The importance of raising concerns at work in the public interest,
known as 'whistleblowing', is beginning to be seen in a more positive light
for the improvements this can trigger in health and social care organisations.
It can lead to better practice and outcomes,
when the concerns of staff, the people who use services, and carers,
are listened to and acted upon.
There's an important discussion going on about whistleblowing.
If I look over my career in the late '90s,
I think there was very little discussion about whistleblowing.
But since Robert Francis's inquiry in relation to Mid Staffordshire,
these issues have quite properly received much work on focus and discussion.
The public know that they themselves may well end up in a care home,
needing social care, or their relatives.
They want staff to raise concerns if they have them,
so things can be put right at an early stage.
So I think we're actually in the middle of quite a big sea change really,
in terms of attitudes to whistleblowers,
and recognising the value of what they do.
I think the key issue for this is...
I think whistleblowing is a symbol, a signal, of an organisation
that's failed to listen to the concerns of its staff.
Therefore I think the thing that we need to get right in health and social care
is how do organisations listen to the concerns that their staff are raising
around quality and safety?
Another indication of the changes taking place
is the Department of Health's 2014 National Guidance for people who work in the sector,
produced by the Whistleblowing Helpline.
I think the key message is that raising concerns
should be seen as part of normal, day-to-day working practice.
There's different sections in the guidance.
One section is for workers: how they can raise concerns properly.
There's also a section for managers, in helping managers to respond appropriately,
which involves thanking the whistleblower for raising the concerns,
even if they think they're mistaken.
To take their concerns seriously, listen to them and to do a proper investigation.
You know, they shouldn't shoot the messenger.
They should look at the information.
Many organisations will have procedures in place
and good practice is to first raise concerns internally.
I would advise staff to, you know, to locate their organisation's whistleblowing policy.
And that will normally set out the process of who they should disclose information to.
It will, typically, be their own line manager,
unless there's a very strong reason why they feel they can't do that.
Maybe they feel if the manager, you know, is implicated in the wrongdoing.
Then they can go to their manager's manager.
But there will come a point when internal procedures are exhausted,
or if their concern is exceptionally serious
and they feel that even the top, senior managers are aware of the wrongdoing
and choose to ignore it, then they can go beyond, to a regulator.
The principal regulator in social care is the Care Quality Commission.
The 1998 Public Interest Disclosure Act
has also been strengthened to protect whistleblowers from harassment and bullying,
and they can now report concerns to their MP.
But whistleblowing to the media remains highly contentious.
They need to take advice, preferably legal advice.
There are certain risks to their employment if they go to the media,
certainly, unless they've made attempts to raise concerns internally first.
If their concerns are exceptionally serious, then they may be protected.
Whistleblowing to the media isn't easy,
as Dr Raj Mattu found out.
He went public after his concerns about patient deaths
in overcrowded bays at the hospital where he worked were not dealt with.
To whistleblow is a huge act, especially to whistleblow in the public domain.
For me personally, that was one of the hardest decisions I've ever had to make.
But Dr Mattu's actions were treated as an employment dispute,
rather than a whistleblowing case, by the hospital management.
Senior management failed to focus on the issues he raised
and lost the opportunity to learn as an organisation.
You end up finding yourself being totally ostracised, demoralised,
and, in my case, I was suspended.
It's important to recognise that my experiences are not unique in the National Health Service.
There are many other whistleblowers
who have spoken to me over the 13 years I've been suspended
and it's remarkable the common theme that runs through them.
In 2014, a tribunal cleared Dr Mattu of wrongdoing,
stating it was not an employment dispute
and that he had whistleblown correctly by exhausting internal procedures
before he went public.
I think it's an absolute requirement that the culture is changed
and that whistleblowing is seen as a positive thing.
And I hope that, in time, we will have a situation where
whistleblowers will stop being seen as the problem -
people will stop trying to shoot the messenger -
and actually start seeing whistleblowers as part of the solution.
We need to stop looking at the whistleblower. We need to start looking at the manager.
We know the whistle... We know people raise concerns, sometimes against all odds.
People have concerns and they talk about them.
Maybe they don't raise it to management
but they talk about those concerns among themselves.
So what you need to start looking at is...
what makes managers listen to concerns
and what halts them from listening to concerns.
Some care organisations are exploring new ways to respond to whistleblowers,
as in this case from the Wirral,
after a student nurse raised concerns with her university tutor.
The types of issues which she was raising were to do with medicine administration,
manual handling, how people were generally being cared for,
and also how they were being communicated with.
She didn't perceive that the experiences were very compassionate or caring
from the staff there.
She reported it to the manager who was at the placement
and she didn't feel that the issues were being taking seriously
while she was at that placement.
So she felt that she wasn't being listened to.
Pat Clarke reported these concerns to the Wirral social services.
The response was immediate.
The care home was investigated
and, working with the local NHS Care Commissioning Group,
an action plan was put in place.
It was a surprise. I think that the surprise was
the extent, or the range, of difficulties.
From not answering a buzzer to actual alleged assault.
And, you know, varying degrees in between.
We were quite taken aback that we didn't realise, if you like.
It was a warning shot to the organisation.
Social services and the CCG's adult safeguarding team
then set about learning lessons from the incident.
For example, new quality self-assessment forms were introduced
to help improve standards across 108 care homes.
The documents themselves contain a series of questions:
staffing requirements, staff training, supervision, actual environment -
what is the environment like for a resident who lives in that home? Is it safe?
We have an open-door policy at Daleside,
which I find very important for all staff,
carers, residents, relatives and visiting professionals.
Any concerns raised, no matter how big or small,
can always have a positive impact on our future practice if we learn from them.
There's been a cultural shift towards listening more carefully to concerns
and student nurses on placements have been encouraged to take a more proactive role.
The message really, for me,
would be, we need to take any concerns raised through whistleblowing
seriously and follow them up,
even though, as is this case...
..we thought at first, "Surely not all those things could not be going on in the home,"
when, in fact, the majority of them were.
For whistleblowing to work in organisations it takes more than top management
wanting to listen to concerns.
You need to have communication that shows people,
that tells people... "These people have come forward with their concern.
Here's how they raised their concern and, look,
this is how we were able to improve our services."
That's the kind of communication you need.
Managers should be encouraging staff to raise concerns at an early stage
and to do so through routine processes,
like supervisions, like... through appraisals, through team meetings.
They need to make it happen and they do that through performance management,
through making their middle managers somehow accountable
for listening to concerns.
So you need to have a, kind of, performance measurement system.
I mean, people behave towards what is being measured.
The key issue that we're looking for when we inspect services,
and this is a part of our new methodology...
We'll be asking the question, how well led organisations are.
And what we'll be looking for there is how open and transparent are organisations?
Anna Patterson is an owner/manager of a home-care agency,
where care workers visit people in their homes.
How does she foster a spirit of openness?
If you encourage an open culture, it makes your life much easier as the leader,
because people will be forever having good ideas.
Because if they see something, they're not going to see it as, "Oh, let's hide that."
You know, they're going to immediately going to flag it up and come to you.
I mean, like, for instance, I had somebody the other day.
Because we have such a culture, when she made a mistake,
she immediately came and said, "Look, I made a mistake,
but I'm looking at ways of how I'm going to correct it."
If she'd hidden that, that could have gone unnoticed,
but then laid there underneath the surface and could have created more problems for us.
It's a much more... I would say, a more happier environment that people can live in.
People don't feel as if they need to look over their shoulders all the time.
I think people feel... I think it will make people feel more comfortable.