Raising Concerns and Whistle Blowing
The Royal College of Surgeons of Edinburgh has an ethos of delivering and supporting the tools for provision of high quality health care. The College recognises that occasionally there may be concerns that the standard of care provided by an individual or an institution is not at a level deemed acceptable.
Recommendations to Fellows, Members and staff:
Doctors have a professional duty under the GMC’s Good Medical Practice (2012), to “promote and encourage a culture that allows all staff to raise concerns openly and safely” and “take prompt action” where “patient safety, dignity or comfort is or may be seriously compromised.”
The Royal College of Surgeons of Edinburgh is committed to greater openness and transparency in healthcare, so we encourage prompt action to rectify malpractice or other serious health and safety concerns they believe is affecting patient care. Please note that for the purposes for this guide, we use the terms ‘raising concerns’, ‘whistle blowing’ and ‘speaking up’ interchangeably.
The Legal Background
In the UK, the Employment Rights Act 1996 (NHS Recruitment – Protected Disclosure) Regulations 2018 and the Public Interest Disclosure Act 1998 offer some protection to those who raise concerns where
- A criminal offence is being committed;
- A person is failing to comply with their legal obligations;
- A miscarriage of justice is occurring;
- Health and safety is being endangered;
- Where there is environmental damage; or
- Information showing any of the above has been or is likely to be concealed.
In very broad terms, legal protection applies in cases where the claimant reasonably believes their concerns are factually correct and in the public interest. Individuals looking to raise concerns should always ask whether patient harm could be caused if a situation is left unchecked and concerns are more likely to be taken seriously as ‘protected disclosure’ if they contain a factual statement of what is wrong.
Please note that bullying and undermining are often treated under separate grievance or dignity at work policies.
If concerns are to be raised, we recommend the following steps.
Firstly, it is important that those wishing to raise concerns familiarise themselves with these Acts and liaise with experts such as their local BMA / BDA representative and/or Medical Defence Union
Clinicians in England can also contact their local Freedom to Speak up Guardian. Guardians ensure that people who speak up are thanked, that the issues they raise are responded to, and make sure that the person speaking up receives feedback on the actions taken.
Secondly, the HR department should be contacted in order to view that employer’s raising concerns policy. All employers should have a formal policy and guidance for raising serious concerns so these should be familiarised with as these should be designed to protect individuals.
Thirdly, concerns should be raised with the immediate clinical team, line manager or head of department. If this is unsuitable, the employer’s raising concerns policy should include a formal procedure and the name of a designated officer.
The raising concerns policy may ask to report concerns in writing or via an incident reporting systems such as Datix. This is advisable as written submissions provide greater legal protection as well as making it more likely that concerns are acted upon.
Finally, you can raise your concerns can with your Trust’s Medical Director and / or Chief Executive.
As internal disclosures are more readily protected under the legal framework, we recommend that concerns should only be raised externally after have been raised internally first. Social media must not be used to discuss concerns.
Advice for Trainees
Trainees should liaise with their Educational Supervisor in the first instance, escalating to their Training Programme Director if this is unsuitable or unsuccessful, they can then approach the Head of School of Surgery and ultimately the Post Graduate Dean who is the trainees Responsible Officer. Trainees can also raise concerns with the GMC who can ultimately consider removing trainees from a training programme if necessary.
The College also has a Trainees Committee that may be able to provide informal opinion and advice.
- British Medical Association Guide to Raising Concerns
- Care Quality Commission Raising a concern with CQC: A quick guide for health and care staff about whistleblowing
- General Dental Council Raising Concerns
- General Medical Council Raise a concern or refer yourself to us
- Health Education England Raising and responding to concerns
- NHS Employers Settlement agreements: a factsheet for employers and workers about speaking up
- NHS Improvement Asking for advice or raising complaints and concerns with us
‘Speak Up’ offers a free, independent and confidential helpline for people working in NHS and Social Care organisations in England (08000 724 725)
Protect is a national charity which aims to protect society by encouraging speaking up in the workplace. It provides legally privileged advice to individuals, supports organisations with their speaking up arrangements and monitors legislative impact and campaigns for change. (020 3117 2520).
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