Raising concerns: a guide for members

In addition to the support structures provided in your workplace, the RCN is here to support you. The guidance below will help you to raise a concern and understand your, and your employer's, rights and responsibilities.

You can also download this advice as a pdf or order a printed copy from RCN Direct (publication number 004 391).

You can call the RCN for support and advice at anytime on 0345 772 6100.

Whistleblowing or raising concerns?
Raising concerns: rights and responsibilities
Nurses and raising concerns
Raising and acting on concerns early
Practical steps when raising a concern
Contact the RCN
Useful resources

Whistleblowing or raising concerns?

‘Whistleblowing’ is the popular term for when an employee, former employee or member of an organisation raises concerns with people who have the authority to take corrective action.

In these pages we talk about ‘raising concerns’ rather than ‘whistleblowing’, as whistleblowing has come to mean a sudden, drastic or last resort act which can hold negative connotations. A ‘protected disclosure’ is the legal term for whistleblowing; the protection is afforded to the person raising the concern in the interest of the public.

The Department for Business, Innovation and Skills (BIS) has published a list of prescribed bodies under the whistleblowing legislation to which such a protected disclosure can be made.

www.gov.uk/government/publications/blowing-the-whistlelist-of-prescribed-people-and-bodies

All employers should have a formal policy for raising concerns, which will usually be known as the ‘whistleblowing policy’, and you should familiarise yourself with this at an early stage if you wish to raise a concern.

If you feel that your situation is more appropriate to whistleblowing, please see our whistleblowing guidance.

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Raising concerns: rights and responsibilities

It is everyone’s responsibility to be aware of the importance of preventing and eliminating wrongdoing at work. You should be watchful for unsafe, illegal or unethical conduct and report anything of this nature. Your employer has a duty to respond, if they do not we can help you escalate your concerns.

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Nurses and raising concerns

Registered nurses must follow the NMC code of conduct at all times, but other members of the team should also use it to guide their practice. The NMC has produced its own guidance on whistleblowing and raising concerns, including a training toolkit.
www.nmc-uk.org/Documents/NMC-Publications/NMC-Raisingand-escalating-concerns.pdf

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Raising and acting on concerns early

Don’t wait for a problem to develop. If you see poor care or feel you are being prevented from providing safe, compassionate care, start discussing it with your colleagues now.

More importantly, ensure you are aware of the approaches you can take to help improve the quality of care and deliver the best clinical practice to prevent a problem emerging in the first place.

For more information about delivering high quality care and to learn more about areas such as dementia and nutrition, see useful resources.

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Practical steps when raising a concern

When do I raise a concern?
Who do I raise a concern with?
How do I raise a concern?
Can I raise a concern confidentially?
What support can I expect?
What response should I expect when I raise a concern?
Will there be personal consequences for me if I raise my concerns?
What are compromise agreements and ‘gagging clauses’?
Managers: how should I act on a concern?

When do I raise a concern?
It can sometimes be hard to know whether a situation should be raised as a concern. You should be guided by this question:

Has the situation caused harm or distress or if you let the situation carry on, is it likely to result in harm or distress?

Your concern must be based on a reasonable belief that you can justify, but you do not need hard evidence that wrongdoing is happening, has taken place or is likely to happen in the future. If in doubt, raise the concern with your manager/senior colleague, and do it as soon as you can.

Who do I raise a concern with?
Your employer’s whistleblowing policy should detail with whom you can raise a concern. It is important to follow the policy guidance, if it is reasonable, as this will ensure that you are protected by the law when you raise your concern (known as making a ‘protected disclosure’). However, if you do not believe your employer’s policy to be reasonable, please contact the RCN for guidance about to how best to proceed.
Your employer’s policy should have information such as that included in steps 1 to 3 below.

What if my employer doesn’t have a policy?
Smaller employers may not have a whistleblowing policy. Your line manager may also be the only manager. You should still raise your concern with your line manager in the first instance – remember the RCN is here to support and advise you if you feel anxious about doing this.

Step 1:
Find and familiarise yourself with the policy for your place of work. An employer’s policy would normally request that you initially raise your concern within your team or directly with your line manager.

If you feel uncomfortable doing this (particularly if your concern relates to management), your employer’s policy should allow for a formal and confidential (if necessary) procedure for raising concerns. It should indicate a designated memberof staff – outside of your immediate line management – with whom you can raise your concern. You can also contact your human resources (HR) department if you have one.

Don’t forget the RCN can help

Step 2:
If your concerns are not addressed, escalate the issue to the next level of management or director of nursing or equivalent depending on where you work.

Don’t forget the RCN can help

Step 3:
If your concerns are still not addressed satisfactorily then escalate the issue again to the chief executive (or equivalent depending on where you work) but ensure your director of nursing is aware that you have taken this step. If you have followed your employer’s policy and your concerns have not been resolved you may wish to consider taking steps four and five.

Don’t forget the RCN can help

Step 4:
If you have exhausted all local workplace policies and procedures you should consider raising your concerns externally. A list of external bodies to which you can make a disclosure can be found at www.gov.uk/government/publications/blowing-the-whistle-list-of-prescribed-people-and-bodies

Don’t forget to get the RCN to help you with this

Step 5:
If you are considering going to the media, which should always be a last resort having exhausted the above routes, there may be confidentiality issues and employer policies that you need to be aware of.

Please contact the RCN for advice and support.

At all stages - ensure that you keep records of your concerns and any steps you have taken to resolve them which you may need to use as reference at a later date.

How do I raise a concern?
When you have identified whom to approach, you can raise a concern either verbally or in writing. You will need to include some background with a history of your concerns and the reasons why you are concerned. However you report your concerns, ensure that you keep records and notes of the issues that you are concerned about for reference throughout the process. At any stage, whether you are following your employer’s policy or the steps outlined here you can contact the RCN for support and advice.

Can I raise a concern confidentially?
Your employer’s policy should enable you to raise your concern confidentially, which means your name is not revealed without your consent, unless required by law. When you raise your concern, whether verbally or in writing, you need to make it clear if you are doing so confidentially.

What support can I expect?
We understand that raising a concern can be difficult. In addition to RCN support, whistleblowing legislation provides you with the necessary legal support. It is important the concern is raised appropriately and is a qualifying disclosure according to the legislation. Do not be worried that this sounds technical – the RCN can guide you through it.

If you work for the NHS, all employees have a contractual right and a duty to raise genuine concerns with their employer that they consider to be in the public interest - including malpractice, patient safety, financial impropriety, or any other serious risks. This is set out in the NHS Terms and conditions of service handbook – section 21.

Additionally:

in England the NHS Constitution and handbook include a pledge to support staff that wish to raise concerns
in the NHS in Scotland staff are covered by nationally agreed Partnership Information Network (PIN) policy on whistleblowing
in Northern Ireland staff are covered by the Regulation and Quality Improvement Authority whistleblowing guidance
in Wales the Health Care Inspectorate Wales has produced a document called Concerns and complaints about health services in Wales which covers NHS services and independent health care settings.

What response should I expect when I raise a concern?
When you raise a concern you should be listened to carefully and without fear of detriment. Your employer should investigate your concern thoroughly, promptly and confidentially. Your concerns should be assessed as to:

how serious and urgent the risk is
whether the concern is best dealt with under the local whistleblowing/raising concerns policy or another local procedure
whether assistance is required or if referral to senior managers, or a specialist function, is desirable or necessary.

The issues you raise should be answered in writing, summarising your concerns, noting whether you raised them openly or confidentially and stating the steps that will be taken to resolve the situation.

If you do not receive this the RCN can help you.

Will there be personal consequences for me if I raise my concerns?
The RCN recognises that raising concerns can sometimes require courage in the face of possible victimisation and we will support those who face difficulties for having taken this step.

Most employers take concerns very seriously and respect their moral and legal obligations, however, legislation protects you if you raise concerns:

your employer should treat any acts of victimisation against you as a disciplinary offence. Your continued employment and opportunities for future promotion or training should not be affected. If this happens, you can bring a claim atan employment tribunal. There is no cap on the awards for victimisation, and some employers in the past have been ordered to pay significant compensation to the worker
accredited RCN representatives who raise a concern on behalf of others or themselves are protected by trade union legislation
an instruction to cover up wrongdoing is a disciplinary offence. If told not to raise or pursue any concern, even by a person in authority such as a manager, you should not agree to remain silent. The NMC identifies a duty of candour for registrants, but this is good practice for all.

However, you also have a duty of honesty:

if you deliberately make a false allegation it may be a disciplinary offence. If you make an allegation which you believe to be true, but turns out not to be, you may be protected by the legislation
committing an act of misconduct and/or breaching your employer’s disciplinary procedures (eg by disclosing patient/confidential records to third parties, unauthorised access to confidential records) could justify your employer taking disciplinary action against you. If in doubt, seek advice from the RCN.

We understand that raising concerns can be stressful. If you feel under pressure, the RCN can provide an opportunity to discuss your situation confidentially.

What are compromise agreements and ‘gagging clauses’?
A ‘compromise agreement’ is a standard method of terminating employment in difficult cases, drawn up between the employer and employee as a final resolution to an ongoing dispute, usually involving the employee leaving the place of work.

Much confusion has arisen in the health sector about the use of compromise agreements and particular clauses which feature in such agreements, commonly referred to as ‘gagging clauses’, which may prohibit an employee from raising a concern about patient safety issues. Gagging clauses are unlawful and cannot be enforced in public interest disclosure cases. However, it can sometimes be hard to determine the meaning of particular clauses in an agreement, especially if you are involved in a termination of employment and feel overwhelmed by the experience. Seeking advice is therefore vitally important. If you think that a gagging clause is being proposed you should contact the RCN and take legal advice.

We strongly advise you to seek additional advice from the RCN.

Managers: how should I act on a concern?
If you are in a management position, creating an environment of openness is paramount. You should model openness and transparency in your own approach and should foster a culture in which all members of staff feel able to raise concerns without fear. You should escalate any concerns you may have appropriately, according to local policies.

Guidance published by the Social Partnership Forum and Public Concern at Work for England outlines how to achieve this type of culture and why it is important. This guidance also includes practical tips for managers in handling concerns including: responding to concerns; communicating the
importance of raising concerns; and auditing, refreshing and reviewing existing approaches.

Similar whistleblowing guidance is provided by the Regulation and Quality Improvement Authority in Northern Ireland, and PIN policies in Scotland. The Health Care Inspectorate Wales has produced a document called Concerns and complaints about health services in Wales . This covers both NHS services and independent health care settings. See useful resources.

At any time you can contact the RCN for advice.

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Contact the RCN

For help and support contact:

RCN Direct on 0345 772 6100
your local rep
regional or country office (Northern Ireland, Scotland, Wales)

If things are becoming difficult and you think you are being victimised, contact us at the earliest opportunity.

The RCN is also here to provide you with moral support and a sounding board to check whether you are doing the right thing in raising a concern, and doing it the right way.

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