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Turn Up The Volume! is a Patient Safety movement open to all. Our aim is:
To promote best practice in patient safety through listening openly to concerns of patients, staff, carers and relatives. A just culture
‘Whistleblowing isn’t a problem to be solved or managed, it’s an opportunity to learn and improve.’
Here’s a 3 minute video of our inaugural event:
‘It takes more than just courage to report concerns about patient safety, as Steve Turner discovered firsthand. Now he wants to make that path smoother for others in the future.
When NHS staff can report concerns without fear, he says, we will have achieved what we have set out to do. Ultimately this about patients’ lives – and staff’s livelihoods.’
More information (England):
Click on the tabs below for more:
Wendy Addison – Speak Out Speak Up from the 2016 Turn Up The Volume! Confernence
Joan Pons Laplana -My Story- from Turn Up the Volume!
Aims and Objectives
Aim and objectives
To promote best practice in patient safety
DISCOVER: How to make care safer through listening openly to staff concerns
LEARN: Contribute to an online resource, suggest and implement actions
SHARE: Support and encourage each other to share best practice locally and nationally
UNDERSTAND: Reflect upon good practice and identify ways to take this forward
IMPROVE: Be able to articulate and promote the relationship between learning oranisations and patient safety
Great resources from our speakers
Great Resources from our speakers:
Happy Staff = Happy Patients from Dr Umesh Prabhu
Regulation – What Whistleblowers Want – Dr Kim Holt
Time for truth and reconciliation in the NHS – Dr Kim Holt
Academy of Fabulous NHS Stuff
Jenny Moore – Social Care the forgotten partner
Jennie Fecitt / Tracy Boylin – A Just Culture
Tracy Boylin – A Just Culture
Maria Paviour speaking at #turnupbristol
Joan Pons Laplana -My Story- from Turn Up the Volume!
A Powerful Message (courtesy of Your Voice Matters)
What happens to whistleblowers in Britain from Nick Pidgeon
Frequently asked questions about whistleblowing
Frequently Asked Questions about whistleblowing
‘This paper was last updated on 13/01/2015 prior to the publication of the Francis Report into the whistleblowing process. It remains relevant and important.” Steve Turner. Please read the disclaimer below.
This paper has been prepared in January 2015 on behalf of the campaigning organisation Patients First in order to provide answers to “frequently asked questions” in relation to speaking up or whistleblowing in the UK National Health Service and UK health care sector generally.
It is intended to provide helpful guidance and to enable readers to access more detailed guidance, advice, help and support from other sources and organisations. It does not in any way constitute legal, financial or other advice of any other kind and any reader is strongly advised to seek and rely on his or her own legal, financial and other advice having regard to the particular circumstances of his or her individual case.
Whilst efforts have been made to ensure that the contents of this paper are not misleading in any material respect, it should be recognised that the law in this area is subject to scrutiny and may change and accordingly no guarantee can be given that the legal position as stated is necessarily fully up to date and no warranty or representation is given to that effect. Neither Patients First nor any director, shareholder, steering committee member nor any other person who has contributed to this paper shall be liable by virtue of contract, tort or otherwise howsoever for its contents.
What is whistleblowing
Whistleblowing is when a worker reports suspected wrongdoing at work. Officially this is called ‘making a disclosure in the public interest’.
In the health service this could be as simple as raising a clinical incident about a system error or near miss. That would be what is known as “internal whistleblowing”
A health worker is expected as part of their duty of care to highlight issues that might impact upon a patient’s health, or increase risk to patients. This might include, reporting that the notes were unavailable, that there were understaffing problems, which impacted on the quality and safety of care, or lack of equipment, drug errors, or surgical errors, or that a vital service provision is to be cut.
Equally workers can report things that aren’t right, are illegal, e.g. fraud, or if anyone at work is neglecting their duties. In addition covering up mistakes or wrongdoing is something that an individual may feel compelled to speak about if it’s in the public interest.
There have been concerns about recent changes to the legislation which has apparently made it harder for individuals to argue that their concerns were valid. It is our experience in Patients First that the majority of health service staff who raise concerns which are ignored or rejected are unable to access adequate support let alone legal advice, and too often are left feeling isolated and alone, which in itself is contrary to the spirit of the law.
Even when staff have followed all the appropriate steps in raising concerns may find themselves in trouble, and suffering detriment or victimisation, which impacts upon their health, and may be suspended, face disciplinary action, or even in some cases redundancy or sacking.
We have heard of numerous staff struggling to find other work having left a job in which they suffered for speaking up. This concerns us because the law seems to be unable to prevent further detriment once an individual has left their job.
How you go about raising concerns in the workplace will depend on the systems and support available for you to do this; the approach of your employers and the culture of the organisation.
If all usual routes fail and these concerns fail to be listened to and acted on then other methods can be used.
The Public Interest Disclosure Act [PIDA] makes no distinction between ‘raising concerns’ and going public, it is all ‘whistleblowing’ and makes no distinction between whether the concerns are raised internally or externally. Indeed all those who “blow the whistle” initially “raised concerns”.
Some NHS employers are working to a fundamentally wrong definition of whistleblower, making a false distinction between the ‘day to day practice’ of raising concerns, and blowing the whistle outside the organisation. This betrays a fundamental misunderstanding of both whistleblowing and the Public Interest Disclosure Act [PIDA].
Source: Submission by Patients First to the Freedom to Speak up Review being conducted by Sir Robert Francis QC (September 2014)
Are there any myths relating to whistleblowing?
In theory the law should protect employees if they raise concerns about something generally provides a remedy after suffering a detriment rather than preventing such detriment. Moreover parts of the NHS are unfortunately not receptive to whistleblowers.
Employers will often argue that the information disclosed was not disclosed to the correct person, was not made in good faith, or in the public interest or that their behaviour of the staff member was not reasonable. Employers do not always accept that the whistleblower is protected by the law or indeed that the disclosure is a whistleblowing disclosure at all. In the current climate many employers will actively try and distance themselves from acknowledging receipt of a qualifying disclosure.
Turning directly to the law for support can be problematic. The protection afforded by the law (such as it is) is very much after the event and retrospective. Interim relief (under s.128 ERA) is only available after dismissal – itself far too late – and in the sample of 70 cases, was obtained in only 2 cases. It can be very expensive to obtain and there is great inequality of financial resources between whistleblower and employers.
Source: Submission by Patients First to the Freedom to Speak up Review being conducted by Sir Robert Francis QC (September 2014)
So, whilst it may be important to get legal advice you should not assume that your original concern can be resolved through the courts and you should be aware how difficult using the law may be.
Whistleblowers are troublemakers
The evidence from our Thematic Review of 70 cases presented in evidence to Sir Robert Francis is that there was a predominance of those staff with significantly greater expertise or experience.
The vast majority of staff who raise concerns, whether they are labelled as “whistleblowers”, just want to do a good job and see others doing a good job too in a system without unnecessary mistakes or errors. However employers are regularly known to victimise those raising concerns and one way they do this is to focus on the person raising a concern rather than on the concern itself… Too often we hear of staff who raise concerns finding themselves under scrutiny or even being disciplined, or by referral of the individual to a professional regulator.
How do I raise concerns?
An individual healthcare professional or manager may have concerns which are not shared by all colleagues, or equally commonly colleagues might be fearful of raising concerns even if they have witnessed them. In some departments where standards may have slipped or resources are chronically short, it may be seen as the norm to follow a certain practice, and so you may feel very alone with raising of the concern. Often new people in a team spot things much sooner than those who have been working there for some time. In particular student nurses and junior doctors can be very good identifiers of problems, but equally they can find themselves disempowered.
Simply because colleagues are unwilling or afraid to raise concerns does not mean you should not raise a concern, but in this case you should be particularly clear that patients are at risk (or there is a qualifying concern). Indeed, if you do not raise such concerns it is theoretically possible you could well be held accountable should harm result.
Adapted from: The Duty of Care Handbook (section 4 How to raise concerns?)http://www.publicworld.org/files/Duty_of_Care_handbook_April_2013.pdf (accessed 24/10/14)
We recommend you read the Duty of Care Handbook which gives practical advice on the duty of care of healthcare professionals and their employers and what we must do to help protect patients and staff.
Who can a worker complain to if they have concerns about what their healthcare employer is doing or allowing to happen?
“any disclosure of information which, in the reasonable belief of the worker making the disclosure, tends to show one or more of the following—
(a) that a criminal offence has been committed, is being committed or is likely to be committed,
(b)that a person has failed, is failing or is likely to fail to comply with any legal obligation to which he is subject,
(c) that a miscarriage of justice has occurred, is occurring or is likely to occur,
(d) that the health or safety of any individual has been, is being or is likely to be endangered,
(e) that the environment has been, is being or is likely to be damaged, or
(f) that information tending to show any matter falling within any one of the preceding paragraphs has been, is being or is likely to be deliberately concealed.
We strongly believe that the responsibility for ensuring that patients are safe and that learning takes place from near misses or mistakes rests with the employing organisation, and as such they should always encourage and support staff who come forward with information. The law should be a last resort.
Unless there is a good reason, the concern should always be raised with the employer first.
This is something that many potential whistle blowers are concerned about as they would prefer to speak with an independent person, especially if they have already experienced some hostility.
If the worker reasonably believes that they will suffer in some way if they make a disclosure, they may be justified in making a disclosure to other individuals set out in the legislation, most notably the CQC or Health and Safety Executive or one of the other bodies listed in the Public Interest Disclosure Act such as:
• to a legal adviser in the course of obtaining legal advice;
• in good faith to a Government Minister;
In the recent past it was a requirement that the disclosure must be made in good faith and not for the purposes of personal gain. That means that the motivation must be that this is about trying to protect patients. However a change in legislation from June 2013 means that under Enterprise and Regulatory Reform Act (ERRA) the requirement that disclosures be made in “good faith” is removed and instead they must be made “in the public interest” to qualify for protection. In the public interest means something you reasonably believe the public needs to be aware of.
How an issue is defined as being in the public interest is clearly of concern. When there is little if any access to legal advice regarding these matters, then individuals will naturally become very anxious.
How can I raise concerns safely, and be heard?
12 steps to blowing the whistle safely:
1. Gather your evidence: stick to the facts and be specific about the particular risks you are concerned about.
2. Get the tone right: express yourself in a low key, professional manner, however angry and distressed you might be.
3. Use a risk assessment framework: identify the particular policies, protocols and guidance you believe are being compromised.
4. Specify your duty of care: relate it to your particular professional code if you are covered by one.
5. Be positive: state what you think should be done, as well as pointing to what should not be happening.
6. Follow procedures: make sure you know how you are supposed to raise a concern.
7. Create a paper trail: keep notes of all relevant conversations and keep a file of all written communication sent and received.
8. Work with others: you might have no choice but to go alone, but you will be more effective and less vulnerable if you can raise concerns collectively.
9. Pose potential solutions: if possible, set out what you think should be done as well as highlighting the problem.
10. Keep it on the record: if you receive assurances of action in response place these on the record. If you are met with silence or receive threats in response, place that on the record too, always professionally and in a low key.
11. Be balanced: how quickly and in what ways you escalate concerns should depend on how urgent or serious they are.
12. Seek allies: look for friends and allies to share the burden with.
You do not have to use your employer’s formal whistleblowing procedure for your concern to be a protected disclosure, as long as you have a reasonable belief that it is a matter covered by the Public Interest Disclosure Act and you have drawn your concern in writing to an appropriate person.
Are whistleblowers ‘blacklisted’ and what can I do if I suspect this is happening to me?
To obtain further information on whether you consider you have been blacklisted you need to write to the Data Protection Officer of your last NHS employer and request your Electronic Staff Record [ESR] in full via a Subject Access Requested [SAR]. Seek further advice on whether the data within your ESR may be causing you detriment in obtaining future employment within the NHS. There may be a charge for this.
If your last NHS employer has now dissolved (e.g. PCT, SHA) you need to write or email to the Department of Health requesting a Subject Access Request for your ESR. Contact details are:
Reviews and Information Team
Legacy Closedown Team
Information and Group Operations Directorate
Department of Health
The Care Quality Commission [CQC] and whistleblowing? Should we make a protected disclosure to them?
You have the option of making a formal protected disclosure to the CQC. If you make the disclosure openly to CQC you will be formally noted as a whistleblower. This may mean that going forwards as part of future inspections the inspectors will follow up on how you are being supported by your employer. It is our experience that by the time people make disclosures to the CQC, they may have experienced some hostility inside their team or Organisation. If you are bullied after raising a concern, either by colleagues or senior managers, you may wish to use this template letter to make a formal complaint to your employer.
It is the employer’s responsibility under the law to prevent such victimisation of staff raising concerns
The CQC legal obligation is to protect the identity of individuals’ making disclosures to them .Their guidance states that information you give the CQC will be dealt with in confidence and they will not disclose your identity without your consent, unless there is a legal requirement for the CQC to do so, e.g. in a Public Inquiry or court of law.
You can raise concerns anonymously with the CQC.
The CQC have told us that they expect all organisations to have effective arrangements to handle concerns raised by employees, and that the CQC take very seriously any employer that victimises a member of staff for raising a concern about safety and quality of care, and will want to know at the next inspection how you are, and whether you are still in this employment or not. In order to be protected by employment law & protect staff raising concerns it is essential that you seek advice and follow your employer’s policy closely in order to protect and strengthen your position.
The CQC ask that you ensure you have seen and read your employer’s whistleblowing policy on raising a concern. If you cannot find such a policy this is something that the CQC do need to be made aware of and this can be raised, anonymously if you wish, via CQC’s website or helpline (03000 616161) .
That CQC has a responsibility to investigate patient safety concerns. When someone makes a disclosure to the CQC the system will forward it to the relevant inspector who will make a judgement regards how to respond. We would expect calls relating to areas where there is an immediate safeguarding issue to be actioned quickly by the caller and the CQC.
There have been problems with how investigations into patient safety concerns have been carried out. Therefore clinical expertise is essential as part of the CQC team if they are going to really understand the potential patient safety issues being highlighted. This is not yet right in too many examples we hear about. Patients First will continue to monitor this and give feedback to the CQC to help them improve.
In practice the CQC are inundated with people contacting them and are currently reviewing how they deal with whistleblowing. As a result there may be no discernible immediate response, something which whistleblowers find very difficult. However at the time of the next inspection any disclosures should be taken into account alongside complaints. We have asked the CQC to help us clarify this process in an attempt to set whistleblowers’ expectations appropriately (December 2014).
The CQC can be contacted by:
Phone: 03000 616161
Writing to: Care Quality Commission, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA
Once you have contacted the CQC please ensure you inform them of any changes to your address and contact details.
What can we expect from the CQC?
Although the CQC is a ‘prescribed body’ to whom whistleblowing concerns may be raised, staff should not assume the CQC can protect them personally if details of their disclosure lead to victimisation by the employer. The CQC may be able to subsequently hold the employer to account but that does not mean it can currently protect individual staff against victimisation. They cannot prosecute under PIDA as they are not the employee.
The CQC have already helped identify and expose bullying in a number of organisations including the William Harvey Hospital, Ashford, Kent and Barts NHS Trust. Patients First continue to challenge the CQC when there is evidence of poor performance in relation to whistleblowing, and are working to enable transparent collaboration.
A particular area of concern is that of whistleblower victimisation overtly linked to the behaviour of Boards, and how CQC will act on this with reference to their responsibilities to enforce Regulation 5, Fit and Proper Persons test. Patients First will continue to lobby the CQC about all the reported instances of omission. It is hoped that this will help resolution of issues in individual cases. How this will work in practice is yet to be determined and may rely on test cases, as well as the initial interpretation of the law.
If you are thinking of referring a Board member to the CQC under the Fit and Proper Person test category, you may find this checklist helpful:
We understand that the CQC will be able to prosecute under the Health and Safety at Work Act from April next year (a power which formerly sat with the Health and Safety Executive). We have asked the CQC for clarification on exactly how they see the new laws will work (December 2014).
We are working to enable transparent collaboration, and we urge CQC to proactively and effectively address issues of workplace bullying and whistleblower suppression in their regulatory activities.
Patients First will continue to lobby the CQC about all the reported instances of omission and feed this back to the CQC, in addition to highlighting examples of good practice.
I feel like I can’t do this on my own. Who can help me?
Very frequently in the current NHS whistleblowing is met with hostility or worse by employers. Employers may choose to “shoot the messenger” rather than fix an issue with resources or organisation of care. As a result, it is normal for our members, in response to the challenges of whistleblowing, to feel worry, confusion, anger, hopelessness, relief, disillusionment, frustration, sadness, regret, fear, disempowerment or empowerment. People often feel different emotions at different stages of the whistleblowing process, and sometimes these emotions come on quite suddenly, perhaps in response to an action or behaviour from a whistleblower’s organisation. For this reason we suggest maximising the informal support you have around from friends and colleagues.
We are also aware that the personal relationships and family members of whistleblowers are often affected. Therefore, we believe it is just as important to look after yourself and get emotional support as it is to obtain practical advice. This may mean scheduling activities into your week which will help take your mind off the whistleblowing. Keeping active with interests outside of work is a very useful distraction technique. As mentioned above try and get support from trusted friends or family members. Accessing professional psychological support through the NHS or privately is also recommended. If you do feel like you are struggling with the emotional impact of raising a concern, it is often helpful to visit your GP to talk through options for extra support. You may wish to print out this information and take it with you.
If you are feeling in desperate need of someone to talk to, you may want to contact Samaritans, which is open 24 hours/day, 365 days/year. They are not a whistle-blowing helpline, but a confidential service for people who are feeling troubled by something.
For some people, the stress of raising a concern can lead or contribute to a mental health crisis or emergency, and based on some of our own whistleblowing experiences, we feel this is very understandable. If your mental or emotional state quickly worsens, it is important to get help as soon as possible. You can call 111 to contact the NHS 111 service and find out where help is available. If you feel that you or someone else are in immediate danger, then call 999.
Is there any published research on whistleblowing?
The Patients First thematic review aims to contribute to an evidence base on the common experiences of whistleblowers, and highlight the impact of whistle-blowing in several domains of life, as well as the impact on those close to them and the patients that they care for. It also outlines key recommendations for changing current practice and organisational culture.
http://t.co/Xt0b67OVvu (This links to a pdf document)
Questions about Patients First
Why was Patients First set up?
Kim’s experience of working her way first through every level of management with GOSH, to the CQC, NHS London, and the Department of Health, led her to realise that there was little support for whistleblowers when the employer fails them. She found that for her information regarding the service in which she worked to be acknowledged she would have to speak openly, despite the risks. What she discovered was that by speaking openly it helped to open up the secrecy surrounding the misuse of power against health professionals, misuse of public money, hiding of patient safety issues, and failures of the regulatory mechanisms. Initially the campaign focussed on the removal of the widespread use of confidentiality clauses to silence whistleblowers, and now the campaign has developed as our knowledge has grown.
There is now a larger network of people who are working hard to build a sustainable organisation that can continue to campaign into the longer term, until the culture has been changed.
We aspire to support whistleblowers and create an NHS where it is no longer necessary to take that difficult step and speak publicly.
Our purpose is to reduce death and harm in the NHS by campaigning for the UK Government to create policies and laws that ensure the NHS becomes open and accountable and we will actively support all those who raise concerns about patient safety.
How is Patients First set up?
patients their first concern by raising concerns about poor standards of
care and unsafe practice and in doing so, have often suffered reprisals in
the workplace for highlighting such concerns.
PF is a network of such health professionals & their supporters.
Those involved in Patients First are not paid, giving their services voluntarily in their own time.
You can donate to Patients First here:
What does Patients First do?
When Patients First began, we would often also provide moral support to new members via telephone or email. However, our membership has since reached capacity, and we are currently unable to do this, as we are staffed entirely by volunteers, many of whom are not in paid employment, and who may still be dealing with the effects of their own whistle-blowing experiences. We have decided that in the coming weeks and months from September 2014, the limited resources that we do have would be best spent on campaigning and raising awareness, as we have had a lot of success in this area to date. We will continue reviewing our role in supporting whistleblowers. If you are a whistleblower or potential whistleblower in need of support, please see our question on further sources of support ‘I feel I can’t do this on my own…’
What has Patients First achieved?
We have heard from nurses, professionals and health care staff, who have raised a concern to their line manager and been hauled in to the ward to answer as to why they raised the concern. This is the level of bullying that is commonplace in too many parts of the health service. It is our view that unless this is acknowledged by the Department, of Health, NHS England and every single Chief Executive in our health services, we will continue to have problems, and staff will remain fearful.
Patients First has been involved in helping the CQC develop their new inspection model, which is beginning to highlight previously uncovered problems with bullying. Through the determination and courage of its members, its supporters and links with other whistleblowers, Patients First has been able to keep up the profile of something many wanted to bury.
Our campaigning work and call for a public inquiry led to the Government Review led by Sir Robert Francis QC. In September 2014 Patients First submitted a comprehensive dossier setting out the need for a zero tolerance approach to bullying and real support and engagement with staff.
We have a number of people now prepared to speak openly about their experiences.
Is the situation better now?
Evidence from the 2013 NHS staff survey, showed that 44% of staff who raise a concern never hear any response.
28% of staff were unable to answer YES when asked if they felt it was safe to raise concerns, that is over a quarter are still worried.
- 22% of all NHS reported being bullied last year with the figure in some
- hospitals being much higher
In addition a Nursing Times (March 2014) survey found that
- 47% of nurses who did raise concerns felt they suffered negative consequences
These findings complement Public Concern at Work research that identified that staff will raise a concern once or twice but if this is not addressed they are likely then to stop raising concerns
What are the Patients First recommendations to the Freedom to Speak Up Review?
- We call for a zero tolerance approach to bullying.
- This issue is so important for patient care and safety that a Public Inquiry into whistleblowing is warranted and some form of restorative justice.
- The NHS should adopt an approach of “early intervention” as soon as any serious patient safety or care concerns are raised so that they are dealt with swiftly and fairly and not allowed to drag on, damaging staff and avoiding the concerns raised.
- It is time to hold to account those who victimise whistleblowers.
- Trusts Boards must take a series of practical steps to ensure patient safety is a Board priority recognising how important it is that staff feel they can safely speak out, without fear of detriment or reprisals, and be valued for doing so.
- This Review must take decisive action to protect whistleblowers as all previous attempts have failed.
Does Patients First have any social media pages?
However we ask that whether or not you agree with what we say, you respond in a respectful, non-discriminatory way. Part of our campaign is to highlight the damaging effects of bullying behaviour towards whistle-blowers, and the last thing we would want to do is replicate that behaviour in our communications with each other. We understand that whistle-blowing can be an incredibly stressful experience, provoking strong emotions and opinions, but please remember that we aim to promote a culture of compassion, mutual respect and honesty among those working for patient organisations.
How can I support Patients First?
You can help us by supporting our campaigns and sharing our materials, additionally if you are in a position to, you can donate to Patients First:
Here’s’ the link: http://www.patientsfirst.org.uk/?page_id=12
Also you can follow us on twitter >>> @PatientsFirstUK
Blogs, letters and documents from campaigners whistleblowers and supporters
Materials from, campaigners, whistleblowers and supporters
- Letter from Dr Lance M Forbat …‘Call for support for who are without recourse due to gagging clauses…’ 28/9/15
- ‘ Fantasy targets’ phsothetruestory Real stories from real people. Added 22/10/15
- @The campaign exchange < click to read document
- Keeping a record, a contemporaneous note < click for details
- ‘Bullying in Healthcare; the sound of silence still prevails’ Roger Kline <click for details
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