Yesterday our Chair, Professor Terence Stephenson, shared his personal reflections about whistleblowing and the everyday challenges of raising and acting on concerns with a group of consultants at a symposium hosted by the Royal College of Physicians of Edinburgh.
You are a young consultant and you have just started working at a new hospital. You realise that, as a direct consequence of the actions of your senior consultants, patients are being put at much greater risk of dying. You try to raise the issue with your superiors but they do nothing and they even threaten to dismiss you. What do you do?
The case that rocked the medical profession
It is scarcely credible but this was the nightmare Dr Stephen Bolsin faced when he tried to put a stop to high risk cardiac surgery by two senior consultants at the Bristol Royal Infirmary between 1990 and 1995. For his efforts, he was marginalised in his post, shunned by employers across the UK and eventually had to resort to moving to the other side of the world in order to continue practising.
The courage Dr Bolsin showed was admirable and has led many doctors to question what they would have done in the same situation.
When they finally emerged, the full extent of the care failings at Bristol rocked the medical profession and a public enquiry into the events led to the development of the first clinical governance in the NHS. As a young consultant, the case had a profound effect upon me. The courage Dr Bolsin showed was admirable and has led many doctors to question what they would have done in the same situation.
What would happen today?
Doctors are much more likely today to raise concerns than they were 25 years ago. That reflects well on today’s doctors who are putting patient safety first. And there are now systems in place which didn’t exist when Dr Bolsin took his stand.
Organisations now have a statutory duty to ensure that they have robust clinical governance systems. And across the UK both Governments and regulators are acting to support whistleblowing through a variety of initiatives. The CQC’s National Guardian role aims to support those who raise concerns in the NHS and improve reporting culture; the Regulation and Quality Improvement Authority are undertaking a review of whistleblowing in Northern Ireland; in Scotland the Government is consulting on a proposed Independent National Whistleblowing Officer role; Healthcare Inspectorate Wales, a “prescribed body” under the Public Information Disclosure Act (designed to provide protection for whistleblowers), has a dedicated resource to investigate whistleblowing concerns.
NHS Employers’ Guardian map lets you see at a glance which NHS trusts have a Freedom to Speak Up guardian who can provide confidential advice and support to staff in relation to raising concerns
In addition, individual doctors are subject to annual appraisal; they also have to revalidate every five years, to show they are keeping up to date. Crucially, the GMC now has a remit to tackle deficient clinical performance, which we did not have in 1995. At that time the GMC could only deal with either unprofessional behaviour by a doctor or health problems suffered by a doctor.
The role the GMC plays in this is significant and we are determined to play our part.
But as we know only too well, in many organisations fear and hierarchy still inhibit honest and open conversation. What is needed? The answer is simple for us to say, less easy to achieve – a culture where doctors and other health professionals feel empowered and supported when they speak up. The role the GMC plays in this is significant and we are determined to play our part.
Changing the culture
In 2012 we published Raising and acting on concerns about patient safety making clear that doctors have a duty to act when they believe a patient’s safety is at risk, or their care or dignity are being compromised. Our leadership and management guidance also sets out what the GMC expect not just from front line clinicians, but also from their managers. We also have an interactive tool to help doctors decide what to do if they have a concern about patient safety.
But as we know only too well, in many organisations fear and hierarchy still inhibit honest and open conversation.
In 2014 we commissioned an independent examination by Sir Anthony Hooper to see what more we could do to support whistleblowers. One of the key recommendations was that organisations making a referral to the GMC should declare whether the doctor has raised concerns about patient safety. By gathering this information from the start, we can consider this throughout our decision making and make sure that we’re only investigating where it is necessary and appropriate.
We’ll be speaking to a variety of partners and organisations across the UK over the coming months and hope to start piloting this process in the summer. You can read more about the progress we are making in our action plan.
In July 2015 we launched new guidance jointly with the Nursing and Midwifery Council on the professional duty of candour, re-emphasising that doctors need to be open and honest with patients when things go wrong. And our sanctions guidance, which Tribunal Members use to help them reach their decisions, also emphasises the importance of openness. Tribunals will now consider:
- a more serious sanction if there is evidence that the doctor has failed to raise, or attempted to cover up, a concern
- a doctor’s apology to the patient or those close to the patient as evidence of insight
This guidance is also used by GMC decision makers when they are deciding whether to refer a doctor under investigation to a hearing.
The GMC supports local improvement of training environments by actively encouraging doctors in training to report safety concerns directly to us through our National Training Survey. More than 98% of over 53,000 doctors take part annually, and we make sure every serious concern they raise is followed up.
In 2012 we set up a confidential helpline for doctors worried about patient safety. To date it has received over 2,700 calls.
In 2012 we set up a confidential helpline for doctors worried about patient safety. To date it has received over 2,700 calls, leading to 288 fitness-to-practise complaints (about 339 doctors), including 145 full investigations.
The GMC also work on the front line to support doctors in difficulty and offer training on how to raise concerns, including through our Welcome to UK practice course. Over the last 18 months, our Regional Liaison Team (England) and our teams in Northern Ireland, Scotland and Wales have held over 165 workshops on raising concerns, for over 4,000 doctors and nearly 1,500 students.
Keeping up the momentum
Every doctor has a duty to raise concerns about patient safety but they must be able to do this without fear of unfair criticism, detriment or dismissal. We will continue to work with administrations across England, Scotland, Wales and Northern Ireland and other partners to ensure every doctor – whether they are starting out in their career or are a senior consultant – has the same protection if they ever need to blow the whistle.
Our confidential helpline is there to help doctors raise serious concerns and seek advice on patient safety when they feel they are unable to do so through their employers at local level. It is staffed by specially trained advisers during business hours (Monday – Friday, 9am-5pm). If you need to raise a concern call them on: 0161 923 6399.
Anthony Omo, the GMC’s Director of Fitness to Practise and General Counsel, talks about our response to the Hooper Review
Anna Rowland, Assistant Director of Fitness to Practise Policy at the GMC, outlines changes to the way we communicate to better support doctors during FTP processes