Whistle Blowing in the NHS
All health professionals should be able to raise concerns about quality of care without any barriers – cultural or organisational - getting in the way.
When a professional working in the NHS is aware that care is threatened, sub standard or dangerous, for whatever reason, they have a duty to make these concerns known and for those in charge to assess and, if necessary, act. This process is called raising a concern and the duty of a doctor to do so is stipulated by the General Medical Council (GMC) in its guidance on Raising and acting on concerns about patient safety and in its Good Medical Practice Guide.
Unfortunately, there are well known examples where concerns that have been raised have not been adequately dealt with by those in charge, and patients have suffered as a result. In some such cases, individuals have “blown the whistle” – taking their concerns to individuals and bodies outside normal channels and management structures in an attempt to protect patient care. This avenue, however, comes with risks and in some cases those who have “blown the whistle” have suffered severely, in relation to their career prospects and their working environment, despite current policy and process.
The RCGP believes that this is unacceptable; individuals should not be blamed or fear reprisal for highlighting unacceptable practices or poor quality care. The College would like to work with patients and professionals across the NHS and social care to foster an environment that deals more openly with complaints and concerns, and proactively uses them as ways to constantly improve service provision. This is relevant to GPs not only because they work as part of teams in their daily lives but due to their new leadership responsibilities within the emerging commissioning structures in England.
The RCGP has produced a position statement exploring some of the challenges around whistle blowing and raising a concern from the perspective of general practice.
Download the RCGP's Position Statement on Whistle Blowing in the NHS [PDF]
Whilst it is not within the College's remit to become involved in individual whistle blowing cases directly, our position statement contains some general guidance for practices.
However, GPs seeking further information about whistle blowing can refer to the following sources of advice and support:
Public Concern at Work
020 7404 6609
NHS and Social Care Whistle blowing Helpline
Phone: 08000 724 725
Department of Health, Social Services and Public Safety
0289 0520 500
Healthcare Improvement Scotland
0131 275 6000
Wales Audit Office
01244 525 980
Other key sources of information include:
The General Medical Council (GMC)
The GMC registers doctors to practise medicine in the UK. Its purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. Raising and acting on concerns about patient safety (2012) sets out the expectation that all doctors will, whatever their role, take appropriate action to raise and act on concerns about patient care, dignity and safety. The guidance came into effect on 12 March 2012 and replaces Raising concerns about patient safety (2006). A similar duty is also stipulated in the GMC's Good Medical Practice Guide
British Medical Association (BMA)
As the recognised trade union for UK doctors the BMA is a worthwhile source of information. The BMA has a dedicated webpage regarding whistle blowing providing information, case studies and guidance for members.
Medical Defence Organisations
Members may find consulting a medical defence organisation worthwhile, such as:
NHS Employers and Public Concern at Work Guidance
These two organisations have published a guide for GPs on whistle blowing, Whistle blowing for a healthy practice, published in 2003.
Department of Health
The Department has published a report on the NHS Constitution And Whistle blowing. This document sets out new requirements in relation to whistle blowers. Also the DH's 2010 paper, Speak up for a Healthy NHS, includes a guide “to support NHS organisations to promote best practice when devising, implementing and auditing their whistle blowing policies and procedures.” A policy template “Model whistle blowing policy for NHS organisations” is also included in the report.
The Care Quality Commission (CQC)
The CQC’s job is to make sure that care provided by hospitals, dentists, ambulances, care homes and services in people’s own homes and elsewhere meets government standards of quality and safety. The CQC has published guidance for workers, for providers of services and a quick guide on how to raise a concern. The CQC has also produced a document explaining to providers of services why they should have a whistle blowing policy and the benefits of encouraging workers to raise concerns. (December 2011).
Northern Ireland does not have its own healthcare whistle blowing policy. However, the Department of Health, Social Services and Public Health will undertake investigations of concerns and will be able to provide support and information on the relevant processes.
Wales does not have its own health care whistle blowing policy. However the Wales Audit Office has a dedicated team to deal with whistle blowing queries. It has this year produced a 'Wales Audit Office Whistle blowing update May 2012'. Despite not being solely health focussed this leaflet does include some useful information for those considering raising a concern or blowing the whistle.
The Scottish Government in 2011 released a document called “Implementing and reviewing whistle blowing arrangements in NHSScotland PIN policy.” This document describes the NHSScotland Partnership Information Network (PIN) policies as a means of ensuring sound staff governance practice. They set a minimum standard of practice in the area of employment policy, helping to ensure a fair and consistent means of managing staff which meets both current legislative requirements and best employment practice. As part of this PIN policy the Scottish Government requires all NHSScotland Boards to have a whistle blowing policy.
Healthcare Improvement Scotland is a health body formed on the 1 April 2011. Their purpose is to support healthcare providers in Scotland to deliver high quality, evidence-based, safe, effective and person-centred care; and to scrutinise those services to provide public assurance about the quality and safety of that care. Healthcare Improvement Scotland publish findings on performance and demonstrate accountability of services to the people who use them. They are also developing a new model for scrutiny which will apply to both the independent healthcare sector and the NHS in future years.