Whistleblowing & Psychological safety by Gill Stanyard

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Three years ago, just before, I was appointed by the Cabinet Secretary to be a Non-Executive Director  , I became a whistleblower. I blew the whistle on an organisation I had previously worked at. The whole process felt like a mini earthquake happened inside of me – I felt physically shattered, on edge and at times, paranoid due to the fear of not knowing what was going to happen next. I was not kept informed and this was the most difficult thing to endure -I did not feel psychologically safe. However, this was bearable compared to the distress of keeping everything in, all the wrong doing I had witnessed and not knowing what to do or where to take it -this ate away at me until I took action to an external source. Despite the high reading on my internal Richter scale, I felt I had done the right thing.  Looking back, I know I did the right thing.

gill-3We have heard a lot lately about Whistleblowing in the press, from Julian Assange to the more recent Dr Jane Hamilton, who met with NHS Scotland Chief Executive and last week’s author of this D & G blog,  Paul Gray,  this month, about her concerns as a Psychiatrist working at NHS Lothian.

So, what does it mean when we talk about Whistleblowing? Public Concern at Work define Whistleblowing as:

A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MSPs/MPs)

In his Report on the Freedom to Speak Up review (“the Report”) published on 11 February 2015, Sir Robert Francis QC defines a whistleblower, in the context of the NHS, as: “a person who raises concerns in the public interest. An important distinction is to highlight the difference between grievances and concerns -the law around whistleblowing (Public Interest Disclosure Act)  responds to ‘concerns’.

 

Grievances                                Concerns

risk is to self                                  risk is to others

need to prove case                   tip off or witness

   rigid process                               pragmatic approach

legal determination                    accountability

private redress                           public interest

 

Fast forward to this present day, as Chair of Staff Governance, I was nominated last year to take on the role of Whistleblowing Champion for the Board -an assurance role created by Scottish Government for Non-Executive Members in November 2015. This was part of an on-going intention to raise the profile of Whistleblowing being safe to do and as part of a response to one of the recommendations from the Francis Report ‘Freedom to Speak Out’.

As Whistleblowing Champion I will look for assurance that investigations are being handled fairly and effectively including:

  • that reported cases are being investigated
  • that regular updates are provided on the progress of the investigations of reported cases
  • Ensure that staff members who report concerns are being treated and supported appropriately and not victimised
  • members of staff are regularly updated on the progress of the concern they reported and advised of investigation outcomes;
  • ensure that any resultant actions are progressed.
  • Ensure that relevant Governance Committees; HR; staff representatives and Whistleblowing policy contacts are being updated on the progress and outcomes of cases; and, recommended actions resulting from an investigation.
  • Publicise and champion positive outcomes and experiences.

 

Around the same time as this role was developed, also in response to the Freedom to Speak Up Review recommendations, the Cabinet Secretary for Health, Wellbeing and Sport announced the development and establishment of the role of an Independent National Officer. This is to provide an independent and external level of review on the handling of whistleblowing cases. This role is still being implemented and recent word from Scottish Government representatives last week, is that focus is on investigating the statutory powers that would need to sit alongside this role, so, it is hoped that the post will be live by 2018. A lot of learning has taken place from the established Guardian scheme in England.

Shona Robison has talked very recently about her desire for all NHS Staff to ‘have the confidence to speak up without fear about patient safety.’ Dame Janet Smith, back in 2004,  when she helped to develop proposals following the Shipman Enquiry wrote “I believe that the willingness of one healthcare professional to take responsibility for raising concerns about the conduct, performance or health of another could make a greater potential contribution to patient safety than any other single factor.”

The Right Honourable  Sir Anthony Hooper, in his report on the handling by the GMC to cases involving whistleblowing (2015) revealed an issue around bullying.  The GMC has recognised that the bullying of those who raise concerns may make persons reluctant to do so. A GMC survey (published in November 2014) of the 50,000 doctors in training found nearly one in ten reporting that they had been bullied, while nearly one in seven said they had witnessed it in the workplace. At the time of the publication Mr Niall Dickson said: “There is a need to create a culture where bullying of any kind is simply not tolerated. Apart from the damage it can do to individual self-confidence, it is likely to make these doctors much more reluctant to raise concerns. They need to feel able to raise the alarm and know that they will be listened to and action taken.’ What I see Dickson referring to is the creation of psychological safety,  defined as ‘…a belief that it is absolutely ok, expected even, that people will speak up with concerns, with questions, with ideas and mistakes…’  Amy Edmondson, Professor in Leadership , Harvard University

gill-1Recently I came across this painting by Gozzolli depicting the story of St Jerome and the Lion.  I had vague recollections of this story from one dusty morning spent at Sunday School, where I thought the golden motes falling in front of the window were a sign from God that it was ok to eat the mini eggs next to the toy donkey on the Easter shrine. Turns out it was just dusty sunshine and the ‘eggs’ were mint imperials in disguise. .   In the story, a lion approaches St Jerome and other monks whilst they were saying prayers in the monastery -whilst the other monks fled with fear out of the window, running for weapons and other ways to attack and scare the lion away, St Jerome sat quietly and looked into the lion’s eyes. He saw pain reflected back at him, and with pricked curiosity, he watched the lion limp up to him and hold out its heavy front paw.  Jerome took the paw and examined it.. He saw the limb was swollen, and with closer inspection saw there was a thorn embedded in the pad. He removed the thorn and bathed the area with healing herbs and water and placed a bandage of linen cloth around the paw.. Expecting the lion to leave, he sat back and waited. The lion looked at him, now with all  trace of pain gone and lay down on the floor and went to sleep. The lion was said to have never left Jerome’s side.

What strikes me about the lion is his courage and self-compassion to remove the source of his own pain and to take action to do so, despite the risks of being attacked by the monks. Whilst of course it was not in the public interest whether the thorn was removed or not from the lion’s paw in whistleblowing cases it is widely recognised that the whistleblower does suffer before, with the burden of needing to speak out and after, with the worry of the consequences of what may happen next. Robert Francis  acknowledged this in his report ‘Freedom to Speak Out’  ‘… that the stresses and strains of wanting to do the right thing can be immense’  Last September I attended a Whistleblowing event at the Royal College of Surgeons in Edinburgh. One of the speakers was  Dr Kim Holt, Consultant Paeditrician gill-4and founder of Patients First. She flagged up concerns to senior management in 2006 about understaffing and poor record keeping at St Ann’s clinic, part of Great Ormond Street Hospital. Sadly, her concerns were not acted upon and in 2007, Baby P died just three days after being seen by a locum doctor at the same clinic, who failed to spot that the toddler was the victim of serious physical abuse. Dr Holt, now recognised by the Health Service Journal as one of the most inspirational women in healthcare, spoke with calmness about the impact her experiences had on her well-being, including becoming severely depressed and unable to eat or sleep. She became a whistleblower, she says, because she feared something terrible would happen to a child and was devastated when her warnings were ignored.

I know it takes courage to speak up and share your concerns. I also know for a fact that we have quite a few St Jerome types here in NHS Dumfries and Galloway.

Our Whistleblowing Policy here at NHS D&G -take a look if you are not familiar :

http://www.nhsdg.scot.nhs.uk/Resources/Publications/Policies/Whistleblowing_Policy.pdf

The two people named in the policy are Deputy Nurse Director Alice Wilson – Tel. 01387 272789   and Deputy Finance Director Graham Stewart – Tel 01387 244033

These people have been given special responsibility and training in dealing with whistleblowing concerns. If the matter is to be raised in confidence, then the staff member should advise one of the designated officers at the outset so that appropriate arrangements can be made.

If these channels have been followed and the member of staff still has concerns, or if they feel that the matter is so serious that they cannot discuss it with any of the above, they should contact: Caroline Sharp, Workforce Director NHS Dumfries and Galloway (Tel : 01387 246246)

Also, the national helpline run by Public Concern at Work is called the National Confidential National Confidential Alert Line – 0800 008 6112

Gill Stanyard is a Non-executive member of NHS Dumfries and Galloway Health Board

 

 

There is no truth, only Perception by Emma Murphy

I recently started as the new Patient Feedback Manager for NHS Dumfries and Galloway. Just as I was settling in to my new role, life popped a little bump in the road and I found myself rushing through the doors of A&E one Friday morning with my poorly toddler. After a number of tests and assessments we found ourselves on Ward 15 for the weekend. I’m usually a reasonably laid back parent and when the kids get unwell, I generally believe in ‘keeping it til it gets better’, but watching my baby girl lie listless in my arms stirred up something almost primal in me. I needed to protect her and I needed to do whatever I could to get her better. Of course, this was paired with the realisation that I alone couldn’t fix this and that we were almost entirely reliant on the doctors and nurses. So there I was, anxious, frustrated, frightened and feeling more than a little helpless. Feelings I am sure many of you have experienced in similar situations.
Later that weekend, as things began to calm, I took some time to reflect. Whilst the treatment we were receiving was of course important, the key thing that was making our experience so positive was the kindness; the gentle tones, the sweet smiles directed at my daughter, the hand placed on my shoulder when I was particularly worried and most of all, the fact that those looking after us genuinely cared. I thought about how I had felt when I first arrived at A&E and how determined I was to ensure that my daughter received urgent help. I imagined how I would have felt if the care had been different. What if the kindness hadn’t been there? What if I was dismissed as an over anxious mother? What if somehow they missed something or didn’t give us the right treatment?
I can see how any one of those scenarios could occur and after many years working in the public sector I can also understand how sometimes, there are justifiable reasons for such. As patients and family members we often don’t know what the doctors and nurses are facing. It’s difficult to fully comprehend the overwhelming task they face each and every day with limited resources, conflicting demands and huge, often unpredictable, pressures. We must remember too that they are juggling all of this alongside their own lives, challenges and all. Whilst sitting here on the other side of this experience it is easy for me to apply that logic and understanding, it would however have been very different had any of those things happened when I was actually in that moment, dealing with those big emotions.
image2-2It can be thoroughly unpleasant when someone complains about you. Even more so if you feel that it is unfair or unjustified. We must appreciate however that it is often about perception. The view from every angle is slightly different. We must too remember that nothing occurs in isolation. Just as a complainant may not know what you are facing that day, you may not know their story. Someone once told me that people shout because they feel they are not being listened to. The anger we sometimes see from complainants often stems from fear or frustration. The same emotions that can make us defensive or even dismissive, when we are on the receiving end of that anger. If we approach complaints from a position of empathy and with a genuine desire to learn and improve, we will go a long way towards reaching more positive resolutions.
Until recently, different parts of the public sector had different approaches to dealing with complaints. This meant that patients, service users and customers were facing challenges negotiating the different procedures which, on top of an existing complaint, often escalated their frustration. Staff were also unclear about how to deal with complaints which led to a further variety of approaches. This issue was identified by the Scottish Government a number of years ago and as a result they have been working towards a standardised approach to complaints handling across the public sector in Scotland. The Scottish Public Services Ombudsman (SPSO) has led on this work, already delivering a model Complaints Handling Procedure to local authorities which they implemented in 2013. They are now working with the NHS to help us to implement a very similar procedure from 1 April 2017 and it is a key part of my role to support NHS Dumfries and Galloway with that task.
image3.pngI know my NHS colleagues care deeply about their patients and the experience they have during their time with us. It is however a little more challenging to try to ignite that same passion about legislation, process and statutory timescales. We all know they are crucially important, but colleagues generally just want to get on with the job they are here to do, which is caring for people. It’s my job to help them understand that these changes will make everyone’s lives a little easier. It will ensure we have a clear procedure and a consistent approach to dealing with complaints. It will also ensure that we are offering the best support we can to those that wish to provide us with their feedback. This will help them to tell us their story and will better assist us in our quest to deliver the best possible care to those in need. Something we are all committed to.

You can learn more about the national changes to complaints handling here – http://www.valuingcomplaints.org.uk
To tell us your story about the care you have received, please contact Patient Services by phone on 01387 272 733 by email at dumf-uhb.PatientServices@nhs.net or by visiting the national Patient Opinion website at http://www.patientopinion.org.uk/

Emma Murphy is the Patient Feedback Manager at NHS Dumfries and Galloway.

Opening Doors by Shaben Begum

SIAA_PrimaryThe Scottish Independent Advocacy Alliance (SIAA) has recently launched an animated film Opening Doors which shows the difference that independent advocacy can make to the lives of parents going through child protection procedures.

Opening Doors follows 3 characters, Laura a young woman with learning difficulties who is pregnant, Ahmed who has a young son and has issues with alcohol and Teresa who has mental health issues. It shows how Moira their advocate helps them know and understand their rights, navigate the system, ensure they are listened to and speak for themselves. The film was made with the help of a focus group made up of parents and advocates with experience of child protection procedures. The focus group helped identify the key issues and used their experience to highlight the difference advocacy makes. Members of the focus group met with the writer to inform the script and ensure that the language was clear and accessible they also met with the animator to ensure that scenes were realistic and that characters were portrayed positively.

The whole process of producing and launching the film was a collaboration with Media Co-op who have a track record of producing high quality, award winning films with a social message.  They worked with us to recruit a professional writer, animator and cast of actors. The part of Laura was played by a woman with learning difficulties.

Intelligence we gathered indicated that advocates were increasingly being involved in advocating for parents with mental health issues, learning disabilities and substance misuse issues who were in danger of losing access to their children.

It’s not unusual for advocates to get involved in supporting people in various situations but the feedback we received showed there was a real need for advocates to know and properly understand the complexities of child protection.

The film is the culmination of our three year Families at Risk project funded by the Scottish Government Third Sector Early Intervention Fund which was administered by the Big Lottery. The initial project was designed to raise awareness about child protection issues amongst advocates and to inform social care professionals and children’s hearing panel members about independent advocacy. Phase 1 developed and delivered training specifically for advocates, providing grounding in key legislation and policy.  Alongside this, guidelines for advocates working with Families at Risk were developed in consultation with advocacy organisations. The guidelines provide a useful reference to best practice in advocacy. They also are used by people using advocacy to get clarity about what they can expect from an advocate and for professionals who want to understand the advocacy role further.

Opening Doors was launched at the Glasgow Film Theatre with approximately 100 people in the audience. The showing was followed by a plenary session made up of representatives from Scottish Government, Children’s Hearings, an independent Safeguarder and an advocate.  The discussion and questions from the audience raised interesting issues around how complex the child protection system is, how difficult parents find it to engage with and how disempowered they feel and crucially the difference support from an advocate can make for everyone involved even if the outcome isn’t what the parents are looking for.

We have received a great deal of positive feedback on the film and it has been viewed and promoted by a range of individuals and organisations across the UK.

Opening Doors will be used as part of training programmes for a range of professionals wanting to learn more about the difference advocacy can make in emotionally difficult and legally complex situations. The film is available in a number of different languages including; Arabic, Urdu, Punjabi, French, Polish and BSL (British Sign Language).

We know that there isn’t enough independent advocacy for people who have a statutory right to access it but we believe that in situations where decisions are made that have a long term and life changing impact then advocacy should be available. We believe that in the ideal world services would be person centred following a human rights based approach so that no one needed the support of an independent advocate but until that day arrives we believe that where families are going through child protection procedures then both parents and children should have access to separate advocates.

Some facts about independent advocacy in Scotland

Research carried out by the SIAA shows that during 2013-14 £11.3 million was spent on advocacy. There are advocacy organisations in every LA area in Scotland and during 2013-14 over 27,000 people accessed advocacy.

Find your local advocacy organisation through Find an Advocate on the SIAA website.

For more information about independent advocacy in Scotland visit www.siaa.org.uk or email us at enquiry@siaa.org.uk

Shaben Begum MBE is the Director of the Scottish Independent Advocacy Alliance