Whistleblowers: heroes or villains? John Tingle
T
he treatment of whistleblowers in organisations has not been generally a good one. They are either viewed as brave righteous souls who have fallen on the sword of honesty and goodness; or disloyal villains who have spilt the beans, sold their soul and made everybody’s life a misery. If only they had kept quiet, life would have been so much easier. The terrible events at Mid Staffordshire show, sadly, what can happen when people generally keep their heads down, don’t rock the boat and tolerate appalling standards of care. It is worth revisiting the Francis report’s findings (Francis, 2013) as a salutary reminder of what can happen if the proper, patientcentered healthcare culture is not in place and the benefit that whistleblowers can bring in those circumstances.
Appalling care standards: the context (from the Francis report) ‘The first inquiry heard harrowing personal stories from patients and patients’ families about the appalling care received at the Trust. On many occasions, the accounts received related to basic elements of care and the quality of the patient experience. These included cases where: ■■ Patients were left in excrement in soiled bed clothes for lengthy periods; ■■ Assistance was not provided with feeding for patients who could not eat without help; ■■Water was left out of reach; ■■In spite of persistent requests for help, patients were not assisted in their toileting; ■■Wards and toilet facilities were left in a filthy condition; ■■Privacy and dignity, even in death, were denied; ■■Triage in A&E was undertaken by untrained staff; ■■Staff treated patients and those close to them with what appeared to be callous indifference’ Francis (2013: 13). The Francis report is now well known in the NHS and the Government is making strenuous efforts to make sure that the terrible events are never repeated. The report covered whistleblowing too: John Tingle is Reader in Health Law, Nottingham Law School, Nottingham Trent University
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‘It is clear that a staff nurse’s report in 2007 made a serious and substantial allegation about the leadership of A&E. This was not resolved by Trust management. These issues
were not made known by the Trust at the time to any external agency, but they were known to the Royal College of Nursing (RCN) because of its involvement with the personnel involved.’ (Francis, 2014: 42) A very telling observation is made in the Francis report of a passive culture among some staff at Mid Staffordshire in the face of events that should have been vigorously pursued:
‘Professional disengagement’ ‘Consultants at Stafford were not at the forefront of promoting change. The Inquiry heard evidence which added justification to the view formed at the first inquiry that clinicians did not pursue management with any vigour with concerns they may have had. Many kept their heads down. A degree of passivity about difficult personnel issues is all too common in the NHS as, perhaps, elsewhere. However, a system that is safe for patients requires a much more rigorous approach. The Trust lacked a sufficient sense of collective responsibility or engagement for ensuring that quality care was delivered at every level.’ (Francis, 2013: 44) The key words and phrases here are ‘passivity’, ‘keeping your head down’ and ‘not rocking the boat’. The Francis report and the appalling care events chronicled in it have set the scene for a welcome review of whistleblowing in the NHS and there has been much discussion since its publication. In its wake has now come the House of Commons (HC) Committee of Public Accounts report on whistleblowing (HC, 2014).
Whistleblowing report This report contains some very important recommendations and some very interesting context and findings to whistleblowing in public organisations, government departments and the NHS where the public purse is spent. The report also offers a useful definition: ‘Whistleblowing is when an employee raises a concern about wrongdoing, malpractice or poor practice in the workplace that has a public-interest aspect to it’ (HC, 2014). The report makes clear that the treatment of some whistleblowers has been shocking and departments have sometimes failed to protect them from being victimised: ‘We have heard of too many cases of appalling treatment of whistleblowers by their colleagues, but departments were unable to tell us if those who have threatened or victimised whistleblowers
© 2014 MA Healthcare Ltd
John Tingle discusses a recent report by the House of Commons Committee of Public Accounts on whistleblowing and reflects on the forthcoming Francis Independent Review of Whistleblowing in the NHS.
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 28, 2015. For personal use only. No other uses without permission. . All rights reserved.
PATIENT SAFETY had been sanctioned. We heard from a whistleblower in the Care Quality Commission who was victimised by senior departmental officials, but it appeared that no-one had been sanctioned as a result’. (p. 5) The report states that whistleblowers are often unclear as to whom they should raise their concerns with. Across the civil service, over one-third of employers do not know how to raise a concern under the civil service code. The report exposes a lack of transparency as to how departments address concerns by whistleblowers. Clearly, it is very important to keep whistleblowers informed of how their grievance case is proceeding. Is it being investigated and by whom? Is the whistleblower’s statement being taken seriously or is it ‘just being shoved under the carpet’? The report says:
© 2014 MA Healthcare Ltd
‘In practice, whistleblowers are not routinely informed about how their concerns have been handled and what outcomes have been reached.’ (p. 6) There is a startling disconnect between the generally good quality of whistleblowing policies in theory and how arrangements actually work in practice. Departments have not properly defined the measures to help them monitor improvements and to understand whether their whistleblowing policies have been implemented properly. An organisation’s effectiveness can be increased if it makes use of intelligence. This intelligence can come from customer feedback, complaints or whistleblowers who identify organisational failings.The report found that departments in the public sector, including government departments, are not best exploiting this intelligence, which can identify systemic failings. The report provides an excellent focus on whistleblowing. It makes clear that whistleblowing policies require urgent attention and a number of important recommendations are made. These include: ■■ Where the identity of whistleblowers is known, departments must ensure that they are protected, supported and have their welfare monitored. This should include: ■■ ‘Ownership’ from the top by assigning a board member who is accountable for the proper treatment of whistleblowers ■■ Providing whistleblowers with appropriate support and advice, such as access to legal and counselling services ■■ Appropriate and swift sanctions against employees, at all levels in the organisation, if they victimise whistleblowers ■■ Departments should provide all employees with a ‘route map’ that clarifies suitable internal and external reporting routes. This map should be replicated through the delivery system with clear obligations on private and third-sector providers delivering public services to employ strong and effective whistleblowing policies. Other recommendations include: having clear arrangements for reporting back to whistleblowers in a timely fashion, addressing their concerns; publicising to the organisation’s workforce and the whistleblower the changes that have been made to policies and practices as a result of the whistleblowing; and the collection and application of intelligence to concerns raised by whistleblowers on the part of departments. This is an excellent report that casts an important light on
British Journal of Nursing, 2014, Vol 23, No 18
whistleblowing in government and other public departments. The recommendations made are very positive and well thought out. The report also heralds a new Francis review. The Secretary of State for Health announced after the Committee’s evidence sessions that Sir Robert Francis will lead an independent policy review into whistleblowing and creating a culture of openness and honesty in the NHS (HC, 2014).
The new Francis review The new Francis review has a dedicated website, freedomtospeakup.org, an independent review into creating an open and honest reporting culture in the NHS. The ‘Freedom to speak up’ review was formally announced on 24 June 2014 by the Secretary of State for Health. Sir Robert Francis wants people to come forward and share their views and experiences in order to inform future practices better. It is important to learn from the errors of the past and not to make the same mistakes in the future. Sir Robert invited contributions from people with both good and bad experiences of raising concerns in the NHS, including: ■■ NHS workers who have successfully raised concerns at work as well as those who have felt deterred from doing so ■■ People who have supported colleagues who have raised concerns ■■ People who say they have suffered detriment as a result of raising legitimate concerns or supporting others who have raised concerns ■■ Employers, trade unions, professional and system regulators, and professional representative bodies; and ■■ Organisations that support those who raise concerns (Francis, 2014). This aspect of the review closed for contributions on 10 September 2014.The review has also involved a confidential survey sent to all NHS workers, employers and associated organisations.There will be a desktop review of whistleblowing policies that will compare those in the NHS with other sectors and countries. Confidential, in-depth interviews will be held with a sample of interested parties. Seminars will also be arranged with individuals and representatives of relevant organisation to discuss issues and emerging themes. These seminars will take place in October 2015. Sir Robert will then gather all his findings and make recommendations to the Secretary of State for Health by the end of November 2014.
Conclusion All this activity on whistleblowing is good news and will help whistleblowers ‘come out of the cold’ so that they can be viewed as the heroes that they are. Sir Robert Francis’ new report will be characteristically thorough, fair, well-reasoned and, where needed, hard-hitting.The whistleblowing landscape BJN of the NHS will never be the same again. Francis (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC, Executive Summary, HC 947. http:// tinyurl.com/bkgyem7 (accessed 29 September 2014) Francis (2014) Freedom to speak up, an independent review into creating an open and honest reporting culture in the NHS. http://tinyurl.com/ oyhd2mb (accessed 29 September 2014) House of Commons (2014) Committee of Public Accounts, Whistleblowing, Ninth Report of Session 2014–2015, HC 593. http://tinyurl.com/qxogot3 (accessed 29 September 2014)
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British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 28, 2015. For personal use only. No other uses without permission. . All rights reserved.
T
he treatment of whistleblowers in organisations has not been generally a good one. They are either viewed as brave righteous souls who have fallen on the sword of honesty and goodness; or disloyal villains who have spilt the beans, sold their soul and made everybody’s life a misery. If only they had kept quiet, life would have been so much easier. The terrible events at Mid Staffordshire show, sadly, what can happen when people generally keep their heads down, don’t rock the boat and tolerate appalling standards of care. It is worth revisiting the Francis report’s findings (Francis, 2013) as a salutary reminder of what can happen if the proper, patientcentered healthcare culture is not in place and the benefit that whistleblowers can bring in those circumstances.
Appalling care standards: the context (from the Francis report) ‘The first inquiry heard harrowing personal stories from patients and patients’ families about the appalling care received at the Trust. On many occasions, the accounts received related to basic elements of care and the quality of the patient experience. These included cases where: ■■ Patients were left in excrement in soiled bed clothes for lengthy periods; ■■ Assistance was not provided with feeding for patients who could not eat without help; ■■Water was left out of reach; ■■In spite of persistent requests for help, patients were not assisted in their toileting; ■■Wards and toilet facilities were left in a filthy condition; ■■Privacy and dignity, even in death, were denied; ■■Triage in A&E was undertaken by untrained staff; ■■Staff treated patients and those close to them with what appeared to be callous indifference’ Francis (2013: 13). The Francis report is now well known in the NHS and the Government is making strenuous efforts to make sure that the terrible events are never repeated. The report covered whistleblowing too: John Tingle is Reader in Health Law, Nottingham Law School, Nottingham Trent University
1002
‘It is clear that a staff nurse’s report in 2007 made a serious and substantial allegation about the leadership of A&E. This was not resolved by Trust management. These issues
were not made known by the Trust at the time to any external agency, but they were known to the Royal College of Nursing (RCN) because of its involvement with the personnel involved.’ (Francis, 2014: 42) A very telling observation is made in the Francis report of a passive culture among some staff at Mid Staffordshire in the face of events that should have been vigorously pursued:
‘Professional disengagement’ ‘Consultants at Stafford were not at the forefront of promoting change. The Inquiry heard evidence which added justification to the view formed at the first inquiry that clinicians did not pursue management with any vigour with concerns they may have had. Many kept their heads down. A degree of passivity about difficult personnel issues is all too common in the NHS as, perhaps, elsewhere. However, a system that is safe for patients requires a much more rigorous approach. The Trust lacked a sufficient sense of collective responsibility or engagement for ensuring that quality care was delivered at every level.’ (Francis, 2013: 44) The key words and phrases here are ‘passivity’, ‘keeping your head down’ and ‘not rocking the boat’. The Francis report and the appalling care events chronicled in it have set the scene for a welcome review of whistleblowing in the NHS and there has been much discussion since its publication. In its wake has now come the House of Commons (HC) Committee of Public Accounts report on whistleblowing (HC, 2014).
Whistleblowing report This report contains some very important recommendations and some very interesting context and findings to whistleblowing in public organisations, government departments and the NHS where the public purse is spent. The report also offers a useful definition: ‘Whistleblowing is when an employee raises a concern about wrongdoing, malpractice or poor practice in the workplace that has a public-interest aspect to it’ (HC, 2014). The report makes clear that the treatment of some whistleblowers has been shocking and departments have sometimes failed to protect them from being victimised: ‘We have heard of too many cases of appalling treatment of whistleblowers by their colleagues, but departments were unable to tell us if those who have threatened or victimised whistleblowers
© 2014 MA Healthcare Ltd
John Tingle discusses a recent report by the House of Commons Committee of Public Accounts on whistleblowing and reflects on the forthcoming Francis Independent Review of Whistleblowing in the NHS.
British Journal of Nursing, 2014, Vol 23, No 18
British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 28, 2015. For personal use only. No other uses without permission. . All rights reserved.
PATIENT SAFETY had been sanctioned. We heard from a whistleblower in the Care Quality Commission who was victimised by senior departmental officials, but it appeared that no-one had been sanctioned as a result’. (p. 5) The report states that whistleblowers are often unclear as to whom they should raise their concerns with. Across the civil service, over one-third of employers do not know how to raise a concern under the civil service code. The report exposes a lack of transparency as to how departments address concerns by whistleblowers. Clearly, it is very important to keep whistleblowers informed of how their grievance case is proceeding. Is it being investigated and by whom? Is the whistleblower’s statement being taken seriously or is it ‘just being shoved under the carpet’? The report says:
© 2014 MA Healthcare Ltd
‘In practice, whistleblowers are not routinely informed about how their concerns have been handled and what outcomes have been reached.’ (p. 6) There is a startling disconnect between the generally good quality of whistleblowing policies in theory and how arrangements actually work in practice. Departments have not properly defined the measures to help them monitor improvements and to understand whether their whistleblowing policies have been implemented properly. An organisation’s effectiveness can be increased if it makes use of intelligence. This intelligence can come from customer feedback, complaints or whistleblowers who identify organisational failings.The report found that departments in the public sector, including government departments, are not best exploiting this intelligence, which can identify systemic failings. The report provides an excellent focus on whistleblowing. It makes clear that whistleblowing policies require urgent attention and a number of important recommendations are made. These include: ■■ Where the identity of whistleblowers is known, departments must ensure that they are protected, supported and have their welfare monitored. This should include: ■■ ‘Ownership’ from the top by assigning a board member who is accountable for the proper treatment of whistleblowers ■■ Providing whistleblowers with appropriate support and advice, such as access to legal and counselling services ■■ Appropriate and swift sanctions against employees, at all levels in the organisation, if they victimise whistleblowers ■■ Departments should provide all employees with a ‘route map’ that clarifies suitable internal and external reporting routes. This map should be replicated through the delivery system with clear obligations on private and third-sector providers delivering public services to employ strong and effective whistleblowing policies. Other recommendations include: having clear arrangements for reporting back to whistleblowers in a timely fashion, addressing their concerns; publicising to the organisation’s workforce and the whistleblower the changes that have been made to policies and practices as a result of the whistleblowing; and the collection and application of intelligence to concerns raised by whistleblowers on the part of departments. This is an excellent report that casts an important light on
British Journal of Nursing, 2014, Vol 23, No 18
whistleblowing in government and other public departments. The recommendations made are very positive and well thought out. The report also heralds a new Francis review. The Secretary of State for Health announced after the Committee’s evidence sessions that Sir Robert Francis will lead an independent policy review into whistleblowing and creating a culture of openness and honesty in the NHS (HC, 2014).
The new Francis review The new Francis review has a dedicated website, freedomtospeakup.org, an independent review into creating an open and honest reporting culture in the NHS. The ‘Freedom to speak up’ review was formally announced on 24 June 2014 by the Secretary of State for Health. Sir Robert Francis wants people to come forward and share their views and experiences in order to inform future practices better. It is important to learn from the errors of the past and not to make the same mistakes in the future. Sir Robert invited contributions from people with both good and bad experiences of raising concerns in the NHS, including: ■■ NHS workers who have successfully raised concerns at work as well as those who have felt deterred from doing so ■■ People who have supported colleagues who have raised concerns ■■ People who say they have suffered detriment as a result of raising legitimate concerns or supporting others who have raised concerns ■■ Employers, trade unions, professional and system regulators, and professional representative bodies; and ■■ Organisations that support those who raise concerns (Francis, 2014). This aspect of the review closed for contributions on 10 September 2014.The review has also involved a confidential survey sent to all NHS workers, employers and associated organisations.There will be a desktop review of whistleblowing policies that will compare those in the NHS with other sectors and countries. Confidential, in-depth interviews will be held with a sample of interested parties. Seminars will also be arranged with individuals and representatives of relevant organisation to discuss issues and emerging themes. These seminars will take place in October 2015. Sir Robert will then gather all his findings and make recommendations to the Secretary of State for Health by the end of November 2014.
Conclusion All this activity on whistleblowing is good news and will help whistleblowers ‘come out of the cold’ so that they can be viewed as the heroes that they are. Sir Robert Francis’ new report will be characteristically thorough, fair, well-reasoned and, where needed, hard-hitting.The whistleblowing landscape BJN of the NHS will never be the same again. Francis (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry Chaired by Robert Francis QC, Executive Summary, HC 947. http:// tinyurl.com/bkgyem7 (accessed 29 September 2014) Francis (2014) Freedom to speak up, an independent review into creating an open and honest reporting culture in the NHS. http://tinyurl.com/ oyhd2mb (accessed 29 September 2014) House of Commons (2014) Committee of Public Accounts, Whistleblowing, Ninth Report of Session 2014–2015, HC 593. http://tinyurl.com/qxogot3 (accessed 29 September 2014)
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British Journal of Nursing. Downloaded from magonlinelibrary.com by 165.123.034.086 on November 28, 2015. For personal use only. No other uses without permission. . All rights reserved.
