What Whistleblowers Really Want
June 21 2018
”The real scandal is not that no-one knows. It’s that everyone knows.”
Not said, as you might imagine, about the events at Gosport War Memorial Hospital but about the childrens heart unit at the Bristol Royal Infirmary 30 years ago. And yet, as applicable today as then, despite all the lessons learned (or not) over the years.
There are many aspects of this which will be wearily familiar to those involved in previous NHS scandals (Morecambe Bay, Stafford) and those in other sectors:-
– warnings or concerns raised by junior staff were ignored or hidden away
– senior staff and colleagues were aware but turned a blind eye
– complainants, both internal and external, were treated as troublemakers
– a tendency to close ranks against those raising concerns
– missed opportunities: all too many moments when something could have been said, should have been said but was left unsaid
– retaliation (or threats of it) against staff. They were warned that if people continued to speak out, it could undermine the good work being done. Some staff highlighting concerns faced “a certain amount of ostracisation”
– a culture of deference: both to senior staff and to the institution
– viewing the protection of the institution’s perceived reputation as more important than dealing with its failings.
Sound familiar? The fact that an institution consistently admired by the public could develop a culture quite as bad and – in its effects on people – worse than in less admired sectors (such as banking or the press) shows how widespread these problems are. Unsurprising really. Most people are not heroes and find it easier to take their cues from those around them.
But the most shocking (and, so far, least commented on) aspect of this story is that even 12 different sorts of investigations over 27 years failed to uncover the full facts or lead to effective action. How can this be? Well, different bodies with different agendas, powers, without access to all the information and sometimes lacking the relevant skillset do not result in the ideal investigative set up. But in truth, institutions – like most people – do not really want to know about their failings.
So it is all too easy – and sometimes unfair – to criticise individuals for not speaking up (see here a nurse describe her shame at not having done more) and to think that training them to have the courage to do so is all that’s needed. Necessary as this may be, it places too great a burden on them. And lets others off the hook.
Too often the focus is on those who knew but did nothing and on the lessons to be learned but not on the critical bit in the middle – the integrity and thoroughness of the investigation. Without it no-one will come forward and “lessons learned” will be seen as lessons which are never learned by those who need to do so.
“Freedom to speak” guardians (the NHS’s most recent attempt to create a better culture) are a nice idea. But what, really, can they do? What those who raise concerns want is not just the freedom to speak but the knowledge that action will be taken once they have spoken.
What they need above all are trustworthy, fearless, independent and tenacious investigators who will really listen to them and investigate properly. And an institution humble enough from the top down to realise – and really mean it this time – that it is only by understanding its failings and mistakes and learning from them that it can improve for the benefit of those it is there to serve.
Only then can individuals have the confidence to know that speaking up is not just the right – but the professional – thing to do. And that it will not be in vain.