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Raising concerns about the mistreatment of older people in Wales

Background

An ageing population has resulted in rising numbers of paid employees caring for ever greater numbers of older people. At the same time concerns are frequently raised in the UK regarding sub-standard care of older people. Against this background employee “whistleblowing” has emerged as  an important yet conflicted managerial mechanism, aimed at keeping organizations and their workers trustworthy and accountable. Although whistleblowing is mandated in local and national health policy the fate of whistleblowers is characteristically bleak, often facing the prospect of being sacked or ostracized and resented by work colleagues.

Aims and objectives of the study

The aims of this research study was to explore the obligations, attitudes, barriers and enablers that exist around whistleblowing in older people’s health and social care settings in Wales.

Method

Semi structured interviews and focus groups (n=50) with practitioners (registered nurses, stuent nurses, carers, physiotherapists, dieticians) and regulatory/legal bodies (police force, nursing regulatory bodies). Data collection sites included hospitals, nursing/residential homes and domiciliary care teams. Ethics and governance approvals were granted by relevant committees. Data were thematically analysed.

Findings.

Whistleblowing was considered a problematic term, associated with “grassing” on colleagues. Such perceptions dissuade staff from raising concerns. Certain expectations such as manageres acting decisively to resolve problematic issues were often unmet, leading to staff disillusionment.

Participants described how workplace norms influenced participants’ behaviours without being articulated, acting as an invisible but powerful force that manipulate employees understanding of what constituted mistreatment or conduct worthy of whistleblowing.

Furthermore, decisions about what to do when confronted with questions such as “Is it mistreatment?” or “Shall I report this?” were also mediated by staff interaction. Little guidance was sought from policy documents or codes of conduct.

Conclusions and implications.

Understanding the nature of the interactions that occur between employees seem key to developing a better understanding of attitudes, barriers and enablers to whistleblowing behaviour.

Establishing and maintaining positive workplace values and norms through regular communication with staff, rather than additional external regulation seems key to establishing an effective reporting culture.

Funder: The Older People's Commissioner for Wales