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What do we mean by raising concerns?

Raising concerns, speaking up and whistleblowing are all familiar terms used to describe the reporting of anything that causes actual or potential risks to the provision of patient care. It can also be about other issues which may impact on wider NHS services, other staff and/or the reputation of the organisation - such as fraudulent activity or a lack of response or cover up of issues being raised.

When things go wrong, it is important that there is opportunity for workers to discuss these issues, reflect on what happened, learn from experiences and to be part of any discussion about what needs to happen to prevent future risk of harm.

Is speaking up the same as whistleblowing?

Different people or organisations may use a variety of terms (as outlined above) to describe the reporting of concerns but they all mean the same thing. Some people may interpret all or some of these actions as "whistleblowing", others may only associate whistleblowing with something that is formally escalated outside an organisation, or to describe the legal protections offered to individuals raising concerns under the Public Interest Disclosure Act.

How you raise these issues may be different, depending on local arrangements and will be dependent on how serious the issue is. Most concerns can be raised by having a discussion with your line manager or nominated Freedom to Speak Up (FTSU) Guardian for your organisation. They may also be raised with a regulatory body such as the Care Quality Commission or a professional regulatory body - commonly referred to within policies as a "prescribed body". A list of prescribed bodies and how and when to raise issues with them can be found on the Gov.uk website

Who can speak up?

All NHS trusts should have a policy and arrangements in place to support workers to speak up and raise issues. This includes all healthcare professionals, non-clinical staff, senior, middle and junior managers, volunteers, students, bank and temporary workers such as agency workers and contractors, and former employees. Employers should make sure these arrangements are well communicated and understood by their workforce. Publishing arrangements on the organisation's staff intranet and public website will help to communicate the organisation's commitment to being open and transparent about its processes and in ensuring all workers can find information more easily when they need it.

There are other routes for patients and their families to raise matters of concern such as the Patient Advice and Liason Services (PALS).

How do local arrangements apply to temporary workers employed through an agency or contractor?

Organisations should outline arrangements for temporary workers in any contractual agreement they may have with an agency or contractor. This can be done in one of two ways:

1) by establishing that the agency/contractor has their own effective arrangements in place to support and respond to concerns or 

2) by agreeing that the agency/contractor promotes the organisation's own arrangements, where there are any concerns which relate to a threat or risk to the services, care and/or reputation of the organisation.

Legal advice should always be taken on how the organisation can best achieve this within any contractual arrangements it may have with agencies and contractors.

Can I raise concerns through NHS Employers? 

NHS Employers is not a prescribed body or regulator, so is unable to get involved in responding to issues raised by workers, patients or the public. We do, however, take all concerns raised with us seriously and will signpost individuals to the options open to them to ensure issues are listened to and are dealt with in the appropriate manner. In the most serious of cases, such as patients safety or poor culture, we may have a duty to refer this to the relevant employer or other professional body. Any such referral will be done in confidence with the agreement of the person raising the concerns and will be limited to ensuring the right bodies are aware and can respond to the individual directly.

What role should line managers play in raising concerns?

Managers are recommended as the first port of call for staff to raise any concerns they may have about risks to patient care or services. They therefore have a critical role to play in effecting a positive and responsive reporting culture. Without their support and involvement, it will be challenging to keep the arrangements alive across the organisation.

All middle and line managers should have appropriate training so that they understand their responsibilities to respond to concerns raised by workers, known how to escalate concerns and have access to support to enable them to this effectively. Our page on information for managers provides information, guidance and other resources which managers may find helpful to refer to.

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