In February, Robert Francis outlined his review into whistleblowing in the NHS and the freedom of nurses and midwives to speak up (Francis, 2015). There is a duty to do so within the Code (Nursing and Midwifery Council (NMC), 2008) and no doubt there are some clauses within contracts of employment in relation to this.
The review and subsequent report looked at how NHS staff are treated when they raise concerns. It found that the vast majority who participated in the review had a poor experience of raising concerns, often describing reprisals and bullying. The report identified five overarching changes that need to happen (Francis, 2015):
- Culture change—free from bullying, with visible leadership to encourage staff to speak out
- Improved handling of cases—speedier and better management of cases including expert input
- Measures to support good practice—training and supporting staff and the need for transparency about incidents
- Measures for vulnerable groups—such as students, agency staff and those from black and minority ethnic backgrounds
- Extending legal protection—such as addressing discrimination for those seeking employment following whistleblowing.
None of the above is new to those working in the NHS or other organisations. As post–registration students in the 1990s, we were taught about Graham Pink, a nurse in elderly care who set out, in a series of letters to a news-paper, the substandard care his patients were receiving due to lack of staff and resources. He was eventually dismissed from the Trust on the grounds of breach of confidentiality but also suffered from isolation in the workplace with variable support from colleagues. More recently, Margaret Haywood was highlighted in the press when she was struck off by the NMC (a reduced sanction was later given on appeal) for undercover filming of neglected elderly patients in a hospital setting. She stated she received no support from her manager and had no other means of raising concerns. Both of these nurses resorted to extreme measures to try and protect their patients. Agree or disagree with their methods, no-one can deny that improving care and respecting the dignity of their patients was their motivation.
I have friends who were dismissed in such circumstances and because the cases were reported in the local press, they found it difficult to obtain work in nursing or midwifery. They all did it because they felt strongly about the cause and lacked support from the workplace and their colleagues witnessing the treatment felt reluctant to step forward and support the allegations made.
So, given the recommendations of Francis are we likely to move forward? Certainly, and cultural change has to be the starting point. Staff should be actively encouraged to raise concerns through appropriate channels and be provided with support throughout the process. Raising concerns must be viewed as a positive approach to improving care and protecting the public rather than as criticism. Leadership is essential as good role models and experienced practitioners should be able to speak out. Managers who may have, in the past, felt they were the subject of criticism from whistleblowers, must have the maturity and leadership to avoid becoming defensive and embark on a neutral and self-critical review of the issues.
It is hoped that supervisors of midwives continue to exist in their non-regulatory role and provide this support. Since the King's Fund review (NMC, 2015) and suggestion that supervisors of midwives are to lose their regulatory function, the role appears to have gained more public recognition and midwives are suddenly seeing the benefits. Statutory supervision might well become stronger and continue to play a valuable role in the protection of the public. Now is the time to see supervisors as professionals who can support Francis's recommendations.
I have supported many students who have had negative experiences after raising concerns on placement. Certainly bullying, being labelled as troublemakers and being isolated by members of staff are common. This causes a great deal of stress for students who are ‘doing the right thing’. The cases I have been involved with have been mostly attitudinal rather than due to direct substandard care. I am proud of the students who have approached me with a view to raising concerns but I have always felt compelled to inform them of the repercussions of reporting incidents: they need to be prepared for the impact it might have.
The altered mind-set and cultural change needed to support those speaking-up is going to be slow and need substantial effort on the part of staff and managers. But it is needed in today's NHS to protect the public and health care staff and ultimately, it is a change worth fighting for. We need to reclaim the trust that women and families had in us before the recent enquiries criticising care. Being receptive to, and raising concerns will go some way to doing this.