In our final interview in this series, we ask NHS whistleblower, Dr Rita Pal, for her thoughts on preventing whistleblower retaliation, the possibilities for incentivisation, changing media and public attitudes, and effective training and communication of whistleblowing procedures.

Incentivisation

Some commentators have indicated that incentivisation could enhance the whistleblowing process by encouraging people to come forward.

What are your thoughts and, should this come about, what do you consider to be potential barriers to acceptance would be and how could they be overcome?

In theory, this is an excellent idea.

In practice, not all whistleblowers are evidence based, nor do they raise concerns in good faith.

Human nature being as it is, there would always be those who, having decided to obtain the offered incentive, would then set out to find something about which to raise concerns, even if they had to make it up.

The next point is that this phenomenon has not been examined in detail and its frequency will not be prevalent until incentivisation is common practice.

While it will undoubtedly increase the number of people raising concerns, the difficulty will be in differentiating types of whistleblower. That would depend on the circumstances and the environment where the concerns are raised.

I am not an avid supporter of financial incentives per se at present. I believe that fraud has many faces and, as a cynic, I am concerned that the researchers in the US have not studied the phenomena and potential for malicious reporting. There are no safety mechanisms in place at the moment.

There will be inevitable conflicts between the interests of the financial organisation vs. public interest vs. interests of the whistleblower.

So I would be on the side of caution and suggest that more work needs to be done to provide protection to whistleblowers from reprisal – and protection to the financial companies [from malicious whistleblowers].

I think if these safety nets are put in place, the legislation may be far more effective without negative consequences.

I worry about financial incentives for whistleblowing in relation to the public sector – it is so easy to be malicious in an organisation that is already failing due to poor public policy.

On a personal note – I would never accept a financial reward.

In fact, if I was given money, I would hand it over to the patient population. This is a personal choice issue though. Money does not motivate or inspire me much. I guess if it did, I wouldn’t have raised concerns about patient safety while placing myself in a precarious situation.

My reward would be an improvement in patient safety and a simple “thank you” would be enough.

I am, however, in support of non-financial rewards and accolades to the whistleblower. I think some recognition is good for those who are vindicated.

I am a little more cautious about financial incentives than Prof David Lewis.

Even though some authorities offer financial incentives already, I am uncertain whether it would work specifically in the health service. This aspect needs to be thought out and studied carefully before any implementation.

Healthcare is often so poor in the NHS that, if financial incentives were in place, staff may view it as an easy way to make money. Which then leads to the question of which budget the incentives would come from – if it is the NHS budget, a high rate of whistleblowing and payouts may have a negative impact on patient safety.

In conclusion, whistleblowing is a multifactorial problem. The solutions are difficult. I would be far more supportive of non-financial rewards as a way of honouring whistleblowers.

Recently, the Royal College of Anaesthetists paved the way by giving Professor Steve Bolsin an award for raising concerns that led to the Bristol Inquiry.

One of the biggest problems for medical whistleblowers is the professional isolation they suffer. It is therefore important for the Royal Colleges to move to recognising the contributions of whistleblowers to the area of patient safety.

This principle should also be applied to non-medical areas and the government should look into rewarding whistleblowers that have placed their livelihood at risk in the public interest.

Lastly, the most important reward that can be given to a whistleblower is continuous employment.

They are often individuals with good skills and stamina who could contribute to society as a whole, yet we have a population of unemployable whistleblowers. The government has never looked into what can be done to make them employable again.

Therefore, an offer of employment, free retraining, and alternative skills may be considerably better than just financial incentives. It is also a more practical solution to fixing the life of a whistleblower.

Media attitudes to whistleblowing

The narrative forces at play in the media when it comes to whistleblowing have historically been problematic. Would you agree that mass media attitudes to whistleblowing are improving?

Firstly, having spent some time reading your website here, it is probably the best selection of intelligent, well written articles I have ever seen. Secondly, I wish the media would follow your example.

I say this because, on a daily basis, I am frustrated with the media’s attitude towards whistleblowers. They are often paraded through TV, newspapers etc as “victims”. I don’t look at myself as a victim – I look at myself as a doctor who did their job.

Evidence-based whistleblowers are often intelligent and very good problem solvers. They may well suffer trauma due to their experiences but I do not believe the message that “if you whistleblow, you suffer from stress” is a good description to present to the public.

Moreover, while they concentrate on the “woe is me” scenario”, there is no “investigative journalism” surrounding the issues they raised concerns about.

The media understands very little about the multiple issues affecting a whistleblower. I have found them to be judgmental, ignorant and often insulting. If you do not fit into their “image” of a “whistleblower” then they do not take people seriously.

In an attempt to help genuinely interested journalists, I wrote a Guidance for Journalists Dealing with Whistleblowers.

I cannot say the media have ever been helpful during my whistleblowing.

Indeed, having featured Elderly Helped to Die in the Sunday Times on 2nd April 2000, the Sunday Times reneged on all their promises to follow it up and washed their hands of the story.

Luckily, I was able to write my own narrative on the internet and never relied on the media again.

Whistleblower retaliation, training and communication

Whistleblower retaliation is an increasing concern in both the public and the private sector.

How do you think organisations can work to minimise negative impacts on whistleblowers?

I have always believed that the UK requires a National Whistleblowing Centre, independent of any other organisations. Such a body could have free advocacy that gathers evidence (often held by the employer) and liaises with the employer, counselling, a support worker, employment advisers, financial assistance/advisers, retraining opportunities in the event of unemployability.

A charity like MIND can provide all this to mentally ill patients. There is no reason why the UK cannot consider opening a National Whistleblower Centre.

It is very difficult for organisations directly involved in any given incident to minimise negative impact on whistleblowers.

Firstly, the personalities of individuals cannot be easily modified, regardless of training or legislation – someone who is predisposed to dislike whistleblowers will continue to dislike them, no matter what steps are taken.

This is particularly true if the actions of the whistleblower have a correspondingly negative impact upon the person who dislikes them, regardless of whether or not they are directly or indirectly responsible for the circumstances.

Although many policies could be in place, they are unlikely to be effective if they are not implemented by management, and consequently there is no specific solution for whistleblowers.

Moreover, accepting that someone is a genuine whistleblower, rather than a vexatious whistleblower or simple troublemaker, is a fairly high expectation for any employer.

Reducing the impact of whistleblower reprisal requires an independent organisation with no conflicts or vested interests – A National Whistleblower Centre.

How do you think organisations like the NHS should approach training and communication about whistleblowing?

The NHS does not understand the multifactorial nature of whistleblowing.

We often have a situation where non-whistleblowers “think” they know what is “right” for whistleblowers. In actual fact, all policies put in place since the Bristol Inquiry have been shown to have failed, and will continue to fail.

The issues/style of training and even communication that will be effective cannot be determined fully without a full investigation into the exact failures that result in the problems.

That said, there are a number of ways that the regulatory bodies can improve matters. None of the NHS regulatory bodies have taken a sufficiently pro-active attitude to improving education, nor have they understood the need to improve recruitment – a change in culture will require a change in the types of personalities hired.

Somehow the medical profession has become so good at selecting those that will not report senior colleagues that the selection processes of medical schools has intuitively or deliberately selected 87% non-whistleblowers (Goldie, Schwartzetal 2003).

This observation is deeply worrying to those who believe that one of the mechanisms for quality improvement in healthcare is reporting poor care (Bolsin 2003; Bolsin, Faunceetal, 2005).

In terms of training, the key really is to start at the beginning and attempt to alter the medical culture by essentially selecting a type of medical student that is likely to advocate for patient safety, bridge the communication gap between doctor and patient and support transparency.

Essentially, this is a root and branch redevelopment of the profession. Without it, no amount of training or education will encourage a certain type of old-style personality into understanding the issues of whistleblowing.

Making the act of raising concerns acceptable practice is probably the only way to improve the system. This is essentially normalising a behaviour pattern that is currently perceived as abnormal.

The mistreatment of whistleblowers is essentially due to personality dysfunction within management or seniors. These established behavioural and personality flaws cannot be corrected by retraining or education.

Prejudices will always remain, much as one cannot retrain/educate a person who is racist to like the ethnic minority.

The situation is very similar with the stigma faced by whistleblowers. One cannot train the work force to “like” whistleblowers when the normalised behaviour pattern is to dislike them.

We don’t live in an ideal world. Sadly, all recommendations and policies made are for an ideal world. We live in a world where the ingrained prejudices against whistleblowers have to be overcome.

This will take time, a root and branch reform, a different style of education normalising transparency and a pro-active recruitment drive to improve the National Health Service.

Like disability or race discrimination, you cannot legislate the thought processes in a person’s mind. In terms of authorities that require education, I believe the courts have no understanding of the plight of whistleblowers and neither do the regulatory bodies.

It is vital that educational material is sent to those making judgments and decisions about whistleblowers.

Alternatively, one could view the whole situation as a human problem – the human desire to correct injustice in conflict with the human dislike of whistleblowers. If the human element could be removed from the equation, then the problem would simply cease to exist.

Speaking purely theoretically, and at an abstract level, this could perhaps be achieved by introducing a system of checks and balances into the very fabric of the NHS, such that the whole organisation became self-documenting, and, therefore, automatically aware of developing problems.

How such a system might work, and the steps required to even assess its viability are far beyond the scope of this discussion, but a means of identifying problems that are inherent in the system, and therefore don’t rely on whistleblowers – and the consequences of their actions – could, in theory, have far greater benefits for service users than conventional attempts to encourage and protect whistleblowers.

Such self-diagnostic systems already exist in other walks of life – such as communications networking technology, for example – so the concept isn’t too far fetched, although, of course, making the notion work in the context of a healthcare system presents many challenges.