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Who's keeping a lid on "priceless" whistleblower information in our health system - and why?

NHS and social care watchdog the CQC appears to be ignoring or even suppressing information from whistleblowers - and failing to protect staff who speak out.

In February 2015 Jeremy Hunt promised “sweeping reforms to end NHS cover up culture”. A ‘Freedom to Speak Up Review’ had surveyed 15,000 NHS trust staff and found almost a fifth of staff who had raised concerns at work reported that they were ignored (19.7%) and victimised (17.3%).

Hunt tasked the Care Quality Commission (CQC) with doing more to protect whistleblowers, and ensuring the rest of the system treated whistleblowers fairly.

But almost two years on, the CQC has not changed its ways. It is still failing whistleblowers in both the NHS and in social care and not acting properly on their concerns.

The CQC says evidence from whistleblowers is “priceless”.

It is very important to say that whistleblowing incidents are one of the main sources of information that we would use...” Mike Richards, CQC Chief Inspector of Hospitals, told the Health Committee in the summer of 2014.

We believe that every complaint and concern raised by staff or people using services is an opportunity to improve as they provide vital information to help CQC to understand the quality of care”, CQC Chief Executive David Behan CQC chief executive told the Review at the end of the same year.

Keeping a lid on the information

The CQC certainly has unparalleled national data on whistleblowing in health and social care. The CQC has received over 33,000 disclosures from frontline health and social care staff since it started collecting data after Winterbourne View in 2011. It seems the great majority (7456 of 8643, 86%) of whistleblower reports to the CQC come from social care staff, based on data reported for the year 2012/13.

However, the CQC makes it very difficult to access this information.

The CQC admits that it “has not performed any central analysis of the reasons behind each whistleblowing concern we have received” even though parliament has asked it to do so.

Departments should collect and apply intelligence on concerns raised by whistleblowers from the full range of arm’s length bodies and other providers involved in their sectors. They should use and analyse the data to identify any systemic issues,” said the Public Accounts Committee in 2014.

The CQC won’t reveal the full extent to which health and social care staff are concerned about shortages, deteriorating standards, poor staffing and management cover ups of these problems. Its inspection reports deal only superficially with whistleblowing matters, and do not reveal the full gravity of disclosures.

All this has the effect of concealing important trends in health and care services, trends that could be a powerful driver for improvement – and that could also be politically embarrassing for government.

Not protecting whistleblowers from reprisals

Nor does the CQC credibly assess how well employers are treating whistleblowers – asking only vague questions rather than setting clear standards.

The CQC is not reliably monitoring how the staff of regulated bodies fare after they have whistleblown. CQC is largely not reporting whistleblowers’ experiences of victimisation.

The CQC even appears to pay little attention to notifications from Employment Tribunals about whistleblowing cases against regulated bodies. It receives notifications of such cases from the ET – but in response to a Freedom of Information request it admitted that it doesn’t centrally collect details and has “not conducted an overall analysis”. This is a serious omission as these cases usually relate to serious cover ups and mistreatment of whistleblowers.

The parliamentary Health Committee recommended that providers who do not treat whistleblowers well “should therefore be refused registration by the CQC”.

There is no evidence that CQC has ever refused registration on this basis. But there are plenty of examples of the CQC rating organisations as ‘Good’ or even ‘Outstanding’ despite mistreatment of whistleblowers.

The CQC and other regulators have protected senior managers who victimise whistleblowers. CQC has not used its powers under “Fit and Proper person” regulations to remove even the worst offenders.

Not following up whistleblowers concerns

Freedom of Information requests have uncovered that the NHS trust about which staff have been whistleblowing the most is North Cumbria Hospitals NHS Foundation trust. There have been 83 staff whistleblowing contacts with CQC in the last three financial years.

Shockingly, the CQC has mostly responded to repeated allegations that North Cumbria managers are fiddling performance figures and putting patients at risk, by merely noting the information for future inspection.

This is despite the fact that North Cumbria was placed into special measures because of persistently poor mortality rates.

The CQC has resisted requests from whistleblowers to improve its inspection methods.

The CQC’s internal documents seem more concerned with managing and minimising the work caused by whistleblowing, than by the content of those disclosures. The CQC appears to have downgraded the priority given to whistleblowing contacts, and given them to less senior staff.

In short, whistleblowers risk all when they seek the CQC’s help to resolve their concerns, but the CQC will not reliably investigate, report, track the well being of the whistleblower or take action against abusers.

Whistleblowers continue to be fobbed off by the CQC, and the message given to employers is that the CQC is unlikely to rock any boats.

After so many years of failure there is an inescapable question of whether the CQC fails by design.

A former CQC insider once observed:

CQC ended up with a role they don’t understand or want.…Whistleblowing alerts were discussed between CQC inspectors and managers with a sigh.…What they excel in is keeping a lid on whistleblowers.…And that’s what the Secretary of State really requires of the organisation.”

The majority of whistleblowers still feel that this is the case and the evidence arguably supports their concerns.

Parliament needs to put aside the pretence of regulation and institute genuine reforms to protect whistleblowers. Without real freedom to speak up for health and social care workers, an already risky situation is made far worse.

The full report and data upon which this article is based, which will be submitted to Health Committee for an accountability hearing with the CQC, can be found here.

About the authors

Dr Minh Alexander was a consultant psychiatrist and whistleblower. She tweets at @Alexander_Minh.

Author withheld.

Pam Linton is one of several whistleblowers at Homerton University Hospital NHS Foundation Trust who raised maternity safety issues. She tweets at @MidwiferySister.

Clare Sardari is a South Devon Healthcare NHS Foundation Trust whistleblower who won her much publicised employment tribunal. She tweets at @SardariClare.


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