Healthcare whistleblowing and patient safety – taking action together.
Steve Turner
Cancer Equity For All @CancerEquity. Trustee @BritAsianCancer. Registered general & mental health nurse; Ba(Hons); P.G. Dip. Ed. Background inc. inter-disciplinary projects, patient engagement, clinical education, IT.
Background:
Following a varied career, I returned to clinical practice and began teaching in 2002. Prior to this I worked in the public and private sector in healthcare, leading clinical I.T. projects, as an interim manager in a?troubleshooting role and as a senior strategic services consultant. Soon after my return to practice I was shocked to find out that raising and escalating genuine patient safety concerns has become problematic. Staff who blow the whistle are subject to victimisation, retaliation and blacklisting. Patient safety concerns become buried under employment issues. As a result, exploring and resolving the original concerns takes a back seat.
Turn Up The Volume!
In 2015 I set up the Turn Up The Volume! event in Bristol followed by a second event in London in 2018
Turn Up The Volume!?was a Patient Safety movement open to all.
Our aim was:
To promote best practice in patient safety through listening openly to the concerns of patients, staff, carers and relatives, and taking actions together.
At the first Turn Up The Volume! event we heard from a wide range of people with different perspectives on, and experiences of, whistleblowing. This set the scene?Turn Up The Volume 2!?where we moved towards looking at the root causes of the victimisation of those who blow the whistle on patient safety issues. Feedback on these events was that they enabled people to get together who would never have met, and that the strength of this networking, and that the non-hierarchical approach adopted, helps in delivering a just culture in health & care.
Patients left to blow the whistle:
The Freedom to Speak Up Review by Sir Robert Francis in 2015 led to a wide range of actions, none of which have been fully effective.?A report in 2022 , by Dr Bill Kirkup OBE, into deaths in East Kent NHS maternity services confirmed that the ‘onus was on patients to raise concerns’ because the culture of fear prevented whistleblowers from speaking out. These consequences were spelled out by the experience of the nursing director who was told that speaking up would harm her career. A further indication of the scale of the problem is that in February 2023 the Independent newspaper reported that the Parliamentary Health Service Ombudsman in England has issued a warning over patient safety, culture and leadership at University Hospitals Birmingham Foundation Trust. This follows BBC reports alleging that staff in the same Trust were punished for raising safety concerns.
This problem whereby patients, carers, parents & relatives?are failed and left to stand alone against powerful institutions is not confined to a few ‘rogue’ organisations, or the result of a few ‘bad apples’, it is widespread. Under the current laws members of the public who blow the whistle have no legal protection, no right to advocacy, and very limited support. These include many families like the family of Robbie Powell, those at Gosport War Memorial Hospital, victims of the Belfast Hyponatraemia scandal, and the parents of Oliver McGowan. As well as the victims of maternity failings across England, including those currently under investigation, there are further shocking cases that are not yet in the public domian.
Making sure a public concern remains a public concern:
The Public Interest Disclosure Act 1998 [PIDA] does not address the public interest concerns raised by whistleblowers. It is overcomplicated, overly restrictive in its definitions, and changes a public concern into a private employment matter. PIDA is not widely known about and poorly understood by those who must implement it. Only 4% of the whistleblowing cases brought before an Employment Tribunal succeed. This has led to employers gaming the system, abusing their position of power and access to funds, in a way that diverts attention from the issue raised by the whistleblower. This has the perverse effect of reinforcing the stigma around whistleblowing, frightening staff off from raising concerns and feeds into an agenda of ‘keeping your head down’ and ‘not rocking the boat’, creating a toxic atmosphere such as when I was warned not to 'poke the bear'. In healthcare this contributes to patient safety failings, suffering and deaths.
The Protection for Whistleblowing Bill establishes an independent Office of the Whistleblower [OWB] to protect whistleblowers and whistleblowing and uphold the Public Interest. The Bill creates offences relating to the treatment of whistleblowers and the handling of whistleblowing cases. It closes the ‘loophole’ which currently means that the whistleblower has to prove the detriment they received has occurred as a result of whistleblowing. This ‘inequality of arms’ is something that is exploited in employment tribunals. Under the Bill the onus will be on the employer to prove lack of a link to whistleblowing. The Bill enables the OWB monitor and enforce standards for the management of whistleblowing cases, to provide disclosure and advice services, to direct whistleblowing investigations, to order redress of detriment suffered by whistleblowers. The Bill will be implemented in a way that will allow a smooth and safe transition to the new system.
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The benefits of an Office of the Whistleblower:
The?Protection for Whistleblowing Bill [HL]?takes the patient safety agenda forward in a meaningful and measurable way. An Office of the Whistleblower will help everyone who has an interest in removing barriers to safe care. An Office of The Whistleblower will help confirm, identify, promote and follow up on actions to resolve root causes of systemic patient safety failings. This includes building on what is already in place.
Critically, the OWB will function as a support to existing regulators, providers, commissioners and associated organisations. Avoiding the dangers caused by duplication of effort & 'reinventing the wheel'. The Office of The Whistleblower aims to promote best practice and add value to all existing successful initiatives.
Some of the benefits of the Protection for Whistleblowing Bill [HL], from a healthcare perspective, include that the Office of the Whistleblower will be:
Don't take my word for this or rely on someone else's summary of the Bill. I urge everyone?with an interest in this subject to read the Protection for Whistleblowing Bill [HL]?and watch the video of?Baroness Kramer introducing the second reading of the Bill.
??To read the Bill and find out more about the work of the All Party Parliamentary Group on Whistleblowing, follow this link:?https://www.appgwhistleblowing.co.uk/
?? To download the Whistleblowing report click here:?https://www.appgwhistleblowing.co.uk/_files/ugd/4d9b72_ffa164221ae540bfafdeb8206a0274db.pdf
Steve Turner (RGN, RMN, Ba(Hons), P.G Dip. Ed.) is a former co convener of the WhistleblowersUK Healthcare Focus Group.
Comments welcome.
I welcome all comments and questions about the need for the Protection for Whistleblowing Bill and the introduction of an Office of the Whistleblower in healthcare. I plan to revise and update this article with the learning from questions and feedback.
Revision history:
28.02.2023 - Section Making sure a public concern remains a public concern added.
31.03.2023 Added a point on support for regulators and providers. Rather than becoming 'another regulator', with the associated dangers of duplication & 'reinventing the wheel', the Office of The Whistleblower aims to promote best practice and add value to all existing successful initiatives.