It is important that all healthcare staff are aware of their duty to protect patients and know that they have an obligation to raise concerns about risks of harm or wrongdoing. This may include patient safety, quality of care, malpractice or regulatory breaches they think may endanger public safety. This is known as raising concerns, speaking up or whistleblowing.
When a public safety concern is raised, NHS service providers must follow the National Whistleblowing Standards (2020). These Standards were developed by the Scottish Government and the Scottish Public Services Ombudsman (SPSO). The SPSO acts as the Independent National Whistleblowing Officer (INWO) service for the NHS in Scotland.
NHS Scotland service providers are required to have a policy and procedure for raising concerns in place that meets the Standards. The INWO has developed a checklist to assist practice teams to achieve this. NHS boards have a responsibility to ensure that providers of NHS services have a policy in place.
Raising a concern, and the outcome from doing so, helps to improve NHS services for patients and staff. Dental team members should feel confident about raising concerns, that those concerns will be managed appropriately and that they will be made aware of the outcome.
There are different ways dental team members can raise concerns about the organisation (i.e. practice, hospital) where NHS dental care is provided.
Raising concerns to the organisation
Dental team members can raise concerns with the practice/organisation by speaking to the practice manager or senior dentist. Raising a concern informally within the practice/organisation can help to resolve it quickly. If the concern cannot be resolved informally, the NHS Whistleblowing procedure will be followed. The raised concern will be treated in confidence. However, it will not be anonymous (see Managing Concerns).
It is possible to raise a concern anonymously within the practice/organisation. However, this means that it will not be handled under the NHS Whistleblowing procedure and can limit the support, legal protection and feedback received by the person who raised the concern. In addition, the INWO will not be able to review the way the concern was handled (see Managing Concerns).
An alternative to raising a concern anonymously through the organisation is to raise the concern to Healthcare Improvement Scotland (HIS).
Raising concerns to Healthcare Improvement Scotland (HIS)
Healthcare Improvement Scotland (HIS) offers NHS staff the opportunity to raise a concern anonymously and for that concern to be handled under the NHS Whistleblowing procedure. Within the ‘Responding to Concerns Programme’, HIS will anonymously raise the concern to the employing organisation, take care to protect confidentiality and will not share the identity of the NHS worker. If a concern is raised under this “Responding to Concerns Programme” the employing organisation must follow the NHS Whistleblowing procedure when managing the concern (see Managing Concerns).
Many concerns that may meet the definition of whistleblowing as identified in the Standards, can be raised and addressed within the dental practice without being formally treated as a whistle blowing concern. INWO refers to this as “business as usual”. If this is not possible or is unsuccessful, a whistleblowing concern should be raised either in the practice or, where this is not appropriate, to an external contact who would act in the best interest of all parties (e.g. local Health Board Whistleblowing champion, Health Board confidential contact, HIS 'Responding to Concerns' contact or the INWO). Concerns raised and managed as “business as usual” are not a component of the two-stage whistleblowing concern procedure (described below).
If the raised concern and the individual raising the concern meet the whistle blowing definitions as identified in the Standards, the two-stage procedure must be followed.
This comprises:
- Early resolution (i.e. for simple and straightforward issues that can be resolved within five days or less)
- Investigation (i.e. for more complex issues that take more than 5 days to address, but no longer than 20 days to respond to the individual who raised the concern).
Further details of the procedure are set out in part two and part three of the Standards
The Standards require each whistleblowing concern to be recorded. For both stages of the procedure, details of the concern, including the date the concern was received, any request the individual makes to keep it confidential, the outcome and any actions taken, need to be recorded. In addition, stage 2 (investigation) concerns must include any actions taken during stage 1 (early resolution). Full details on how to record a concern are detailed in part five of the Standards. A Raising concerns reporting form (including INWO Whistleblowing Stage 1 and Stage 2) template available.
NHS service providers must report the whistleblowing concerns to their Health Board on a quarterly basis. These reports should include the 10 key performance indicators as specified the Standards
Each NHS Health Board will have systems in place to facilitate the reporting of whistleblowing concerns from service providers; practices should be aware of the types of information that may be requested. Further details of reporting whistleblowing concerns are in part 5 of the Standards.
Following the two-stage procedure, if the individual is not satisfied with the way the concern was managed, the outcome, or the way they were treated, the INWO can act as an independent reviewer. If a concern was not permitted to be raised through the two-stage process, the individual can also ask the INWO to investigate the refusal and/or concern.
A training and information resource on the Whistleblowing Principles and Standards can be accessed via TURAS (log in required).
Put together a practice policy on raising concerns and whistleblowing that includes the procedure for managing concerns. This should comply with the National Whistleblowing Standards. The INWO provides a checklist to help to ensure key requirements are included (see Raising Concerns and Whistleblowing Policy template).
Ensure that all members of staff are aware of the policy and their duty to protect patients by raising concerns at the earliest opportunity.
Encourage a culture that enables all members of staff to raise concerns using the practice procedure.
Ensure the contact details for the Health Board confidential contact, Whistleblowing Champion and/or the HIS 'Responding to Concerns' are available in the practice.
If a whistleblowing concern is raised, follow the practice procedure and ensure the individual who raised the concern is made aware of the outcome.
Keep a confidential record of whistleblowing concerns raised, and the action taken in response to these concerns (see Raising Concerns Reporting form).
Report whistleblowing concerns to your Health Board quarterly. A quarterly report is not required if no whistleblowing concerns have been raised. However, an annual report should be submitted.