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NHS whistleblowers must be protected

Marilyn Eveleigh
Nurse Adviser and Independent Trainer
East Sussex

What is it about whistleblowing that brings out the extremes - from passion to cynicism - in nurses? Where are you in the spectrum?

There is a passionate call for whistleblowing to be the right and moral obligation of every nurse where they see poor practice, wasted resources, actions not in the patient's best interests, risks to patient safety and other issues that they believe should be reported and exposed. This is often expounded by professional advisers and those in senior and influencing positions who tend to be distant from those working at the patient interface.

Cynicism around whistleblowing is often held by those who are at the bottom or middle of a management hierarchy - and who have experienced or witnessed cases where highlighting poor practice or concerns about professional behaviour have been ignored or have backfired and the status quo remains.

There is always a steady stream of articles, discussion on nurse forums and cases highlighted in the media that keep the subject buoyant in professional circles. It is a hot topic now. The latest whistleblowing catalyst is the Mid Staffordshire Trust independent inquiry where staff knew of the problems but were fearful about raising concerns. This was followed by the Panorama exposure of bullying and humiliation of residents with learning disabilities at Winterbourne View care home that had been reported to, and ignored, by the regulator, the Care Quality Commission (CQC).

It is a revelation to link into the many nursing online forums and debates where both extremes of passion and cynicism are illustrated with real-life stories. It makes uncomfortable reading: nurses disciplined by management for revealing malpractice; nurses who have become ostracised from a team for raising issues - especially where their colleagues may be the subject of the complaint; nurses who feel their reputation and employability have been damaged; and nurses who have left the profession through feeling alienated and disenfranchised for speaking out.

Even those who believe they have done the right thing and change occurred, indicate in most cases that it was hard, prolonged, exposing and often lonely. I have never read of one case that said it was truly easy, or that practice or behaviour were changed for the better, forever. Most thought any success a hard slog, fraught with justifications, reports and uncertainty.

In 2010, the Department of Health report, Speak Up for a Healthy NHS, charged organisations to develop a culture of positively encouraging employees to raise concerns that would protect patients under the care of the NHS. In November the Nursing and Midwifery Council (NMC) stated that 'poor care
must never be tolerated' and issued new guidance that would 'support nurses and midwives to effectively manage risk and empower them to speak out on behalf of the people and families in their care'.1

However, there is a swelling demand for better protection for healthcare staff who speak out about substandard care and poor practice. A parliamentary inquiry is to be held into the suffering and punishment of NHS whistleblowers after cases revealed that careers have been destroyed, and whistleblowers suspended pending the investigations of their allegations. Such treatment has developed a culture of fear among professionals working within the NHS.

Now, Stephen Dorrell, the Chair of the inquiry, has hinted that registered professionals will be held to account by their regulating body, the General Medical Council or NMC, for remaining silent and, therefore, complicit in any wrongdoing. It appears there will be no hiding place for professionals who do not reveal clinical incompetence and poor professional practice.
Will these attitudes and approaches change the way health professionals think - be it cynically or passionately - about outing substandard care? Will it alter the way we behave? Only if there are real safeguards to protect us if we blow the whistle.

1. Department of Health (DH). Speak Up for a Healthy NHS. London:
DH; 2010.

Your comments (terms and conditions apply):

"I absolutely agree that it is the culture which needs to change to one in which poor practice is not tolerated and health care professionals feel empowered to speak out and challenge poor practice. As a nurse I feel so angry at the latest CQC report on dignity and nutrition, fundamental aspects of care that we are still not getting right and as always it is the most vulnerable patients who are suffering. In the current climate of financial cuts on training and development and quick fixes it is up to us
as nurses to stand up for our patients when care is not up to standard not sit on the sidelines!" - Donna Davenport, Manchester

“This excellent article summarises the evidence from nurses of the difficulties encountered in challenging poor practice. We are still a long way from the NHS having an ‘open culture' to patient safety. Groups such as Action Against Medical Accidents (AvMA) claim that the rise in Trusts' acknowledgement of medical errors is not as great as it should be. Yes, it is up to individuals to speak up, but there are other sources of evidence to support nurses raising issues of poor care. For example, reports from NHS Information Centre showed that some hospital Trusts are simply choosing not to publish data on complaints about staff and services.  Our Local Involvement Network (LINks) noticed that one (of 4) Trusts serving the population did not include any information on patient complaints in their Quality Account Report.  The LINks comment was then documented in the QA, a publicly available document. LINks will soon become merged into the new organisation of Healthwatch which hopefully will continue the good work.  I would urge nurses to utilise the reports and data gathered by these groups to enhance understanding of the patient experience of services, and use it to influence planning for improvements.” - Catherine Gleeson, West Yorkshire