Guide for raising concerns in the NHS

Ideally no-one will need to blow the whistle on fraud, corruption or inadequate patient care again. However currently we are a long way from this situation, so I will try and highlight how as a member of staff we can protect ourselves and where to go to for help.

There has also been Health Select Inquiry in Parliament on 18 March 2014, into raising concerns where whistleblowing in the NHS was discussed.

More recently Jeremy Hunt had commissioned Freedom to Speak Up Review looking into NHS whistleblowing, which was led by Sir Robert Francis QC.   

We are however, a long way from an ideal situation where staff can voice their concerns safely without persecution.

Working in the NHS there will always be things that go wrong; that is inevitable. For the sake of patients, and in order to achieve best use of NHS money and resources, we should be able to raise concerns without fearing the consequences. We want to try to help others not get into job-threatening situations; such an outcome is devastating to the committed professional.

Be prepared – Cover yourself

Trades Union/Societies – It is advisable that you belong to one.

Read your trust whistle-blowing policy. It is a part of good governance and practise that all health establishments have a whistle-blowing policy and that this should be readily accessible in the policy section of their intranet or their HR dept.

Some trusts have anonymous reporting systems; others have lead people to whom one can report concerns.

Where possible, raise any disclosures or concerns verbally and then follow up in writing using e-mails or letters so that there is a documentation trail. Always keep a safe copy where you are able to access easily.

If you are able to get supportive written statements from colleagues, then this will add to the strength of your case.

Normally there is step-wise progression, depending upon the level of concern, risk and the initial response from the management team. It can be difficult to challenge management in the NHS, especially if they have made poor decisions regarding resources or may be otherwise implicated in the concerns.

However, there are outside bodies to whom one can report but with regards to NHS, I have at present not found any that I can recommend.

There are however, some trusts where raising concerns is met with a positive response.   Much of this later advice relates to those occasions when raising concerns has been met with a negative response.

Most unions will be well-informed on whistle-blowing, especially currently, following a lot of publicity and concern regarding Mid Staffs hospital and other high profile cases. The unions will often be willing to discuss matters at an early and informal stage.

As the situation escalates, make sure that you keep copies of all emails and letters, and if you feel that the unions should be pushing harder on your behalf do not be afraid to challenge them. However, this will only work if you have been completely open and told the truth throughout and if you have not had any disciplinary charges brought against you that were justified.

Throughout it is very important to try and maintain your composure, keep emails factual, have somewhere to go and let off steam and generally try to remain professional. This will all work in your favour if the situation progresses.

Make sure that you build as strong a network as possible of colleagues, be honest and open, and seek help from others who have had similar concerns.

Ideally concerns should be raised by a team to be more effective and should be in writing. It may be important at an early stage to have someone “in the know’ supporting you. Where possible, try and collect supportive statements from work colleagues whom you trust. Try and do this at early stages of raising concerns. If the worst happens, i.e. you are suspended or dismissed, they will be too scared to be seen to support you.

If raising concerns internally within your organisation has not been helpful one can go to external regulators. Many whistleblowing groups and individuals are  currently concerned that these regulators are not supporting whistleblowers sufficiently and are not acting on concerns raised. However, it is important to follow steps as dictated in the whistle-blowing policy.

MPs can be very helpful in raising questions in the House, speaking to Trusts and in informing the press of concerns where matters of patient safety are the issue. As a constituent you are protected by parliamentary privilege if you speak to your MP.

Finally, one may need to resort to the media in order to have the issues brought out into the public domain. Fraud corruption, and dangerous practice are all matters that could well need to be raised in this way in the public interest, but at this stage it is imperative both to check out the whistle-blowing policy and to seek union or legal advice. Indeed, at mid staffs there has been much criticism that staff did not speak publicly about the problems. In some case press exposure has protected the whistleblower but it is not something that one should do lightly because of the huge pressure that it brings with it. We can advise on this matter as many of us have spoken to the press. However, we know that there can be repercussions for raising concerns and the following then applies.

Legal Support

If things deteriorate, you may need to obtain legal support yourself and this can be expensive.

Legal cover is often included in your home insurance. You need to be several months into the insurance before you can claim. They won’t cover any ongoing issues.

The types of legal cover provided by each company differ significantly. The amount of cover can be anything from £50,000 up to £150,000.

If you are pursuing an employment tribunal claim, legal expenses for lawyers and barristers can easily be in excess of £150,000. So always choose the higher cover if possible. Always read the small print. Some insurance won’t cover if you belong to a union as they expect unions to do the legal aspects of a case. So, taking out insurance may be a waste of time unless you do not belong to a union. Always check the ‘small’ print for any opt out clauses.

Remember that if you have any freelance earnings at all that may be seen as dependent on your primary employment then you may be able to obtain tax relief on legal expenses incurred in the protection of that primary employment.

Keeping together

If the worst happens and you are either suspended or dismissed following your raising your concerns then the most important thing you can do for yourself is to keep yourself mentally and physically healthy.

Many  are just unlucky to be the wrong person in the wrong place at the time. We  do not ask for these things to happen; so try not to take it personally.

If you are suspended, then remember that whilst you are an employee you can liaise with HR to organise access to your personal items, collect relevant evidence from your files stored electronically etc. as you are still a trust employee. Do this as soon as possible before  vital things are ‘lost’.

The best way of keeping yourself strong is to keep busy and discussing your situation with people that you feel close to. They will able to help and support you if they know what is wrong.

Always have belief in yourself and be strong in the knowledge that what you did was the right thing to do.

During this period you may gain new friends as well as lose friends and colleagues you thought would always be there for you. This is often the case with work colleagues. This is mainly because they are scared and they may have been advised formally by management not to contact you. Staff at work may not, in fact, have been advised accurately about the background to your departure. If, however, they are true friends, they will be in touch. Don’t let this aspect get you down. Just expect it and accept it. Staff are simply scared.

Things to do

Talk to someone. Get it off your chest. Don’t keep quiet and bottle things up. Friends can make a difference; but there may only be so many times that they are willing to listen to the same story!! So beware.

GPs can refer for counselling, or your employer may provide psychological support or access Occupational Health.

Contact your union, insurance or lawyers – whichever is more appropriate for your circumstances – always be honest then you should get through this more safely.

Remember you are not a villain. You were/are behaving responsibly because you care. You are doing what you feel is the right thing to do.

From having a busy working schedule to sitting at home is totally disorientating experience. So, set a daily routine for yourself and try and stick to it, even if you don’t feel like it.

Go out every day. Go on walks, meet friends, go shopping, take on a new hobby, join classes, volunteer at charities, help a friend or a neighbour, take a dog out etc.

It is particularly important, especially if you live alone, to meet other people and not to isolate yourself. Of course there will be times you will want to be alone.

I found it helpful having the television on in the background as sudden change from a busy environment to a totally quiet one can be disorientating. I found the smell of scented candles soothing – though it can become costly if you’re not careful. I took up card making and learning about gemmology – I always liked sparkly stones!!

Reading novels will be helpful. However, like myself you may find it hard to concentrate on anything for any length of time. Try doing crosswords or Sudoku instead which requires less concentration time and will help you keep your mind off things for a short time.

Try and meet up with other whistleblowers. You may find it both helpful and supportive to know that you are not on your own. It’s good to share similar experiences. You may also gain some information from their experiences and help them in return.

Disclosing externally

When you have exhausted all internal avenues for raising concerns under the Public Interest Disclosure Act you can make “external disclosures.” At this point it is important to discuss with experienced and informed others where and how to do this.

However if you inform your MP you are protected under parliamentary privilege. MPs can write to the Board, can raise questions in the House and act in many ways both to have the concerns aired but also to support you as a whistleblower.

The CQC now have on their website a whistle-blowing contact point. However, effectiveness of this is questionable especially given that under Fit and Proper Persons Test, no senior managers have been held to account.

Unions are well informed in whistle-blowing and as PIDA falls under employment law they can advise regarding next steps particularly when considering going external to your employer with concerns. .

If you are subsequently dismissed

Contact your union and/or insurers if you have legal insurance about Interim Relief Hearing. However, unions will not act if you have employed your own lawyers – so check for best option

If you have collected sufficient evidence of raising concerns and your dismissal was a direct result of this, then you can make application for Interim Relief hearing

Application has to be made within 1 week of being dismissed. So you have no time to sit back and get depressed!!

You will need to see an employment lawyer If you win, then your income will be reinstated until settlement

It may cost in the order of £30,000. However, if your income is secured, then your chosen legal firm may allow to back in monthly instalments. Check with the law firm for costs, likelihood of winning and payment methods.

In my case, unions were unable to help me with legal representative, due to costs involved, so I had to seek and fund my own. If you have legal insurance, they may cover.

If your case is going ahead with the hearing and is a strong case, you could invite the papers to attend. Check with your legal team beforehand.

Media have proved to be a very strong support for whistleblowers and the subsequent ongoing battle  but always ask your legal team or union beforehand.

Remember if you have decided  to go public, make sure what you say is backed up by evidences and paper trail. Otherwise you will be accused of slander.

Keep strong and focussed. Remember you  have raised concerns because you care. Patients and public trust you to do the right thing. You are amazing because you care and put others before yourself. Keep going. We are here behind you!!