Independent National Whistleblowing Officer for NHS Scotland engagement event: outcomes

6 Conclusions and Considerations

Set out below is where there was mainly clear agreement during discussions. In addition areas have been highlighted that perhaps need some further consideration and there may be some additional work streams that could be considered once the INWO role is established as a result of these outcomes from the workshops.

6.1 Both from the workshops and the consultation it is fair to say all participants felt that the INWO role should include a learner focus approach to cases that could act as a catalyst for wider cultural and system change. That it should be independent of all other parts of the healthcare system in reviewing and making its findings and a similar model of principles and standards as there is for complaints would be welcomed for the reviews.

6.2 There was general consensus that statutory powers were required as proposed in the consultation with only a few feeling what was in place already was sufficient.

6.3 In principle delegates did feel that internal procedures should be exhausted first. For exceptional circumstances consideration should be given to referring matters to the INWO earlier, where it was clear from both parties this would not be able to be resolved internally and where relationships and communication was proving fraught despite best intentions. There were also views that there was some merit in Health Boards being able to refer cases to the INWO or for individuals and Health Boards to do so jointly.

6.4 It is fair to say that from opposing positions from delegates there were different views on the role of the Non-Executive Whistleblowing Champions. Once in post, it may be worth the INWO and Scottish Government undertaking a further piece of work around this role or if any additional roles are required that would have more of an advocacy type basis.

6.5 There is a clear gap identified from delegates regarding support to the whistleblower throughout the whole process to minimise any psychological impact and ensure equity and fairness for vulnerable groups. This could be considered if a further piece of work is undertaken as identified in line with 6.4. As well as whistleblowers, Health Boards do have concerns about this change and how the INWO role will work with them. This could be one piece of work establishing a very positive collaborative approach which would bring benefits for all and align with the INWO role having a leadership role and acting as a catalyst that could bring wider cultural change.

6.6 The ability for organisations and government to understand emerging themes where harm could be done is paramount. This is to ensure that we do not continue to have those sudden exposure moments as we have seen with Mid Staffs and with other organisations where we have seen media coverage of systemic failure and harm including Oxfam, Hollywood (Weinstein) and even Houses of Parliament. Where the INWO can bring effective change to systems by enabling individuals to easily and effectively raise a concern with protection is critical, systems to enable effective reporting will offer the benefit of capturing and analysing data to highlight emerging themes. Data analysis provides the ability for intervention planning, with subsequent impact analysis of interventions. Being able to understand themes, positive impacts and lessons learned will further yield longer term benefits for the culture within healthcare. Real-time data would provide accurate and timely information, benefiting stakeholders with assurances for greater knowledge and confidence of transparency. It is essential therefore for there to be strong links with Scottish Government and Health Boards in working towards this culture change and developing these systems as an additional work stream.

6.7 Most delegates felt that historic cases were not possible to include. In practical terms few delegates disagreed, however, it was identified that this could result in loss of key learning from some. To counter this, once the INWO is in post, some workshops could be held with whistleblowers who had or have historic cases to tease out any relevant learning that could start to inform system and cultural change.

6.8 The principles and standards were welcomed as definitely a step in the right direction and delegates were pleased with the arrangements that a working group had commenced to work on these and refine these to the specific challenges of whistleblowing. A gap identified in them by delegates was the fact that the standards and principles needed to take into account Healthcare Professionals duty to also report concerns under their codes of conduct.

6.9 Most delegates stated whistleblowing and raising concerns should be deemed to mean the same thing for understanding by all staff and that the legalistic definition should not be used as this was not appropriate for the purposes of the INWO investigations.

6.10 To avoid concerns being turned into employment matters delegates felt the principles should set out very clearly and define what is employment matters and what is raising concerns.

6.11 There was consensus from delegates that it was important for the INWO role to also establish if the whistleblower had been treated reasonably as a result of raising a concern .

6.12 The timescales and two stage process of 5 and 20 days was generally agreed to be the appropriate starting point for the process for the INWO. Appropriate communication also would be taken into account that had taken place between parties.

6.13 As the INWO was established and an appropriate number of cases had been reviewed intelligence and any common themes would be gathered and shared back into the system with NHS organisations to allow for learning and change to occur.

6.14 Reporting on assurances that recommendations made by the INWO were implemented was also viewed as important for most delegates and a process for building this in needs to be considered.

6.15 Some delegates felt it would be helpful if Scottish Government could work with Health Boards to consider a 'Once for Scotland' approach in reporting and recording concerns. Again it was felt that this may need a separate piece of work with stakeholders on the current systems such as datix and others, available systems not being used that might provide an appropriate mechanism and how it could be used for benchmarking. This would provide helpful intelligence when having to pass information to the INWO for the purposes of their investigation.

6.16 Most delegates felt confidential and anonymous concerns should be allowed to be raised with the INWO for intelligence purposes only whilst trust was being built in the system. However, if it could be investigated from the information available then it should do so. It therefore may be worthwhile considering this.