By Tony O’Reilly-
The National Health Service (NHS) of the United Kingdom finds itself facing a critical challenge when it comes to counteracting the discouragement of a culture of whistleblowing.
A deeply ingrained culture within the NHS discourages individuals from speaking out against wrongdoing.
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The risk of practitioners —essentially doctors -particularly surgeons and nurses to feel vulnerable on a daily basis to potentially ‘prying eyes’ and reporting ‘mistakes’ can be real and daunting; but evidence over the years has at the same time established the frightened need in all services, regardless of their field.
A prevailing perception among senior medical practitioners that whistleblowers have ulterior motives has often been used to tarnish their intentions as being driven by personal vendettas rather than genuine concerns for patient safety, according to nurse Stephen Goodchild, an adviser on The Eye Of Media’s thinktank in matters concerning the Nhs
Mr Goodchild (pictured)said: ‘I would say that there is a a prevailing culture that whilst publicly stating it fully supports and encourages whistleblowing, the actions I have seen over the years with seem to indicate otherwise.
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In relation to the statement of possible ulterior motives, there is another facet that should be taken into consideration. In the case of Lucy letby, her manager is now being investigated by the NMC for her fitness to practice; attempts to vilify one manager will not assist or help eradicate the problem, which I have heard, witnessed and seen over the years.
”There are staff who have been moved along several times in their career, but not promoted up, Goodchild said.
”Apparently, after some time, it becomes inevitable that this person is promoted up without the realization that they were not particularly capable of doing the job they are paid to do, let alone being moved up the ladder.
”Unfortunately, this often leads to a case where somebody is promoted to a level beyond their own incompetence.
‘In one case, a nurse in charge of an accident and emergency unit and would cry every time they saw blood and require counselling from their colleagues and up to two hours time away from the floor .
‘Whilst appreciating not everybody can do everything it would seem to be an oxymoron to have a chief accident and emergency nurse who cannot deal with seeing blood.
”There is example after example of different trust staff moving by “mutual agreement”, meaning they are, in the trade’s eye at least, under investigation for some other indiscretion.
”There is also a fact that should be taken into account that within specialist units such as but not precluded to , accident and emergency, intensive care, units, neonatal or surgery, staff sets here tend to form into networks of protection or clicks, these being essentially held together by a set of managers.
”If you are a member of one of these groups, you working life would feel well supported. If however, you fall out or are not one of these groups, your working life can be made to feel like a living hell sometimes in manner of shift patterns, designated patients or areas, staff support or even in some cases, negotiated hours being switched last minute or even cancelled.
”In some instances, it would feel like nurse managers have some form of agreed cognitive bias that gets set into motion if their motivations or actions are questioned.
Suspicion of ulterior motives do not justify proper independent investigations when complaints are made.
This sentiment is particularly concerning given the critical role that whistleblowers play in uncovering negligence, misconduct, and malpractice, ultimately safeguarding patient well-being.
Competitiveness and Bullying Culture
Beyond the skepticism toward whistleblowers’ motives, allegations of competitiveness and bullying culture within the NHS pose significant barriers to accountability.
The NHS, like any other large organization, is not immune to internal rivalries and power dynamics, but in a highly demanding and stressful environment, the need to maintain one’s professional reputation can inadvertently lead to suppressing dissenting voices.
Good child continues: ”This competitive mindset not only stifles communication but also fosters an atmosphere where speaking out against potential wrongdoing is seen as a threat to personal advancement.
”Moreover, the presence of a “better than thou” attitude among medical professionals further exacerbates the issue.
”When colleagues perceive themselves as superior or infallible, admitting to mistakes or raising concerns becomes challenging, if not impossible. This creates a culture where accountability is overshadowed by the need to protect reputations and maintain an appearance of excellence.
The Case of Lucy Letby and Its Implications
The case of Lucy Letby, the nurse accused of murdering several babies, serves as a harrowing reminder of the consequences of failing to address issues related to whistleblowing.
Letby’s alleged actions underscore the importance of early intervention and the value of open channels for reporting concerns. It is imperative to examine how the existing culture within the NHS contributed to the delayed recognition of potential red flags and the hesitancy to report suspicious behavior.
Solutions for Improvement
Addressing the culture of discouragement surrounding whistleblowing within the NHS requires a multifaceted approach that encompasses structural changes, cultural shifts, and robust safeguards for reporting concerns. Here are a few potential strategies to consider:
The Implementation of mandatory training programs for all medical professionals to foster an understanding of the importance of whistleblowing and its role in upholding patient safety. This education should include real-life case studies and examples of positive outcomes resulting from whistleblowing.
Confidential and independent reporting systems where individuals can raise concerns without fear of reprisal would be a useful way forward.
These systems should be accessible to all employees, ensuring anonymity and protection from potential consequences.
Good child added: ‘A shift in the overall culture within the NHS. Promote an environment that values transparency, accountability, and the well-being of both patients and staff.
‘Leaders should actively promote an open-door policy and lead by example in addressing concerns.
”There should also be legal protections for whistleblowers to shield them from retaliation and provide avenues for seeking legal recourse if necessary to alleviate concerns about personal and professional consequences.
There have also been suggestions that the introduction of external oversight mechanisms to ensure that whistleblower reports are thoroughly investigated and acted upon. This would reduce the potential for internal biases or conflicts of interest to impact the resolution process.
The healthcare system’s commitment to patient safety and the well-being of its employees hinges on its ability to address this issue head-on.
A multifaceted approach, encompassing education, structural changes, and cultural transformation is necessary to create an environment where individuals feel empowered to raise concerns without fear of retribution.
As the NHS navigates the aftermath of cases like that of Lucy Letby, the imperative to encourage a culture of accountability and transparency becomes more urgent than ever.
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