Speaking Out Discouraged in NHS
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- Published: Monday, 04 December 2023 10:24
- Written by Peter Ingle
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Dental teams are familiar with well-intentioned projects supposed to protect the public, or raise standards, that all too often have achieved the exact opposite. A senior figure in the profession has now concluded that yet another initiative intended to make healthcare safer is not fit for purpose.
The NHS has a poor record with whistle blowers, seeing them frequently suffering adverse consequences as a result of their speaking up. One of the recommendations of the Francis report into the appalling failures that occurred at the Mid Staffordshire Hospitals Trust was the appointment of a National Guardian. The National Guardian’s Office (NGO)’s mission is to make speaking up become "business as usual" in healthcare.
The NGO uses the term "speaking up" rather than whistleblowing to support healthcare workers to raise ideas for improvement as well as concerns. The office is an independent, non-statutory body with the remit to lead culture change in the NHS in England and is sponsored by the CQC and NHS England.
The NGO encourages speaking up across healthcare through a network of FTSU guardians. Their role is to support colleagues in speaking up. 700 Guardians were appointed from over 400 organisations. As well as supporting health workers, part of their role is to work proactively within their organisation to tackle any barriers to speaking up.
Stuart Johnson, who is Communications Lead for an LDC Federation - Lancashire and South Cumbria Local Dental Committees, agreed to register as a Guardian in 2020 as part of their work to support practitioners.
The hope was that by being involved there was a better chance of a workable scheme for dental practices, and also that by offering an LDC based guardian it would make it very easy for local practices to set up effective policies together, and demonstrate compliance if asked by the CQC or other bodies.
Over time, Stuart recognised that there were problems. The scheme is based on the protection that employees are afforded by the Public Interest Disclosure Act - which does not apply to self-employed people. This excludes the majority of dental clinicians and therefore abandons those who are most likely to raise concerns.
The major issue is that Self Employed dentists put themselves in a vulnerable position when raising concerns. Responses have included termination of contract, through to weaponisation of the regulatory bodies including the GDC, NHS England and the CQC. Tit for tat complaints are often seen, or even direct legal action from the other party, for example citing defamation of character or damage to professional reputation.
The NGO acknowledged the issues, described them as ‘challenges’, but nonetheless pressed on pushing FTSU into primary care. In Stuart’s opinion these are not just challenges, they are fundamental issues which completely undermine the validity of the scheme.
The NGO recently presented a report to parliament extolling how many guardians there now are in primary care, but without acknowledgment of the problems Stuart has identified and reported. He came to feel that not only was he wasting his time and effort - but that even his continuing as a guardian was helping to prop up, in his words, “the charade that the scheme will ever work in primary care.” He also pointed out that ‘Guardian’ is something of a misnomer when there are no investigatory, enforcement or protective powers.
His conclusion: “The intention behind the scheme may be laudable, but raising concerns as a self-employed associate has to be a carefully considered action and the false reassurance of protections which don’t apply really isn’t helpful. Having tried Speaking-Up about Speaking-Up, and been ignored, it’s time to abandon the pretence; we need to go back to the drawing board on how achieve these aims in Primary Care.”
As a result, and despite unwavering commitment to patient safety and raising appropriate concerns, Stuart has now resigned as an FTSU Guardian. In his letter to the NGO he wrote, “I am simply not prepared to encourage my self-employed colleagues to speak up, knowing that I am leading them into professional, career and financial jeopardy. Neither am I prepared to continue an association with the NGO who fail to accept fundamental issues and persist with a false representation of the situation - both to the public, the professions, and parliament. This is no self-fulfilling prophecy - we can’t ‘wish’ primary care into being a different environment.”
If you do wish to speak out on this matter, Stuart can be reached through the Lancashire and South Cumbria LDC Website where there’s a contact form; www.lasc-LDC.co.uk This can also be discussed on the GDPUK forum,
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