B. When to consider speaking up

22. The first question to ask yourself is whether you believe that patient/public safety is or may be at risk as a result of what you are concerned about, or you have propriety concerns, such as observing something that appears seriously wrong or is not in accordance with accepted standards. If you are concerned that patients and/or the public are at risk of death or serious harm, you must speak up without delay.

23. Examples of issues that appear seriously wrong or are not in accordance with accepted standards include fraud, failure to meet health and safety requirements, or failure to comply with data protection legislation.

24. A patient/public safety issue may be quite easy to identify if you have personally witnessed an incident where a patient came to harm, or if the issue is very visible (such as problems with the premises from which care is being provided). In other situations, it may be that you believe there is a risk to patient/public safety that has not yet come to pass. Remember that patient/public safety risks can come from a variety of different sources and in many forms, and that risks are not limited to physical harm. A patient/public safety concern could also arise from a lack of action, such as a failure to send a referral that an optometrist has initiated.

25. Concerns about risk to patient/public safety are not necessarily going to be about another healthcare professional or optical business. They may be about another organisation such as an educational institution, a policy or process, a student, healthcare commissioner, member of support staff or someone involved in patient care outside of your workplace.

26. The next question to ask yourself is whether what you are concerned about is within your control to resolve. If it is something you could put right within the scope of your role as an optical professional, do so. You should still share the issue with colleagues, however, so that lessons can be learned and reoccurrence prevented. This is consistent with our candour guidance.

27. If you cannot fix the problem yourself, you must speak up about it, even if you are nervous or fear an adverse impact as a result of doing so. Your professional duty to protect patients and the public must come first. Legislation provides you with legal protection when you make ‘protected disclosures’. More information about protected disclosures can be found in section D of this guidance.

28. You do not need to wait for proof before speaking up about your concerns – simply an honest and reasonable belief in what you are speaking up about. If the information you have is based on second-hand information, or if someone else has told you about patient safety issues, encourage that person to consider speaking up about them as well as speaking up yourself. This is because it is easier to act appropriately and have concerns taken seriously if they are raised first-hand so that they are not misinterpreted and evidence can be sought from the appropriate person.

29. Sometimes issues related to employers’ policies and processes, or those you witness outside your normal working environment, will not be as easy to resolve and you should escalate these appropriately. What amounts to an appropriate escalation will depend on the nature of the concern and we will discuss the options that may be available to you in the next section.

30. It is best to speak up at the earliest opportunity, as concerns tend to grow over time.