PATIENT SAFETY
slightly higher proportion of staff - 18% - reported that colleagues had been the source of bullying or harassment on one or more occasions. Fewer than half of staff who had experience of bullying or harassment had reported it.2
In the same survey, a surprising find perhaps, it was reported that by grade 23% of consultants, 20% of medical trainees and 24% of other doctors and dentists had experienced workplace bullying, harassment or abuse during the previous year. Only 33% of those who had experienced it, reported it and trainee doctors were the least likely to make a report. Principle 14 specifies local accountability for adopting fair, honest and open behaviours and practices when raising or receiving and handling concerns. Where there has been a concern formally raised, there should be a prompt, swift, proportionate, fair and blame – free investigation to establish the facts. In addition, there should be personal and organisational accountability for:
l Poor practice in relation to encouraging the raising of concerns and responding to them
l The victimisation of workers for making public interest disclosures
l Raising false concerns in bad faith or for personal benefit
l Acting with disrespect or other unreasonable behaviour when raising or responding to concerns
l Inappropriate use of confidentiality clauses.
Freedom To Speak Up Guardians Robert Francis suggests that locally there should be a person appointed to each Trust as a Freedom to Speak Up Guardian, to act in an independent fashion, to receive reports of concerns. Additionally, there should be Board Level engagement with the process by naming a non-executive director, as well as at least one executive director who should take responsibility. Within each department, there should be nominated managers to receive reports of concerns. It is to this accountability by the organisation that there needs to be a balance provided by an unbiased external person. That person should be an independent national officer whose key role is to provide a number of core functions. Robert Francis3
names the functions
of the role to: l Review the handling of concerns raised by NHS workers and/or the treatment of the person or people who spoke up where there is cause for believing that this has not been in accordance with good practice
l Advise NHS organisations to take appropriate action where they have failed to follow good practice, or advise the relevant systems regulator to make a direction to that effect
l Act as a support for Freedom to Speak Up Guardians
l Provide national leadership on issues relating to raising concerns by NHS workers.
In Scotland, the Government has appointed an Independent National Whistle blowing officer so that in the event of health boards not managing the issue satisfactorily, there will be external back-up.
National policy A national policy4
was drafted after the
Francis Review by the following year, by NHS Improvement and NHS England. It was designated as a policy to be adopted by all NHS organisations as a minimum standard to help normalise the raising of concerns for the benefit of all patients.
The policy gives examples of risks, malpractice or wrongdoing which staff or patients or relatives may wish to raise as: l Unsafe patient care l Unsafe working conditions l Inadequate induction or training for staff l Lack of, or poor, response to a reported patient safety incident
l Suspicions of fraud (which can also be reported to our local counter-fraud team)
l A bullying culture (across a team or organisation rather than individual instances of bullying).
The policy states with clarity: “If you raise a genuine concern under this policy, you will not be at risk of losing your job or suffering any form of reprisal as a result. We will not tolerate the harassment or victimisation of anyone raising a concern. Nor will we tolerate any attempt to bully you into not raising any such concern. Any such behaviour is a breach of our values as an organisation and, if upheld following investigation, could result in disciplinary action. “Provided you are acting honestly, it does not matter if you are mistaken or if there is an innocent explanation for your concerns.” The manner in which the health service has dealt with issues before has been very much to disengage with the individual and, in many instances, invoke disciplinary measures on unrelated matters, to put pressure on the individual to drop their concern. The above must have seemed almost unbelievable.
All the new designated people holding responsibility for Speaking Up, in the Trust are named in the policy and their contact details identified. The policy also states that the investigation will be objective, evidence based and will produce a report that focuses on identifying and rectifying any issues, and learning lessons to prevent problems recurring.
Wales, Scotland and Northern Ireland
In Wales, the policy specifies whistle blowing, as the phrase they prefer to use. There is an advice leaflet available to guide healthcare professionals working in Wales,
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WWW.CLINICALSERVICESJOURNAL.COM
regarding the appropriate mechanisms for raising concerns and making disclosures. At the prescribed body, the office of The Healthcare Inspectorate in Wales, has a Concerns team, who will investigate issues if they have not been dealt with satisfactorily locally. In addition, the large Trust in Cardiff
has started a helpline which is aimed at escalation for staff, if the issues have not been managed at department level appropriately. In Scotland, the Government has appointed an Independent National Whistle blowing officer so that in the event of health boards not managing the issue satisfactorily, there will be external back-up. It is noted that legislation will be needed in order to bring the role under the auspices of the Scottish Public Ombudsman. Rosemary Agnew, the Scottish Public
Services Ombudsman, said: “It is important to me that any challenge to the way in which public services are delivered is listened to, properly considered and results in both resolution and appropriate, proportionate improvement.
“Giving us the role of independent national whistle blowing officer for the NHS in Scotland, brings whistle blowing in line with service complaints, providing an independent final consideration of the way in which a matter is investigated and responded to.” In Northern Ireland, the process is overseen
by the Regulation and Quality Improvement Authority (RQIA), with many of the same principles for whistle blowing as in the other devolved nations. Staff, described as workers, who are concerned about wrong doings or failure can make disclosures to a prescribed body for example the RQIA. For a disclosure to be protected by the Public Interest Disclosure (Northern Ireland) Order 1998 (Amended January 2011) the worker must: l Make a decision in good faith, which means with honest intent and without malice
l Reasonably believe that the information, and any allegation it contains is substantially true, and
l Reasonably believe that they are making the disclosure to the correct/appropriate ‘specified person’.5
Guidance for Trust boards
Recently a new document was released by NHS Improvement jointly drafted by them and the National Guardian’s Office.6
It is to
provide a benchmark for Boards and to give guidance to Trusts regarding their approach
SEPTEMBER 2018
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