RCS guidance on raising concerns and whistleblowing

The Royal College of Surgeons (RCS) is today publishing a comprehensive manual that advises clinicians on how to act if they consider patients are receiving poor care. Acting on Concerns: Your Professional Responsibility guides surgeons on how best to collaborate with colleagues to monitor performance and quality of care, deal with problems, raise concerns and support others to do the same.

Real excellence in surgery comes from managing past failures and future risks well, with teams supporting each other through difficulties and responding to problems in a timely and constructive way. It is vital that surgeons make every effort to foster a culture where the quality of patient care provided by each individual member of the team is everyone’s concern.

This publication provides practical advice on how to develop an open culture where there is a willingness to address issues. It urges individuals not to wait for things to go wrong before personally attending to the quality of clinical governance in a team or department.

Key recommendations include:

• Don’t wait for things to go wrong: If you believe there are weaknesses in quality management, start discussing them with your colleagues now – before it becomes a patient safety issue. Treat discussions about performance as an opportunity to celebrate the best and set standards to aspire to, as well as an opportunity to attend promptly to possible problems.
• Don’t ‘explain away’ dissonant or worrying data: It is a natural human tendency to seek to explain away data, events or outcomes that conflict with our preferred version of reality. To ensure this doesn’t happen, all surgical teams must be receptive to benchmarking and other forms of comparative outcome data and audit.
• Be aware of the avenues open to you to raise concerns: Depending on the severity or urgency of the situation, it is a matter of judgement whether you raise concerns through organisational routes or with the relevant regulator. This document provides guidance on the available options, drawing on practice wisdom and evidence to suggest ways in which you can increase the likelihood of achieving a successful outcome.
• Understand the legal protection in place for whistleblowers: The Public Interest Disclosure Act protects the employment rights of individuals who raise genuine concerns about wrongdoing in their workplace. This manual is designed to help you understand your rights and provides clarification on important issues such as patient confidentiality.

Miss Clare Marx, Consultant Orthopaedic Surgeon and council lead for patient safety, said:

“The doctor’s first duty must always be to the patient rather than a colleague or a team. Expressing a concern will not be easy, but it is important that when problems emerge clinicians do not bury their heads in the sand and so become guilty of passive inaction. Greater accuracy of outcome measurement and enhanced clinical audit is paving the way to excellence for surgeons but, as we see the results, so the challenge of managing concerns identified will become even greater. We hope this manual will help surgeons create an environment of trust and openness, where concerns can be raised, listened to and acted upon.”

Notes to editors

A copy of Acting on Concerns can be accessed here.

For more information, please contact the RCS press office on:

• 020 7869 6047/ 6052
• communications@rcseng.ac.uk
• Out-of hours: 07966 486 832