Exercising the right to be heard

Throughout history whistleblowers have been viewed in one of two ways: as honest and brave individuals carrying out their moral responsibility, or as traitors to the organisation and people they work for. However, for health professionals, including paramedics, the act of whistleblowing should be seen as an obligation rather than a choice.

Standard 1 of the Health and Care Professions Council’s (HCPC) Standards of Conduct, Performance and Ethics states that registrants should act in the best interest of service users (HCPC, 2012). It goes on to say it is the duty of registrants to act immediately if they become aware of a situation where a service user may be put in danger, and to take appropriate action to protect the rights of children and vulnerable adults who are at risk (HCPC, 2012). In short, registrants are required to place the safety of service users before any personal or professional loyalties at all times (HCPC, 2012).

But while it may be the duty of staff to raise concerns where necessary, this will not be done if they feel whistleblowing policies are not implemented properly.

The Francis Inquiry into the scandal at Stafford Hospital illustrated what can happen when staff fail to speak out against inappropriate care. As a result, one of the key recommendations that emerged from the Inquiry was the promotion of whistleblowing. However, what the Inquiry also revealed was the ‘culture of fear’ that exists around the act. Although theoretical protection is provided to NHS staff by the Public Information Disclosure Act 1998 (c.23), this is unlikely to be of much reassurance to potential whistleblowers who know they will have to face the wrath of their colleagues (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013). Ken Lownds of CURE made the point that regardless of protective legislation and policies, it was the culture that mattered. Without a positive culture, it will never be easy to raise concerns (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013).

Only last month a paramedic was banned from two hospitals after he spoke out about overcrowding in A&E (BBC, 2015). Luckily the individual involved was later issued an apology and had the restrictions lifted, but this did not stop union bosses claiming the case was a clear example of victimisation.

The raising of complaints and concerns is essential in ensuring the highest quality of care is upheld in the NHS. Employees who raise concerns should be valued, respected and protected, not victimised and bullied. A recent report from the Health Committee admitted that the treatment of whistleblowers remains a ‘stain’ on the reputation of the NHS (Health Committee, 2015). It is therefore imperative that this stain is eradicated so that staff are emboldened to carry out their duty without fearing the consequences.

References

BBC (2015) Worcestershire hospitals ban paramedic Stuart Gardner. BBC. http://tinyurl.com/p6de2zo (accessed 2 February 2015)

Health and Care Professions Council (2012) Standards of Conduct, Performance and Ethics. HCPC, London

Health Committee (2015) Fourth Report of Session 2014–15, Complaints and Raising Concerns. HC 350. The Stationery Office, London

The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Robert Francis QC. Volume 1: Analysis of evidence and lessons learned (part 1). The Stationery Office, London

Public Information Disclosure Act 1998 (c.23) The Stationery Office, London

Taken from Journal of Paramedic Practice, published 6 February 2015.

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Francis calls for cultural change

The public enquiry report chaired by Robert Francis QC concerning the standards of hospital care provided at the Mid Staffordshire NHS Foundation Trust has emphasized a need for cultural change within the NHS.

The 3-volume, 1782-page report highlighted the failure of the NHS system to detect poor quality care and to ensure that services meet the standards that the public expects. This failure to communicate concerns illustrates a betrayal of the trust that members of the public should be able to place in the NHS.

Francis called for a patient-centred culture, which has a commitment to serve and protect patients. His recommendations for achieving this include: a structure of fundamental standards, which identify the basic standards of care a patient can expect; an openness and statutory duty of doctors and nurses to be truthful with patients; compassionate, caring and committed nursing; and stronger healthcare leadership.

The report includes a number of recommendations for changing nursing training, regulation and professional support that, if implemented, will have an impact on nurses in all sectors of the NHS, including practice nurses. Francis identified that nurses are at the heart of patient-centred care, and stressed that training standards need to be strenghthened to ensure that qualified nurses are competent to deliver compassionate care to a consistent standard. These principles apply to nurses working in all sectors of the NHS.

‘Nurses throughout the NHS will feel devastated at the picture of poor and unsafe care that took place at Mid Staffordshire,’ said RCN president Andrea Spyropoulos. ‘What commentators often forget is that no one is more saddened or frustrated by stories of poor care than nursing staff themselves.’

The report has important implications for nursing leaders, particularly for the Royal College of Nursing (RCN). Francis found that nursing needs a stronger voice. According to the report, this can be achieved through strengthening nursing representation in the leadership of all provider organizations, enhancing the links with their professional regulators, and introducing a better appraisal system. It was also recommended that the RCN consider splitting its trade union and professional functions.

Taken from Practice Nursing, published 18 Feb 2013.