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Found 199 results
  1. Content Article
    This blog is prompted by a recent newspaper crossword in which one of the clues, quadruplicated, was 'Whistle-blower'. The four answers were, respectively, 'canary', 'snitch', 'telltale' and 'betrayer'. The blog draws attention to negative perceptions of whistleblowers in the eyes of some people. It emphasises how wrong these perceptions are and how damaging this can be, with serious patient safety implications. In this blog I provide a crossword counterpoint (attached below to solve), which seeks to support learning about the realities of hostility against some staff who speak up in the NHS. I will share a follow-up blog which contains the solution to this crossword and seeks to provide further education on this topic where there is so much confusion and misunderstanding.
  2. Content Article
    It's that time again. 'Speak Up Month' in the NHS. In this blog, I discuss the definition of 'whistelblowing' and why this is important. I believe that although the Francis Report has stimulated some positive changes, the only way to successfully move forward on this is to celebrate and promote genuine whistleblowers. This includes using the word 'whistleblowing', not a euphemism. It also needs us to involve everyone, including patients, in the changes. "Whistleblowing isn’t a problem to be solved or managed, it’s an opportunity to learn and improve. The more we move away for labelling and stereotyping the more we will learn. Regardless of our position, role or perceived status, we all need to address this much more openly and explicitly, in a spirit of truth and reconciliation." What is whistleblowing? "In the UK, NHS bodies have been guilty of muddying the waters. Sometimes implying that whistleblowers are people who fail to use the proper channels, or are troublemakers, especially when they go outside their organisation with their concerns. In fact, the Public Interest Disclosure Act makes no distinction between ‘internal’ and ‘external’ whistle-blowers..."
  3. Content Article
    In this story from a former Policy & Performance Officer, the truth is told about how ineffective hierarchies often result in a culture of dishonesty.
  4. Content Article
    This poster was presented by Hugh Wilkins at the UK Imaging and Oncology Congress in June 2019 and highlights the serious problem of retaliation against NHS staff who raise concerns in the public interest.
  5. Content Article
    Findings from an independent review, commissioned by NHS Improvement in February 2020, at the request of the Department for Health and Social Care, into the handling of whistleblowing at West Suffolk NHS Foundation Trust.
  6. Content Article
    This study in Risk Management and Healthcare Policy aimed to explore healthcare workers’ perceptions of patient safety culture at primary healthcare centres in the Eastern Province of Saudi Arabia, and the factors that influence them. It also aimed to identify the challenges of adopting patient safety culture in these centres. The study findings highlight a number of areas for improvement, particularly in relation to event reporting, non-punitive responses, and openness in communication. The authors highlight that error reporting should not just be considered a means of learning from mistakes, but should also be considered the first step towards preventing injury and improving patient safety. They highlight the need to eliminate three crucial elements associated with errors - blame, fear, and silence - in order to build a safety culture.
  7. Content Article
    A recent highly critical NHSEI External Review of The Christie NHS Foundation Trust was prompted by whistleblowers. The Review was provided with detailed evidence that there were very significant (and distressing) problems with the Trust’s approach to race discrimination, bullying and the response when concerns were raised. The External Review (Paragraph 2.2.6.) states In this blog, Roger Kline considers whether the Trust’s own data supports the assertions in the Trust Chair’s email to staff in response to the Review. He considers how the NHSEI Review addressed the issues. He suggests that the Trust’s response; the shortcomings of the NHSEI Review response to the issue of race discrimination; and the NHSEI response to the Review once published mean that further scrutiny of the Trust and NHSEI’s response is required if staff are ever again to risk raise legitimate concerns in this Trust – or rely on NHSEI to support staff who do so.
  8. Event
    Dr Leslie Hamilton, assistant coroner and retired cardiac surgeon, will speak about the importance of creating and maintaining a no-blame culture within NHS and independent healthcare organisations. This should help to ensure that people feel able to share and reflect honestly whenever things go wrong in care, so that lessons can be learnt and changes made to improve patient safety. Register
  9. Community Post
    Strategy - NHS Culture Change.pdf
  10. Community Post
    Is it time to change the way England's healthcare system is funded? Is the English system in need of radical structural change at the top? I've been prompted to think about this by the article about the German public health system on the BBC website: https://www.bbc.co.uk/news/health-62986347.amp There are no quick fixes, however we all need to look at this closely. I believe that really 'modernising' / 'transforming' our health & #socialcare systems could 'save the #NHS'. Both for #patients through improved safety, efficiency & accountability, and by making the #NHS an attractive place to work again, providing the NHS Constitution for England is at the heart of changes and is kept up to date. In my experience, having worked in healthcare for the private sector and the NHS, and lived and worked in other countries, we need to open our eyes. At present it could be argued that we have the worst of both worlds in England. A partially privatised health system and a fully privatised social care system. All strung together by poor commissioning and artificial and toxic barriers, such as the need for continuing care assessments. In my view a change, for example to a German-style system, could improve patient safety through empowering the great managers and leaders we have in the NHS. These key people are held back by the current hierarchical crony-ridden system, and we are at risk of losing them. In England we have a system which all too often punishes those who speak out for patients and hides failings behind a web of denial, obfuscation and secrecy, and in doing this fails to learn. Vast swathes of unnecessary bureaucracy and duplication could be eliminated, gaps more easily identified, and greater focus given to deeply involving patients in the delivery of their own care. This is a contentious subject as people have such reverence for the NHS. I respect the values of the NHS and want to keep them; to do this effectively we need much more open discussion on how it is organised and funded. What are people's views?
  11. Community Post
    Most healthcare professionals are familiar with Datix incident reporting software. But how and why has Datix become associated with fear and blame? Datix’s former chief executive and now chairman of Patient Safety Learning, Jonathan Hazan, has written a blog for the hub looking at why this has come about and what needs to be done to improve incident reporting. Do you have any ideas on how we can improve incident reporting? We'd love to hear from you. Reply to this topic below.
  12. Community Post
    Following the posting of the recent anonymous blog by a brave nurse - a discussion was started on Twitter about the aspect of accountability, duty of candour mixed with a no blame culture. If there has been a drug error: The person who did the error needs to feel secure in the knowledge that there is a no blame culture, otherwise they may not report it in the first place. The patient needs to be told that they has been an error with their care The person who did the error needs to be held to account So, can these three points coexist or are we wanting the impossible?
  13. Community Post
    A question posed by a delegate at our Patient Safety Learning Conference 2019: 'How can we change the blame culture without blaming others?' What are your thoughts?
  14. Community Post
    Have you witnessed poor care, reported an incident but you weren't heard or felt unsafe at work? Do you have the courage to speak up? Why should we need 'courage' to speak up at work?
  15. Community Post
    We know that blame and fear is toxic. It makes working in healthcare unsafe for staff and is a huge barrier to patient safety - staff won’t share what goes wrong if they expect not to be listened to or worse, will be criticised or blamed for errors that are really attributable to unsafe systems. It would be really valuable to better understand how this feels and the impact it has on clinicians and the safety of patients and service users.
  16. Content Article
    The NHS Staff Survey is an essential tool for assessing the experiences and opinions of NHS workers in Trusts in England. It also provides valuable insights to help understand the speaking up culture in the NHS. In this report the National Guardian’s Office analyse the results of the 2022 NHS Staff Survey, focusing on questions relating to speaking up.
  17. News Article
    West Suffolk Foundation Trust’s investigation to find a whistleblower was “intimidating…flawed and not fit for purpose”, according to a damning review which is highly critical of the organisation’s leadership. The long-awaited review, published today, was triggered by ministers back in January 2020 following allegations that trust directors had ordered staff to give fingerprints and handwriting samples during a “witch hunt” for a whistleblower. The review, led by Christine Outram, has corroborated many of the allegations. It concluded trust leaders’ investigation to uncover the identity of the author of an anonymous letter sent to a patient’s family was “intimidating, flawed and not fit for purpose… impractical and unwise.” It said: “The decision to use fingerprinting and handwriting analysis in an NHS hospital, in the context of an anonymous letter and where no crime has been committed, was highly unusual and without doubt extremely ill-judged.” Read full story (paywalled) Source: HSJ, 9 December 2021
  18. News Article
    A ‘macho’ culture within ambulance trusts is leading to widespread abuse of female staff. HSJ has been told of multiple cases including sexual misconduct, harassment or abuse against staff in the last two and a half years. These include: women being told that giving sexual favours would help them get on to paramedic training a woman who was told she would pass her driving course if she gave oral sex to a superior a student on placement who could not take off her jacket without comments being passed on her breasts, and therefore would wear it even on the hottest days a student given a lift by her supervisor who then proceeded to rub his hands up and down her legs during the journey. In a freedom of information request, the 10 ambulance trusts in England were asked for the number of incidents in which allegations of sexual misconduct, harassment or abuse had been made against staff. The trusts reported 221 cases since April 2019, of which at least 27 resulted in dismissal and at least 44 resulted in other disciplinary action, with some cases still under investigation. Read full story (paywalled) Source: HSJ, 7 December 2021
  19. News Article
    A ‘culture of distrust’ between consultants and the use of incident reporting as a tool of ‘reprisal’ impacted patient care at a trust’s cardiology department, a review has concluded. An external review undertaken for Hull University Teaching Hospitals Trust has made a series of recommendations after looking into allegations of bullying and several examples of poor care within its cardiology services. In a report published in the trust’s board papers, the Royal College of Physicians reported a “perceived tendency to downplay clinical incidents, and, to undermine those who wanted to raise patient safety issues”. It added: “We met a group of individual consultants who did not work well as a team. There is a culture of distrust, a lack of departmental cohesion and allegations of bullying in the department. All of which reinforce a clear divide between the interventional and non-interventional consultant cardiologists." “There have been a number of allegations of belittling, intimidation and undermining…The review team heard accounts of a culture where datix has been used as a tool for possible personal reprisal along with ignoring/downplaying incidents that have been raised.” The review concludes: “This behaviour is impacting on patient care and therefore, all medical staff should be reminded of good medical practice as the [General Medical Council] code of conduct of how doctors must work collaboratively with colleagues.” Read full story (paywalled) Source: HSJ, 16 November 2021
  20. News Article
    Women in a newly opened psychiatric intensive care unit (PICU) had concerns for their sexual safety, a Care Quality Commission (CQC) report has revealed. Inspectors found women in the PICU at Cygnet Health Care’s Godden Green Hospital, in Kent, were afraid to shower because male staff did not always knock before entering bedrooms and staff entered bathrooms without permission. Patients were often looked after by male staff despite having asked for a female staff member and, in some cases, had an all-male care team. Most patients the inspectors spoke to had concerns about their sexual safety. The CQC carried out an unannounced inspection of the PICU in October, following concerns raised by members of the public and to check concerns identified in an earlier inspection of the hospital’s child and adolescent mental health services were not organisational. The PICU opened in November 2019. Since the summer, Kent and Medway NHS and Social Care Partnership Trust has commissioned some of the beds, but HSJ understands it stopped admissions for a time to review the care being provided. Inspectors found records referred to PICU patients as “difficult” and “troublemakers” and warned a ”culture of negativity towards patients had developed among some staff”. Read full story (paywalled) Source: HSJ, 4 December 2020
  21. News Article
    The Care Quality Commission (CQC) has raised serious concerns about a major teaching trust’s maternity services and taken action to prevent patients coming to harm. The watchdog has imposed conditions on the registration of Nottingham University Hospitals Trust’s maternity and midwifery services at Nottingham City Hospital and Queen’s Medical Centre and rated them “inadequate”. Following an inspection in October, the CQC identified several serious concerns, including leaders lacking the skills to effectively head up the service, a lack of an open culture where staff could raise concerns, and staff failing to complete patient risk assessments or identify women at risk of deterioration. In its findings, the CQC reported how “fragile” staff wanted to escalate their concerns directly to the regulator, particularly around the leadership’s response to the “verbal outcome of the inspection”. The regulator called this “further evidence of the deep-rooted cultural problems” and escalated these concerns directly to trust CEO Tracy Taylor, who would be “personally overseeing the improvement process required”. Inspectors also found the service did not have enough staff with the right skills, qualifications and experience to “keep women safe from avoidable harm”. The CQC also issued the trust a warning notice over concerns around documenting risk assessments and IT systems. The trust has three months to make improvements. Read full story (paywalled) Source: HSJ, 2 December 2020
  22. News Article
    Organisations across the UK and beyond are set to benefit from a unique NHS- academic partnership which sees a focus on staff safety and morale – and delivers significant cost savings. Together Northumbria University and Mersey Care NHS Foundation Trust are pioneering professional development courses on Restorative Just Culture. This approach at the Liverpool-based Trust has seen reduced dismissals and suspensions, leading to substantial business savings, and has generated great interest across the health sector. Starting in 2016 Mersey Care has worked to deliver a Restorative Just Culture. And despite increasing its workforce by 135%, the Trust has since seen an 85% reduction in disciplinary investigations and a 95% reduction in suspensions – helping them drive down costs significantly. During the same period, it has also seen improved staff engagement and safety culture scores as measured by the NHS national staff survey. Mersey Care’s Executive Director of Workforce Amanda Oates says: “Mersey Care started on our journey towards a Restorative Just and Learning Culture after conversations with our staff about the barriers staff faced delivering the best care that they could possibly give." “The feedback was overwhelmingly about the fear of blame if something didn't go as expected. This was preventing staff from telling us what wasn’t working. More importantly, it was preventing the opportunity for learning from those things to prevent them from happening again. As a Board, we had the conversation - are we looking at problems the wrong way?” Read full story Source: FE News, 27 October 2020
  23. News Article
    A hospital boss championed by Matt Hancock has been told to end “a toxic management culture” after doctors were asked to provide fingerprint samples to identify a whistleblower. The Royal College of Anaesthetists (RCoA) has urged the chief executive of West Suffolk hospital, Steve Dunn, who Hancock described as an “outstanding leader”, to take urgent action to improve the wellbeing of senior clinicians and “thereby the safety of patients”. In a strongly worded letter sent to Dunn in July, seen by the Guardian, the RCoA president, Prof Ravi Mahajan, reminded him that “undermining and bullying behaviour is unacceptable”. Following a three-day review of the hospital, Prof Mahajan’s letter said senior anaesthetists had complained about a “toxic management culture that risks impairing their ability to care safely for patients”. The incident, and other failings in patient safety, contributed to the hospital becoming the first ever to be relegated by Care Quality Commission (CQC) inspectors from “outstanding” to “requires improvement” in January. A spokesman for the trust said: “Ensuring our colleagues work in a supportive, safe environment is good for our staff and means better patient care, which is why we have done extensive work this year to act on feedback about our working culture, including taking action to address the concerns raised by the Royal College of Anaesthetists.” Read full story Source: The Guardian, 11 September 2020
  24. News Article
    NHS whistleblowers have required counselling and medication and a quarter would not raise concerns again due to the stress and lack of support, a report found. A review of existing policy at NHS Greater Glasgow and Clyde found “concerning” evidence of a significant impact on the mental health of both whistleblowers and managers with little support provided. It found there was “no clear documented process” to highlight serious, urgent issues to the appropriate manager. Healthworkers’ union Unison said staff were often labelled ‘trouble-makers’ with senior managers "defensive from the outset". Sixty percent of staff reported that their mental health was negatively impacted by whistleblowing with some requiring counselling or medication to cope with the stress of disclosures. The report said it was of concern that a quarter of staff stated that they would not raise concerns such as unsafe clinical practices again given their experiences, a figure which it said was likely to be higher as this information was only recorded if it was volunteered by staff. Unison’s Regional Organiser Matt McLaughlin said, “Unison welcomes this paper and the Boards commitment to follow the updates national guidance. “However it will take more than a new policy for whistleblowers to feel valued within NHS GGC. The organisation is too defensive and staff who whistleblow often do so out of shear frustration that legitimate concerns are ignored – or worse, where the whistleblower is seen as a trouble maker. " "NHS Greater Glasgow and Clyde needs to embrace and welcome staff speaking out; rather than being defensive from the outset." Read full story Source: The Herald, 28 April 2021
  25. News Article
    Hospitals and care homes are failing to properly investigate incidents before referring nurses to their regulator, fuelling a blame culture and repeat failures, the head of the nursing watchdog has told The Independent. In her first national interview, Andrea Sutcliffe, head of the Nursing and Midwifery Council (NMC) said some employers were referring nurses without any investigation at all, while half of initial enquiries to the NMC were rejected or required further work. She told The Independent this emphasis on blaming the individual meant underlying causes of safety errors were being missed and so they were likely to be repeated. Her ambition is to transform the nursing regulator, which oversees 725,000 nurses and midwives across the UK, into a more forceful watchdog that will flag systemic issues of concern with NHS trusts and care homes. In a wide-ranging interview, Ms Sutcliffe called on ministers to ensure that planned legislation to reform the way clinicians are regulated be made transparent and maintain the public’s confidence. She also stressed that the impact of coronavirus on nurses mental health meant rushing to restart routine operations in the NHS had to be carefully planned to avoid driving nurses out of the health service. Read full story Source: The Independent, 16 March 2021
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