absolutely ridiculous to assess clinical care with untrained non clinical staff.'

    They probably do ask clinical folk, to input expertise on clinical issues - but lots of aspects of bad behaviour, are not directly related to clinical competence.

    The 'complaints and regulatory bodies' don't work very well, as I'm sure everyone is very aware. The problem, is how to get the necessary people to agree on what would work better, and is to be done.

    To my mind, the initial action' needs to be faster, less 'confrontational' and more 'is there a real problem, but not individual blame, here ?' where possible (not always possible, I agree), and crucially more 'independent of the organisation'.

    mike wants more nurses involved, I want more laymen involved - but none of these systems currently work, because many laymen complain because they do not want something bad which happened to them personally, to happen to anyone else in the future: not 'looking for retribution', but trying to improve 'behaviour'. But as soon as you make a formal complaint (and you have to - nobody pays attention, to informal concerns) the professionals and organisations invariably tend to become defensive, confrontational and very bloody annoying ! That does not lead to improvement - it leads to annoyance and time-wasting all round !

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  • Michael, laymen are already involved with the CQC, that is partly why it doesn't work! To assess care, you need to understand clinical best practice and understand clinical care. Laymen cannot do that.

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  • CQC is built to be toothless and ineffective - the state seeks to protect itself at every opportunity. Can anyone remember a public enquiry where anyone lost their jobs or had major sanctions put against them / resulted in a criminal trial?

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  • Mike'c comment seems to me to be so ill-informed as to be dangerous. My wife worked for CQC as an inspector. Her background is as a service user. From observing the problems she experienced, the central issue with CQC is too many staff having a professional background, hence seeing the system from a professional perspective, and therefore MISSING CRUCIAL THINGS that only the direct experience of using a service personally will pick up.

    Michael Stone is absolutely correct.

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  • Peter, I hardly consider my viewpoint dangerous. Your own however, as Michaels before you, simply highlights part of the reason the CQC is not working, and THAT is dangerous. Yes a service user must have an input, but as a non clinical service user, you would miss FAR more than clinical staff would, simply because you do not know what to look for or what the standards should be! The central issue of too many staff having a clinical background? What are you on about? The issue is the exact opposite of that, that is why even the NMC chief exec has come out of the ivory towers for a change and said something! non clinical staff CANNOT assess standards of care alone or with only minimal clinical input, and neither should they be allowed to. As qualified clinical personnel, we do not want to raise our concerns about specific standards of care with laymen, we need to redress these concerns with clinical staff who may have a clue what the hell we are talking about!

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  • michael stone

    Peter Relton | 5-Jul-2011 1:08 pm

    I am with you on this - but I would be, wouldn't I !

    A lot of issues are not 'clinical' but wider - being 'too concerned with the clinical' can be a problem. Everyone, tends to apply their own experience and perspective, to what the person considers to be 'important and relevant'. A post elsewhere, had a nurse explaining that her father, despite 'crying out in pain', was given a pain score of zero - no 'layman' would ever do that, but someone trained in 'pain-scoring' might !

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  • Whistleblowing cannot be encouraged without the system to support it. Being on all sides of the fence (Senior RN, patient and carer/relative), I would say the latter two roles are the ones where I identified patient problems (and in some cases life-threatening), that needed addressing the most. From a professional perspective, most of the isuues seem to be related to staffing levels, where in many cases can be solved by 'different ways of working', and that includes the whole team, not just nurses, and bullying.

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  • michael stone

    mike, I will wander slightly off topic, with an illustration from the area which bothers me, because it illustrates this ‘perspective’ and experience thing. If professionals have been trained poorly, without realising it, their behaviour ‘sometimes does not make sense’ – this links in with the perspective point, raised by both Peter Relton and myself. Some things seem intuitively obvious to laymen, but not to clinicians !

    The scenario is an End-of-Life patient for whom no Do Not Attempt Resuscitation Order exists, but who has become totally fed-up of his situation and suffering. He lives at home with a single family carer, his son, and the following happens. One evening, the father initiates a conversation with ‘Son, I’m really struggling here. I really can‘t put up with this. Would it upset you, if I’m just allowed to die, if you think I have stopped breathing?‘. It could end with ’We‘ll sort this out with the GP tomorrow, but if I die before then, don’t phone 999‘.
    The question, is this: What should the son do, if he thinks his dad has stopped breathing, before anyone else has been told of the conversation ?

    Now, most people who answer that, which is actually a legal question, and despite some very dodgy clinical guidance in the area, whether clinicians or amateurs, come up with ‘Let his dad die, as he was told to’.
    But a nurse who is an EoLC Facilitator and hugely experienced and qualified (26 years of nursing (4 years Community Nursing (DN), 11 years Specialist Palliative Care, 5 years
    GSF/EoLC project work, paliiative care degree, DN qualification, Masters module in health
    and social care) came up with this answer:

    ‘Refuse Treatment (ADRT) has not been made and the father has not verbalized his wishes to a professional involved in his care then the son would have to call 999 as his conversation with his father has not been witnessed and not evidenced as “in his best interests”’

    That is an answer, that ONLY someone who had read your dubious guidance, could come up with ! And your guidance is rubbish, because it was written by clinicians, who have introduced a layer of ‘bias’ above a perfectly reasonable, if somewhat flawed, piece of legislation. Plus the clear implication, that relatives can be ASSUMED to be dishonest !

    A Consultant in Palliative Medicine with came up with ‘Wait and call GP later to certify the death’ which is right except it should be ‘to decide whether to certify the death’.

    The highly-trained expert nurse, struggles with that question because it is legal, not clinical: the doctor was guided by the ‘patients have the right to refuse an offered treatment’ principle, which is the only place you can start from if you wish to define a coherent behaviour set.

    Similarly, this one: What is the difference between a patient saying to his GP ‘If I arrest from now on, I’m forbidding resuscitation attempts’ or saying to a relative ‘If you think I have stopped breathing, let me die in peace and do not call anyone until I am dead’ ?

    All ‘normal people’, who do not have the dubious benefit of having read the clinical guidance about CPR decision-making, come up with ‘Surely they are the same thing !’ – but nurses (who do seem to understand that logically they MUST be the same thing) struggle with that one !







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