16 / 6 / 2014 2.19pm
Following the independent inquiry into care in Mid Staffordshire, the area that seems to get most press attention is raising concerns and whistleblowing. Good. It's important that this issue remains on the agenda. It is though unfortunate for patient care that the RCN has a session at their conference entitled ‘how to raise concerns and keep your job'. This does nothing to reassure staff, nothing to change cultural behaviours and nothing to encourage staff to continue to raise concerns. The RCN know that every day staff raise concerns and issues. All the staff survey results demonstrate this. To raise unnecessary fear in staff is wrong.
I recognise they want to raise important issues but this must be done more responsibly. Part of the problem is that the word ‘whistleblower’ now has entirely negative connotations. We have lost the essence of the concept which is that when you see a concern and can't resolve it and need help, blow a whistle to summon attention and help. But it has become a word associated with troublemaking. Employers, trade unions and the media are responsible for that. We have to address it.
The debate about whistleblowing and reporting concerns has been generally healthy. There is clear national agreement among all parties, including trade unions and employers to work together and make raising concerns ever more effective. Everyone recognises a problem, everyone knows that guidance will only take us so far, and everyone accepts that not resolving underpinning cultural issues is bad for patient care.
However progress on raising concerns can be slowed by some basic misunderstandings, often perpetuated by media, which are frustratingly persistent.
First, let’s be clear that a problems exists. It is true that staff sometimes don’t have their concerns about patient care addressed effectively and then find themselves mistreated when they, rightly, resort to blowing the whistle with regulators or the press. Any alienation, lack of cooperation or poor treatment of such staff is not fair, is unsafe, it’s bad for culture and it’s bad for patients.
I’m not saying bad management of these issues doesn’t happen or that poor handling is ever acceptable. It isn’t. I know some bad things happen – we can all see the referrals employers make to the regulators. I’m saying it’s not the norm and that staff confidence to raise concerns ought to keep growing.
New national helplines for raising concerns are being well-used, which is a very good sign of progress, and figures from the annual NHS Staff Survey shows positives and negatives:
- 90 per cent of staff know how to raise a concern
- Most feel safe to do so (10 per cent do not, which is 10 per cent too many)
- 90 per cent of staff who saw issues affecting care say they raised them
- 60 per cent reported they had not received feedback.
As can be seen, staff do raise concerns, regularly, but it is that last statistic which most worries me. Not feeding back means some staff will seek to address concerns externally. To whistle blow, but more worryingly other staff will simply give up in frustration. That is bad for patient care.
Promoting excellent systems for reporting concerns is about boards being visible, managers engaging with staff, and being responsive to what staff are telling them. Unions know they also play a key role in helping to develop a culture where staff feel they can raise concerns and that they will be properly addressed. Staff are the eyes and ears within the workplace and it’s important they are heard. This will happen much more reliably if their own representatives have confident, supported relationships with employers.
In the last year NHS Employers has hosted a number of debates and seminars on raising concerns in the workplace. Guidance, communications resources and templates have all been updated and we've produced informative podcasts, videos and case studies - all aimed at raising awareness of good practice in relation to affecting cultural change. I hope all of these are proving useful. To reassure the public, I'm sure we will need a more concerted effort in developing recommendations for change in processes, language, practice and culture.
I'm pleased that trade unions have this on the agenda too, but I would rather their conference session be entitled' how to raise concerns, what to do if you are not being listened to and how your trade union will support you to put patients first'
Dean Royles is chief executive of NHS Employers