Medical whistleblowing - a guide to raising concerns in the NHS

Whistleblowing is the popular term applied to a situation where an employee raises concerns to people who have the power and presumed willingness to take corrective action. All employers should have a formal policy for raising concerns, which will be known as the whistleblowing policy, and the doctor concerned should familiarise themselves with it. The Public Interest Disclosure Act 1998 gives statutory protection to employees who disclose information reasonably and responsibly in the public interest and who are victimised as a result.

It’s been a significant employment issue within the NHS. A BMA survey in 2009 found that three quarters of hospital doctors have had concerns about issues relating to patient safety, malpractice or bullying over the course of their careers. Seven in ten had raised the issues at their trust, but their experiences had often been negative, for example because they were unaware that anything had happened as a result (46%).

Types of concerns for whistleblowers

It can be hard to know whether a situation should be raised as a concern. Doctors should be guided by this question: if you let the situation carry on is it likely to result in harm to others? Typical issues might be systemic failures that have endangered patient safety; poor quality of care; malpractice; welfare of subjects in clinical trials; acts of discrimination or bullying or fraud; substance abuse or inappropriate relationships.

Issues with training may be a cause for concern for both trainees and trainers, and PMETB and postgraduate deaneries are empowered to address this type of concern. If a doctor contacts the deanery the training programme director would be the best point of first contact. This should be pursued if local routes, such as approaching the educational supervisor, are unsuccessful.

The welfare of subjects in clinical trials or other research may also be a cause for concern. If a doctor sees problems that the ethics committee did not then it is their duty to say or do something about it.

Professional obligations with whistleblowing

Raising concerns with a manager is an integral part of a doctor’s duty to maintain a professional attitude to colleagues and patients. Every doctor has an obligation to protect fellow colleagues, patients and themselves from unprofessional conduct or acts of clinical negligence.

There are specific obligations in the GMC’s Good Medical Practice on raising concerns about systemic problems. It says: “If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources, policies or systems, you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.”

There are also obligations about raising concerns about colleagues: “You must protect patients from risk of harm posed by another colleague’s conduct, performance or health. The safety of patients must come first at all times. If you have concerns that a colleague may not be fit to practise, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary.”

How should doctors raise concerns and whistleblow

Doctors must follow their employer’s policy on raising concerns to receive protection under the Public Interest Disclosure Act. The policy should identify who a doctor needs to raise the concern with and, if necessary, how to escalate it.

Generally a policy will request a doctor raises their concern with their team or their manager. If you feel uncomfortable doing this, speak to the designated officer. A confidential approach outside the line management structure should not be necessary in the first instance.

If the concerns are not addressed it should be escalated to the medical director. If they’re still not addressed it should be put through to the chief executive, ensuring the medical director is aware of this step.

Only once all the local workplace policies and procedures are exhausted should a doctor consider raising their concerns externally. Going to a local elected representative, such as an MP, or the media should only be considered if the employer has a record of ignoring, discouraging or suppressing concerns and the problem continues after having escalated through local procedures.

Concerns can be raised verbally or in writing. A doctor should provide some background and the reasons why they’re specifically concerned. Through the process a doctor should keep records of their concerns and steps that have been taken to resolve them.

Further consequences for whistleblowers

An employee who is victimised after having made a whistleblowing 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 heavy fines for employers in the past. Advice should be sought from their representative organisation.

Sources of support and information

Public Concern at Work provides information on whistleblowing in the NHS.

This article is a summary of the BMA’s Whistleblowing Guidance, which contains more detail and advice.

Tags: Whistleblowing