I attended the RCN Congress on Sunday 19 until Thursday 23 May. While there, the BBC aired a programme about abuse to vulnerable people with learning disabilities. Alongside this, it was hard to hear some of the speakers at Congress speaking about experiences in work when working with people with learning disabilities and to listen to agenda items where members spoke about their experiences of bullying in the workplace.
There were a number of items on the agenda that struck a chord with me at Congress – the bullying item being one of them.
During the debate, representatives urged RCN Council to insist bullying is addressed urgently and to introduce legislation to tackle bullying in the workplace. Personally, I’m conscious that multi-disciplines in healthcare are coming together trying very hard to reduce bullying, if not eradicate bullying behaviours altogether and are establishing a practical guide to tackling bullying in the NHS.
The other debate was an emergency resolution from the RCN Learning Disability Forum in response to the news reporting of the abuse at a home in Yorkshire the night before.
What struck me when listening to these stories was why concerns were not addressed when they were raised at the time? If RCN representatives do not feel they have the power to escalate and raise these concerns this is deeply concerning.
Going down the litigation route is a last resort in my opinion (speaking from experience of whistleblowing in the NHS) and although I learnt that by taking things as far as I did influence changes in the NHS, it is a long process. Those bullying practices need to be addressed now, I cannot see how litigation can actually prevent bullying or ensure people are not afraid to speak up. We have the Public Interest Disclosure Act and Health and Safety at Work Act and still people are afraid.
But then again it is how those concerns are communicated; it needs to be in such a way that it provides detail of why a practice is unsafe, what impact does that have on patients and the public, on staff and staff wellbeing; and on the organisation in order that there is an understanding and what is needed to change practices and systems – a working together with shared reflections.
Trusts may look upon union representatives as looking at things from the angle of a grievance or other litigation and become on the defensive, not really getting an understanding from a shared learning perspective. Or a representative may give advice to members that may not necessarily deal with the problem immediately because they may be looking at things from an angle of a claim somewhere down the line by way of representation. I understand that when somebody has suffered harm. However from a professional perspective and not a trade union perspective, Freedom to Speak Up Guardians and Champions are in positions to address those concerns immediately, safely for nurses and other healthcare workers so that they are supported and protected.
The RCN and other unions have members that are bullied and intimidated, and also members that bully and intimidate. These practices must stop. We hear of bullying and harassment practices in other public services, such as the police, fire services and in the government, but we must make moves to get it right with our own members before condemning governments for failing to introduce legislation to prevent bullying in the workplace. Government see the number of nurses that are heard at the NMC - there are 400,000+ RCN members in the nursing workforce. As a professional body there is so much more we can achieve on the freedom to speak up agenda and bullying agenda. The NMC has changed its policy so that nurses are better supported internally, moving away from a blame culture.
When I joined the queue to speak on the bullying item, I’ll not deny I was very nervous about speaking to the 3,000-plus audience but for me it wasn’t an option not to - it was an opportunity to change thinking.
I wanted to share good practices of what works well when speaking up and the positive outcomes for patients, staff and the organisation in improving patient safety, staff morale and learning together, improving a culture of listening and acting. I wanted to say, ‘we need to learn to speak up smartly’ however, I was among the dozens that didn’t get to speak when it became necessary for the Chair to draw a line in the queue.
When listening to the safety culture item it was again clear to me that when hearing people speak about their concerns they are either not being raised or escalated internally which demonstrates a real issue with speaking up, or they are not being heard.
I did not hear anyone speak about Freedom to Speak Up Guardians or Champions, and don’t recall hearing anyone speak about sharing good practice on what works well when speaking up, which was so very important to reflect a balance and an opportunity to debate shared learning.
At Congress I would have liked to have had the opportunity to say all union representatives and Freedom to Speak Up Guardians need to be working together in collaboration with trusts and colleagues so that there is an understanding of patient safety concerns and engaging staff in implementing improvements. I would have informed the 3,000+ members about a conference on ‘a practical guide to tackling bullying in the NHS’. That was however subsequently cancelled because there was not enough delegate interest – again this is worrying.
We are three years down the line from the introduction of the Freedom to Speak Up Guardians following inquiries into Mid Staffs and Sir Robert Frances’s Review on patient safety and improving protection for whistleblowers. I have seen some immediate responses to concerns raised recently in trusts that evidences a listening and responsive culture and while there are some really positive engagements and outcomes in some areas we are not there yet, but I am very optimistic that this form of communication can work across healthcare.
I’d like very much to see more people speak up collaboratively, share experiences and reflections in patients' and the public’s best interest; and in the interest of colleagues and feel strongly about opportunities for nationwide engagements that can then lead to implementing improved practices when speaking up.
Reflections are a powerful force for learning and sharing reflections is a powerful resource for influencing when shared with integrity. I have delivered feedback to many trusts leading to positive interactions and outcomes for patients and their families, the workforce and the organisation; in some cases leading to turning services around positively. While I work in children’s services some of those experiences shared are transferable to other services and across systems.