Recently, Sir Robert Francis QC (Queen’s Counsel), who led two major inquiries into failures at Mid Staffordshire NHS Foundation Trust, launched a call for NHS staff to share their experiences of blowing the whistle on incidents of poor patient care.
Sir Robert said: ‘We need a culture where “I need to report this” is the thought foremost in the mind of any NHS worker that has concerns, a culture where concerns are listened to and acted upon.’
According to Sir Robert, the Mid Staffordshire Public Inquiry showed the appalling consequences for patients when there is a ‘closed ranks’ culture within organisations.
The ‘closed ranks’ culture, as described by Sir Robert, is evident in all sectors, but is particularly noticeable in healthcare given the enormous disparity between individuals and the NHS, which is essentially the largest organisation of its kind.
Despite professional standards clearly stating that whistle blowing is a requirement for healthcare workers, a large number of NHS staff feel unable to take that all important step to formally report what they consider to be bad practice.
A recent report for the Public Accounts Committee has highlighted how poorly those that have whistle blown have been treated.
The Commons Public Accounts Committee said whistle-blowers were often subjected to bullying and harassment.
It found there was a ‘startling disconnect’ between policies encouraging whistle-blowers in theory and what happened in practice.
Labour MP, Margaret Hodge, who chairs the Public Accounts Committee, said: ‘I think it is really important that there are proper sanctions in place in an organisation so if someone does blow the whistle, they are properly supported, and if anyone dares bully or harass them, they are not only reprimanded but punished.’
The committee heard from Kay Sheldon, a board member of the Care Quality Commission, who had been ‘victimised’ by senior officials after she tried to raise concerns about the way it had been operating.
The report stated that nobody had faced any form of sanction over her treatment.
Being a whistle-blower is not easy, says Kay Sheldon.
In fact she feels she is regarded as ‘tainted’ after giving evidence to the public inquiry – and predicts she will not be reappointed to the board of the Care Quality Commission later this year.
She believes poor care in the NHS ‘goes unchallenged’ because people risk being victimised if they speak up.
Mrs Sheldon says past mental health problems were ‘used against her’ after she gave evidence to the inquiry chaired by Sir Robert Francis.
Shockingly, stories such as that of Kay Sheldon are not uncommon within the health service.
Depending on the nature of information disclosed and who it is confided to, a whistle-blower is legally protected from suffering from any detriment as a result of their actions.
The 1998 Public Disclosure Act protects workers who disclose information about potential criminal behaviour and other malpractice at their workplace, provided certain conditions are met.
Whilst the legal protections afforded are a step in the right direction for whistle-blowers, this in itself does little to bring about a top down change in culture for those organisations that carry out work of a public nature.
Like many public organisations, our regulatory body the GDC (General Dental Council) has not been immune to accusations of poor conduct, with former chair Dr Alison Lockyer acrimoniously resigning from her post and raising a number of serious allegations in the process.
In a report by the Professional Standards Authority, Dr Lockyer highlighted a number of serious allegations about the quality of the GDC’s governance arrangements, which in her view have impacted on the council’s ability to hold the GDC’s chief executive and registrar, Evlynne Gilvarry, and the executive management team to account, as well as on the council’s ability to progress matters that are important to public protection.
In particular she alleged that those who stood up against the executive’s decisions were threatened with complaints being made against them, thereby preventing the executive from being held to account.
The startling irony is, of course, that these accusations are being made of the very organisation that seeks to hold its registrants to account if they do not whistle blow when it is in patients’ best interests.
Regardless, Francis is quite right to call for a more open and honest culture where patient safety and care is put at the forefront by both staff and management.
However, for this to take effect in any meaningful sense, not only do we need people with the moral conviction to stand for what they believe in, we also need those at the top of the hierarchy to respect the position of the whistle-blower and engage in constructive dialogue.
If instances of threats and reprisals against those who raise legitimate concerns are not dealt with appropriately, it is difficult to envisage how any organisation could ever break free from such a ‘closed ranks’ culture.