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John Tizard: Public service outsourcing must promote whistleblowing

Monday October 9th, 2017

Last week the Bath Chronicle reported that Virgin Care asked staff not to report their safety concerns to the Care Quality Commission (CQC) or other regulators.

John Tizard

If this is the case, it is wrong and unacceptable. Registered managers in health and social care have a legal obligation to report issues to the CQC if they feel their service is unsafe.

Virgin Care is reported as having asked its managers in Bath and North East Somerset to “hold off” from contacting the CQC as they struggled with IT issues affecting community health and social care services.

This raises questions about the public sector client – in this case Bath and North East Somerset Clinical Commissioning Group (CCG). When outsourcing, public sector clients cannot transfer their ultimate responsibility and accountability for performance and service user/patient safety. They should be monitoring performance.

When letting outsourcing contracts the public sector should not only insist on the highest statutory standards of provision and safety but also require providers to report regularly on their performance against these standards. Public sector clients should monitor performance and audit the returns from providers. Where services are externally inspected by regulators such as the CQC the client can triangulate statistics, data and evidence. They should be interested in narrative reports from stakeholders and not be solely reliant on data and provider-generated performance reports.

This means that public sector clients should speak to staff, even when they are employed by the provider, service users and voluntary bodies that represent service users.

We don’t know what the monitoring procedures and practices are in Bath and North East Somerset so we cannot comment on what did or did not happen in this case in respect of the client. Therefore, I am not going to comment on this contract beyond what is already in the public domain. However, this case should make us think about what would be good practice in any public service outsourcing project.

We can and should expect all public service outsourcing contracts to include suitable provision to ensure:

  • providers have effective staff and wider stakeholder whistleblowing and complaints policies including how issues raised through such policies are to be responded to
  • staff and other stakeholders are free to bring their concerns to the attention of their direct managers, more senior management within the provider organisation, the public sector client, and inspectorate and regulators such as CQC, Ofsted, NAO, etc
  • protocols are in place to manage these policies and processes in ways that are practical yet never inhibit staff and stakeholders from speaking up
  • staff have access to independent advice and counselling in respect of whistleblowing and that this should include a meaningful role for trade unions
  • client contract monitoring and other client professional staff – and in some cases non-executives and politicians – can have access to staff, service users and other stakeholders when monitoring performance and provider behaviours
  • providers are required to prepare evidence and attend local authority scrutiny panels and health and wellbeing boards to explain performance, etc
  • that the provider’s performance and reports on complaints, their investigations and consequential actions are made public (in ways that do not compromise staff rights or any legal actions)
  • providers and clients conform with the Freedom of Information Act

There is a strong case for protocols on whistleblowing to be agreed between the major public service regulators and inspectors and local government, the NHS, police, central government and other public sector clients. Consistent and standardised approaches to covering these issues in contracts and how regulators and inspectorates should interface with public sector clients – we should not forget that the clients are themselves regulated.

The same standards and protections should apply when services are outsourced as they are when services are in-house, so the public sector should ensure that standards and practices are exemplary in the services they manage.
Ultimately what matters is the safety and wellbeing of service users, communities and staff, not the political vanity of the public sector or the profits of providers.

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