What is Whistleblowing in Health & Social Care?

Whistleblowing is when an employee raises a concern, in the public interest, about something which is illegal, poses a risk to others, is malpractice or otherwise constitutes wrongdoing. Whistleblowing in health and social care is especially crucial as workplaces which care for children and other vulnerable populations must be held particularly accountable for any wrongdoing and there must never be barriers in place to reporting and investigating any concerns quickly.

In this article, we will explore what whistleblowing is, the challenges and risks, the correct process, as well as an example of whistleblowing in healthcare.

What does whistleblowing mean in practice?

So, what could be reported under whistleblowing laws? This is complex but can include anything from bullying, lack of safeguarding, corruption, unsafe patient care or working conditions, lack of training or procedure and much more. Importantly, in all cases, the disclosure of the complaint must be in the public and not just for your interest. That means individual disputes, for example between 2 staff members, would not usually be considered whistleblowing.

In all cases, whistleblowing has to fulfill a few requirements.

1. You have to be an employee or otherwise contracted worker. This includes agency workers, volunteers and students.
2. You have to believe you are acting in the public interest. This means that you have to believe that others will benefit from you raising this concern and it cannot be solely for personal gain.
3. You are not committing an offence by raising the concern.
4. You must believe that what you are disclosing is true
5. You must believe that what you are disclosing falls within the regulatory remit of the agency you are reporting it to
6. You must believe that the concern you are raising shows past, present or likely future wrongdoing of several categories, including criminal offences, miscarriage of justice, failure to comply with legal obligations, safety concerns and others.

If a healthcare worker feels that they cannot raise a concern themselves with an employer they can use a ‘prescribed person’ which is an individual or an organisation which the government has decided is qualified to receive information about certain wrongdoing or crime which may be the subject of whistleblowing. Usually, this means a regulatory body or a professional association. In healthcare, this is usually a body such as the Care Quality Commission (CQC), which regulates all health and social care services in England, the General Medical Council (GMC), who regulate doctors, the Nursing and Midwifery Council (NMC) who regulate nurses, nursing associates and midwives, and many others.

A prescribed body is responsible for listening to concerns, investigating any report made, and taking action where necessary. This adds protection for those who need to raise concerns as they do not have to contact their employer directly and it provides reassurance that all concerns are addressed impartially. It is important to contact the correct prescribed body and when safe and possible to do so, raise concerns with the employer directly first to ensure they can be resolved swiftly.

How it applies to health and social care

As we said before, this is particularly important in health and social care to maintain the high ethical standard that all healthcare professionals must be held to as well as to protect patient safety.

You can also think about this in terms of medical ethics.

Autonomy, the patient’s ability to make decisions for themselves, is often the subject of complaints made as part of whistleblowing. This is particularly serious as it is often a large-scale problem rather than an individual report. An example of this is cases where medical error has been concealed.

Beneficence, to act in the best interest of the patient, must be maintained and in cases where healthcare workers are found to be taking actions which go against good patient care, this must be reported.

Non-maleficence, to prevent harm coming to your patients, is often the subject when there are unsafe working practices, such as understaffing, lack of training or non-disclosure of medical error. When these include a risk to children or vulnerable adults this can also be reported to local authorities.

Justice, the fair distribution of resources and treatment, often becomes the subject of whistleblowing when there are discriminatory practices in place or patients are otherwise not receiving fair and equitable care.

It is important to remember that all healthcare providers have a duty to protect their patients and that includes reporting any concerns about patient care that they have within their workplace.

Why it’s important

Whistleblowing in healthcare is important, as it awards legal protections to those who disclose systemic issues and allows them to be investigated impartially. This prevents harm from coming to patients and upholds trust in healthcare workers and the NHS. It also promotes transparent working practices and enhances accountability within the system.

Challenges and risks

Medical whistleblowing faces some challenges and risks.

As you may imagine, the primary concern of many whistleblowers is retaliation. This means that employers may disadvantage or otherwise unfairly mistreat employees if they raise concerns. This can include impact on career progression, learning opportunities and unfair treatment when it comes to shifts and leave. This can happen but there are legal protections in place to prevent this from occurring and protect those who make reports (See “How can a whistleblower be protected legally?“). Sometimes legal protections may be inadequate or poorly enforced which can put whistleblowers at risk.

The psychological impact of whistleblowing is also important to take into account. Whistleblowing can cause employees to feel stressed, anxious or depressed and can be associated with mental health disorders. This can cause issues in their personal life and workplace relationships as well, especially if the intentions of the report are misinterpreted. It is therefore especially important to offer support to peers or employees that raise concerns in this way.

Confidentiality also poses issues when making reports and whistleblowers may face both personal as well as institutional backlash over this. This can be added to by lack of support and complex reporting practices (see ”What is the process for whistleblowing?”)

What are some reasons somebody in health care might whistleblow?

We’ve already discussed some cases of why someone might whistleblow but some more specific examples include:

1. Unsafe staffing levels risk patient safety, for example when for prolonged periods of time there is an inadequate number of doctors, or no doctors available
2. Systemic abuse of patients, especially those who are vulnerable populations, for example, cultures of bullying or belittling patients
3. Systemic bullying of healthcare staff and other unfair treatment, for example, when healthcare workers refuse to communicate or systematically exclude or mistreat another employee, or if management does this.
4. Violations of confidentiality or unsafe practices for data storage, for example if paperwork is improperly stored in an area easily accessible to the general public
5. Unethical research practices, for example, research being carried out without ethical approval

Legal protection for a whistleblower?

The legal protection for whistleblowers is complex. In simplest terms, there are 5 main guidelines, laws and organisations in place to help protect whistle-blowers and enable them to make reports without facing unfair repercussions.

The first is a law, the Public Interest Disclosure Act (1998) which is the primary protection for whistleblowers in the UK. It protects people who disclose malpractice, illegal activity or danger in the workplace. There are additional rules in place for this as well but at its core, this law protects anyone who makes a disclosure about the aforementioned topics in the name of public interest from unfair dismissal, victimization and other unfair treatment. The Employment Rights Act (1996) is the original document to which the Public Interest Disclosure Act adds and affords some protection by itself as well.

The Prescribed Persons and Bodies Order (2014) outlines what a prescribed person is and lists individuals and bodies that can act as a prescribed person. We’ve already covered the role of prescribed persons but it is important to remember that not everyone or every organisation has the right to act as a prescribed person.

In health and social care, the Health and Social Care Act additionally outlines that health and social care providers must have policies in place that protect whistleblowers and make it safe and possible to report concerns. Individual NHS trusts should also have specific policies and support available to protect and encourage those who need to report a concern through whistleblowing including helplines and nominated persons to contact about concerns.

Finally, the Care Quality Commission (CQC) which regulates health and social care services, and the GMC which regulates doctors and is nominated to protect doctors in case of whistleblowing can offer assurance and help, especially if someone is already facing repercussions due to a report they made.

What is the process for whistleblowing?

The process for whistleblowing will differ depending on the concern that is being reported but tends to follow the same structure. Once a concern, such as illegal activity, has been identified, it should first be reported internally wherever possible. Dedicated hotlines and email addresses exist in some trusts and organisations to make this process easier or more confidential. If the person reporting the concern is unsure what to do there are organisations such as the charity Protect which can help advise them.

If concerns are not being taken seriously, or acted on or if it is not possible or safe to report it internally then it can be escalated to external bodies which can act as prescribed persons.

All concerns, whether reported internally or externally, should be investigated promptly and if the whistleblower wishes they can receive updates on the investigation (unless they have reported anonymously).

An example case study

A good example of how whistleblowing can be successful is the Mid-Staffordshire NHS Foundation Trust whistleblowing case, leading to the Francis Enquiry. In this case, significant failings from 2005 – 2009 were found to have led to the death of between 400 – 1,200 patients due to inadequate basic care and staffing levels as well as a systemic issue with bullying among staff which resulted in many being afraid to raise concerns.

When whistleblowers reported concerns they said they felt ignored and felt discouraged from speaking out about issues. Many said they feared retaliation as well as new or increased bullying from management staff at the trust. However, the concerns raised led to investigations being carried out which exposed systemic failures in patient safety and other areas within the trust. These included a lack of compassion with patients and a focus on financial targets over patient care. Both regulatory bodies as well as the trust itself faced criticism from the inquiry and the media for failing to act on initial reports and warning signs.

The Francis report made many recommendations including implementing Duty of Candor in guidelines and the Freedom to Speak Up Campaign. This appointed whistleblowing guardians to make the process more accessible to those who need to use it.

Despite this, whistleblowers and those who raise concerns are not always taken seriously. If you want to read more about cases of whistleblowing you can look at:

1. Dr Ranson Case
2. Mr M Pitman Case
3. Chris Day Case

You can also research around the case of Lucy Letby, which has been heavily publicised and think about how this case may relate to whistleblowing in health and social care.

Unfair treatment after whistleblowing

No one should be treated unfairly after whistleblowing and we have discussed how various organisations will protect whistleblowers. If someone is being treated unfairly after whistleblowing then this can and must also be reported. In some cases, unfair dismissal cases have been brought against their trust by whistleblowers and those cases can be fully, or partially successful. It is important to consider that while protections are in place, whistleblowers still face issues in the workplace and must be supported whenever possible so concerns can be raised in a timely and safe manner.