If you or someone you know has concerns with care either from a practicing point of view, or as a recipient of care – it is advisable to raise this concern as early as possible so a solution can be found.
In this article, we will outline some of the common questions when raising concerns from RCN members, RCN representatives, and as a member of the public.
Guidance for RCN members
When to raise a concern
It is not wise to wait for a problem to develop – if you feel you are being stopped from providing safe and compassionate care, concerns should be raised as soon as possible.
There is a contractual duty for NHS employees to raise concerns with their employers that they consider to be in the public interest. This extends to malpractice, financial impropriety, patient safety, or any other potentially serious risks.
How to raise a concern
There will be formal policy for raising concerns specific to your employer, which should be consulted for guidance on how to properly raise your concern. This policy should outline exactly who the concern should be raised to.
Concerns can be raised either in writing, or verbally. There will be a need to include some background to the issue, alongside a history of concerns and the reasons why you are concerned. It is imperative that you keep records and notes regarding the issues of concern, for future reference.
Your employer has a duty to respond, and if they do not the RCN can help to escalate your concerns. The RCN’s Raising and Escalating Concerns guidance includes a step-by-step guid on how to raise concerns.
RCN Support
At any stage of the complaints process, you are able to contact the RCN for further support and advice. Either talk to your local RCN representative, or call the RCN on 0345 772 6100.
Guidance for patients and the public
Complain about care received in the NHS
If you are dissatisfied with the care you have received, you should begin by contacting the care provider and lodging a complaint. This will provide an opportunity for them to ‘right the wrongs’.
If you are dissatisfied with how this complaint is then subsequently handled locally, you can request the Parliamentary and Health Services Ombudsman to investigate.
Complain about care received from another organisation
As above, you should first begin by contacting the independent provider and lodging a complaint. This will allow them a chance to rectify things.
If you are dissatisfied with the response, you should then contact the Association of Independent Healthcare Organisations for further advise.
Complain about a care home or social care service
If you are dissatisfied with the care you have received from a social care service or a care home, you should first begin by contacting the provider to lodge a complaint.
If you are unhappy with the response, you should then contact the Local Government Ombudsman.
Further Support
The Patient Advice and Liaison Service (PALS) will offer free and confidential advice as well as support and information on a variety of health-related matters. You should contact your local service if you would like further advice on making a complaint.
The Care Quality Commission (CQC) is the independent regulator for all health and social care services in England. This is for all care services provided by the NHS, private companies, local authorities, or even voluntary organisations. Although the Care Quality Commission cannot investigate individual complaints, they would still like to hear about any negative experiences.
The Nursing and Midwifery Council (NMC) regulates nurses and midwives, if you have a complaint about a nurse or midwife and are unable to resolve it locally you can then raise concerns with the Nursing and Midwifery Council.
Guidance for all RCN representatives
Raise concerns early
Members shouldn’t have to wait for a problem to develop. Although concerns may not necessarily have an immediate effect on patient care, there may be long-term effects. Raising concerns early before there is an impact means reps can offer support in finding workable and pragmatic solutions.
Be prepared to support members
If approached by a member with a concern, it is wise to ask:
“Has the situation caused harm or distress or if you let the situation carry on is it likely to result in harm or distress?”
If the answers are either “yes” or “unsure” the concern should be taken forwards.
Although members may choose to discuss their concerns with any RCN rep, stewards are the ones primarily responsible for supporting them. Safety and learning reps should direct members to the local RCN steward who will arrange a meeting to discuss concerns. Stewards will also represent members if speaking out will affect the terms and condition of their employment.
If there is no local RCN steward then the member should be referred to the RCN so that they can be supported by a member of staff. Help should be offered to the member in accessing and reading the RCN’s guidance on raising concerns to help prepare for their meeting and provide reassurance that they will be supported by RCN throughout the process.
Guidance for RCN stewards
Meeting the member to discuss concern
Stewards should arrange to meet members in a comfortable and safe environment when discussing concerns. Questions to ask are as follows:
- When did the issue of concern happen?
- Where did the issue of concern happen?
- Who was involved?
- What happened?
- How did it happen?
- What evidence do you have? (If any)
Notes should be kept about topics of discussion and it is advisable to go through the story again for clarification if needed, and also to make sure you have heard the full extent of their concerns.
Following on from this, use the Principles of Nursing Practice to illustrate exactly where care is falling below standard. You can also use the Principles of Nursing Practice mapping form to aid you in clearly setting out where the member’s concerns show that this may be happening.
The member is now ready to write a statement to their employer highlighting their concerns. You should ask to be sent a copy for completing paperwork or opening a file on the RCN case management system.
You will be able to discuss the case further in more detail with your mentor during mentorship/case supervision meetings. You should not hesitate to contact them at any time if extra support is needed, or to document further developments.
Mentorship records should be used to capture your involvement in supporting a member to raise concerns, this will provide both you and the RCN with an audit trail of efforts made on behalf of the member.
As appropriate, you should also discuss any concerns with other RCN reps in your organisation and/or other trade union reps so you can co-ordinate any further actions.
Support the member to escalate a concern
If a concern is not being acted upon or being taken seriously, you will need to help support the member to escalate it. Firstly, you should use your mentorship session to review the case and explore next steps – which could involve further actions locally or formally handing the case to the RCN regional office to raise at a higher level withing your organisation.
If the case is passed to the regional office, the member should be informed in writing that you have done so – as well as who will be supporting them from then on.
Your mentorship record should be used to record and document the next steps. If any further information comes to light or you are finding the process challenging, contact your mentor at the earliest opportunity.
Any concerns raised by a member, rep, or the RCN as an organisation will be investigated by the health care regulator. If a positive response is not seen from the employer, discuss with your mentor how best to escalate the issue further, including raising it with the regulator. This action can be done anonymously and findings will always be feedback.
It is possible to feel conflicted as a nursing professional and RCN rep, and you may wish to raise the concern yourself as an accountable practitioner. For example, by alerting the regulator. The RCN encourages and supports all members to raise concerns, so they should be made aware that you have done so.
Following up
Use the action journal through the RCN case management system to record all the key actions agreed upon, and to remind yourself of the next steps. The member and the RCN will have an expectation of you to feedback any actions taken. Ask the member to keep you informed of what is happening in the workplace.
Guidance for RCN safety reps
Safety reps should direct members with concerns to a local RCN steward and arrange a workplace inspection of the area in question, ideally with other trade union safety reps.
This activity should be discussed with your mentor, and the steward representing the member should be kept up to date with any developments. If any other concerns about employment practice are raised, these should be discussed with the steward.
The RCN Handbook for Safety Representatives is a good tool to help you.
You may desire to discuss the situation with other trade union safety reps and raise any concerns together. You must be mindful to not disclose any details of individual members.