An NHS Scotland whistleblowing helpline has been subjected to criticism after the number of calls that it received declined considerably.
A new report suggests that calls being fielded by the helpline has plummeted by 75% since it was initially created just two years ago.
Critics suggest that it is ultimately utterly toothless, and can be considered little more than a token effort to address any whistleblowing issues.
Public Concern at Work (PCaW), an independent charity, has been paid over £50,000 to run the alert line for NHS Scotland since April 2014.
But only 18 whistleblowers actually called the helpline between July 2015 and January 2016.
Meanwhile, an NHS staff survey suggested that nearly one-quarter of employees believe it would be unsafe for their career to challenge “quality, negligence or wrongdoing” by staff.
And NHS Scotland’s chief executive, Paul Gray, has already conceded that staff fear being victimised for outlining wrongdoing in the NHS.
Dr Jane Hamilton, a campaigner and consultant perinatal psychiatrist, believes that an independent service must be set up instead.
“The bottom line is if it’s not independent and it has no powers, no statutory powers to investigate, then how can it be of any use at all?”
Meanwhile, Cathy James, chief executive of Public Concern at Work, defended the efforts of the hotline to field whistleblowing enquiries and information.
“PCaW run a free legal advice service for any worker in the UK who has witnessed malpractice and is unsure what to do. The service commissioned by NHS Scotland is substantially different to the one suggested by the petitioner. We believe that an investigatory service aimed at whistleblowing cases across the NHS could make a real difference to the experience of those raising concerns in the health sector, but this is not the service we provide to NHS Scotland or in any event.”
But James also acknowledged that the service has experienced problems.
“Raising concerns in any sector can present real challenges and far too often those who speak truth to power suffer as a result.”
Nonetheless, James was adamant that PcaW were providing a valuable service.
“Our service receives outstanding feedback from those who use it and it is incredibly valuable to have access to truly independent advice, but we cannot remove the risk of a negative response entirely – the real power here lies with the health boards and the regulators. As a society we must do more to celebrate and champion whsitleblowing rather than allow the suffering to continue. There is much work to do.”
Scottish Health Secretary Shona Robison also defended the hotline, but noted that the fears staff have expressed regarding whistleblowing should be taken seriously.
“All staff should have the confidence to speak up without fear and with the knowledge that any genuine concern will be treated seriously and investigated properly. The NHS confidential alert line provides a safe place where they can confidentially raise any concerns they may have about malpractice and wrongdoing in NHS Scotland. Increasingly, callers have raised their concern internally first, which may suggest staff feel more confident using internal procedures.
Robison also announced that “work is also under way to establish the independent national whistleblowing officer who will provide external review on the handling of whistleblowing cases in NHS Scotland”.
An investigative report conducted by The Daily Telegraph has suggested that whistleblowers in the NHS face the prospect of being blacklisted due to insufficient legal protection.
Maha Yassaie had been awarded £375,000 compensation from the Department of Health, following an internal enquiry which revealed that she had been informed she was too honest to work for the NHS.
Yet the post-NHS career of Yassaie has been frustrating, with The NHS apparently having indicated that she had been dismissed from her previous job, even though this was not accurate.
Many other individuals have experienced similar problems, pointing to a toxic culture for those who go public on problems and potential corruption in the health system.
And experts on the matter, speaking to The Daily Telegraph, suggested that the error could in fact be malicious.
Yassaie herself stated that she was an experienced and highly paid manager, with a fantastic career in the NHS, and has found that the health service is completely destroying her future employment prospects.
John Bowers QC, considered one of the biggest experts in Britain on employment law, suggested that there is a lack of specific protection within existing legislation, and that this can lead to the unwarranted blacklisting of whistleblowers.
Bowers is also principal of Brasenose College at Oxford University and sits as a Deputy High Court Judge.
“It is a problem that there is no law that stops blacklisting of whistleblowing claimants. It is particularly serious in the NHS for two reasons. Firstly, because there are more whistleblowers in the NHS than anywhere else, due to the nature of what people deal with. Secondly, although there are lots of different employers, it is effectively one large super employer. And if you are blacklisted by one, you are probably not going to get another job. For many things it is effectively a monopoly organisation.”
The Information Commissioner’s Office suggested that the Department of Health Had been put in an unfortunate position by data protection legislation.
“If someone was dismissed then that would be included, but if it is established that they were dismissed unfairly, a note should then be added to the record. An individual is entitled to this under the Data Protection Act.”
Meanwhile, the Department of Health insisted that all of its staff records are accurate, and that it has fully complied with the existing Data Protection Act.
“We want to make the NHS the safest healthcare system in the world and will support staff to speak up when things go wrong, without fear of reprisal. That’s why, as well as working with individuals to ensure that their electronic staff records are accurate and up to date.”
Recent efforts have been made to ensure that whistleblowers can indeed come forward in the NHS, but it seems increasingly clear that these have been inadequate.
The NHS has been forced to endure a major embarrassment, after the resignation of an individual who was appointed to a key position only two months ago.
Dame Eileen Sills was appointed as the first ‘national guardian’ with a remit to support NHS whistleblowers, but has resigned from the post.
Sills indicated that her decision was related to her commitment to patients and staff at Guy’s and St Thomas’ NHS foundation trust, where she remains the chief nurse.
Commenting in a statement posted on the website of the Care Quality Commission, Stills pointed to the fact that combining the two roles was simply too demanding.
“It has been a very difficult decision to take, but after two months it is very clear that it is not possible to combine the role of the national guardian – and establishment of the office – with the increasing challenges NHS providers face, while doing justice to both roles.”
Nonetheless, the chief nurse looked forward to fulfilling her new job with requisite concentration, predicting that it would be both difficult and challenging.
Only one month ago, Sills had stated that it was her intention to contribute to and deliver “a new culture of transparency and openness”.
But evidently the job has proven to be too demanding considering her existing schedule.
At the time of her appointment, Sills indicated that she would work two days a week in her new role, and stated that she considered it to be particularly important.
“It is very important to me that I remain present in my NHS trust. My new appointment has to give credibility to the role, but I also need to be there for staff.”
Yet despite the potential embarrassment of this rather fleeting appointment, the decision has not come as a surprise to many experts and analysts.
NHS observers have suggested that the position of the Guardian should be a full-time commitment, and thus many sages have suggested that the decision of Sills was inevitable.
The CQC stated that non-executive support to the office of the national guardian had been offered by a CQC board member, Sir Robert Francis QC, until a new appointment is finalised.
Francis released a brief statement on his position.
“The office of the national guardian is a vital element in the drive to change the culture of the NHS to one which welcomes and supports staff who raise concerns.”
Francis’ review of the NHS in 2014 first opined that an independent national guardian for whistleblowers was a necessity.
At that time, Francis discovered that NHS staff who blow the whistle on substandard and dangerous practices were being ignored, bullied or even intimidated in a “climate of fear”.
Whistleblowers have suggested that unqualified foreign nurses are putting NHS patients in danger.
These individuals are often being inappropriately left in charge of hospital wards, and this is causing significant difficulties for NHS customers.
Overseas-trained nurses who have come to Britain to work are being asked to carry out critical duties they are not trained for.
This is an issue reflecting both NHS and private wards according to a concerned group of British nurses.
The nurses in question approached the media in an anonymous capacity, suggesting that unqualified nurses are becoming a major issue in the health service.
According to whistleblowers, unqualified nurses are being allowed to do sensitive tasks such as administering drugs and changing intravenous insulin levels for diabetic patients.
Commenting on the issue, the Royal College of Nursing suggested that the testimony was indeed deeply worrying.
Although the NHS relies on thousands of overseas nurses to boost its workforce, foreign-trained staff must pass a six-month university course and be registered with the UK Nursing and Midwifery Council.
Testimony from many of the whistleblowers suggested that foreign and from qualified nurses have been carrying out the duties of Band 5 individuals in the National Health Service.
This is an unusual and inappropriate situation, as such nurses should be working as lower-paid healthcare assistants in support roles until qualified adequately.
Commeting on the situation, J.P. Nolan, head of nursing practice at the Royal College of Nursing, was suitably worried about the issue.
“It is deeply worrying if some HCAs are being pushed into doing the work of registered nurses, particularly in the absence of any permanent, registered staff to supervise them. Many hospitals are still shockingly over-reliant on agency staff due to long-term staffing problems, but placing more responsibility on the unregistered, unregulated workforce is unfair on the staff and a very poor solution for patients.”
Several of the whistleblowers pointed to dangerous situations occurring within various NHS trusts.
The issue will further intensify the situation related to the training of nurses, with strike action planned to oppose the government’s plans to vastly change the way that student funding is conducted.
In addition, with evidence indicating recently that the NHS is particularly reliant on immigration in the nursing profession, there are clearly logistical issues for both the government and health service to face.
Once again, the issue is indicative of major structural issues that the NHS must address in the remainder of this decade.