1. Nottingham CCG - Practice Managers
2 December 2014
Nottingham CCG
Practice Manager Session
2 December 2014

2. Nottingham CCG - Practice Managers
2 December 2014
Objectives
Whistleblowing – what it is and why it matters
Myth busting – the real experience of whistleblowing
Legal rights
Your policy
Receiving concerns
Case study

3. What is whistleblowing?
A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MPs)
Source: PCaW

4. Grievances and concerns
Grievances Concerns
risk is to self risk is to others
need to prove case tip off or witness
rigid process pragmatic approach
legal determination accountability
private redress public interest
©PCaW

5. Nottingham CCG - Practice Managers
2 December 2014
Advice line
We have advised over 17,000 whistleblowers to date.
Top sectors: health, care, local government, charities, financial services. Top concerns: financial malpractice, public safety and patient safety.
Source: PCaW

6. Nottingham CCG - Practice Managers
2 December 2014
Whistleblowing then
©PCaW

7. Nottingham CCG - Practice Managers
2 December 2014
Whistleblowing now
Whistleblower Michael Woodford settles with Olympus?
26 June 2014
thejournal.ie
The British chief executive who blew the whistle on a $1.7bn (£1bn) corporate fraud at Japanese electronics giant Olympus has brokered an out-of-court deal with the company over his sacking, believed to involve a multi-million pound pay-out.
29 May 2012 The Telegraph
Staff at hospitals enabled Savile and refused to believe his victims
Throughout each of the 28 reports into Jimmy Savile’s abuse at hospitals in the UK, one theme repeatedly emerges: how staff ignored, and in some cases, enabled him.
Tesco's £250m accounting black hole first flagged during Phil Clarke's reign
A Tesco employee who highlighted that the supermarket had over-stated first half profits to the tune of £250m first told his superiors of the problem when Philip Clarke was still in charge of the retail giant
24 October 2014
The Telegraph
NSA whistleblower Edward Snowden is nominated for Nobel Peace Prize
Former government contractor could join President Obama, Henry Kissinger and Nelson Mandela in historic list.
29 January 2014
The Independent
©PCaW 7

8. Nottingham CCG - Practice Managers
2 December 2014
©PCaW

9. Nottingham CCG - Practice Managers
2 December 2014
Raise internally?
Keep quiet?
A concern about malpractice
Go Outside?
©PCaW

11. Myth 1: Whistleblowers are persistent
The majority of whistleblowers (44%) raise a concern only once and a further 39% go on to raise their concern a second time. Majority (83%) will only try internal options once or twice and then give up.
Small window of opportunity to address wrongdoing
Importance of front line and middle management training
Very few are persistent in raising their concern- only 22 individuals from our research went on to raise their concern 4 times.

12. Myth 2: Whistleblowing is always going outside
83% of whistleblowers blow the whistle internally.
Supported by YouGov survey in 2013: The majority of working adults in Great Britain (83%) said if they had a concern about possible corruption, danger or serious malpractice at work they would raise it with their employers.

13. Myth 3: Whistleblowers are always trashed
60% of those who called our advice line did not report any response from management (either negative or positive).
Of the 40% who told us of a response, the most common action is formal action short of discipline and 15% were dismissed.
Our YouGov 2013 survey: overwhelming majority of British workers (72%) view the term whistleblower as positive or neutral

14. Myth 4: Whistleblowers only want money
74% of whistleblowers say that nothing is done about the wrongdoing. They want the concern to be addressed.
Majority of respondents to the Whistleblowing Commission did not want a system of financial rewards.
Rewards are not a substitute to strong legal protection. More needs to be done to strengthen legal framework- the Public Interest Disclosure Act 1998.

15. EY Survey Headlines
93% of respondents said they have formal whistleblowing arrangements in place
But 1 in 3 think their whistleblowing arrangements are ineffective
54% said they do not train key members of staff designated to receive concerns
44% confuse personal complaints with whistleblowing
1 in 10 say their arrangements are not clearly endorsed by senior management
©PCaW

16. YouGov Survey Headlines
Nottingham CCG - Practice Managers
2 December 2014
YouGov Survey Headlines
1 in 10 workers said they had a concern
Two thirds of workers raised their concern
83% of workers said if they had a concern about possible corruption, danger or serious malpractice at work they would raise it with their employers
42% of workers said their employers have a whistleblowing policy
72% of workers view the term whistleblower as positive or neutral
©PCaW

17. ©PCaW

18. The Public Interest Disclosure Act 1998
Lord Nolan’s praise for ‘so skilfully achieving the essential but delicate balance between the public interest and the interest of the employers’.

19. ©PCaW

20. Nottingham CCG - Practice Managers
2 December 2014
Whistleblowing arrangements
Your policy messages
The role of managers
Training
What you expect from staff
Independent advice
Review of arrangements

21. Nottingham CCG - Practice Managers
2 December 2014
Whistleblowing Commission: Code of Practice
Developing procedures - consult staff and their representatives
Clear, written procedures should be available to staff detailing:
Avenues for raising concerns including senior managers, an identified senior executive and/or board member and relevant external organisations
Assurances of protection from reprisal
That confidentiality will be maintained where requested
Clear communication about processes, time frames and final outcomes
How to access to independent advice
That there is a zero tolerance of the victimisation of whistleblowers
Training on whistleblowing arrangements at all levels

22. Managers: Do you know…? What is whistleblowing?
How do I know which policy to use?
What support do I have in handling?
When should I seek help? From whom?
What is my role in promoting whistleblowing?
When do I record? Where?
Patient safety? Where to go?
Relationship with safeguarding?

23. Managers: Key questions to ask
IMMEDIATE RISK
5 Ws - who, what, how, where and when
Why now?
Broader context
What has been done already
Any solutions?
Identity - prepared to share with you? Who else?
What do you want to happen?
Willingness for formal statement

24. Managers: Key issues to discuss
Assurances
done the right thing
support
their protection
confidentiality and limitations 
Managing expectations
Timescales, process and feedback

25. Handling the concerned employee: Top tips
Lead by example: engage with staff regularly, encourage them to raise concerns
Thank those who do come forward, if they are mistaken, reassure and explain
Acknowledge concerns about their own position and give reassurances reprisals will not be tolerated
Manage expectations if necessary and respect confidentiality
Discuss feedback options
Investigate - serious? Who else should be notified? Any external agencies?
Be mindful of the confidentiality of others i.e. the accused
Keep records of serious concerns raised - anonymising where necessary

26. ©PCaW

27. Nottingham CCG - Practice Managers
2 December 2014
Whistleblowing Commission: Code of Practice
How effective are your arrangements?
Consider:
Number and types of concerns raised and outcomes of investigations
Feedback from individuals who have used the arrangements
Complaints of victimisation
Complaints of confidentiality breach
Other existing reporting mechanisms
Adverse incidents (e.g. patient complaints, publicity or wrongdoing identified by third parties);
Disputes / Litigation
Staff awareness, trust and confidence in arrangements.

28. ©PCaW

29. Nottingham CCG - Practice Managers
2 December 2014
Case study: Slide 1
You are a long-serving Practice Manager at a small practice led by two partner GPs. Kwame is a salaried GP who has been with the practice for 18 months. Kwame has noticed that one of the partners, Bill, is in at the crack of dawn and leaves later than everyone. His appointments always overrun, he sends s to staff in the early hours and often comes in over the weekend. What seemed to be dedication is now becoming more worrying, and Kwame is increasingly concerned that Bill is suffering from stress.

30. Case study: Slide 2
Bill looks exhausted and unkempt, he is constantly unwell but does not take time off. More worryingly, Kwame has seen three patients this week who have been referred by Bill for investigatory tests that seem to be unnecessary. When Bill’s regular patients have turned up at Kwame’s clinic he has noticed that they seem to be on medication that seems over the top for the conditions they are treating. Bill’s Registrar has just finished her placement and mentions to Kwame she thinks someone ‘needs to keep an eye on Bill’, without elaborating. Kwame is worried for Bill’s health and wellbeing and feels it is only a matter of time before something goes seriously wrong.

31. Case study: Slide 3
Kwame’s instinct is to talk to Bill about it so he asks for five minutes with Bill at the end of clinic. Bill gets irate and cuts Kwame off, ‘I do the very best for my patients’ he says and ‘if I want a second opinion, I’ll ask for one’. He asks Kwame to leave and let him get on with his work. Kwame doesn’t feel able to approach Bill again and so decides to speak to the other practice partner, Judy. She is dismissive, ‘the patients aren’t complaining’ she says. Kwame would like to get Bill some support for his stress, but he doesn’t know where else to go. He researches some options for raising the concern with the CCG or NHS England, but doesn’t feel any clearer. He then decides to speak to the GMC for advice.

32. Case study: Slide 4
The GMC tell Kwame they are taking the concerns as a referral under Fitness to Practice and they launch a case against Bill. The situation escalates fast and Kwame feels he has lost control. Everyone in the practice is pointing the finger at him, the atmosphere is terrible and people avoid talking to him. Bill’s patients are furious. Kwame can’t believe he has got himself into this situation. He doesn’t believe Bill is a bad doctor, he just wanted to get him some help and prevent patient harm. Now he’s wondering if he’ll still have a job himself.

33. Case study: Questions
Kwame 1. What else could Kwame do in the circumstances? What could he have done differently? Practice Manager 2. What could you have done to encourage Kwame to approach you as Practice Manager? 3. When would have been best for Kwame to approach you? 4. What other questions do you have for Kwame? 5. How should you have handled the matter when it was brought to you?