Anyone who is unhappy with the procedure the NHS provider decides to use to handle their complaint/ concern may complain to the SPSO or the INWO (depending on the procedure they are trying to access).  If someone expresses unhappiness, you should consider whether they have raised any matters which would lead you to review your decision on the procedure and, if not, signpost to SPSO/ INWO.

If staff, students, trainees or volunteers have concerns about the way another organisation or provider is delivering NHS services (and their concern meets the definition of whistleblowing) they should raise this with their manager.  Where appropriate, the concern should be considered through existing contractual/ management/ professional arrangements or through other business as usual processes. 

If this does not resolve the concern, the “worker” can raise this as a whistleblowing concern.  They can use their own organisation’s confidential contact if they do not feel safe sharing their concerns with their manager.  Management would then need to share this information with the other provider (keeping the whistleblower’s identity confidential), and come to a shared decision as to how the concern should be investigated.

To access the Standards, visitors must meet the definition of a whistleblower in that they are delivering NHS services, even if they are visiting a service provided by another organisation. 

Visitors who meet the definition in the Standards should be encouraged to raise their concern with the other organisation, such as with staff on the ward at the time.  This would be “business as usual”.  If this does not resolve the issue they should be able to access the Standards with the organisation they are visiting.. 

Visitors who do not meet this definition are not covered by the Standards, but should still be encouraged to raise their concerns through existing contractual, management or professional arrangements, as business as usual.  They also have the option of raising an anonymous concern, but this would not be covered by the Standards.

Raising awareness, and showing enthusiasm for the process from senior leadership, right down to line managers, will be critical to the success of this procedure, and to encourage staff in raising concerns.  

Organisations must make sure information on how to raise concerns is readily available, such as through posters and other materials which can be easily and discretely read.  There is training available for managers and others that may receive concerns, as well as for staff that may want to raise a concern on the Turas  Learn website. It is important for managers to access this training, to make sure they know how to handle concerns that come to them. 

Communications teams play an important role too.  It can be helpful to use a range of internal communications channels, so that staff from across the organisation hear about these changes.

Beyond the process itself, good news stories and positive outcomes from when others have raised concerns will help to build trust in the process.  This is an important part of promoting the process itself which should not be overlooked.

Anyone delivering NHS services is covered by the Standards.  This applies to staff at every level of the organisation, as well as board members.  Each organisation must identify a suitable route for concerns raised by or about senior staff, and ensure that this route is well understood by both senior management and confidential contacts.

The National Whistleblowing Standards provide a standardised procedure which is a legislative requirement for all NHS service providers to comply with.  The Standards are not a HR procedure.  However, they do impact on employees, and as such, each organisation must decide whether and how they want to write these requirements into their own HR policies.  

For NHS Scotland board employees, a Once for Scotland policy is in place.  This applies to all NHS employees and refers directly to the Standards.  For employees of other organisations, it is up to the organisation to decide whether the Standards are written into internal HR procedures, but any internal whistleblowing policy must facilitate access to a procedure which is in line with the Standards, as a legal minimum.

Each organisation will need to have their own systems and structures in place for oversight and management of the whistleblowing procedure.  This oversight function will include ensuring that cases are being actively progressed, that updates are being provided to those raising concerns, that support for those involved is provided, and that recommendations are implemented appropriately.  

The INWO recommends that responsibility for whistleblowing sits better with an executive function, other than HR, such as risk management. 

Whistleblowing procedures and HR policies are separate, have different legal bases and duties, and cover different issues. It is easier to maintain the whistleblowing focus on the risk of harm or wrongdoing if this responsibility is not held within HR.  This frees up HR personnel to focus on HR issues and procedures. This can also reassure those raising concerns that the focus will be on improving safety rather than on HR issues. 

Human resources do, however, have a critical role in ensuring that support is available for those that raise concerns, and that managers are fully trained in receiving concerns. They also need to ensure that any HR issues that are raised within the context of whistleblowing are handled effectively and supportively, alongside any whistleblowing investigation.  They may also need to provide advice where investigations reveal HR issues which need to be addressed.

Any manager can receive a concern, either from someone they manage or from someone else that delivers services in their team or department.  Senior managers (such as lead clinicians or service directors) may receive concerns from anyone within their service, and more widely within their organisation, as sometimes it will be difficult to raise a concern within a department or service where this would create risk for the individual. 

In addition to line management routes, all organisations delivering NHS services must provide confidential contacts – someone that is trained in receiving concerns and in the organisation’s arrangements for receiving concerns.  This may involve signposting to another member of staff, or logging the concern and ensuring action is taken by another member of staff if the person raising the concern is not willing to take the concern to another manager. 

Staff wanting to raise concerns about primary care services can raise their concern with the board’s primary care confidential contact, as this may be the safest way for them to raise a concern.  The confidential contact will then need to decide how the concern can best be investigated, and share information accordingly.

Most boards will be able to use Datix to record concerns.  We worked with the Datix users group to ensure that Datix can easily be used for logging whistleblowing concerns, in line with the Standards. The critical elements to recording are:

• Confidentiality – case details need to be kept confidential to a high degree, with limited access, reviewed on a case by case basis.
• Information to be gathered is detailed on our page about Reporting and recording.
• Reports need to be shared internally at least quarterly (such as to risk management committees) and shared at full board committee meetings. They need to be made publicly available at least annually.

Contracted services, including primary care services, need to have systems in place for recording in the same way as boards, as above.  These services need to report this information to the board on concerns raised about the services provided for that board. Boards can use this information to inform their contract management.

From 1 April 2021, the INWO has been able to accept complaints about whistleblowing.  However, we normally expect the issue to have been reviewed by the internal whistleblowing procedure before we investigate it.  There may be instances where people feel the need to come to the INWO before raising their concern internally.  We would be happy to discuss such cases, and will assess what action we can take on a case by case basis.  It is very likely we would ensure that an internal investigation was appropriately undertaken (including support for anyone raising the concern), before starting any INWO investigation.

From 1 April 2021, every organisation that delivers NHS services must have a procedure that is in line with the National Whistleblowing Standards. They must have procedures in place that enable their staff, students, volunteers and others delivering health services, to access the Standards. The INWO will then be able to investigate complaints about concerns that have been through the local whistleblowing process.

Discuss with the person raising the concern and check whether they work for the organisation (either as staff, student, trainee or volunteer) and therefore have access to the whistleblowing Standards.  Concerns about care and treatment could include for example, poor standards of care, delays in receiving treatment, or refusals to provide care.

·         If they are doing so on behalf of the friend/ relative and would like an individual response to questions about their care, consent should be sought and this should be handled through the NHS complaints procedure.  This would mean the patient’s personal injustice could be considered, as well as wider patient safety concerns. 

·         If the patient does not know about the concern or does not want to complain about their treatment, business as usual should first be attempted, then the whistleblowing Standards should be followed, as it is not an NHS complaint covered by the MCHP. 

The first thing to consider is whether they work for the organisation (either as staff, student, trainee or volunteer) and therefore have access to the whistleblowing Standards.  If they are not, then the Standards don’t apply.

If they are, and have no concerns about their personal care and treatment or that being received by the friend/ relative, but have witnessed something of concern happening to another patient they do not know while receiving care or visiting others, then this is a matter for the whistleblowing Standards.  However, it is important to establish what they have seen, and why they consider this to have wider implications beyond the care of a single patient.

If someone is raising concerns:

·         about their own care and treatment, and

·         there is no reference to risk, care or treatment of others, or

·         they are suggesting there may be a broader public impact but they have not witnessed or do not provide evidence of witnessing broader impact

The concerns should be handled through the NHS complaints process (MCHP), not through the whistleblowing Standards.  Reassurance should be given that wider impact will be addressed through lessons learned.

This potentially could be raised under both the Standards and the NHS complaints procedure.  The NHS provider will need to decide how to approach these types of scenarios on a case by case basis.  This should involve discussing with the person raising the concern what outcome they are seeking. 

• If the person has concerns about their own personal care, for which they are claiming an injustice, that element should always be handled under the NHS complaints procedure.   

• If the person has concerns, but is not claiming a personal injustice, and they simply want to raise the wider issues they have witnessed, the concerns should be handled under the whistleblowing Standards. It is important that they have witnessed these concerns in relation to others, and are not simply saying that, because it happened to them, it could happen to others.

• If they are claiming a personal injustice relating to their care and treatment, and claiming there is a wider risk but have not witnessed these concerns in relation to others then it should be handled as a patient complaint.  Simply saying that, because it happened to them, it could happen to others is not enough to make it a whistleblowing concern.  Reassurance should be given that wider impact will be addressed through lessons learned from the complaints handling process.

• If they are claiming a personal injustice relating to their care and treatment, and have witnessed the care and treatment of others which they believe constitutes a wider public interest risk, then the issue may need to follow both routes.  That said, there should be discussion with the person raising the concerns, to establish whether this should be a concurrent investigation or whether one should take place first.  The service provider needs to be clear what is being dealt with through each route.  It may be, for example, that the complaint is handled through the NHS complaints procedure, and that addresses the wider issues to the person’s satisfaction.  It may be, that the patient safety issues are so significant that these are addressed immediately through the whistleblowing Standards.

In all circumstances, the focus should be on ensuring, that all aspects are considered through one or both processes and that the person raising the concern clearly understands what route(s) is being used and why.