The scene

One patient who was continent but immobile confided that nurses had given her an incontinence pad to sit on because they didn't have time to take her to the toilet and that several other patients had the same experience. Later that week, the doctor noticed that that four patients who were unable to feed themselves had had their meals taken away untouched because no one had time to help them.

She tried to speak to a charge nurse but they told her they were too busy and the consultant in charge was away.

Disturbed by what she'd found, the doctor called the MDU for advice on how best to raise her concerns.

MDU advice

The medico-legal adviser agreed the doctor had an ethical duty to act if she believed patients' dignity and comfort were being compromised. Deciding to raise concerns was an important first step but she needed to do this in the right way and satisfy herself the problem had been properly addressed.

The adviser suggested she could speak to her trust's Freedom to Speak up Guardian (FTSUG) whose role was to help staff raise concerns. Her report would be more powerful if she could provide examples and it was important to focus on patient care.

The outcome

The doctor went on to raise her concerns through the trust's freedom to speak up process, describing the incidents she had seen. She followed this up in writing and kept a record.

To the doctor's relief her concerns were taken very seriously and it turned out the doctor's predecessor had recently taken the same step. Soon afterwards, the trust announced it was appointing a new departmental lead and revising its minimum staffing policies on the elderly care wards.

Learning points

You must raise concerns if you believe patient safety, dignity or comfort is compromised.
Don't allow personal or professional loyalties to outweigh your duty to patients.
Follow your employer's process first – seek advice if you are thinking of raising concerns outside the organisation.
Put your concerns in writing and give examples.
Keep a record and follow up to check something has been done.

Time to speak up

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