Who do I approach in order to raise a concern?
Generally, it will be advantageous to follow the procedure set out in your employer’s raising concerns policy. If you don’t know where to find this, contact your human resources (HR) department.
Following your employer’s procedure should help to protect you if you are later subjected to detrimental treatment. It is also in accordance with your employment contract to respect and follow internal procedures. If you have any concerns about following your employer’s raising concerns policy then you should contact the contact the BMA or Public Concern at Work (PCAW) for guidance on how best to proceed.
Your employer’s policy should have information such as that included in steps 1 to 3 below. When you are preparing to raise a concern, ensure that you keep dated records and notes of the issues that you are concerned about for reference throughout the process. At any stage, whether you are following your employer’s policy or the steps outlined below, you can contact the BMA or PCAW for support and advice.
In normal circumstances, you should initially raise concerns with your immediate clinical team by informing your line manager or head of department. If you feel uncomfortable doing this or for any reason you think it would be unhelpful, you may prefer to speak to someone else in your organisation. Your employers’ raising concerns policy should contain a formal procedure and give the name of a designated officer who you can speak to. If for any reason you are unable to raise your concern with the designated officer, we recommend that you contact us for guidance.
Some issues (such as bullying or discrimination against staff by other staff) should normally be raised under a separate dedicated policy such as a grievance policy or dignity at work policy. It is important to use the right policy. If you are unsure which policy to use, it may be helpful to speak to your human resources department. Alternatively, you can contact the BMA for guidance.
Your employer’s raising concerns policy may require you to make a written record or report of your concern. If it does not, it is advisable to do this, either by raising your concern in writing in the first instance, or, if you raised your concern orally, to make a dated note of what you said. It is also advisable to make use of formal reporting methods where appropriate. Doing this can be essential to protecting yourself legally while also making it more likely that your concerns will be taken seriously and addressed.
Raising a concern in writing could include:
- Emailing your line manager, supervisor, or a senior colleague to initially raise or follow up your concern (if this step is not already part of your employer's policy). For example, this could relate to knowledge of future staffing shortages, concerns about cross covering too many wards or unfamiliar specialties, or difficulties with handover to other specialties.
- Exception Reporting, for Junior Doctors on the 2016 junior doctor contract. You can use exception reporting to raise workload issues, or missed breaks and educational opportunities, for example.
- Using an Incident Reportingsystem such as Datix to formally record issues which have resulted in patient harm or a near miss that require an organisational response. For example, you might report a computer systems failure delaying access to blood results, lack of bed capacity, failure to stock and check emergency trolleys, or recurrent or predictable staffing issues.
While it is essential for patient safety, and for your own accountability, to report concerns as they arise, it is important to remember that not all concerns will be 'protected disclosures'. The whistleblowing legal framework is specifically designed to protect workers who raise concerns about about one or more of the following issues:
- A criminal offence being committed;
- A person failing to comply with their legal obligations;
- A miscarriage of justice occurring;
- Health and safety being endangered;
- Environmental damage; or
- Information showing any of the above has been or is likely to be concealed.
For the protection to arise (i.e. the right to claim compensation if you are victimised for raising the concern), the worker must have reasonably believed that their concerns were both true, and in the public interest. Legal protection will still apply even where the disclosure turns out to be untrue, provided the worker reasonably believed it was true at the time.
The tribunals and courts have also emphasised the importance of making a 'disclosure of information' as opposed to simply expressing concern. Your disclosure is more likely to qualify as a 'protected disclosure' if it contains a factual statement about what is wrong.
In some cases, you will have serious concerns about the consequences of raising a concern. You may have reason to believe you will be met with resistance or face immediate reprisals. In those situations, you will need to carefully consider who you raise your concern with in the first instance. Alternatives to raising your concern with your clinical team or designated officer are discussed below.
Your employer's raising concerns policy should set out what the next steps are after you have raised a concern. Usually you will have the opportunity to hear from your employer what they are proposing to do to address your concerns. However, generally speaking, your employer does not have to provide you with all of the information they have relating to the concerns you raised or tell you everything they are doing to address your concerns. Having said this, if the problems you identified in your concerns are continuing you should raise them again, particularly where someone's health or safety may be at risk.
If your concerns are not responded to by your line manager or the designated officer, you should notify the Medical Director of the concerns you raised, when you raised them and the fact that they have not been addressed.
If your concerns are still not being responded to satisfactorily then you may wish to escalate the issue again, up to the Chief Executive. We recommend if you do this that you ensure that your Medical Director is aware that you have taken this step.
If you have followed your employer's policy and your concerns have not been adequately responded to, you can consider raising your concern externally. See step four below.
In most circumstances, it is preferable, in terms of your legal rights, not to raise your concerns externally unless you have raised them internally first and not received a satisfactory response. This is because internal disclosures are more readily protected under the legal framework.
However, there are situations when it may be appropriate to proceed directly to raising your concerns externally and in certain circumstances the law can provide protection.
If you do need to raise your concern externally other organisations to approach may include the Care Quality Commission (successor to the Healthcare Commission), the National Patient Safety Agency, your local SHA, Local Health Board, NHS Board or Health and Social Care Trust (depending on where in the UK you work). In some circumstances, it may be advisable to raise your concern directly with your local elected representative (such as your relevant MP, MSP, AM or MLA) or the media.
We strongly recommend taking advice from the BMA or a defence body on how best to protect your legal position and your employment before raising a concern externally.