Do No Harm Wales is a Welsh NHS whistleblower victim support group, an independent group of healthcare professionals who have raised concerns within NHS Wales and subsequently suffered retribution. This is our response to the 2023 Welsh Government guidance Speaking Up Safely: A Framework for the NHS in Wales.
While we welcome any efforts to support and promote speaking up safely within NHS Wales, we are concerned that Do No Harm Wales was not consulted in the drafting of this document. We submitted recommendations to the Welsh Government regarding a robust protected disclosure procedure, which appear to have been overlooked. The following issues are of specific concern to us.
Aspirational and incomplete
1. None of the framework content suggests the proposals are compulsory. It reads not as a definitive, but rather as an aspirational document. We question who would be responsible for overseeing this, and what are the means by which the Welsh Government plans on reviewing and auditing this process. We note the vague wording in the document, which allows for a wide legal interpretation rather than specific wording with clear legal obligations.
2. Speaking up safely requires a system to ensure that the inherent imbalance of power between clinicians and unaccountable and unregulated managers is addressed. We feel that is not addressed here.
3. Whistleblowing victims do not feel safe accessing health services from the health board in the area where they whistle blew. This was not addressed.
4. Other regions of the UK have addressed legacy issues regarding treatment of NHS whistleblowers. The NHS Highland ‘healing process’ is one example of this. The framework ignores this question.
5. Redeployment is mentioned in the framework, but more detail is needed. In England there is a specific rehabilitation programme.
Omissions and obstacles
6. There is no mention of the Kark report. Its recommendations include that all directors should meet certain professional standards to sit on an NHS board; a central database should be created that holds key information about qualifications and employment history; references should be a mandatory requirement for director posts; and a power should be created to disbar directors for serious misconduct (including expanding the definition of that). Leaving this out is a serious omission.
7. We have reservations about the independence of board members chosen as Speaking Up Safely Board Champions. Eleven independent members of the Betsi Cadwaladr University Health Board (BCUHB) were forced to resign earlier this year, saying, “We have no confidence in the Welsh Government’s grasp of the situation.” We have little faith in the Welsh Government to either properly appoint or listen to concerns raised by independent members.
8. We are confused over whistleblowing as a ‘protected disclosure’. It is not clear at which point the individual is actually making a protected disclosure within the legal framework of the Public Interest Disclosure Act 1998 (PIDA, an Act of Parliament that protects whistleblowers from detrimental treatment by their employer). We also have concerns regarding the ability of Protect (an England-based advice and support organisation for whistleblowers) to understand the complexities of devolved Welsh health. We refer to our own document and again request that this law is looked at, as it neither protects those making ‘protected’ disclosures nor sits easily within a devolved health setting.
Too slow, too little, too late
9. We remain concerned about the ongoing potential for whistleblowing to be dismissed as malicious or vexatious. Do No Harm Wales members have experience of evidence being tampered with and removed, in order to present the person raising concerns as either mentally deranged or vexatious. More work needs to be done to ensure that falsifying evidence by senior managers is addressed, as well as ensuring transparency of NHS investigations. Research suggests that malpractice is far more common amongst managers. Vexatious staff cases are very uncommon.
10. There is no specific advice for encryption or safeguarding the identity of those wishing to raise concerns. This is addressed by speak up systems in other UK nations, which are well ahead in creating and improving proper speak up systems. England has had this for nearly a decade, and uses encrypted data collecting; there are lots of companies which provide this specific service. Why not Wales?
Additionally, it is problematic that these matters have not been addressed at an earlier date (in view of the Francis Report, Freedom to Speak Up, published in 2015). Many of the 2013 Donna Ockenden report recommendations regarding the Tawel Fan scandal still had not been addressed years later. There is an evident pattern in Welsh health of too slow, too little, too late.
The Framework states that it “sets out the responsibilities of all NHS Wales organisations, their executive teams, and boards, along with those of managers and individual members of staff in further building a culture in which ‘Speaking Up’, is supported within a safe environment”.
We do not feel that it can create such a safe environment for whistleblowers as written. In summary, we remain unconvinced by this document and refer once again to the Ten Point Plan we sent to the Welsh Government in 2019. Or are people with real and difficult experiences of whistleblowing still not to be listened to?
