The review of NHS reporting culture led by Sir Robert Francis QC, which has been working achieve better protection of NHS whistleblowers who raise concerns, will report later today. The “Freedom and Responsibility to Speak Up” review was expected to be published in November 2014 originally.
Evidence gathered during the review points to instances of staff being deterred from raising concerns, as a result of a managerial culture which ignores, bullies or intimidates the messenger(s) of awkward truths. There is sometimes an adversarial approach to silencing or destroying whistleblowers, instead of a willingness to address problems and learn. These problems are thought to persist in places, despite progress since the Francis Inquiry report (February 2013) in making the NHS more open and transparent.
Brimelow, A. (2015). NHS staff afraid to speak out, whistleblower report finds. London: BBC Health News, February 11th 2015.
The review recommends:
- The appointment of a “Freedom to Speak Up Guardian” in every NHS trust to support staff.
- The appointment of a Independent National Officer (INO) (aka “Independent National Whistleblowing Officer”) to help these guardians where cases are in dispute.
- A support and reparation scheme to help NHS staff who have suffered detriment as a result of raising concerns.
- The establishment of processes in all trusts to ensure concerns are heard and investigated properly.
Triggle, N. (2015). NHS ‘to get whistleblower guardians’. London: BBC Health News, February 11th 2015.
We must listen to whistleblowers – Simon Stevens. London: NHS England, February 11th 2015.
The Department of Health has published the Government’s response to this review (and the 2013 Francis Inquiry).
The Freedom to Speak Up Report
The full report proposes 20 principles:
Principle 1: Culture of safety. Organisations providing NHS healthcare should actively foster a culture of safety and learning, allowing staff feel safe to raise concerns.
Principle 2: Culture of raising concerns. Raising concerns should be part of normal routine business for well-led NHS organisations.
Principle 3: Culture free from bullying. Freedom to speak up about concerns requires a culture free from bullying and other oppressive hierarchical behaviour.
Principle 4: Culture of visible leadership. Employers of NHS staff should, through visible leadership, welcome and encourage the raising of concerns by staff.
Principle 5: Culture of valuing staff. Employers openly value staff who raise concerns, and celebrate the benefits for patients and the public from ensuing improvements.
Principle 6: Culture of reflective practice. Staff require regular opportunities to engage in reflection on concerns at work.
Principle 7: Raising and reporting concerns. NHS organisations require structures to facilitate informal and formal raising and resolution of concerns.
Principle 8: Investigations. Concerns raised formally require prompt, swift, proportionate, fair and blame-free investigation of the facts.
Principle 9: Mediation and dispute resolution. Expert interventions may be required to resolve conflict, re-build trust and / or support staff who have raised concerns.
Principle 10: Training. All staff require training in their organisation’s approach to raising concerns, receiving concerns and acting on them.
Principle 11: Support. All NHS organisations should ensure a range of persons to whom concerns can be reported easily and without formality. All NHS organisations should provide staff raising concerns with access to mentoring, advocacy, advice and counselling.
Principle 12: Support to find alternative employment in the NHS. Where NHS workers who raise concerns cannot continue in their current employment (as a result), the NHS has a moral obligation to offer support.
Principle 13: Transparency. NHS organisations should be transparent in exercising their responsibilities in relation to raising concerns, including the use of settlement agreements.
Principle 14: Accountability. Everyone should be held accountable equally for adopting fair, honest and open behaviours and practices when raising, receiving and handling concerns. Personal and organisational accountability is required to deter poor practice, victimisation of workers, the raising of false “retaliatory” concerns in bad faith, disrespect or other unreasonable behaviour when raising or responding to concerns and / or inappropriate use of confidentiality clauses.
Principle 15: External review. There should be an Independent National Officer, resourced by national systems regulators and oversight bodies, authorised to: review the handling of concerns raised by NHS workers, and / or the treatment of persons speaking-up; advise NHS organisations on appropriate action where they fail to follow good practice, or advise the relevant systems regulator to act; support local Freedom to Speak Up Guardians; supply national leadership on the raising of concerns by NHS workers; and publish reports on their activities and guidance.
Principle 16: Coordinated Regulatory Action. Coordinated action by national systems and professional regulators is required to enhance protection of NHS workers making protected disclosures, and to promote public interest in the proper handling of concerns.
Principle 17: Recognition of organisations. The CQC should recognise NHS organisations which adopt and apply good practice in the support and protection of workers raising concerns.
Principle 18: Students and trainees. These principles should be applied in education and training settings for students and trainees in healthcare.
Principle 19: Primary Care. These principles should be applied, with necessary adaptation, in primary care.
Principle 20: Legal Protection should be enhanced.
“This will make the NHS a better place to work and a safer place for patients”.
Sir Robert Francis QC (2015). An independent review into creating an open and honest reporting culture in the NHS: Report. London: Freedom to Speak Up (freedomtospeakup.org.uk), February 11th 2015.
There is also an Executive Summary.
Escal8: New Model for Raising and Escalating Concerns (Nursing Times)
The authors of the following Nursing Times article explain how raising and escalating concerns are integral parts of healthcare governance, and present the “Escal8” model outlining the main steps. It is important to learn and share insights from escalation, with a view to improving quality and patient safety.
Full Text Link (Note: This article may require a suitable Athens password, a journal subscription or payment for access).
McSherry, R. [and] McSherry, W. (2015). A model to support staff in raising their concerns. Nursing Times. February 18th 2015, Vol111(8), pp.15-16.