The launch of the Independent National Whistleblowing Officer (INWO) service and the National Whistleblowing Standards (the Standards) on 1 April 2021 created a new process for handling whistleblowing concerns about the NHS in Scotland.
The Standards were developed by the INWO in consultation with NHS organisations, unions, regulators and previous whistleblowers.
The Standards outline a two-stage procedure for organisations to use when handling whistleblowing concerns raised by people in their organisation. The whistleblower can bring their concern to the INWO if the local process has been completed and they remain unhappy with how the concern has been handled, or how they have been treated. In some limited circumstances the INWO may become involved before the local process has been completed (for example, if the whistleblower is being denied access to the process). The INWO is a completely independent service that can review, investigate and make recommendations where failings are identified.
Remember that the whistleblowing process applies equally to anyone delivering services on behalf of the NHS and not just NHS employees. Click here for more information on who can whistleblow. For example, if you are contractor or work in primary care you can raise a concern with your employer, or through the NHS board that contracts your service. The process gives people support and protection to feel confident in raising concerns wherever and whenever they see something wrong For more information on how the Standards apply to staff who are not directly employed by the NHS, please click here or contact the INWO team.
What should I do if I have a concern?
Take note of key details
If possible, make a note of key details, such as what caused your concern, when things happened and who was involved. Such records will provide useful evidence, and will assist any investigation of the concern.
Raise the matter early
The earlier the problem is raised and looked into, the earlier any issue can be addressed and everyone can be sure that things are in order.
It is also important to be aware that many NHS staff – such as doctors and nurses – have a professional obligation to raise any concerns they have about patient safety.
It is important to get the advice and support you need to ensure you are able to raise the concern in a safe and effective manner, irrespective of the process being followed.
There are a range of options available, including going to designated confidential contacts within each NHS board, unions, independent legal advisers, and Protect, the whistleblowing charity.
More information about getting support is available here (opens in new window).
The INWO advice line can also provide information and signposting for those raising whistleblowing concerns.
Business as usual processes
In many cases, concerns can be resolved through informal conversations with colleagues and managers, and through ordinary or ‘business as usual’ processes (such as incident reporting systems). Concerns handled under ‘business as usual’ should be actively resolved without any detriment to the person who raised them. More information on raising concerns through business as usual processes (opens in new window).
While many whistleblowing concerns can be resolved in this way, it is clear that raising concerns can involve staff in potentially more complicated and difficult situations, where it is advisable to consider more formal whistleblowing options.
Overview of the initial stages of raising a concern (opens in new window)
When to use the Standards
You should consider raising a concern under the Standards where business as usual processes have not worked, or are inappropriate. Likewise, if your concern requires investigation or is a serious matter that you think needs to be formally raised, then use the procedure in the Standards. You can also use the Standards if you have concerns about the way you will be treated for speaking up, for example, if you have had a negative experience from speaking up in the past.
The Standards set out a two-stage process to handle concerns within NHS organisations. The first stage is short and could involve an explanation or limited action in response to the issue. The second stage is for concerns that require investigation and for this reason will be a longer process. There is more detail about what to expect from each stage below.
Who to speak to
In most cases, this will be your manager. If you do not feel this is appropriate, you could contact a more senior manager, or your organisation’s designated confidential contact. More information on who to raise a concern with (opens in new window).
The arrangements within primary care, and for students and volunteers, may be slightly different.
Can the concern be looked at under the Standards?
Whoever receives your concern will need to check whether it can be handled under the procedure outlined in the Standards. They are likely to discuss with you:
- Whether your concern fits the definition of whistleblowing i.e. is it in the public interest and about harm or wrongdoing?
- If it is being handled through a business as usual process already. The business as usual process should normally run its course to avoid duplication.
- The outcome you are seeking. It may be that another process will get you a better outcome, for example, a grievance.
- If the concern has been raised in time. It should normally be raised within six months of you becoming aware of the issue of concern.
- If you want to use the Standards. It’s your choice. If you choose not to use the Standards the organisation will decide how to investigate.
More information about the initial discussion and what happens if your concern cannot be handled under the procedure (opens in new window).
What protections are there for people who raise concerns?
The Standards provide protection and support for whistleblowers. They say that people who raise concerns must be:
- Thanked for speaking up
- Listened to and provided with support
- Treated with dignity and respect
- Assured their details will be kept confidential, and
- Responded to appropriately without detriment or retribution from other staff.
If this doesn’t happen the INWO can investigate how the whistleblower was treated and make recommendations for improvement (and redress if it is appropriate).
There is also legal protection for whistleblowers provided under the Public Interest Disclosure Act 1998 (PIDA). PIDA is often called the ‘whistleblowing law’. It is there to protect all ‘workers’ who have made a ‘protected disclosure’ from being treated unfairly as a result of raising a concern. More information about the Public Interest Disclosure Act and the employer’s duty of care to those raising concerns.
Confidentiality, anonymity and unnamed concerns
People who raise concerns may be naturally concerned about being identified as someone who has spoken up.
The Standards require that your details are kept confidential and are not routinely shared, even if an investigation is required. If there is a risk of your confidentiality being compromised then managers may be able to use discreet methods to gather information as part of an investigation, for example through an audit or staff survey. Data protection legislation also applies to how your details are stored on any system for logging concerns. This means that only people who need to access your details should be able to do so. Who will have access should also be discussed with you.
Anonymous concerns cannot proceed under the Standards and they cannot be brought to the INWO for independent external review. Anonymous concerns limit your legal protections and your organisation's ability to provide feedback and offer support.
Similarly unnamed concerns, i.e. where you ask for your name to be withheld from being registered with the concern, cannot proceed under the Standards or be brought to the INWO for review.
Remember that you are protected under the Standards from any potential victimisation.
More information about anonymous and unnamed concerns (opens in new window).
Stage 1 of the process involves little or no investigation, but does formalise the concern and allows for early resolution. The response will usually be a straightforward solution to the problem. You should get a response within five working days with an explanation of the outcome, and limited action might be taken in response to the issue you raised. You should also get details of how to raise your concern to stage 2 if you are unhappy with the response.
Stage 1 isn't appropriate for serious concerns or concerns that need detailed investigation.
More information about stage 1 of the Standards (opens in new window),
Stage 2 concerns are usually about serious risks or complex issues that need investigation. You can ask for your concern to be looked at under stage 2 if you think a full investigation is needed.
Whoever is handling your concern will acknowledge it within three working days and respond to you in 20 working days. If the investigation is complex and is taking longer, they may need to extend the timescale.
An independent senior manager will investigate your concern. You will get a written response and action may be taken on the back of your concern. The response should tell you how you can raise your concern to the INWO if you are unhappy with how it has been handled.
More information about stage 2 of the Standards (opens in new window).
How do I bring a complaint to the INWO?
You can contact the INWO at any time for advice if you are not sure about something.
The INWO will normally only investigate a concern after it has been through both stages of the local process, although in some circumstances the INWO can become involved before this. If you have trouble raising a concern under the Standards or are unhappy about the way the organisation is dealing with a concern you have raised, you can contact the INWO for advice. We can also intervene in the process if necessary. We call this a monitored referral. If the organisation decides your concern is not whistleblowing then they must signpost you to the INWO, who can review the decision.
If you have completed both stages of the local process, you should have a stage 2 letter which says that you can bring your concern to the INWO. A concern brought to the INWO is referred to as a ‘complaint’. You should bring your complaint to the INWO within 12 months of when you first became aware of the issue.
The INWO can consider complaints about:
- Any actions taken by your organisation in response to your concern
- Whether your organisation followed the process laid out in the Standards
- How you were treated during and after you raised a concern
- How the organisation supports a culture of speaking up.
The INWO will investigate and come to a decision on your complaint. She can:
- Refer the concern back to the organisation if it has not been fully investigated. If you remain dissatisfied with the organisation’s further response, the INWO can investigate the complaint.
- Discontinue an investigation where an appropriate resolution has been agreed between the parties.
- Uphold your complaint. The INWO can make recommendations to ensure that the situation doesn’t happen again. She can also recommend redress where people have been personally affected.
- Not uphold your complaint.
If you are unhappy with a decision on your complaint, you will have an opportunity to provide comments and express why you feel the decision is not correct.
More information about independent review by the INWO (opens in new window).
Other ways of raising whistleblowing concerns
Other organisations who can receive whistleblowing complaints about NHS services in Scotland are noted below.
Healthcare Improvement Scotland (HIS)
HIS is responsible for responding to concerns raised by NHS Scotland employees (or referred by another organisation) about the quality or safety of patient care delivered by NHS services. Unlike the INWO, they can look into concerns raised anonymously with them. Details on their process for handling whistleblowing concerns are available on the Healthcare Improvement Scotland website (opens in new window).
Professional regulators
Concerns about a medical professional, such as a doctor, nurse, dentist or pharmacist can be raised with the relevant regulator. Each regulator’s website will have info about their process. Contact information for regulators can be found here.
NHS Scotland Counter Fraud
You should raise concerns relating to fraud, embezzlement, theft, corruption and other irregularities against NHS Scotland with NHS Counter Fraud Scotland (opens in new window). They provide a more appropriate route for these kind of concerns than the INWO.
The role of the confidential contact
Every NHS provider must ensure their staff have access to someone who can provide them with information about raising concerns, a safe space to discuss their concern, and assistance in raising their concern with an appropriate manager. They might not always be called a ‘confidential contact’, but their role is the same. The Standards state that the key elements of this role are to:
- promote a culture of trust, which values the raising of concerns as a route to learning and improvement
- through direct contact with frontline staff, ensure they are aware of and have access to the support services available to them when they raise concerns
- assist managers in using concerns as opportunities for learning and improvement
- (for NHS boards) work with the board’s Whistleblowing Champion to ensure that all staff are aware of the arrangements for raising concerns within their organisation
- work with the chief executive (or equivalent) and those they have identified to oversee application of the Standards, to ensure implementation is functioning at all levels of the organisation.
This role requires excellent interpersonal skills, and the ability to work with people at all levels in the organisation. Confidential contacts must have a good understanding of the barriers people may face in raising concerns, and be willing to work hard to overcome these barriers and enable staff, students and volunteers to raise concerns safely.
Confidential contacts support people that raise concerns and ensure that their concerns are progressed to a manager who can take action. They can also be a useful link between management and the whistleblower, providing updates when necessary, and supporting the individual with the outcome at the end of the process. Normally they should not be involved in making decisions on behalf of the organisation, as theirs is a support role. For example, they are not responsible for making a decision as to whether an issue is whistleblowing, though they could give their opinion on whether an issue appears to fit within the definition in the Standards.
More information on key roles and responsibilities (opens in new window).