YES
Dr Jonathan Fielden,
chairman, British Medical Association consultants’ committee
We have concerns around the culture of many organisations in the NHS. A recent
BMA survey has shown that three quarters of hospital doctors have raised
significant concerns but frequently the response to those concerns was
negative. Most often they felt their concerns were not looked at in adequate
detail.
Almost one in six doctors was given some indication that speaking up could
have a negative impact on their employment. This is completely the wrong
culture. We must move towards a culture where every individual in a health
service organisation can raise concerns that are looked at and acted upon
appropriately.
Organisations need to value people who are concerned about improving quality
of care. This needs to come right from the top. Board members and governors
of trusts need to be saying “we want to hear where you think we can do
things better”. Even the best organisations can improve.
The majority of doctors know that they have a contractual right to speak out.
They understand there is an ethical responsibility to do so. But many
organisations make this process difficult and turgid to the extent of
putting people’s jobs at risks. Even though people raise concerns they
repeatedly get beaten back. Ultimately concerns won’t be raised. That is why
we are calling for a change of culture, and supporting our members with a
dedicated telephone advice service. Every organisation should have a
whistleblowing policy and a culture that wishes to hear concerns of how it
can improve.
The main reason for the suppression harks back to the target culture set
centrally by politicians which means that trusts that are not delivering
political targets — rather than clinical targets — had a very negative
response from ministers. That negativity pervades the entire service. Some
major concerns have hit the headlines. In Mid Staffordshire, where it was
reported that 400 people died needlessly, concerns were suppressed and
medical and nursing staff were not listened to, resulting in higher
mortality. In Maidstone & Tunbridge Wells, concerns over handling
patients with MRSA were not heard and were overruled to deliver on national
targets.
It is important that employees know and utilise the channels within their
organisation first rather than going to the press. That gives the
organisation the chance to put something right more quickly and in a way
that hopefully does not worry patients. Striking off a nurse for exposing
wrongdoing (via Panorama) was at best a confusing message. We hope
that a change of culture will minimise the need to go to the press.
The General Medical Council needs to give the message that as long as you act
reasonably, following guidelines set by your organisation, then you are not
going to fall foul of the regulator.
We must move away from a culture where clinicians’ livelihoods are threatened
if they do not toe the line.
NO
Ann Keen,
Health Minister
I welcome the debate on whistleblowing at the BMA Conference, which
highlighted this important issue. Doctors at the conference clearly and
emotively demonstrated that they want to report issues that affect the
safety of patients and are rightly upset when they are prevented from doing
so.
The tragic failure of care at Mid Staffordshire NHS Foundation Trust has
etched in the minds of all NHS staff that whistleblowing can save lives.
Employers can be heavily fined if they are found to have victimised
whistleblowing employees. Dr Fielden has warned that there could be a repeat
of what happened at Mid Staffordshire because of a culture of inactivity in
the NHS. He is right to urge vigilance but he is wrong to say that the NHS
is inactive on this issue.
Having been a nurse for 28 years, I have always placed the utmost priority on
patient safety and have never tolerated anyone who stands in the way of
this. I know that on this issue I can speak for all my clinical colleagues
and ministers in the Department of Health. We have made it absolutely clear
that the Government supports whistleblowing and expects the NHS to support
it too.
One of the first things this Government did in 1998 was to introduce the
Public Interest Disclosure Act (PIDA), which gives employees the right under
the law to raise any concerns they may have — in the case of NHS staff,
about the quality of patient care — with their employer. This has been
further backed up this year by the new NHS Constitution which enshrines the
right of all staff who report wrongdoing to be protected.
In addition to ensuring that there is a legal framework to protect
whistleblowers, the Government requires every NHS organisation to have
procedures to support whistleblowing. Results from the NHS Staff Survey over
the past three years suggest this is happening. There has been a consistent
improvement in the proportion of staff who say they know how to report
concerns (82 per cent in 2008) and know they can do so in confidence.
If a member of staff does not feel comfortable about raising concerns with
their employer, there are other routes that still afford the protection of
PIDA. These include raising the matter with a legal adviser, their union or
staff organisation, their MP or the independent regulator, the Care Quality
Commission.
For staff who wish to speak out but work in a culture where it is hard for
them to do so, we have an independent helpline through Public Concern at
Work, the charity. The phoneline, 020 7404 6609, is staffed by lawyers with
expertise in whistleblowing and is available to all NHS staff. All calls are
treated in strictest confidence.
Listening to and acting on the concerns of those who work on the front line is
a vital way to drive up standards and guard against poor care. I have seen
for myself that the NHS is actively engaged in this work and is making huge
