By Alex Leonards
Clinical scents and sounds travel through the children’s ward of a busy central London hospital. Noisy halls are silenced in the sister’s office, the only quiet space in the department.
Patients walk by along bright green floors; passing mint coloured walls decorated with stickers depicting a woodland scene.
The paediatrics, or “forest” department of Guy’s and St.Thomas’ hospital is always busy. Staff rush by intently wearing navy blue scrubs and surgical caps; they’re ready for action in theatre, but not always prepared to speak up.
Transparency in the NHS, on a superficial level, is encouraged. However negative attitudes towards reporting staff or incidences within hospitals leave many suffering in silence.
Those that do draw attention to problems may face unwanted consequences.
“Whistleblowing works,” says ODP Alison Brown*. “I remember when we didn’t have any mops. Theatre floors were covered in blood, and weren’t cleaned properly. I sat down, filled in an IR1 form, sent it to the head of departments, and literally 12 hours later there was a month’s worth of mops”.
IR1 forms on the NHS trust intranet are used to raise a matter of concern. The process is simple; staff members fill in the form, and disclose the details of the incident. The report is then sent to the heads of departments.
Alison, who has worked in the paediatrics department of Guy’s for over a decade, is no beginner in filing complaints: “I fill them out quite regularly. I’ve got really good at filling them in really quickly!”.
However Alison is familiar with the unwanted consequences of flagging up a problem:
“I have been told off for doing them. Managers have said ‘I don’t think it’s appropriate you do them’. And I think, well that’s not upto you to decide.”
According to the British Medical Association (BMA) NHS staff often avoid speaking out because they fear disrupting relationships with managers and co-workers. The BMA’s discussion paper Supporting Doctors in Raising Concerns lists fear of bullying, ‘complaint fatigue’, impact on careers, conflicts of interest and confusion about how to approach reporting an incident, as deterrents for drawing attention to issues in hospitals.
These consequences pose a very real threat of bullying. After an incident involving the misplacement of drug keys, which are used to control drug dosage, Alison filled in an IR1 form.
“It went down like a lead balloon”, she says, “It caused an absolute storm in the department. Whistleblowing prompted staff bullying, because it had highlighted extremely bad practice. I did the form, so it all came back on me”.
The NHS annual survey monitors how effective and fair staff think procedures for reporting errors, near misses and incidences are. On a scale of one to five, one representing unfair procedures, and five representing fair and effective procedures, Guy’s had an average score of 3.64.
An acceptable score, but the hospital does not have much competition. Of all acute hospitals in the UK, the highest score was 3.73.
“They do encourage it in some ways” she says, unconvinced “ But on the other side of it, if you’re highlighting things in the department that aren’t working, it reflects badly on them.”.
Alison emphasises the great importance of being transparent about things going wrong in the NHS: “ This is people’s health, its serious. You’re not working at Mcdonald’s where you might forget cheese in a cheeseburger”.
“There is a real compliancy that everything will work out in the NHS, and people put the health service in such high esteem, but sometimes theatres are filthy” she says fervently “Ramsay’s kitchen is cleaner than some of them. You have to speak out, other wise things never change”.
*Names have been changed.