Case study: Learning from local experience
3.6 Regulators Introduction
3.6.1 Eighteen system and professional regulators were sent a survey to find out about their role in advising on, and handling, staff
concerns. The survey results are published at www. freedomtospeakup.org.uk and summarised at Annex Diii. There was sufficient information to make tentative observations but not to distinguish between responses from professional and system regulators. A number of system and professional regulators also wrote in to the review and/or attended our seminars to share their views. Some focused on the action they had, or were taking, to improve their own processes and guidance. Others offered views and evidence to inform further thinking.
Overarching issues Culture
3.6.2 In line with a range of other contributors, professional regulators referred to issues related to culture including fear of being bullied or referred to professional regulators after raising concerns and factors such as divided loyalties and the ‘bystander effect’ that can be a deterrent to speaking up. System regulators also noted that negative connotations associated with the term ‘whistleblowing’ could act as a barrier to speaking up. One regulator noted that it gave a commitment that reports are used for local and national learning only and not for punitive actions so that healthcare professionals had no fear of repercussions from using their reporting systems.
3.6.3 As other contributors had done, regulators noted that some cases are complex with whistleblowing and human resource issues intertwined.
3.6.4 Some professional regulators stressed that patient safety depends upon a learning culture where errors and near misses are openly discussed and learnt from. However, absence of a blame culture may not be sufficient to encourage staff to
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be open about mistakes. Any attempt to change culture without a better understanding of the human and organisational behaviour factors that underpin it risks continued failure.
Consistent approach among regulators
3.6.5 A common understanding about what good looks like in terms of raising and handling concerns is needed so that regulators are consistent in their judgement about organisations on this issue. Partnership working
3.6.6 The broader agenda related to raising concerns required partnership working by national and local organisations. One regulator stressed that all parts of the healthcare system (employers, professional bodies, unions, educators, commissioners, regulators, insurers and the legal system) needed to promote a common expectation that everyone who works in the system must:
• speak up without delay
• encourage and support a culture where anyone can raise concerns openly and safely
• listen to, respond appropriately to, and learn from any patient safety concerns
• hold to account anyone who mistreats someone because they have raised concern
• be held to account, by employer and regulator, if they fail to do any of this or mistreat
someone because they have raised a concern. Raising Concerns
3.6.7 Our survey of regulators indicated that the majority allowed concerns to be reported anonymously. The majority also sought to ensure the confidentiality of a named person raising a concern although most noted that this might not be possible in all circumstances.
3.6.8 Some professional regulators stressed that registrants have an individual ethical responsibility to raise concerns. However, managers and team leaders should encourage and support a culture where staff can raise concerns openly and without
fear of reprisal. They noted that experiences of registrants raising concerns in the workplace were mixed, with some reporting poor experiences. Raising concerns to a professional regulator was seen as a last resort.
3.6.9 System regulators appeared to place great value on information from staff acknowledging that every concern provides them with vital information to help understand quality of care.
“ It is absolutely priceless to have the
whistleblowing information in terms of being able to target your time and energy. And also when we get whistleblowers it does say a thing about the trust and why these people are sharing information with us and they can’t share with the trust. So, it is always important and useful to hear specifically from whistleblowers.”
3.6.10 Staff sometimes approach a regulator in an attempt to relieve themselves of the ‘burden’ of the concern. Regulators do not have the remit to resolve individual cases but sometimes staff feel that they have no one else to turn to. A regulator is not always the best body to help and this can leave its staff ‘feeling relatively helpless’ as well as leaving the person raising the concern frustrated. There could be an impact on both the whistleblower and on the staff of the regulator dealing with them.
“ Some come to us because they’re dissatisfied with the response they’ve had from the Trust. Some come to us because they don’t have faith in their managers to address it robustly, and some come because they can raise concerns with us anonymously, and they feel more secure in doing that.”
3.6.11 Professional regulators noted that staff need to know how to report, what to report, or when to report. They need tools to challenge and raise concerns so that they did not progress to the extent that individuals felt compelled to blow the whistle.
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Handling concerns
3.6.12 People should initially report concerns about suspected wrongdoing to their employer. One system regulator cautioned against any changes that might undermine the existing responsibility of providers in this area.
3.6.13 Professional regulators noted that whistleblowers should be supported and encouraged to be part of a solution, and not penalised or discriminated against. The need for collective reflection was also highlighted.
3.6.14 One system regulator noted that some concerns cannot be corroborated and suggested that the Review needed to strike a balance between encouraging an open reporting culture while ensuring that public money and time is appropriately spent. Another highlighted the need for coordination between regulatory bodies where the focus of concerns raised is difficult to identify.
3.6.15 The majority of regulators stated that they kept the person reporting the concern informed of progress of any investigation and some also noted that they publish the number of concerns raised with them, the number of investigations conducted as a result of concerns being raised and the outcome of investigations.
Resolving concerns
3.6.16 Regulators agreed with the view of employers (see 3.4) that giving a whistleblower a response to their concern did not guarantee ‘closure’ for that person.