Is it good to talk? Whistleblowing

Pharmacists and technicians have a professional obligation to blow the whistle if they are aware of wrongdoing, yet 15 per cent of whistleblowers end up getting the sack. P3 investigates the dilemma for those who may decide they need to speak out  

Investigations into health scandals such as those at the Mid Staffordshire NHS Foundation Trust revealed that some staff had concerns about what was happening but were unsure whether or how to raise them, or had raised the issue only to be ignored. In many of these cases the consequences were devastating for patients, families, staff and the organisation itself. This is why getting whistleblowing in healthcare right is vital. And it’s as relevant to pharmacy as it is to any other healthcare environment.

According to Health Secretary Jeremy Hunt, a ‘culture of openness’ is now spreading through the NHS, with almost 1,000 whistleblowers reporting poor care every month. Mr Hunt claimed in February that the NHS had moved on from the Mid Staffs scandal, with the Care Quality Commission having received 7,626 ‘contacts’ from whistleblowers in that financial year to date.

Whistleblowing, raising concerns and speaking up are all phrases that describe being able to disclose information safely to an employer or, where appropriate, a regulator, the police or the media about possible malpractice, wrongdoing or safety issues. Pharmacists and technicians have a professional obligation to report concerns under their code of ethics and under their NHS Terms of Service.

The GPhC’s ‘Standards of Conduct, Ethics and Performance’ standard 7.11 states that pharmacists and technicians must ‘make the relevant authority aware of any policies, systems, working conditions, or the actions, professional performance or health of others if they may affect patient care or public safety. If something goes wrong or if someone reports a concern to you, make sure that you deal with it appropriately.’

According to Health Secretary Jeremy Hunt, a ‘culture of openness’ is now spreading through the NHS, with almost 1,000 whistle- blowers reporting poor care every month

Whistleblowing responsibilities are also now enshrined in the NHS Constitution. And guidance on how to blow the whistle is available from the Royal Pharmaceutical Society, PSNC and the Care Quality Commission, among others.

The inside story

  • 83 per cent of workers blow the whistle at least twice, usually internally
  • 74 per cent of whistleblowers say nothing is done about the wrongdoing
  • 60 per cent of whistleblowers receive no response from management, either negative or positive
  • 15 per cent of whistleblowers are dismissed
  • Senior whistleblowers are more likely to be dismissed
  • Newer employees are most likely to blow the whistle (39 per cent have less than two years’ service).

The down side

Despite plenty of helpful support and guidance, the reality of whistleblowing can be rather different. Last year’s report on ‘Whistleblowing: the inside story’ (see box, top right) analysed the experiences of 1,000 whistleblowers and highlights why many workers are reluctant to speak out. The report was published by Public Concern at Work (PCaW), an independent charity that promotes accountability and responsible whistleblowing across all sectors.

PCaW chief executive Cathy James says: ‘From the Libor banking scandal, the Mid Staffordshire hospital inquiry and the Leveson inquiry into phone hacking, it is clear that staff did express concern that wrongdoing or malpractice was taking place. The worrying truth is that they are often ignored or, worse, discouraged, ostracised or victimised.

‘Media attention on whistleblowing makes for contradictory reading: ministers and employers say whistleblowing is vital for an open and transparent workplace culture, but ask the whistleblowers and the story is starkly different; they are gagged in the NHS, arrested in our police forces and blacklisted in many industries. While organisations may be better at addressing wrongdoing, they are still shooting the messenger and overlooking crucial opportunities to address concerns quickly and effectively.’

In light of these findings, PCaW launched a commission into the effectiveness of whistleblowing that made 25 recommendations, including that the Secretary of State should adopt the Commission’s Code of Practice, which would be taken into account by courts and tribunals. It also recommended that regulators require those they regulate to adopt this code, and that regulators become more transparent about their own whistleblowing arrangements.

The barriers

Whistleblowing legislation, in the form of the Public Interest Disclosure Act 1998, was introduced to protect workers from reprisals, dismissal and victimisation that might follow after the disclosure of concerns that are made in the public interest. The law states that people are protected against dismissal and detriment if their disclosure alleges criminal offence, failure to comply with a legal obligation, miscarriage of justice, risk to health and safety, or environmental damage. Disclosures are protected whether they concern actions or omissions that took place in the past or present, or are likely to occur in the future. The Act grants protection to those who raise a concern internally with their employer and a prescribed regulator (such as CQC). It allows employees who are sacked for whistleblowing to make a claim for compensation for unfair dismissal to an employment tribunal. In certain circumstances, disclosure to the media may be protected.

But this legislation does not protect the self- employed, such as pharmacy locums. Ideally, locum contracts should include a section on whistleblowing and specify how the locum can raise a concern and be protected for doing so. But it doesn’t work that well in practice, according to the Pharmacists’ Defence Association, with superintendents becoming more defensive than proactive when whistleblowing occurs. ‘There’s too much fear among locums because they’re concerned they won’t be re-booked,’ says John Murphy, PDA director.

Employees often have two main concerns about whistleblowing, says Mr Murphy. One is the fear of retribution, and the other is the risk/benefit consideration. That is, ‘Why put myself through this if nothing is going to change as a consequence?’

PDA chairman Mark Koziol urges employees not to underestimate the gravity of their situation and to report their concerns to organisations such as the PDA as early as possible. Pharmacists involved in unprofessional practice under pressure from their employer can face being struck off, he warns. ‘It’s too serious not to do anything about it.’

Airing concerns

The difference between making a complaint or grievance and blowing the whistle may not always be immediately obvious. Typically, a complaint or grievance is personal to the complainant and involves being poorly treated, breach of employment rights or bullying. These should be handled under an employer’s complaint or grievance procedure and the complainant is expected to prove their case. Whistleblowing issues have a component of others being affected (eg customers, members of the public, or an employer) and the person blowing the whistle may not be directly, personally affected by the malpractice or wrongdoing.

Guidance from the Royal Pharmaceutical Society recommends that the best way to raise a concern is to do so openly, although concerns can also be raised confidentially or anonymously. A worker raises a concern confidentially if they give their name only on condition that it is not revealed without their consent. But they raise a concern anonymously if they do not give their name. Guidance on drawing up whistleblowing policy for each pharmacy, which is a clinical governance requirement under the NHS contract, is available from the Society and PSNC.

If considering blowing the whistle anonymously, there are additional risks to consider:

  • Being anonymous does not stop others from guessing who raised the concern
  • It is harder to investigate the concern if people cannot ask follow-up questions
  • It is easier to get protection under the Public Interest Disclosure Act (see panel) if the concerns are raised openly
  • It can lead people to focus on the whistleblower, maybe suspecting that they are raising the concern maliciously.

Advice at hand

A whistleblowing hotline for NHS Scotland staff is set to continue after a successful pilot period began in April last year. PCaW, the service provider, undertook a six-month evaluation of the service and some of the feedback received indicates the value of the service, quoting a user as saying, ‘I’m glad I’ve got to this point and can now look forward to feeling satisfied that I have, at last, done something positive to deal with this experience.’ The hotline dealt with 146 cases reported by NHS Scotland staff between April 2013 and the end of the calendar year.

An RPS advice line has also been commissioned from PCaW, from which pharmacist members in any sector can get free, confidential advice on 0800 668 1883.

RPS eight core principles for pharmacy whistleblowing policies and procedures

All pharmacy whistleblowing policies and procedures should:

  • Be readily accessible at the place of work and available to all workers, including temporary staff, contractors and locums.
  • Comply with the good practice recommendations made within the British Standards Institute’s Code of Practice on Whistleblowing arrangements.
  • Contain a commitment to zero tolerance of victimisation for all persons, including workers, temporary staff, contractors and locums who have raised. whistleblowing concerns.
  • Remind pharmacists and technicians of their obligation in GPhC standard 7.11. relating to raising concerns.
  • Include options for the person raising the concern to do so on a confidential basis when requested.
  • Include an escalation process and options to raise concerns outside of line management, including detail of routes of contact for the superintendent and, where appropriate, how and when concerns can be expressed externally.
  • Be supported by a culture that encourages and reinforces the use of the policies and procedures as a valued governance mechanism.
  • Provide an explanation that distinguishes between a whistleblowing concern and a grievance.

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