A non-clinical member of staff from a BME background raised concerns about the approach taken by a senior director in awarding business to external contractors. After raising the concerns, a new manager was bought in to oversee this contributor’s work and began to undermine them and closely monitor what were described as ‘performance issues’.
The contributor hadn’t previously experienced any problems at work and felt that they were being singled out for speaking up. They were treated differently to other members of staff. For example, the new manager was unwilling to make any concessions to allow them to observe important cultural customs. They felt they were being treated less favourably than their non-BME colleagues.
3.3.6 After raising a concern, BME staff were:
• more likely to report being victimised or ignored by management than staff from a white background
• slightly more likely to report being victimised by co-workers than staff from a white
background
• less likely to report being praised by management than staff from a white background.
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Figure 3f – Reaction of management and co-workers to BME staff raising a concern
Source: Freedom to Speak Up staff survey
25 20 15 10 5 (% of respondents) 0
Victimised by Ignored by Victimised by Praised by management management co-workers management
White background BME background
“ I’ve seen, and I know my colleagues have seen, a large pattern of South Asian origin doctor whistleblowers, because I think there’s a different culture. There isn’t that collegiate med school, we’re all in this together, rugby team mentality that might exist a little bit more with UK educated doctors, although I may be showing my own prejudice here. Asian doctors – South Asian doctors in particular – can find themselves ostracised very quickly.”
3.3.7 In addition, after supporting a colleague who had raised a concern, BME staff were:
• more likely to report having suffered detriment than staff from a white background
• more likely to report having been victimised by management compared to staff from a white background
• more likely to report having been victimised by co-workers compared to staff from a white background.
3.3.8 BME staff reported being less likely to raise a concern again if they suspected wrongdoing than staff from a white background.
BME staff in primary care
3.3.9 A similar survey of staff in primary care (GP practices and community pharmacies) was carried out. About 24% of primary care staff who responded were from a BME background. This excludes those reporting themselves as white non-British. As for the trust survey, the largest BME group was from an Asian or Asian British background, making up about 16% of the total respondents and about two thirds of the BME respondents. The vast majority of respondents (almost 95%) worked in pharmacy.
Differences between responses from BME staff in trusts and primary care
3.3.10 The messages from BME staff in primary care were broadly in line with those from BME staff in trusts. However, trust staff from a BME background were considerably less satisfied with the response to their concern than staff from a white background whereas BME staff in primary care were broadly as satisfied as staff from a white background. The reason for this is not clear from the survey response.
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Suggestions to improve the process and outcome of raising concerns for BME staff 3.3.11 Suggestions from BME staff to improve raising and handling concerns were in line with suggestions from other contributors such as:
• culture change
• clarification of the process
• a named contact in each organisation to act on concerns raised
• stronger leadership
• better accountability
• more transparency.
3.3.12 One BME specific suggestion was that CQC should consider as part of their inspection process issues such as:
• how many BME doctors are undergoing a disciplinary process
• how many BME doctors have excellence awards
• the outcome of incidents amongst BME patients alongside the outcome of concerns raised by BME staff.
3.4 Employers
Introduction3.4.1 Employers and their representatives
(referred to as employers in this chapter) highlighted examples of good practice to learn and build from in terms of raising and handling concerns and suggested the focus be on drawing attention to such examples and encouraging their spread across the NHS. They accepted that there was room to bring all up to the standard of the best. They favoured practical, rather than legal or regulatory, solutions. Overarching issues
Culture
3.4.2 Evidence from the qualitative research indicated that employers fall into two groups when handling concerns:
• those who might be described as ‘gatekeepers’, who seek to maintain and emphasise the formal boundaries of what the law recognises as a protected disclosure resulting in a
somewhat inflexible approach to what can be covered and how it can be addressed
• those who adopt a more flexible open-minded approach, experimenting with less rigid
procedures aimed at increasing communication and engagement throughout the organisation.
“ Leadership in the NHS is about receiving feedback day-in, day-out with a view to improve. It’s the way we need to be, and many are.”
3.4.3 Employers recognised that a move from a blame culture to an open, transparent and learning culture was important and necessary and that culture starts at the top of an organisation. However, they noted that there could be very different cultures in different parts of an organisation. They agreed that raising concerns should be a normal part of the job for anyone working in the NHS.
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“ There is a unanimous view from employers that they want their staff to raise concerns, be curious, ask questions and shout up if they think patient safety is being compromised.”
3.4.4 Employers recognise that there are a
number of barriers that can still influence behaviour and prevent people speaking up such as: fear of being viewed as a troublemaker; fear of reprisals from colleagues and peers; and a lack of confidence that their employer will take their concern seriously. We heard how some trusts were taking action to address this.