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6 – A senior GP is paying her husband to work as a consultant for double the expected rate. There is no evidence to show any work done. Is It…. What Do The NHS And CQC Say ?. What do the NHS and CQC say?. Whistleblowing is key to protecting patients, staff and public resources
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6 – A senior GP is paying her husband to work as a consultant for double the expected rate. There is no evidence to show any work done.
What do the NHS and CQC say? • Whistleblowing is key to protecting patients, staff and public resources • Whistleblowing needs to be better managed • Whistleblowing is a key area of inspection: • What do staff know? • What do local partners such as local authority/healthwatch say? • Are there records of how disclosures have been handled?
National Guardian For Speaking Up Freely & Safely In The NHS Dr Henrietta Hughes, Practicing GP London
The NHS Needs More… “…Of the trust and joy and love hormone oxytocin.”
The KLOEs • Safe: The practice encourages its staff to be open and honest about safety, and supports them to report concerns and incidents. • Well led: Staff are encouraged to raise concerns and the practice listens to what they have to say. Any concerns are investigated and acted on.
What should form a whistleblowing policy? • What type of issues should be reported • To whom they would be reported to • Confirming that whistleblowers will be protected • High levels of confidentiality
Q: Which of the following would not normally be an appropriate route for a disclosure? • A disclosure to the local newspaper • A disclosure to a named senior manager within the company • A disclosure to the Environment Agency • A disclosure to the Foods Standards Agency
Q: Which of the following would not normally be an appropriate route for a disclosure? • A disclosure to the local newspaper • A disclosure to a named senior manager within the company • A disclosure to the Environment Agency • A disclosure to the Foods Standards Agency
Q: Which of the following is not one of the aims of a whistleblowing procedure? • To prevent wrongdoing within the organisation • To provide a route for employees to report genuine concerns internally • To root out disloyal employees • To minimise damage to the business
Q: Which of the following is not one of the aims of a whistleblowing procedure? • To prevent wrongdoing within the organisation • To provide a route for employees to report genuine concerns internally • To root out disloyal employees • To minimise damage to the business
Q: Which of the following is not valid motivation to whistleblow? • To protect patient safety • For the opportunity of financial gain • To prevent criminal wrongdoing • To prevent misuse of practice resources
Q: Which of the following is not valid motivation to whistleblow? • To protect patient safety • For the opportunity of financial gain • To prevent criminal wrongdoing • To prevent misuse of practice resources
What do the academics say? The stats. PLAY 74% 1. Whistleblowers who were ignored when first raising a concern (PCaW) 56% 2. Employees who say they have observed conduct that violated company ethical standards (Ethics Resource Centre, 2007) 63% 3. Proportion of those who observed it, reported it. 53% 4. sample of US Government employees who did not report wrong doing because nothing would happen (Near et al., 2004) 5. The proportion of fraud prevention and ethical lapses identified by tip offs to the employer (US accountancy firms) (in Gallagher, 2013) 42%
A culture of openness • Employees thanked for raising issues – no reprisals • Suggestion schemes • Issues and ideas warmly encouraged at team meetings • Any actions or improvements are communicated (where possible) • Option for anonymous reporting? • “You said, we did”
What’s to come? The NHS are launching a national whistleblowing policy which is expected to apply to primary care and be implemented by 31st March 2017
Source: Sir Robert Francis QC (2015) Freedom to Speak Up: an independent report into creating an open and honest reporting culture in the NHS.
Some Case Studies
Case Study 1 • Irene part-time receptionist at a GP practice • overheard female patient telling a receptionist that she did not want to see Dr. Lewis (male GP) – again. • The receptionist muttered: “Well, it’s not the first time.” • Irene mentioned this to practice nurse. The nurse told her to ignore her colleague. • She took a call from another female patient who refused an appointment with Dr. Lewis. • Irene has read a story in the press about a doctor abusing female patients and feels she ought to do something.
Case Outcome 1 • Irene saw a Public Concern at Work poster, she called to ask whether she should tell the GMC or the CCG. • PCaW said it would be better if she spoke to the practice manager first. • A couple of days later Irene called to say that she had talked to the practice manager, who had thanked Irene for coming to see him. • He assured her that there had been no complaints and that Dr. Lewis’s patient list was no different to any other. • However, he said he would make a note of the issue and keep an eye on things, and if Irene had any future concerns to let him know as soon as possible.
Case Study 2 • Claire, dental nurse, small practice, two dentists, one associate. • she became aware that the associate was fiddling the books. • meant to provide practice with half income from private dental work and supplementary charges to NHS patients. • On one occasion he told Claire not to record the extra payments he received from NHS patients. • Claire refused and recorded the information properly. • The dentist then erased the entries Claire had made. • Claire is worried that the partners might not believe her and that it will permanently sour relationships in such a small practice.
Case Outcome 2 • Claire called the health authority • After discussing it with Claire, the health authority said it would meet with the partners to explain the concern and suggest they investigate. • Investigation found the associate had stolen significant sums and he was dismissed with immediate effect. • The dentists thanked Claire and told her that she had done the right thing but added that they might have to let her go as they would not have enough work for her until they found a new dentist. • Claire worried that it might take a while to attract a new dentist to such a remote area and jobs were scarce. • Claire called Public Concern at Work to discuss her options. • PCaW agreed to liaise on her behalf with the dentists and the health authority to see if a positive solution could be found. • A couple of days later, Claire called PCaW to say that the dentists had realised that they would still have the same workload and that it would be mad to let her go, particularly when she had done them a favour.
Case Study 3 • Sarah, care assistant, small private nursing home . Worked for years with Joan, a senior nurse who she considers Joan to be a friend. • Sarah noticed that Joan had begun to treat everyone in an off-hand way. • Sarah did not mind for herself but began to worry about the effect on residents. • She heard Joan shout at the residents and then found that Joan was sedating a particularly difficult resident without a prescription. • Joan’s response was that the doctor would prescribe it soon anyway and that she was just giving everyone a bit of peace. • One night when a resident got out of bed shouting, Sarah saw Joan put her hands briefly around the woman’s neck before pushing her back to her room. • Sarah then heard screams coming from behind the door.
Case Outcome 3 • Sarah mentioned to a locum GP she was worried - a colleague was being rough with residents. • The GP said Sarah should report it and told her she could get advice from Public Concern at Work. • Sarah rang and they talked her through her options. • Sarah said she did not trust the new manager but was worried about what would happen if she went outside the home to the care inspectors. • Sarah decided the manager would take issues of care seriously. PCaW suggested Sarah meet with him privately to explain her concerns. • Sarah spoke to the manager and he began an immediate investigation. • Though initially denying a problem, other staff began to describe incidents that Sarah knew nothing about and Joan was suspended. • The police were called in and ten months later Joan was convicted and jailed for two years.
