Whistleblowers - heroes not headaches

The recent Francis review of whistleblowing in the NHS has recommended promoting a culture where people feel safe to report concerns. But how have previous whistleblowers responded to the report? What is the future of whistleblowing, and what role do psychologists have to play?

The Freedom to Speak Up report was carried out after concerns had been repeatedly raised over whistleblowing in the NHS, with a 2013 staff survey showing only 72 per cent of respondents confident that it was safe to raise a concern. Sir Robert Francis's review found mistreatment of whistleblowers in the NHS, as well as people who lost their jobs after raising concerns. Contributors frequently described a culture of fear, blame, defensiveness and 'scapegoating' when concerns were raised. The report noted: 'These perceptions of the culture, real or otherwise, result in some staff refraining from raising concerns.'

Sir Robert writes in his report that a vast majority of those who wrote to the review spoke of bad experiences: 'Many described a harrowing and isolating process with reprisals including counter allegations, disciplinary action, and victimisation. Bullying and oppressive behaviour was mentioned frequently, both as a subject for concern and a consequence of speaking up.'

In concluding his review, Francis sets out 20 principles and actions for implementation by NHS organisations that provide healthcare. These include a suggestion that psychological support and counselling should be available to those who raise concerns. He writes: 'We heard harrowing accounts from people about anxiety and depression due to the stress and repercussions of raising a concern, and in too many cases counselling appeared to have been promised but never materialised.'

The recommendations also include creating a shift in culture where staff feel safe to raise concerns and are free from being bullied. Structures need to support people in raising concerns formally and informally, and once a formal concern is raised these should be investigated promptly. 'Freedom to Speak Up Guardians' across organisations could give people someone to turn to.

The British Psychological Society submitted a response to the Francis review (see also box). Neuropsychologist Narinder Kapur, a Chartered Psychologist and Fellow of the Society, contributed to the response. Professor Kapur was dismissed from Addenbrooke's Hospital in Cambridge where he worked as a consultant, after raising concerns about patient care and safety. He suggested his role as a psychologist was probably central to his raising concerns: 'As psychologists we are trained to observe, analyse and try to understand behaviour, and also ways in which behaviour can be changed for the better. When concerns are raised, and when those who raise concerns are badly treated, usually there are key behaviours at the core,' he said.

Professor Kapur, who now works as a visiting professor of neuropsychology at University College London, added there was some hope for the future after the review and praised its recommendation of installing Freedom to Speak Up Guardians in the NHS, as well as the suggestion of ensuring psychological support was available to those who do raise concerns. He said there would be a role for psychologists in the future of whistleblowing and not only in providing support: 'Psychologists may be able to give advice on patient safety issues that underlie concerns, since many of these issues have a behavioural component. They may help to understand and modify management behaviour, which is often critically involved in the treatment of those who raise concerns.'

However, Kapur also said he had some major concerns over the report, adding that the lack of redress for the suffering of those who had previously raised concerns had caused sadness among many whistleblowers. 'The Francis Report does not go far enough to reward those who have raised concerns or in the future will raise concerns. I propose an award scheme, similar to that announced by the Prime Minister for those NHS staff who went to Africa to help with the Ebola crisis. These staff took risks to put the care of patients before their own well-being, and a few have suffered. NHS whistleblowers also took major risks, and many more have suffered.'

Kapur added: 'In that small group of sacked whistleblowers who met Jeremy Hunt and Simon Stevens in June 2014, four were black and minority ethnic staff. Yet, not a single member of the Francis Review Team was black and minority ethnic. That was an unfortunate omission.' The review did note 'a perception that BME staff are more likely to be referred to professional regulators if they raise concerns, more likely to receive harsher sanctions, and more likely to experience disproportionate detriment in response to speaking up.'

Dr Hayley Dare is former clinical lead of women's forensic directorate and consultant clinical psychologist at West London Mental Health NHS Trust. Despite a 20-year career in the NHS, she was sacked after raising concerns. Dr Dare told us that she followed the Trust's whistleblowing policy and spoke to the Trust's chief executive Steve Shrubb in March 2013. After falling ill with anxiety and severe depression, she took time off work and began discussing her return. However she soon received a three-line e-mail telling her she was being dismissed.

Dare told us that she had some concerns over the Francis review, and that not enough had been done to protect whistleblowers. 'The latest Francis Report did nothing to actually protect whistleblowers. If you ask senior managers, they don't want whistleblowers in the organisation. Whistleblowers are viewed as "headaches" that need to be silenced as quickly as possible. There may be a pseudo-investigation into claims, but when are these investigations truly independent? NHS career managers investigating for the Trust in which they work, are simply covering their own backs.'

Dare added that she was 'deeply saddened' at how whistleblowers are treated. She said: 'In my view, I want the NHS to be flooded with whistleblowers. They are the staff who care about patients. Managers need to realise that the NHS was not set up to give them a job, it was set up to provide care to patients. Until managers are held truly accountable for their actions, no whistleblower is safe to speak out.'

Dare said that psychologists should be actively involved in trying to facilitate change, adding: 'I would very much like to see our profession actively involved in campaigning for true support for whistleblowers. This means lobbying Parliament, being actively seen and participating in national debates and organisations supporting change. The Nursing Times promoted the "Speak out Safely" campaign that many Trusts allege they are signed up to; as psychologists, we need to be helping to identify what needs to happen to encourage staff to speak out, be it within schools, hospitals, prisons, et cetera. Don't just say you support whistle-blowers, show it; after all next time you or your relative is undergoing a surgical procedure, wouldn't you like to truly know you were in safe hands?'

In a letter to The Psychologist (coming up in the April issue), Chartered Psychologist Margaret Charlton recommends Whistleblowers UK, a non-profit organisation run by whistleblowers for whistleblowers. 'The organisation can give confidential support and advice for those who are considering acting on their conscience before or after their situation escalates,' Charlton said. The website reminds visitors: 'Blowing the whistle is not something that anybody will have planned; they will have fallen into the position of revealing what they have discovered probably quite unexpectedly and they will either currently be worrying about the effects of what they are about to do – or undergoing the immense stress of what they have just done in disclosing their observations.' Featured prominently is the famous quote attributed to Edmund Burke: 'The only thing necessary for the triumph of evil is for good men [and women] to do nothing.'

BOX: BPS reactions to the Francis Review

The British Psychological Society's response to the independent review had a focus on psychological safety of employees. After the publication of the review in February, Dr Joanna Wilde, who led the Society's contribution, said: 'Our profession must step up to help create these cultures. We can also make a significant contribution to recruitment and support for the Freedom to Speak Up Guardian roles advocated across the NHS. The recommendations also have scope to be reinforcing of good practice and de-escalation, rather than predominately focused on bad practice, which psychologically we know leads to more effective behaviour change.'

As a result of her invitation to the pre-launch event, Dr Wilde was asked to speak about psychological safety and what we need to do to a select senior group. She told us: 'The Society is now centrally involved in a joint set of recommendations for the NHS based on the output from this Whistlblowing review and the data collected by the Founders Network listening events, organised by Clare Gerada (Royal College of General Practitioners) and Rex Haigh (Royal College of Psychiatrists). The BPS will be signing up to a joint letter focused on the steps needed to address staff wellbeing across the NHS.'

Dr Ian Gargan, Chair of the Society's Professional Practice Board, endorsed Dr Wilde's comments. He said: 'Practitioner psychologists have significant contributions to make offering individual support, education and training as well as stabilisation within the workplace for the whistleblower and the organisation as a whole. Specific points to highlight are: educating managers and HR professionals on how to communicate with those who whistleblow, to prevent deterioration in mental health. Psychology is particularly well placed to provide support for the stress and depression that we know these experiences have created for whistleblowers; defining mechanisms which support the whistleblower; and creating guidelines to support the organisation which may be affected by the consequences of negative information, having undermined confidence and well-being at work.'

Professor Kate Bullen spoke on behalf of the Society's Ethics Committee. 'If patient-centred care is a fundamental value of the NHS, this places an obligation on psychologists to advocate for the best available care on behalf of their patients. However, this obligation can only be demanded by employers, and by wider society, if a robust and supportive framework of care is provided for those who have the courage to whistleblow. Similarly, if managers are obliged to provide and support a system of support for staff, it is not unreasonable that they could expect staff not to raise vexatious or malicious claims against their employers, or their colleagues. There are reciprocal rights and responsibilities between staff and managers and also between colleagues. For many people who "blow the whistle" it is an act of desperation, arising from the frustration of working within a system where their concerns have not been accepted or acted upon. Providing robust and trustworthy processes which enable staff to raise their concerns are essential to pre-empt the need for whistleblowing. The Ethics Committee's role is to provide guidance through our Code of Ethics and Conduct, to hear the concerns of psychologists who contact the Society, provide a reasoned ethical opinion, and to direct them to appropriate sources of support if they decide to take their concerns forward.'