Summary
In a previous blog, 'What is a Whistleblower',[1] Hugh drew attention to negative perceptions of whistleblowers in the eyes of some people. A crossword and clues were published on the hub to emphasise how wrong such perceptions are and how damaging they can be, with serious patient safety implications.[2]
This follow-up outlines the nature of the journey travelled by some NHS staff who have spoken up and the problems which still exist with NHS whistleblowing culture. It provides a link to an attached file which contains the answers to each clue. The attachment also shows the completed crossword in larger, easier-to-read, format than the small illustration in this blog.
There is a further link to companion notes which expand on the answer to each clue. These notes contain more detail about the realities of speaking up. They reinforce the link between hostility towards those who speak up and an ongoing series of patient safety scandals.[7-21]
Content
If you haven't had the chance to do the crossword yet, you can access it from the following links, in either PDF or Word formats.
Blank crossword and clues (pdf).pdfBlank crossword and clues (word).docx
The answers to each clue and the completed crossword can be found in the attachment below:
SOLUTION - Glimpses of NHS whistleblowing terrain.pdf
Notes on the answers can be downloaded from the following attachment:
A guide to the whistleblower's galaxy
This crossword is offered as a travel guide to help others navigate the complex and at times treacherous track trod by NHS staff who have suffered retaliation after speaking up. It can be a bewildering trek. Everybody's journey is different but there are common experiences. Travellers' tales suggest a pattern in milestones often encountered along the way.
Lonely planet
One of the cruellest manifestations of organisational hostility towards some NHS staff who have raised concerns about poor patient care is that they are propelled into orbit, pushed around on a procedural merry-go-round by alien and sometimes unseen forces, but excluded from professional circles in which they have built and practised their career. This isolation is often a deliberate intended consequence of actions taken by those who orchestrate reprisals against staff whose 'crime' is identifying areas where improvements are needed to improve patient care.
Isolation tactics include:
- suspending staff on some spurious pretext and instructing them not to speak to colleagues;
- denying them access to crucial documents or other information which supports their case;
- manipulating them into signing non-disclosure agreements – sometimes referred to as settlement agreements (formerly known as compromise agreements), confidentiality clauses or gagging clauses. Although such agreements are void and unenforceable under whistleblowing legislation in respect of protected disclosures they tend to inhibit communication nonetheless, and thus contribute to whistleblower isolation and exclusion. They also prevent true learning from whistleblowers' experiences.
Crossword aims
The aims of the crossword, this blog and others in this series,[1-5] are firstly to raise awareness of the realities of speaking up and, secondly, to support stakeholders who are trying to find a way through the morass. These stakeholders include policy-makers, legislators, leaders, campaigners and, last but not least, whistleblowers themselves. Their voices need to be heard.
There seems to be a shared view amongst stakeholders that the current situation is unsatisfactory. All concerned say that they want NHS staff to speak up if they are aware of poor practice affecting patient care. However, the latest NHS national staff survey results show that only 62% of staff said they feel safe to speak up about anything that concerns them in their organisation.[6]
This worrying statistic is an indication of the magnitude of the systemic problem which stakeholders are trying to solve, as well as being a reflection on the effectiveness of existing approaches. Effective problem-solving requires good analytical skills. It also requires knowledge and understanding of the true nature of the problem in question, and ability to challenge the status quo when necessary.
The problem for NHS organisations is that large numbers of their employees are afraid to speak up about poor patient care. Not speaking up and hostility towards those who do speak up are linked to an ongoing series of patient safety scandals.[7-21] The problem for many staff who have suffered retaliation after speaking up is that they have lost their careers, their livelihood and sometimes much more.
In such situations, NHS organisations tend to wash their hands of their responsibilities towards whistleblowers whose health and wellbeing they have harmed. This irresponsibility, and the culture which fosters it, has to change if leaders really want NHS staff to speak up when they are aware of sub-optimal and dangerous practices within their organisation.
The 62% staff survey statistic illustrates interconnected problems for organisations, patients and members of staff. It is a symptom of an underlying pathology that needs to be treated – the mistreatment of whistleblowers. As always in attempting a cure, it is important to treat the cause not the symptoms.
The aims of this contribution are to provide insight into the phenomenon of retaliation against healthcare professionals by their employers, and thus support effective action to address the root cause of these serious problems. It builds on foundations laid by many others.
Whilst the contents of this blog are to the best of my knowledge correct, for the avoidance of doubt this is not legal advice. Comments, feedback and discussion are welcome.
References
- Wilkins H. What is a whistleblower? Patient Safety Learning, the hub, posted 2 February 2022.
- Wilkins H. Crossword counterpoint: glimpses of NHS whistleblowing terrain. Patient Safety Learning, the hub, posted 16 March 2022.
- Wilkins H. Organisational culture and patient safety (MPEC 2021). Patient Safety Learning, the hub, posted 14 October 2021.
- Wilkins H. The right - and duty - of NHS staff to speak up. Patient Safety Learning, the hub, posted 22 June 2020.
- Wilkins H. The mistreatment of NHS whistleblowers must stop (UKIO 2019). Patient Safety Learning, the hub/Learn/Culture/Whistleblowing, posted 17 March 2021.
- NHS Staff Survey. 2021 National results briefing, March 2022, q21e, p27.
- Kennedy I. The Bristol Royal Infirmary Inquiry. Learning from Bristol - the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995: 2001.
- Smith J. The Shipman Inquiry (2002-2005), second report: the police investigation of March 1998: 2003.
- Holt K. Great Ormond Street and 'Baby P': was there a cover-up? BMJ 2011; 343.
- Francis R. The Mid Staffordshire NHS Foundation Trust Public Inquiry. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry volumes 1-3: 2013.
- Clwyd A, Hart T. A review of the NHS hospitals complaints system: putting patients back in the picture, October 2013.
- Dyer C. Whistleblower was unfairly dismissed in case lasting 12 years, tribunal rules. BMJ 2014; 348.
- Kirkup B. The report of the Morecambe Bay investigation 2004-2013: 2015.
- Kirkup B. Report of the Liverpool Community Health Independent Review: 2018.
- James G. Report of the independent inquiry into the issues raised by Paterson: 2020.
- Kirkup B. The life and death of Elizabeth Dixon: a catalyst for change - report of the independent investigation: 2020.
- Cumberlege J. First Do No Harm: the report of the independent medicines and medical devices safety review: 2020.
- Outram C. West Suffolk Review: 2021.
- Care Quality Commission. Monitor. Monitor and CQC review into whistleblowing concerns at the Christie NHS Foundation Trust: 2022.
- Ockenden Report. Findings, conclusions and essential actions from the Independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust: 2022.
- Dyer C. Whistleblowing: nephrologist who reported colleagues to GMC was unfairly dismissed. BMJ 2022; 376.
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