We understand that raising a concern can be a daunting prospect for any employee but the PIDA provides you with the necessary legislative support.
Newly published documents are intended to provide you with additional supportive mechanisms. For example, in addition to the GMC guidance referenced above, the Department of Health has amended the NHS Constitution and handbook to include a pledge on behalf of NHS organisations to support staff that wish to raise concerns following its consultation on the NHS Constitution and Whistleblowing.
3a. Staff - your rights and NHS pledges to you
The NHS commits:
“to support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Public Interest Disclosure Act 1998 (pledge).”
When you have identified whom to approach to raise a concern, you can do so either verbally or in writing. You will need to include some background with a history of your concerns and the reasons why you are concerned.
Ensure that throughout the process you keep records of your concerns and any steps you have taken to resolve them which you may need to use as reference at a later date. The ideal situation is one where you feel you are able to raise your concern openly where those involved know what the issue is and who has raised it. Openness can make it easier for your employer to investigate your concerns. However, in practice you may feel uncomfortable about being open and have good reason to wish to raise your concern confidentially.
Your employer’s policy should enable you to raise your concern confidentially, which means your name would not be revealed without your consent, unless required by law. When you raise your concern, whether this be verbally or in writing, you need to make it clear whether you are doing so confidentially. You do not need evidence and facts, although these are always helpful, but you do need to have a reasonable belief that wrongdoing is either happening, has taken place in the past or is likely to happen in the future.12
What should I expect when I raise a concern?
When you raise a concern you should be listened to carefully and without fear of detriment. Your concerns should be assessed as to how serious and urgent the risk is and whether the concern is best dealt with under the raising concerns policy or another local procedure. Consideration should also be given to whether assistance is required or if referral to senior managers, or a specialist function, is desirable or necessary. The issues you raise should be answered in writing summarising the concerns, noting whether you raised them openly or confidentially and stating the steps that will be taken to resolve the situation.
Will there be personal consequences for me if I raise my concerns?
The BMA recognises that raising concerns can sometimes require courage in the face of possible victimisation or other detriment, and the BMA will support those who face difficulties for having taken this step. An employee who is victimised after having made such a disclosure under the Act can bring a claim at an employment tribunal. There is no cap on the awards for victimisation, and there have been very heavy fines for employers in the past. This alone will give your employing organisation a strong incentive to protect you, quite aside from their moral and legal obligations.
Obviously being in such a situation can sometimes be stressful, but be reassured that there are protections there for you. If you feel under pressure, the BMA Counselling and Doctor Advisor service gives doctors and medical students in distress or difficulty the choice of speaking in confidence to another doctor. The service is available 24 hours a day, 7 days a week on 0330 123 1245.
Contact the BMA
The BMA will support you and you should contact First Point of Contact on 0300 123 1233 early or contact Public Concern At Work (020 7474 6609) to ask for help with raising concerns and speaking out about patient safety. If things are becoming difficult from the point of view of victimisation, again contact the BMA at the earliest opportunity.
Going directly to your local elected representative (such as your relevant MP, MSP, AM or MLA) or the media is only advisable if you have run out of options. The BMA can offer advice on whether any additional action ought to be taken before contracting your local elected representative or the media.
Managers: how should I act on a concern?
In the first instance, if you are in a position of management, creating an environment of openness is the overall objective. As the new GMC guidance makes clear, fostering a culture in which all members of staff feel able to raise concerns is a key obligation for all doctors.13 New guidance published by the Social Partnership Forum and Public Concern at Work outlines how to achieve this type of culture and why it’s important:
“Encouraging staff to raise any serious concern they may have about malpractice or serious risk as early as possible, and responding appropriately, is integral to achieving this. Importantly, it will help NHS organisations to deal with a problem before any damage is ever done.”14
This guidance also includes practical tips for managers in handling concerns such as the following:
- Thank the staff member for telling you, even if they may appear to be mistaken.
- Respect and heed legitimate staff concerns about their own position or career.
- Manage expectations and respect promises of confidentiality.
- Discuss reasonable timeframes for feedback with the member of staff. Advice is also provided in the area of developing policy, communicating it the staff and auditing arrangements relating to raising concerns.
Advice is also provided in the area of developing policy, communicating it the staff and auditing arrangements relating to raising concerns.
Raising and acting on concerns early – what are the benefits?
Raising concerns at an early stage should achieve an early resolution to the issue which will benefit you as an employee, the organisation and most importantly, the patients within your care. Withholding concerns when they arise may escalate the problem or situation and mean that the issue is not resolved as quickly as it could have been.