Whistle blowing post Francis…A time for change.

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Whistle blowing can cause a prolonged and prominent assault upon health care staff well being. Whistle blowers speak of overwhelming and persistent distress, alcohol problems, and paranoid behaviour at work, acute anxiety, nightmares, flashbacks and intrusive thoughts (Peters et al, 2011). So naturally, I felt this was an important issue to blog about. I recently contributed to the Wikipedia entry for the psychological impact of Whistle blowing along with David Drew and Minh Alexander, although I am still on a learning curve with this concept as it forms a significant part of the background work on my thesis.

Whistle blowing improves the quality of care for patients as lessons are learnt from failure. Health care professionals suffer from the interminable condition of being ‘Human’ and we must understand that whenever we enter the health services, we take on the risk of human error. Yet ‘Whistle blowing’ as a term has such negative connotations, perhaps we need a more friendly rhetoric for it? Whistle blowers should not be seen as the problem, but as the solution to better care as they become a part of every day conversation. But I do not believe that an open culture exists just yet.

Positive rhetoric and good intentions do not always result in positive change and we still hear stories about the negative consequences of whistle blowing in the NHS.

“I was pulled into a side room and questioned as to whether I would ‘Blow the Whistle'”

“I was told that the conversation had ‘Never Happened'”

Many more stories can be found here on the poor experiences of whistle blowers.

In 2013 Sir Robert Francis’s report into care failings, warned that secrecy and an acceptance of poor standards had emerged at all levels of the NHS (Francis, 2013). As a result of this, the government pushed for an explicit professional duty of candour, so that any avoidable or unintended patient harm must be reported. Despite this, where front line staff attempt to address concerns about abysmal care, they are often met with a wall of silence and hostility by management (Drew, 2015). These silencing cultures are evidenced by the fact that at least 45 staff spanning 50 organisations have signed confidentiality clauses, some with payment deals in return for silence since 2011 (Sprinks, 2014).

In 2015, Sir Robert Francis released his report of his review into whistleblowing in the NHS: The freedom to speak up review. Among a multitude of recommendations proposed by this report, the most important ones that stand out to me are creating a cultural change towards open, transparent and learning cultures which value communication and engagement, and the appointment of Freedom to Speak Up Guardians, supported by a national Independent National Officer (INO). Cultural change and normalizing conversations about risk, error and poor practise will be essential to producing a healthier work environment for all, and better patient care. Blaming and scolding really have no place here, and if we are to move forward and improve, we must continuously learn from all actions and omissions. There is damage caused by denial, to both the health service and the health and well being of NHS staff. I fear that any Freedom to Speak up Guardian may have an insurmountable hill to climb and may themselves become more at risk of work based hostility. These guardians will require protection and support for their own well being if they are to ignite change and protect the duty of candour.

A guide for the new duty of candour regulations can be found here. This duty controls what NHS staff say as well as what they do, through the threat of criminal sanctions. Criminal sanctions is something I feel very uncomfortable with. I am a keen advocate for alternatives to discipline and in a culture of fear, I do not believe that front line staff are going to work with the intention to damage patient care through a wall of silence.

This is a time for change, and I have to believe that better times are on the horizon because “The NHS is blessed with staff who want to do the best for their patients”. – Sir Robert Francis.

Drew, D (2015) Francis NHS whistleblower report: a new beginning? Guardian Healthcare Network available from http://www.theguardian.com/healthcare-network/2015/jan/29/francis-review-nhs-whistleblower-report?CMP=share_btn_tw

Francis, R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary London: The Stationery Office

Francis R. (2015) Report on the Freedom to Speak Up review. London: The Stationery Office, 2013.

Peters, K., Luck, L., Hutchinson, M., Wilkes,L., Andrew, S., Jackson, D (2011) The emotional sequelae of whistleblowing: findings from a qualitative study. Journal of Clinical Nursing, 2011; 20 (19-20): 2907

Sprinks J (2014) Survey highlights slow progress in increasing staff whistleblowing. Nursing Standard Feb 12-18;28(24) P14-5

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