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‘I don’t want to hear anything bad’ – whistleblowing in health & social care.

August 15, 2019 By Steve Turner

Exposing the reality behind the spin

Summary

I am a healthcare professional, a nurse prescriber with experience in senior management in both the NHS and private sectors. I work as a clinician with vulnerable adults on the margins of society.

Over the past ten years I’ve become involved with a situation I was previously unaware of. The widespread marginalisation and victimisation of health and care staff who raise concerns about patient safety, and lose their careers as a result. I’ve learned that this problem is part of a much bigger picture which affects all of society, all industries and public sectors, in all countries of the world.

In this blog I reflect on the situation in England based on my experiences and those of the many people I have met as a result. All of whom experienced the backlash that can happen when organisational reputation trumps patient safety. One thing many of us have in common is that, put simply, we never intended to become known as ‘whistleblowers’ we were just trying to do our job to the best of our ability.

In conclusion, I look at key areas to be worked on in order to protect the public and really ‘learn lessons’. These cross all sectors and areas of work. They include the need for an individual duty of candour (duty to tell the truth); an end to self-regulation in healthcare and elsewhere, and recognition of the value to society of those who risk everything to fight for justice and truth.

A dawning realisation

I began to realise something was seriously wrong when I returned to clinical work in 2002. Having previously worked in senior management (as Head of I.T. in an NHS Trust) and management consultancy, I became concerned that my employer appeared to be putting reputation over patient safety, and if concerns were raised, they were not followed up. I recall looking at Board papers and directions to trusts from the Department of Health [DH] to try and understand this further. One thing I remember is a letter to Chief Executives from the DH which talked about creating an ‘outward-facing’ organisation. I didn’t realise at the time, what I now see as the real meaning of this, and its link to the ‘no bad news culture’. This involves putting reputation above patient safety.

Later I tried to raise my concerns with a Trust Executive at an early stage, only to be told in both words and body language that the trust didn’t want to hear anything bad. This attitude, and what I saw happening to the team and staff around me, led me to leave the NHS and become self-employed working for the NHS on projects related to medicines and prescribing. Eventually my experiences led me to make a protected disclosure in 2014 , in which I set out the patient safety concerns. As a result, the CQC requested an external investigation of my concerns in 2013.

Since being interviewed for the investigation report in 2013 I have heard nothing further.  I never saw the investigation report and was never contacted about it. A recent FOI request to the CQC produced the response that my concerns were dismissed as ‘all third hand’ (which is incorrect) and I was told that the CQC had ‘lost the report’.

Prior to the FOI request, I was employed as a CQC Specialist Advisor (a zero-hours contract), however following the FOI request this contract was ended without a specific reason being given.

The wider picture in healthcare

I’ve only briefly mentioned some of the aspects of my story here. The most important thing for me was that I found out the common themes behind all genuine healthcare whistleblowers’ stories.

Three things stand out for me.

1. The psychological effect on the whistleblower

I experienced the isolation that whistleblowers are subjected to and the psychological effect this has on individuals. Suddenly you’re on your own, and people you worked with avoid you. In my case, I also kept my distance from some co-workers, as I realised they were being bullied as a result of supporting me.

For me (now self-employed) offers of work dried up and a real feeling of being ‘sent to Coventry’ set in. In addition to the loss of income, this isolation has a deep effect on my mental health and home life. I believe the approach of employers here is called ‘gaslighting’. It’s deeply troubling.

2. The NHS cold shoulder / being blacklisted

Secondly, I have discovered through meeting other whistleblowers that blacklisting of those who speak out is very common. This can take many forms, ranging from informal blacklisting, to interventions to prevent career development, to giving unsolicited (and unfair) bad references.

For those employed by the NHS the Electronic Staff Record [ESR], which is shared throughout the NHS can be used as a way of sharing detrimental information on whistleblowers. This has caused people to be denied a fair chance to gain further employment. I believe the full extent of this is yet to come to light.

In my case the blacklisting takes the form of repeatedly being given the  ‘cold shoulder’ for example being excluded from meetings; letters not replied to and generally avoided. Of course, this is subjective, and maybe sometimes I’m wrong, as healthcare is a tough work environment. However, I have been subject to some clear examples of detriment.

On one occasion my company was enthusiastically awarded a contract of work one day, then the very next day the same person ‘phoned me and cancelled the order saying only that it ‘wasn’t what they wanted’.  Very strange. Also last year I found out that staff from the trust I worked for are told not to speak to me, even though in one case it was to ask me a question about my clinical work.

In addition, I was deeply upset when the NHS Trust, who commissioned one of my projects, failed to acknowledge its success. A poster was presented at the NICE Conference in 2015 and it was highly commended by NICE.

Prior to the Conference, I contacted the trust to let them know of the success and all attempts to engage the trust were ignored. As you can see in the poster (which was produced by NICE) the space for the trust’s logo, on the bottom left, is empty:

In fact, I have several examples of work on the NICE Shared Learning pages, none of which have ever been acknowledged in any way by local NHS Trusts, or any healthcare organisations, in Cornwall.

Click here for the link to a recent Shared learning example Patient Led Clinical Medicines Reviews. This project also was presented live at the NICE Conference in Manchester in 2019.

3. The effect that the victimisation of healthcare whistleblowers has on patients

Thirdly, as I looked further into the problem, I began to see the full impact that the victimisation of genuine healthcare whistleblowers has on patients. This for me is the most shocking aspect of the problem.

In 2015 I set up the Turn up the Volume! Movement. This is an attempt to bring together all involved in an open and transparent way, with a focus on the core issue of patient safety.

Through this initiative I have met many more people in a similar situation and learned first-hand the effect lack of transparency and denial has on patients. This is well illustrated, for example, in the report of the Gosport Independent Panel Report (2018), where those who raised the alarm were initially listened to, then ignored and their concerns re-labelled as ‘allegations’. As a result of this, in the words of the report, ‘the lives of over 450 patients were shortened while in the hospital’.

90 second #vlog

Next steps

Based on my experience in trying to link together people in health and care with similar experiences and focus on patients, I believe there are three vitally important areas in healthcare that need addressing.

The need for an individual duty of candour

Firstly, I was shocked to find out that in the NHS the duty of candour (duty to tell the truth), brought in following the Mid Staffordshire inquiry, is an institutional duty of candour. This relies on staff telling the truth to their employer in order to highlight what went wrong.  Thanks to the tireless work of campaigner Will Powell the need for an individual legal duty of candour for professionals, managers & leaders in healthcare has been demonstrated. This has parallels to the calls for a ‘Hillsborough Law’. Without this, there is no real mechanism to hold individuals to account for cover-ups and for not being honest.

Making sure initiatives are effective

Secondly, I’m disappointed at the failure to learn and improve patient safety through listening to genuine whistleblowers, whether they be patents or staff, and failure to take measurable actions to change. I believe the effect of the National Freedom to Speak Up Guardian programme needs a full independent review (from outside the NHS). Evidence suggests it is making the situation worse in some trusts, where it is used as a cover for continued victimisation of those who speak out.

Ending self-regulation

Thirdly, in common with industry, I firmly believe that self-regulation in health and care does not work and the only solution will be to set up a truly independent body to oversee and enforce this. This body must include patients, who raise concerns at great cost to themselves and their families, against all the odds, often when people have suffered and died.

Health regulators in England and the people who they regulate are often uncomfortably close. For example, I was deeply disappointed when I found out only recently that the CQC Inspector involved in dealing with my concerns raised in 2013, is now working as Compliance Lead in the same trust.

You can comment on the issues raised in this blog here: https://www.pslhub.org/forums/topic/113-blacklisting-by-the-nhsit-never-ends/

Author: Steve Turner.  Date: 15th August 2019. Revised 29th August 2019. Revised 1st September 2019, to add an outline list of the concerns I raised in 2013. Short video added 05.09.2019.

Updated 13.01.2020 with some more detail on the nature of the blacklisting.

Updated on 11.05.2020 with more examples of the ‘NHS cold shoulder’.

Updated: 11.08.2020 with link to comment via the Patient Safety learning Hub

Steve Turner RGN; RMN: Ba(Hons); P.G. Dip. Ed, is co-creator of www.patientled.education, Head of Medicines and Prescribing for #MedLearn, tweeting as @MedicineGovSte , and Associate Lecturer at Plymouth University.

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Filed Under: Care Right Now, Human Factors, Leadership in Health, NHS, Organisational Culture, Transparency, Uncategorized, whistleblowing, Workshops Tagged With: #tutvlondon, accountability, health, just culture, leadership, NHS, socialcare, transparency, whistleblower, whistleblowing

Changing mindsets and delivering safe care in Cornwall together. #devocornwall

March 20, 2017 By Steve Turner

We want the best health care system in the world, & the most efficient and effective system …

We have an opportunity to do things differently in Cornwall

How do we achieve this?

 

The challenges in Cornwall

There’s a huge amount going on with health and social care in Cornwall. Including the Sustainability and Transformation Plan [STP]; exposure of abuse and neglect in care homes; concerns over hospital closures, delayed discharges taking up hospital beds, and devolution of services on the way.

Although I have worked in health and care for over 30 years, I struggle to keep up with the issues and understand how services are organised.  This isn’t helped by the current polarisation of views.

On the one hand we have a big dose of NHS and Council ‘spin’, excessive bureaucracy and even bullying. On the other hand we have public concern, often expressed around specific issues, and sometimes based on unfounded rumours.

Neither of these positions are helpful, and neither represent the vast majority of people (public, staff and patients) who just want good services delivered by kind people who are open, accountable and transparent.

#devocornwall

We have a great opportunity now with the devolution of health and care services. This will be realised if we all build bridges, and transcend the usual hierarchical boundaries. We all need to listen and learn. Everyone, to coin an overused phrase, needs to step out of their comfort zones.

Why we need to think differently?

Several community hospitals are under threat of closure, leading to anger and dominating the headlines. Less attention is given to identifying and measuring the benefits, and any disadvantages of community hospitals. For example, can they be staffed adequately, bearing in mind this means Doctors, Nurses, Physiotherapists, Radiographers, Dieticians, Speech and Language Therapists, Social Workers etc.? Is home care a viable option for patients and carers?  Are there any creative options such as bringing back the old style ‘convalescence’? Is rural isolation and lack of public transport the major issue?

It’s becoming increasingly difficult to book a timely GP consultation. This has led to several inaccurate scare stories in the press about ‘cuts’ to face to face GP contacts. This needs deep thought as there are times when easy access to a GP on the ‘phone, or on-line, may actually be a better option. Access to health information from Community Pharmacies or in NHS run clinics in shopping centres, or better health information and advice available locally, may be more effective approach. Leaving GPs free to spend more time with those who need their help and expertise most.

It’s now widely accepted that the NHS and Social Care is underfunded. Despite this there is still a great deal of duplication and waste in the system. How many times have you been asked to repeat information to Health Professionals which others already have? Do some services overlap, and are there gaps? Do different organisations link seamlessly with other organisations? Are all services accessible to all? Many people have important stories to tell on these areas of inefficiency.

Now’s the time to talk about this, find out what’s planned, and take action together. ‘Patient engagement’ key component of the STP and #devcornwall.

Patients and public need to take the lead on this. It’s not the NHS or Cornwall Council’s plan it’s ours.

Personal views of Steve Turner. MD Care Right Now CIC, a Cornish Company

Version 2

Date: 30/03/2017

This article is adapted from a letter which fist appeared in the St Austell Voice

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Filed Under: Care Homes, Care Right Now, Children Health, CIC, Elderly care, Human Factors, Jargon Buster, Leadership in Health, Medicines Optimisation, NHS, Organisational Culture, Transparency, Uncategorized, whistleblowing

5 Reasons You Should Employ a Whistleblower – Guest Blog from Tim Martin CEO, SpeakInConfidence

May 6, 2016 By Steve Turner

5 Reasons You Should Employ a Whistleblower

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Over the past few years my role as CEO of SpeakInConfidence has brought me into contact with quite a few whistleblowers;  It’s also brought me into contact with lots of the cases and stories of whistleblowers.

On starting down the path of becoming a whistleblower people will know it is likely to be the end of their career in the organisation they are in.  Sadly it is all too often the end their chosen career in the sector they are in.

Imagine the conversation with your boss when you let them know about your decision:

Boss “How did the references on Jane Bloggs, your preferred candidate for head of Finance turn-out”

“Oh we are not bothering with those – she was fantastic in interviews, just what we need and references will only be pro forma as she left her last job following a successful whistleblowing case”.

So here are 5 reasons should seriously consider being clear that “Yes applications from whistleblowers are welcome”.

  • You have to be pretty committed to be a whistleblower – the journey can be a hard one – and you are probably hiring someone with a high degree of commitment rather than being a passive by stander.
  • Trust: If I am going to trust someone I have never met before, I think I would put whistleblowing high on the list of qualifications.  Given that in the UK whistleblowers don’t gain financially, and risk a huge amount, chances are you are hiring someone who is exceptionally committed to doing the right thing.
  • Don’t you want to know you have people on your team who will have the courage to tell you if they think things are not headed in the right direction? How many mistakes can be avoided if you avoid group think?  Is it really in your interests or those of your organisation to surround yourself with yes people?
  • Imagine the signal to your staff – “We don’t shun people who raise concerns – we hire them”. What does that say to the rest of your staff?  Want to create an open honest culture – what better signal can you give.
  • It’s the right thing to do. Think you are an equal opportunities employer?  Think you are a courageous manager?    Well start acting like one.  By all means fail to select someone because they cannot do the job, but not because they had the courage to speak up elsewhere.

Given the assumptions people sometimes make, unless it’s blindingly obvious from past conduct of your organisation, maybe it’s even time to make it explicitly clear “Whistleblowers welcome here”.

Tim Martin is CEO of SpeakInConfidence, the Anonymous Dialogue Platform.

Send anonymous feedback to your organisation at
www.makemyworkbetter.com

SIClogoMake my work better


A note on our guest blogs:

092JessopWe welcome submissions of guest blogs for all who share our values.

Please send them to info@carerightnow.co.uk


Added: 6/5/2016

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Filed Under: Care Right Now, Human Factors, Leadership in Health, NHS, Organisational Culture, Transparency, whistleblowing

My Story – Steve Turner, Campaigner for safer healthcare

December 8, 2015 By Steve Turner

My Story – Steve Turner, Campaigner for safer healthcare

092Jessop

 

Steve Turner is a man on a mission – to create a better climate within our National Health Service where people can speak out about unsafe practices without fear of losing their jobs.

He’s a rare breed of health professional whose career spans hands-on nursing, training and innovation as well as campaigning for greater transparency within the NHS.

Steve began his career as a nurse specialising in mental health inspired by, and slightly scared of what happened to his grandfather who had suffered major depression all his life.
His appetite for learning took him through a degree in Social Policy and then into the world of healthcare IT. Steve spent the next decade working on clinical systems for American giant Shared Medical Systems, progressing from project manager to Senior Strategic Services Consultant of the US arm of the company, working with leaders of clinical teams in the UK

Steve then returned to the NHS, successfully revamping the Information and Technology department at Tunbridge Wells prior to a trust merger.

A spell in consultancy for the Kent and Medway Cancer network followed, with Steve leading two multi-organisational projects to identify the most effective information and prescribings systems . These brought clinical teams together to manage a complicated buying system in a much more efficient and cost effective way.

Then came a career crossroads. Steve and his partner decided it was time for a lifestyle change. They had enjoyed many holidays in Cornwall and decided this was the place to be. Plus Steve wanted to return his first love of hands-on nursing. He did a Return to Practice Nursing course and began work as a community mental health nurse in St Austell. Then he moved to an assertive outreach team based in Truro and dealing with some of the most vulnerable people in the community. This involved long term relationships and building trust with patients, something Steve much enjoyed. He also became a Nurse Prescriber, specialising in drugs within the mental health framework.

However in 2008, with proposed cutbacks on the horizon, Steve gently told his patients about the changes and that he might not necessarily be their regular nurse in the future, a step he thought was an important part of good care planning.

Following the standard procedures, he raised his concerns with the Cornwall Partnership NHS Foundation Trust. His only mistake was to copy his grievance letter to three GPs with whom he’d been working closely.

An attempt was made to discipline him but he accepted that what he had done was outside the policy of the Trust.

However the matter didn’t end there. The cuts had particularly upset two of Steve’s patients who realised that their continuity of care was being threatened and so they filed formal comments about the changes. But once these forms reached the desks of senior management, Steve was accused of bringing the organization into disrepute and suspended from work. Realising that the Trust would be pressing on with the cutbacks, and that his hopes of eventually winning a senior clinical job were scuppered, he resigned.

Steve returned to his training skills, developing medicines management training for staff at the Trust and worked on some major projects involving clinical governance and prescribing for patients with substance issues.

However by 2013 he was becoming increasingly concerned at the plight of the mental health staff he was training. They were becoming tearful in training sessions and were clearly stressed. They told Steve they were afraid to speak out for fear of victimisation as there was no alternative employer within travelling distance.

Steve attempted to discuss his concerns with the Trust but he quickly hit a brick wall. The Care Quality Commission were more sympathetic and arranged for an external person to review his complaint. However he was shocked to be left out of the loop, and merely told there had been ‘ recommendations.’ He heard nothing more.

This process cemented Steve’s ambition to campaign for better transparency in the NHS. He decided to set up Care Right Now as a structured company with an ethical base, delivering change management consultancy within health care, and a new breed of patient led education for clinical staff.

He has also created a movement to bring together people who raise concerns about patient safety and share their experiences, with Turn Up the Volume! on Patient Safety, a new initiative run on a charity basis. With a highly successful inaugural conference in Bristol under its belt, the movement is swiftly gathering momentum.

Does he have any regrets about what he did?

None at all, Steve says he would do it all over again. But he admits it took its toll on his personal life, taking him to the verge of bankruptcy, affecting his home life and linked to episodes of major depression.

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.

 

Updated: 20/03/2018

 

 

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Filed Under: Care Right Now, Human Factors, Organisational Culture, Transparency, Uncategorized, whistleblowing

Why I set up Turn Up The Volume! (3)

October 18, 2015 By Steve Turner

Now the event is complete three things stood out for me:

  1. That this is a  movement not just a  conference

  2. That between us we have the answers if we work together

  3. The need for truth and reconciliation

 

Click here for the resource pages.

 

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Filed Under: Care Right Now, Human Factors, Leadership in Health, Organisational Culture, Transparency, Uncategorized, whistleblowing, Workshops

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Important thread on #HighIntensityNetwork & SIM model. As a #mentalhealth nurse, who formerly worked in an #assertiveoutreach team, I have concerns that echo what many users of services are saying I'm keen to learn more #TeamPatient 💚 #Patients #patients #PatientExperience ⬇️⬇️ twitter.com/Centrefo…

About 42 minutes ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Looking for reliable sources of information on #medicines (UK)? Includes #Children & #mentalhealth resources & link to download BNF app. carerightnow.co.uk/5… #TeamPatient 💚 #TeamNHS 💙 #MedLearn #prescribing #patients #patientcare #patientsafety #PatientEngagement

About 6 hours ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

👍A 'CLOSED TWITTER GROUP to share/discuss/read all things PATIENT related?'👍 #TeamPatient 💚#patients #patient #patiente #TeamNHS 💙#NMPPU #SOMNMPCPD #share4safety twitter.com/NusratMe…

Yesterday from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Steve & Sam discuss what they learned as #nurse & service user: spreaker.com/user/ap… #assertive #care #change #collaborative #community #health #holistic #illness #mental #nhs #nursing, #outreach #prescribing #psychiatry, #psychology #respect #MedLearn TY @apospodcast

About 4 days ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

Fantastic to run our first pilot 'My #Medicines' session with @TheFlourishing8 yesterday. Thank you for this opportunity to develop our #patient led work. #MedLearn #TeamPatient 💚 #patients pic.twitter.com/8iDH…

About 5 days ago from @MedicineGovSte #MedLearn#TeamPatient#TeamCOVID19's Twitter via Twitter Web App

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