+ What do whistleblower campaign networks seek from regulation to improve patient safety?’ Westminster seminar

+ What are staff seeking when they raise concerns Transparency Investigations- - independent and robust into concerns raised about patient safety Improving patient care, reducing avoidable risk- our main focus. Fairness and respect for their professional opinion.

+ Ref Nigel Ellis Head of Investigations statement to Mid Staffs Inquiry para 96,p27. On February 2008 the HCC’s helpline received a batch of 40 letters and local newspaper reports which had been collected by Julie Bailey in respect of various patients. The allegations related to understaffing, and poor nursing care and lack of hygiene. Many of the concerns related to older patients and failure to answer buzzers, change sheets, give medication and change patients.

+ Closing cure the NHS statement for the mid staffs PI There are also deeper questions. What is it about the culture of NHS hospital care that created a system where the voice of the individual patient or nurse is drowned out by political pressure, targets and/or processes? A culture that seeks to deny and defend, rather than be open and self-critical, whose first response to criticism is to seek an alternative explanation, rather than investigate the most likely and most serious cause or causes, and that fears to empower patients and front line workers in hospital lest their decisions on how to run a ward or a waiting list are incompatible with the latest political direction?

+ Professor Michael West Lancaster University how staff are managed is the decisive influence on quality and safety the level and nature of staff engagement is the best predictor of patient outcomes organisations with high staff “engagement” are more likely to be “learning” organisations with better outcomes

+ Transparency- relevant indicators and warning signs Have we agreed this in regulation? What assessment of staff engagement is an accurate measure? The mortality alerts caused the Healthcare Commission to investigate Mid Staffs- are we taking enough note of such data. Clinical incident reports- are all of them investigated or logged? How do you know? Do we take enough note? Complaints- every one a gem.- verbal, or formal, are they all included? How do we know?

+ Investigations. Regulators should investigate individual concerns- this is potentially crucial for patient safety. Eg waiting times for A&E being manipulated to make it appear they are being met? – should this not be taken as a serious patient safety risk issue?

+ Staff expect regulators to recognise & deal with bullying behaviour In the worst cases, staff raising concerns are explicitly told to stay quiet, threatened, sidelined. Most often ignored. All of these behaviours are dangerous for patients and will lead to staff leaving, ill health and disengagement. Bullying of those staff leading the way in speaking up needs to be urgently addressed. Regulators have a responsibility towards patients to ensure bullying is addressed.

+ Investigations into complaints about doctors Competent case managers. Understand how vexatious referrals might happen Be supportive of doctors and nurses mental health Ensure that all case managers understand what raising concerns is like, why staff do it, why they escalate concerns and the levels of stress associated with concerns Ensure accountability for anyone who has vexatiously complained about another health professional.

+ In the NHS, bullying is key “Robust staff engagement and encouraging a culture of openness and trust are key in addressing under-reporting. Confidence to report bullying is directly related to confidence to report workplace concerns.” Dean Royles – NHS Employers in Nursing Times. 12 July, 2011

+ summary Regulation needs to always be patients first and not protecting the status quo or the establishment- agree key indicators – do we really understand the issues? Regulation needs to be transparent Investigations should include investigating individual concerns and ensuring that patient safety is addressed. Investigations need to be transparent, involve the whistleblower(s), be proportionate and openly shared. Bullying of staff who raise concerns needs to be addressed by regulators to prevent patient harm