Public Concern at Work –the charity that supports whistleblowers- recently used the launch of their biennal review to pose the question “ Whistleblowing – a right or a duty?”. Val Moore, our Partner on the spot, reported some disturbing contributions from people who had reported concerns within the NHS. Those people who had eventually taken their fears to the media had previously taken them to colleagues, managers, Directors and Board members, trade unions, Regulators and monitoring bodies of various sorts. People talked of meeting a blank wall of resistance, disbelief, aggressive denials, accusations of trouble making and even suggestions of mental instability. One person had been offered a substantial financial pay off but with a gagging clause. Whilst most of panel and audience felt the media should not be the only effective way of uncovering serious malpractice and unacceptable behaviour in the health service, they all felt that at the moment it was the only effective way to get the lid off the most serious situations. These views chimed with the MAC experience that the users of publicly provided services, such as health services, are often met with scepticism or disbelief and often a blank wall. And yet, the providers of those services – certainly at the point of delivery – have to know what is really going on and some of them must wish they had the courage to be whistleblowers!
Aviation leads and Doctors follow
The only Regulator in the audience willing to be identified was from the aviation industry. He was a brave man to speak out in what was undeniably a heated atmosphere but pressed on to make his point that some 15 years ago the aviation industry realised that they had to encourage rather than discourage employees to report faults of all kinds at the earliest possible moment. He said it had become a matter of congratulation rather than recrimination when an employee spotted and reported problems and passenger safety was set above all other considerations. Perhaps encouraged by this contribution, the representative of the British Medical Association said that whilst it had traditionally been a professional duty for doctors not to criticise each other, this was changing and the medical profession realised the need for openness and the importance of patient safety.
So it was interesting to see a copy of the NHS Staff Survey where question 19 asks whether the respondent had seen and if so, reported concerns about fraud, malpractice or wrongdoing. This is the whistle-blowing question along with later ones asking directly about incidents where staff or patients might have been hurt and how management react to such incidents. The follow-up questions for q19 to be answered by those who knew how to report such things, ask whether the member of staff felt safe and confident that the Trust would address those concerns?
What hope for candour?
The capability to cross-reference question 19 with the responses to the conventional staff survey-type questions about recommending the Trust as a place to work and degrees of trust and job-satisfaction will give some very useful data not just on the incidence of worrying events and the proportion of them that are reported but give an interesting general future indicator on the how the ‘duty of candour’ might work. Staff who feel unsafe and worried about being blamed for incidents (Q27d ‘My Trust blames or (should we add ‘and’) punishes people who are involved in errors, near misses or incidents’) will not be fearless and candid. Being told that they must be, will not wash. Perhaps they will indeed end up accessing ‘counselling services at your Trust’ (Q31a)
The Killer Metric?
We look forward to seeing the results – especially the answers to 21b ‘If a friend or relative needed treatment, I would be happy with the standard of care provided by this Trust’. The search is always on in the NHS for the ‘killer metric’ – the question that pulls together all the strands of opinion and experience to illuminate the state of the NHS – and this is a very strong candidate.