By Philippa Shirtcliffe is QCS’s Head of Care Quality (www.qcs.co.uk)
Those who stand up for what is right have always been integral to the moral wellbeing of our society. They are moral barometers. Our attitude towards them is a key indicator of the society that we live in. Sadly, these brave men and women, who often risk their careers to bring misconduct to light, are increasingly being demonised for doing so. Many, therefore, feel they have no choice to bypass their bosses and become whistle- blowers.
As a former deputy safeguarding lead and head of whistle- blowing for a large primary and social care provider, I can tell you that whistleblowing in the care sector is on the increase. The Care Quality Commission (CQC), for instance, has reported a 55 percent increase in concerns during the Pandemic.
Another study commissioned by The Daily Express lists a lack of PPE, social distancing and issues around infection prevention and control as the three top concerns.*
STATISTICS RAISE AS MANY QUESTIONS AS ANSWERS
There are several questions that immediately spring to mind. Why do so many staff feel they cannot raise the issue with their Registered Manager? Are they frightened that they might be shunned, vilified or even fired by the provider? Or perhaps they reported their concerns only for their complaint to fall on deaf ears? Finally, when whistleblowers did alert the CQC, what action did it take to put things right?
Let me tackle the last question first. In the absence of face-to-face inspections, the CQC decided to apply a risk-based approach to regulation using the Emergency Support Framework (ESF). In doing so, it focused on care providers with a poor regulatory record, and those it perceived from ESF phone interviews were not cop- ing well. However, a recent article published by Care Home Professional says that “50% of CQC’s physical inspections during COVID-19 were informed by whistleblowers and information from the public”.**
If this is correct, it shows those providers in a poor light. But Debbie Harris, the founder of Autumna, an organisation which aims to help families
find better later-life care options, says “the CQC could have been more transparent in its approach during the lock- down”. When the CQC failed to publish Emergency Support Framework reports, Debbie and her team published them.
Debbie says, “For the last ten years we have been supporting self-funding families to make an informed choice about care options. It is impossible to do this, however, without transparency from the regulator. That’s why, with the provider’s permission, we took the deci- sion to publish ESF reports. If we hadn’t have done so, it would have prevented the consumer from making an informed choice.”
But returning to care providers, who were reported to the CQC by whistleblowers and the public, why haven’t these providers put effective whistleblowing policies in place? And, more to the point, how do you go about doing so?
WHERE TO ACCESS WHISTLEBLOWING POLICIES AND PROCEDURES
At Quality Compliance Systems, our content writers have created a whistleblowing policy, which tens of thousands of customers utilise. Not only is the guidance we provide easily-digestible and clear, it is supplemented by constant policy updates. We also work closely with a number of partners, one of which is Royds Withy King (RWK), who share best practice with us.
Take James Sage for example. Mr Sage, a partner in RWK’s Health and Social care team, has written extensively on whistleblowing disclosure policy. He says that it is not only “vital that managers are alert to the increased risk of whistleblowing disclosures” during Covid-19, but have “sufficient training to spot them” too.
From a compliance perspective, it is essential that as a second step, services have a clear set of policies and procedures in place to safeguard staff and those they look after. What should those protocols look like? Well, they should be easy to understand and provide staff wishing to raise concerns with clear a roadmap detailing the steps they need to take to submit their concerns correctly and safely.
‘OPENNESS’ THE MOST IMPORTANT WORD
I think if there’s one key word that should be woven deeply in into the fabric of any whistleblowing policy, it’s ‘openness’. By this I mean, that Registered Managers must create safe space within their service, where staff feel that they can raise concerns – safe in the knowledge that if they do – positive action will be taken. As part of this open and transparent culture, managers should encourage staff to raise concerns, as this is a good indicator of how well a service is performing. If there are no complaints or concerns raised, it is actually a bad sign because it indicates that people aren’t being listened to and action is not being taken.
In addition to openness, Mr Sage says that providing reassurance to staff is incredibly important too. He explains that any culture of reassurance needs to extend to staff “knowing that any disclosure will not adversely affect their position at work”. Secondly, he adds that staff need to be confident that they will be protected from “any repercussions that emerge from colleagues who they may have complained about”.
Autumna’s Debbie Harris adds, “Transparency is incredibly important too. Without it, not only are consumers running the risk of choosing a care home, where issues have been flagged, but regulators also risk losing public trust, when the problems that have been hidden from view are exposed by investigative journalists.”
I agree with this, but where I disagree with some whistleblowing experts is around the subject of creating a system for anonymous reporting. While I understand the rationale of advocates who champion it – their belief is that it may persuade staff to disclose their concerns to a manager rather than going straight to the CQC – my view is that in an open culture staff should feel safe to raise concerns. On the contrary, a culture of anony- mous reporting, can make it difficult to investigate a grievance fully as the whistleblower cannot revert back to the whistleblower lead and check if action has been taken, nor can the whistleblower lead gather addition- al information, which might provide crucial in concluding a case. What is vital, therefore, is that the culture within a service is free from bullying or intimidation.
A MEASURED AND CONSISTENT APPROACH IS THE BEST WAY FORWARD
In terms of making and receiving a complaint, it is really important that a measured and consistent approach is taken by the care provider. Effective whistleblowing needs support from senior management. In larger organisations it is often the inertia on the part of the Registered Manager and the culture within the service that leads to a whistleblower’s complaint. It is important, therefore, that the provider has a well-com- municated escalation plan in place so that staff know who to whistleblow to.
On this note, the decision to appoint a Registered Manager as the provider’s whistleblowing lead needs careful consideration. What do I mean by this? Well, take for example if the Registered Manager is both the whistleblower’s line manager and the whistleblowing lead. Now let’s imagine that a safeguarding issue has been escalated, but the manager has failed to act. The staff member, who has made the initial complaint, may be reluctant to challenge their manager for fear of reprisal. Therefore, the role of safeguarding lead may sit better with someone else who is impartial, but at the same time has the authority to take action.
THE POWER OF COMMUNICATION
As the complaint is being progressed, regular communication is paramount, as is monitoring the whistle- blower’s wellbeing. It may be that making a complaint against a colleague has caused them great stress and anxiety. Therefore, if the member of staff is willing, a Registered Manager (if they are the whistleblowing lead) might recommend additional supervision where he or she can give advice, or arrange professional counselling on their behalf if required.
When a complaint is concluded, providing the staff member with a sense of closure is equally important. Therefore, Registered Managers need to be able to not only show that the matter has been dealt with, but also that lessons have been learned and that steps have been put in place to stop the incident of malpractice from reoccurring.
AUDITING TOOLS HAVE A KEY ROLE TO PLAY
Finally, having access to effective auditing tools can make a huge difference, as in James Sage’s words this allows Registered Managers “to record the number and nature of whistleblowing disclosures and to regularly audit them to spot any patterns”.
Whatever statistics, trends and patterns emerge, however, what really counts is that those who are courageous enough to put their necks on the line to reveal what are often uncomfortable and painful truths are not penalised for doing so. Adopting a clear set of policies and procedures like the ones in this article is the first step in protecting them, their colleagues, the service users – and their futures.