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, malpractice or regulatory breaches they think may endanger public safety. This is often known as whistleblowing.
From 1st April 2021, all NHS service providers must meet the National Whistleblowing Standards (2020). These Standards were developed by the Scottish Government and Scottish Public Services Ombudsman (SPSO). The SPSO will act as the Independent National Whistleblowing Officer (INWO) service for the NHS in Scotland.
The Standards comprise 10 parts that set out how the INWO expects whistleblowing concerns are to be managed and include:
- the whistleblowing principles,
- a two-stage procedure for managing the concerns,
- governance measures for recording and reporting,
- information for NHS primary care providers, volunteers and students relating to the new process.
Not all 10 parts will be relevant to all organisations or staff members.
NHS Scotland health service providers are required to have a raising concerns policy and procedure in place that meets the Standards. The INWO has developed a checklist that will assist practice teams to achieve this. NHS boards have a responsibility to ensure the NHS providers have the policy in place.
Raising concerns, and the resulting outcomes, can assist in improving NHS services and could be used for quality improvement learning opportunities. Dental team members should feel confident about speaking openly to raise concerns about risks of harm and wrongdoing, and that those concerns will be managed appropriately.
Many concerns that may meet the whistleblowing definition can be raised and addressed locally within the dental practice. 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 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 that raised the concern).
Further details of the procedure are set out in part two and part three of the Standard
The Standards require each whistleblowing concern to be systematically recorded. For both stages of the procedure, details of the concern, including the date the concern was received, any request the person 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. There is also a SDCEP developed 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 included in the Standards (as below).
- a statement outlining learning, changes or improvements to services or procedures as a result of consideration of whistleblowing concerns
- a statement to report the experiences of all those involved in the whistleblowing procedure (where this can be provided without compromising confidentiality)
- a statement to report on levels of staff perceptions, awareness and training
- the total number of concerns received
- concerns closed at stage 1 and stage 2 of the whistleblowing procedure as a percentage of all concerns closed
- concerns upheld, partially upheld and not upheld at each stage of the whistleblowing procedure as a percentage of all concerns closed in full at each stage
- the average time in working days for a full response to concerns at each stage of the whistleblowing procedure
- the number and percentage of concerns at each stage which were closed in full within the set timescales of 5 and 20 working days
- the number of concerns at stage 1 where an extension was authorised as a percentage of all concerns at stage 1, and
- the number of concerns at stage 2 where an extension was authorised as a percentage of all concerns at stage 2.
Although 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 whistleblower is not satisfied with either 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 whistleblower can also ask the INWO to investigate the refusal or concern.
A training and information resource on the Principles and Standards can be accessed via TURAS (log in required).
Put together a practice policy 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 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 and/or Whistleblowing Champion 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 systematic 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. If no whistleblowing concerns have been raised a quarterly report is not required, however an annual report should be submitted.