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Standing Up forHigh Standards
How the RCM will support midwives,
student midwives and maternity support
workers if they have concerns at work
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Standing Up for High Standards
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Standing Up for High Standards
Introduction
The exposure of shortcomings in The Report
of the Mid Staffordshire NHS Foundation Trust
Public Inquiry (Francis, February 2013) has
thrown a spot light on the way that concerns
about standards, systems and practice are
raised and dealt with in the NHS. In March
2015 The Report of the Morecambe Bay
Investigation lead by Dr Bill Kirkup highlighted
serious failings in the Furness General Hospital
maternity unit between 2004-2012. The
high profile given to the subsequent reviews
and investigations means a new approach is
required throughout the NHS to support staff
and students who wish to raise concerns.
The RCM believes that all midwives, student
midwives and maternity support workers
(MSWs) should feel able to speak out if they
have any concerns about the quality and
standards of care provided or if they suspect
treatment or care will or has caused harm.
The RCM will do the following.
• Support and encourage members to
use existing mechanisms within their
employing organisations to raise issues.
• Provide guidance for members who
wish to raise concerns.
• Promote good working relations and
lines of communication between
midwife managers and RCM
workplace representatives so that
issues are raised in a climate of honesty
and transparency.
• Facilitate forums for midwife
managers, supervisors of midwives
(SoMs) and RCM workplace
representatives to share with others
views, evidence and perceptions about
their working environment.
• Direct concerns brought to its attention
to the most appropriate office holder
and escalate if required.
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Standing Up for High Standards
Learning from past failings and changing expectations
Following the Francis Report many organisations
have recognised the need to be open and
transparent with their staff and to promote a
culture where staff feel valued and able to raise
concerns freely; it is essential that staff are not
afraid to raise concerns. The Freedom to Speak
Up Review (Francis February 2015) sets out 20
Principles and Actions which aim to create the
right conditions for NHS staff to speak up, share
what works right across the NHS and get all
organisations up to the standard of the best and
provide redress when things go wrong in the
future. A consultation on the recommendations
closed on 4 June 2015. The RCM responded to
this consultation, one of the main principles is
that there should be a “Freedom to Speak up
Guardian” in all NHS organisations (England and
Wales), the RCM supports this. The Secretary of
State for Health published Learning not blaming
on the 16 July 2015. In the document he outlined
that NHS England will produce guidance
by September 2015 on how to implement
the principles and actions in the Freedom to
Speak Up report in primary care. This included
local Freedom to Speak up Guardians and an
Independent National Officer hosted by the CQC.
We feel it is important to consider how
this role will interact with local trade union
representatives and the important role they
have in supporting members raise concerns and
it will be important to ensure that this role is
developed in a way that does not undermine the
legitimate role of trade union representatives.
There are huge pressures on staff working in
the NHS which may give rise to concern over
safety, quality, compassion or standards of care.
Examples may include:
• workloads too heavy to be
undertaken safely
• tasks or roles inappropriately or
unsafely delegated
• insufficient or inappropriate
staffing to provide a safe service
• unsafe equipment or
working environment
• being expected or instructed to
overlook concerns when you have
a duty to raise such concerns
• bullying or other undermining
behaviours between or within
staff groups.
One of the most important lessons from the
Mid-Staffordshire inquiry is the importance
of raising concerns at work as a crucial
early warning system which should give
organisations an opportunity to put right
issues of poor practice or wrongdoing at an
early stage. The best organisations empower
their staff to feel they can have a dissenting
voice as long as it is constructive.
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Rights and responsibilities of NHS staff
Throughout the UK the NHS expects that staff
will work together for patients, that patients
will come first in everything we do, and that
staff will speak up when things go wrong. The
NHS terms and conditions service handbook
(Amendment number 30 Pay and Conditions
Circular (AforC) 1/2014 section 21: Right to
raise concerns in the public interest) states:
All employees working in the NHS have a
contractual right and a duty to raise genuine
concerns they have with their employer
about malpractice, patient safety, financial
impropriety or any other serious risks they
consider to be in the public interest.
Each UK country has set out a framework in
which patients have the right to be treated with
a professional standard of care, by appropriately
qualified and experienced staff and in which
staff will encourage and welcome feedback.
These can be found in:
• Speaking Up Charter (NHS Employers,
England, May 2012)
• Implementing & Reviewing
Whistleblowing Arrangements
(Partnership Information Network,
NHS Scotland, December 2011)
• Right to Raise Concerns in the
Public Interest (Whistleblowing)
Northern Ireland
• All Wales Policy Raising Concerns
(Whistleblowing) (NHS Wales, July 2013)
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Standing Up for High Standards
The Royal College of Midwives: Championing the highest standards
The RCM believes that NHS staff should feel able to speak out if they have any concerns about
the quality and standards of care being provided, or if they suspect treatment or care has or may
cause death or serious injury. RCM workplace representatives and full time officers will support
individuals and groups of staff to make use of the right channels for raising their concerns.
The RCM supports the introduction of a statutory duty of candour on healthcare providers in
England, as recommended by the Francis report and accepted by the Government.
We also agree with the Government that there is no need for a separate statutory duty of
candour to be placed on individual practitioners, because that duty is already covered by
professional codes, registration and regulation.
EnglandThe aim of the NHS Constitution in England (NHS England, March 2013) is to set out clearly what patients, the public and staff can expect from the NHS and what the NHS expects from them in return. It sets out the rights, pledges and responsibilities for patients, the public and NHS staff which the NHS is committed to achieve. “Respect, dignity, compassion and care should be at the core of how patients and staff are
treated notably not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered, and supported.”
It also sets out the rights, pledges and responsibilities for its staff. This includes both clinical and non clinical and those working in local authority public health services. Amongst these is the right “to raise any concerns with their employer, whether it is about safety, malpractice or other risk,
in the public interest.”
The NHS in England commits “to encourage and support all staff in raising concerns at the earliest reasonable opportunity about
safety, malpractice or wrong doing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Public Interest Disclosure Act 1998.”
Northern IrelandThe Department of Health, Social Services and Public Safety in Northern Ireland has identified that public safety must be the first concern of everyone who works in or manages in healthcare. Effective care should place an emphasis on improving safety processes in order to prevent harm, and to improve the service user and carer experience.
This is set out in policies that guarantee all employees working in the NHS a contractual right and duty to raise genuine concerns they have with their employer about malpractice, patient safety, financial impropriety or any other serious risks they consider to be in the public interest.
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On 3rd July 2015 the NMC and General Medical Council published joint guidance on the duty of
candour. The guidance focuses on the professional duty of candour of midwives and nurses to be
open and honest when things go wrong.
The guidance focuses not only on the duty to be open and honest with patients but also on the
need to be open and honest within organisations in reporting adverse incidents or near misses that
may have led to harm. They must be open and honest and not stop someone raising concerns.
The RCM agrees that it is right to encourage professionals to be candid with patients, colleagues
and those undertaking statutory responsibilities. We want to encourage reporting transparency
in order to improve health outcomes in the NHS. We want to see a management culture in the
NHS where those who shed light on wrong doing do not fear for their careers.
ScotlandThe Patients Rights (Scotland) Act 2011 aims to improve patients experiences of using health by respecting the rights of patients and staff. It sets out a series of Healthcare Principles which all staff should take into account, including avoidance of injury or harm.
NHS Scotland wishes to ensure that employees have the opportunity and confidence to raise concerns by requiring all Health Boards to have a whistleblowing policy. “A responsible attitude to whistleblowing helps each organisation to promote a healthy
workplace culture built on openness and accountability. Encouraging staff to raise any serious concern they may have about malpractice or serious risk as early as possible, and responding appropriately, is integral to achieving this.”
WalesNHS Wales has a legal duty and responsibility to protect the interests and wellbeing of its service users. The ambitions for the NHS in Wales are set out in 21st Century Healthcare which includes commitments to improve health outcomes by ensuring the quality and safty of services is enhanced and by improving patient experience.
Ensuring staff play a role in achieving this is set out in the All Wales Policy on Raising Concerns which requires “Healthcare organisations ensure that staff are supported by processes which permit them to
raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery, treatment or management.”
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Standing Up for High Standards
The RCM will not normally act on anonymous
letters making claims about individuals
or organisations. However members who
formally raise their concerns with the RCM can
be certain we will pass these to where they can
be most effectively dealt; most commonly this
will be the Head of Midwifery Services and/
or the Local Supervisory Authority Midwifery
Officer. In some cases it may be the Director
of Nursing or Chief Executive. Where student
midwives are undertaking a placement in
the area giving rise to concern, consideration
will be given to informing the NMC and their
Higher Education Institution.
The RCM is not an inspectorate and does not
have the authority to investigate incidents
or concerns. However, where we see or are
made aware of concerns about quality or
safety we will work with members to help
to resolve them, or if that is not possible, to
escalate them.
Through its organising and engaging
activities the RCM often develops insights into
professional cultures, clinical developments
and practice issues within organisations. Our
staff will often be involved in advising and
supporting maternity management and the
clinical workforce as they address these issues.
Inspectorates such as the CQC in England now
routinely ask professional organisations such as
the RCM to share their positive and negative
insights before embarking on scheduled visits.
This provides another opportunity for the RCM
professional voice to raise concerns on behalf
of members.
The Francis report recommended that the
Royal College of Nursing should formally
consider dividing its professional and trade
union functions. The RCM has considered
this recommendation and whether it has
relevance for the way we work. We do
not believe it is necessary to separate our
professional and trade union roles. In fact
we believe that pursuing in tandem the
highest quality and standards for women
and the fair and equitable treatment of staff
are complementary and mutually supportive
objectives. The RCM believes that where the
NHS has the right number of properly trained,
fairly remunerated and well motivated staff
it is more likely to see high standards of safe,
effective woman-centred care. Furthermore
the roles of representing individuals whilst
also supporting services that may be
challenged are equally important to achieve
our ultimate objective of raising standards of
maternity services.
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Guidance for all midwives, student midwives and MSWs
It is important for all employees to feel
safe to raise their concerns without fear of
reprisals and to have the confidence that
they will be listened to and taken seriously
by their employer. Every employer should
have a robust and up to date policy on raising
concerns at work and every employee should
be aware of this.
RCM workplace representatives should be
actively involved in formulating policies;
working in partnership is an important part of
ensuring fairness and promoting awareness of
policies, procedures and support mechanisms.
These policies need to be communicated and
publicised widely at regular intervals and
be seen to work in practice. It is the role of
the RCM workplace representative to help
communicate policies to members and to help
them follow the policy when raising a concern.
Whether you are a midwife, student midwife
or MSW you have a duty to raise concerns.
You may not be alone in the concerns that
you have and others may feel the same, a
collective response is often a more powerful
way of ensuring appropriate action is taken.
RCM workplace representatives will support
you to raise your concerns using organisational
policies and guidelines. If you raise concerns
collectively victimisation and reprisal may be
less likely.
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Standing Up for High Standards
The culture within an organisation is extremely important. Organisations which value openness,
transparency, fairness, honesty, compassion and trust will listen to staff that raise concerns. These
organisations demonstrate a commitment to improving services and to giving high quality, safe
and compassionate care, promoting dignity and respect. So what do you do if there is a conflict
between what your employer expects you to do and what you believe is in the best interest of
the women you are caring for? What should you do if employer’s instructions or expectations
place you at risk of breaching of your professional code? First, be clear about your responsibilities
under your professional code.
Professional Accountability for MidwivesMidwives and nurses must abide by the Nursing and Midwifery Council code of conduct, standards and guidance. As a midwife you have a professional duty to put the interest of the people in your care first and to act to protect them if you consider they may be at risk.
The Code: Professional standards of practice and behaviour for nurses and midwives (2015)
Midwives rules and standards (2013)
Raising Concerns, Guidance for nurses and midwives (2013 updated in 2015)
Guidance on professional conduct for nursing and midwifery students (2009)
Advice and information for employees of nurses and midwives (2012)
The NMC guidance Raising Concerns states that: “as a nurse or midwife, you have a professional duty to put the interests of the people in your
care first and to act to protect them if you consider they may be at risk. Where we use the term in your care throughout this document, it is used to indicate all of those people you come across or know about because of your work as a nurse or midwife, not just those people you deliver specific care for or have direct clinical or managerial responsibility for”
“We recognise that nurses and midwives who raise a genuine concern and act with the best of intentions and in line with the principles laid down in this guidance are meeting their professional responsibilities”
Your Supervisor of Midwives should support you should you wish to raise concerns.
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Any expectations or instructions that compromise compliance with your professional code must
be questioned challenged and if necessary refused. This can not be left to other members of staff
or to the RCM representative; they must be raised by the individual who has the concern. It is
however sensible to take advice before taking action if you can; you are personally accountable
for your acts or omissions, so failure to act appropriately could ultimately lead to a charge of
professional misconduct. If you consider there is a risk of immediate harm then you must report
your concern to the appropriate person immediately.
Raising concerns can be very challenging. A midwife, student midwife, MSW or midwifery
manager may have concerns which are not shared by colleagues, or colleagues may be fearful of
raising concerns. Raising concerns means verbally and in writing bringing to the attention of your
immediate line manager the issue or situation which you are worried about.
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Standing Up for High Standards
If raising concerns does not have the desired result, e.g. you do not see appropriate action or
receive a satisfactory response or if the concern is urgent or there is real risk of harm you may
need to make use of your organisations whistleblowing policy. We advise you to exhaust the
internal procedures first. It is important to be clear about the legal protection available to those
who raise concerns.
If you are considering whistleblowing we strongly advise you to contact your local RCM
representative for advice and support with this procedure, they can help you draft letters as it
is extremely important to keep a paper trail setting out clearly what your concern is and what
you hope to achieve. Your organisation may also have a “Freedom to Speak Up Guardian” who
can advise and support you to raise your concerns if you do not feel able to approach your
immediate line manager.
The law and whistleblowingHealthcare workers who whistle blow have a statutory protection from victimisation through the Public Interest Disclosure Act 1998 (updated 2013) and Public Interest Disclosure (Northern Ireland) Order, 1998. This Act protects all employees, workers (including students on workplace training) contractors, trainees or agency staff who make a disclosure in good faith.
The Public Interest Disclosure Act 1998 (PIDA) was introduced to protect people who raise genuine concerns about wrong doing or malpractice in the workplace, when they do so in good faith, are acting in the public interest and are victimised or dismissed, or both, for doing so. The act has a tiered approach to disclosure (whistleblowing) which gives workers protection for raising concerns internally. Also from the 1 October 2013 under the PIDA there is new protection for disclosure to all health and social care regulatory bodies including the NMC.
Each member of staff has a responsibility to ensure they comply with their legal duties and registered staff must adhere to their professional code of conduct. If there is a continuing risk or concern then it is best in the first instance to raise this with your immediate line manager or with your supervisor of midwives. You should ensure there is a written record of the concern you have raised and request a meeting with your manager. A record of your concern will ensure no ambiguity and you will have a record of the date the concern was raised and to whom. Sometimes actually placing your concerns on record and having a discussion with the manager may be sufficient to produce the desired result. A concern raised verbally could be denied later.
A recent amendment to the Public Interest Disclosure Act (s.43F) which will came into effect on 6 April 2014 (not in Northern Ireland) means workers are protected from discrimination or dismissal if they make disclosures to any Member of Parliament. In order for the disclosure to be protected, the worker must show that he or she reasonably believes that the incidents or issues disclosed fall within the matters for which the person is prescribed and that the information disclosed, and any allegation contained in it, are substantially true.
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Step By Step Guide to Raising Concerns
Step 1: Find out what your employer’s policy says about raising concerns.
Step 2: If a policy does not exist or you think it is inadequate raise this with your RCM workplace representative.
Step 3: Be clear about the requirements of your professional code.
Step 4: IIf you believe you are being asked to contravene your code, raise it immediately yourself with your Supervisor of Midwifery and your RCM Workplace Representative.
Step 5: If you are raising a concern, be clear about what you are concerned about and why.
• Whatevidencedoyouhave,canyougetmore?
• Doestheconcernaffectonlyyouorshoulditberaisedcollectively?
• Placeyourconcernsonrecord
• Setoutwhatyouwishtoachieve,beasclearasyoucan
• Canyouworkwithyouremployertoaddresstheconcern?
• Checkyouremployersprocedureforraisingandescalatingconcerns
• Prepareforanymeetingswithyourmanager
• SeekadvicefromyourlocalRCMrepresentativewhocansupportyou
Step 6: If you believe your concerns have not been addressed and you want to whistle blow, contact your RCM representative first.
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Standing Up for High Standards
Guidance for midwife managers
All of the earlier guidance applies to midwife
managers who wish to raise concerns,
but managers are a group who may face
additional pressures in the face of staff
raising concerns.
Midwife managers must comply with the
requirements of the professional code of
conduct and, in Raising Concerns (NMC 2013
updated 2015) the NMC places a duty on
nurse and midwife managers to promote
“an open work environment in which staff
are accountable and encouraged to raise
concerns about the safety of people in their
care” which “will help identify and prevent
problems and will protect the public”.
Other requirements will be set out in your
job description and in local arrangements for
clinical governance. Senior managers now have
specific standards they are expected to comply
with, these are being developed in each
country; for example in England, Standards
for Members of NHS Boards and Clinical
Commissioning Group Governing Bodies
in England (PSA, 2013) have already been
published and in Wales a new Code of Conduct
for NHS managers is currently in preparation.
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NHS employers from Board level down are expected to provide a working environment that
promotes high quality safe care by ensuring appropriate allocation of resources and a culture
which welcomes staff or patients to speak out if they believe patient safety is being compromised.
This provides a useful checklist for midwife managers, who must:
• be aware of the trust policy and guidelines
• understand how to use the policy and ensure staff are trained
• thank members of staff for raising concerns
• promote a no blame culture (do not pre judge)
• show compassion and respect towards staff
• challenge poor behaviour
• act on concerns raised
• give feedback to the person raising the concern
• escalate if necessary
• understand confidentiality, anonymity and protect members of staff if necessary
• act on any reprisals
• investigate concerns and raise with HR support if necessary
• keep records of concerns raised
• share learning, resolutions, discussions at team meetings around problem solving
• promote robust relationships with in the team
• evaluate the process and feedback any issues.
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Standing Up for High Standards
Guidance for student midwives
In an amendment to PIDA (Public Interest
Disclosure Act 1998) student midwives are now
covered under the legislation as they are:
Provided with work experience provided
pursuant to a training course or programme or
with training for employment (or with both)
otherwise than
(i) under a contract of employment, or
(ii) by an educational establishment on a
course run by that establishment;
and any reference to a worker’s contract, to
employment or to a worker being “employed”
shall be construed accordingly.
All of the earlier guidance concerning
how to raise concerns in a timely, local and
proportionate way is relevant. One of the
worrying pieces of evidence from the Francis
Inquiry came from a witness who said:
“The failure of students to complain suggests
that they were being socialised to accept a
culture of indifference where poor standards
were the norm.”
The NMC guidance on Raising Concerns (NMC
2013 updated 2015, paragraph 8) states;
The principles in this guidance apply to nursing
and midwifery students in the same way that
they apply to registered nurses and midwives.
To uphold these principles, you should act as
set out below in the following situations.
8.1 Inform your mentor, tutor or lecturer
immediately if you believe that you, a
colleague or anyone else may be putting
someone at risk of harm.
8.2 Seek help immediately from an
appropriately qualified professional if
someone for whom you are providing care has
suffered harm for any reason.
8.3 Seek help from your mentor, tutor or
lecturer if people indicate that they are
unhappy about their care or treatment.
The RCM recognises that this may be difficult
for you to do and that RCM workplace
representatives will help and support you to
raise any concerns that you have.
Universities also have a responsibility to
ensure midwifery students understand their
responsibilities and appropriate policies for
dealing with issues raised.
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Standing Up for High Standards
Guidance for maternity support workers
Although not yet a regulated profession, MSWs have a responsibility just as any other member
of staff to raise concerns and the earlier guidance will be useful for you. The RCM recognises that
as a group MSWs may feel less confident and more vulnerable in raising concerns. This is why it is
important for MSWs to join the RCM and make use of the support of local RCM representatives
to raise their concern.
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EnglandSkills for Health, funded by the Department of Health have developed a Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England 2013 which states: “Following the guidance set out in the Code of Conduct will give you the reassurance that you
are providing safe and compassionate care of a high standard and the confidence to challenge others who are not”.
The guidance states “Be accountable by making sure you can answer for your actions or omissions, report any actions
or omissions by yourself or colleagues that you feel may compromise the safety or care of people who use health care services and if necessary use whistleblowing procedures to report any suspected wrongdoing”.
Northern IrelandWhilst there is no specific guidance for MSWs in Northern Ireland the guidance contained within Section 21 of the Agenda for Change Handbook applies to all HSC staff and all Trusts have local policies in place which apply to all staff including MSWs.
ScotlandIn Scotland guidance for MSWs is found in the Code of Conduct for Healthcare Support Workers 2009. This useful set of standards and guidance is based in the principle of protecting the public. It says all support workers must “Make sure patients, members of the public, visitors and colleagues are protected from dangers and
risks and that nothing you do or don’t do results in harm or risk to others“.
It says MSWs can achieve this by “…do what you can to reduce risk of accidents or harm. You will also make sure you report any
concerns you have to a supervisor to reduce risks in the future“.
WalesWales developed A Code of Conduct for Healthcare Support Workers in 2011. There is also a Code of Practice for Employers in relation to HSW’s based on the basic principle of protecting the public, and provides an assurance framework so that the public can understand what standards they can expect of Healthcare Support Workers.
Each of the four UK countries has issued guidance for support staff:
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Standing Up for High Standards
Further information
The NHS Constitution (England) commits “to support all staff in raising concerns at the earliest
reasonable opportunity about safety, malpractice or wrong doing at work, responding to and
where necessary, investigating the concerns raised and acting consistently with the Public Interest
Disclosure Act (1998) http://ow.ly/Pk4F1
The NHS Terms and Conditions of Service Handbook (section 21) confirms that raising concerns
is a contractual right and duty. It states “all employees working in the NHS have a contractual
right and duty to raise concerns they have with their employer about malpractice, patient safety,
financial impropriety or other serious risk they consider to be in the public interest”.
http://ow.ly/Pk4Iq
Nursing and Midwifery Council Is the nursing and midwifery regulator for England, Wales,
Scotland, Northern Ireland and the Islands http://www.nmc-uk.org/
Nurses and midwives http://www.nmc.org.uk/standards/code/
Midwives rules and standards 2012 http://ow.ly/Pk4UL
Raising concerns Guidance for nurses and midwives http://ow.ly/Pk4X1
When studying to be a nurse or midwife http://ow.ly/Pk53G
Advice and information for employers of nurses and midwives http://ow.ly/Pk5mH
NMC Guidance on professional Duty of Candour 2015
http://www.nmc.org.uk/standards/guidance/the-professional-duty-of-candour
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The Speaking up Charter May 2012 (England) states “this charter outlines a commitment to work
more effectively together to create a just culture which is open and transparent. A just culture
ensures individuals are fully supported to report concerns and safety issues and are treated fairly,
with empathy and consideration when they have been involved in an incident or have raised a
concern… we aim to develop a culture that provides for an environment where people feel able
to raise concerns, be they staff, users of health and social services, their relatives or anyone else”
http://ow.ly/Pk5rO
A healthy health care provider has these characteristics
• Open culture
• Just culture
• Reporting culture
• Learning culture
• Informed culture
Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry
http://www.midstaffspublicinquiry.com/report
Freedom to Speak Up Review February 2015 https://freedomtospeakup.org.uk/the-report/
Learning not blaming http://ow.ly/PSz7R
The Report of the Morecambe Bay Investigation Dr Bill Kirkup CBE http://ow.ly/Pk5Av
Whistleblowing Guidance for Workers and Employers in Health and Social Care (England March
2014) is guidance designed to help employers to work in partnership with the trade unions at local
level to achieve best practice when devising, implementing and auditing their whistleblowing
arrangements. The guidance includes contributions from trade unions, employers’ associations,
campaigning groups, regulators, professional bodies and whistle blowers themselves. The contents
of this guidance have been endorsed by the Social Partnership Forum and the Social Care Institute
for Excellence and includes access to a helpline, reached by telephoning 08000 724725, emailing
[email protected] or visiting the website on www.wbhelpline.org.uk
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Standing Up for High Standards
Local Supervising Authority Midwifery Officer (LSAMO) Supervision of midwives is a statutory
responsibility which provides a mechanism for support and guidance to every midwife practising
in the UK, both those employed in the NHS and for those who are self employed. The purpose
is to protect women and babies by actively promoting a safe standard of midwifery practice,
supporting midwives to practise with confidence and therefore preventing poor practice. If you
have raised a concern with your local supervisor of midwives and feel your concerns have not
been acknowledged or acted on then you must escalate the concern to the LSAMO.
http://www.lsamoforumuk.scot.nhs.uk
Monitor is the sector regulator for the health service in England, their role is to protect and
promote the interest of patients by ensuring that the whole sector works for their benefit
www.monitor-nhsft.gov.uk
Care Quality Commission (CQC)(England) has statutory powers to intervene, has a
whistleblowing helpline and has produced guidance on Raising a Concerns with the CQC, a quick
guide for health and social care staff about whistleblowing www.cqc.org.uk
Regulation and Quality Improvement Authority (RQIA) has produced guidance for health and
social care staff who wish to make a protected disclosure about wrongdoing in their workplace
www.rqia.org.uk
Health and Safety Executive may also be the most appropriate organisation to raise particular
concerns with and RCM health and safety representatives can support members to do this.
http://www.hse.gov.uk
Wales
Health Inspectorate Wales Responsible for all NHS-funded care (including independent
hospitals).029 2092 8850 www.hiw.org.uk
Department for Health and Social Services (Wales) English 0845 010 3300 Welsh 0845 010 4400
www.wales.gov.uk
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Scotland
Care Inspectorate 0845 600 9527 www.careinspectorate.com
Healthcare Improvement Scotland Edinburgh 0131 623 4300 Glasgow 0141 225 6999
www.healthcareimprovementscotland.org
The Scottish Government 0131 556 8400 or 0845 7741 741 www.scotland.gov.uk
The National Confidential Alert Line for NHSScotland employees was launched on April 2, 2013.
This service is run by Public Concern at Work (PCaW), an independent whistleblowing charity. It
provides a safe space where staff, who feel they may be victimised as a result of whistleblowing,
can raise concerns about patient safety and malpractice. Support and advice is provided by legally
trained staff, and where appropriate, concerns can be passed to the appropriate Regulatory
body. It is now to run for a further two years until 2016. http://ow.ly/Pk5Da
Northern Ireland
Regulation and Quality Improvement Authority Northern Ireland 028 9051 7500 www.rqia.org.uk
Department of Health, Social Services and Public Safety (Northern Ireland) 028 9052 0500
www.dhsspsni.gov.uk
Crown Dependencies
Jersey States of Jersey, Health and Social Services Department 01534 442 000 www.gov.je
Guernsey States of Guernsey, Health and Social Services Department 01481 725 241 www.gov.gg
Isle of Man Isle of Man Government, Department of Health 01624 642 608 www.gov.im
www.rcm.org.uk
Updated: 22 July 2015
