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Freedom to Speak Up Review: “How can it influence change?”

Prof Derek Bell, President of the Royal College of Physicians of Edinburgh

“The Royal College of Physicians of Edinburgh welcomes the publication of the Freedom to Speak Up Review and believes it imperative that the lessons learned are acted upon; on too many occasions in the past reports of other NHS inquiries and reviews have not sufficiently influenced change.

“We recognise that much more needs to be done to support doctors and other NHS staff in raising concerns about poor practice within the NHS. As outlined in our recent editorial, we believe that a transparent supportive environment in which the open reporting of concerns is welcomed, used as a positive learning experience and acted upon is now essential.

“To address these issues we believe it necessary to build on the success of Patient and Public Involvement and give similar priority to addressing and supporting the needs of NHS staff and recognising the ‘people’ element within the NHS, without which care could not be provided. Only by adopting a holistic approach of this nature and looking at the NHS as a whole, how it functions and its people, will be able to progress.

“Our recent editorial in the College’s journal on preventing further serious failings in care made three recommendations related to this area, which we believe must be acted upon:

“Doctors, nurses and other health professionals should be reminded of their value to the NHS and of their responsibility to provide the highest quality of care to patients, to continually seek to improve service delivery, to act professionally at all times and to report concerns regarding poor quality care; where they do not do so, they should be held accountable.

“Managers should be encouraged to support professionals in their clinical decision-making, in developing the leadership skills of those responsible for leading teams, in delivering the highest quality care and in reporting concerns; they should also work within their Boards and Trusts to foster a supportive environment in which staff are seen as valued individuals and in which innovation is encouraged.

“All Boards and Trusts should be encouraged to develop, publish and promote policies aimed at engaging staff, understanding and responding to professional concerns and valuing staff.

“The editorial reviewed the reports of 10 major Inquiries and Reviews into serious failings in care in the UK since 2000, including Mid Staffordshire, Bristol, Lanarkshire and the Vale of Leven.”

David Behan, Chief Executive of the Care Quality Commission

“It takes great courage for health professionals to raise concerns about care and so they must be reassured that when they do come forward that they will not suffer as a result.  No one should be punished for acting in the public’s best interest.

“As Sir Robert Francis’s review highlights, while there are some services that are reporting and acting on concerns as a matter of routine, sadly we know that this is not happening all of the time. This means that vital information about patient safety is going unreported and risks can remain. Every organisation needs to create and nurture an open and transparent culture of safety and learning.

“From our inspections, we know that progress has been made in building this. Every planned inspection of ours investigates how well services handle complaints and concerns as it can be an indicator of the quality of the service’s leadership and a reflection of how safe and responsive its culture is.

“We have found care services that support staff in raising their concerns, confident in the knowledge that they will be listened to and that action will be taken. It is important that services can learn from those that do this well, so that this can become a reality across the care system.

“We strongly welcome the publication of the Freedom to Speak Up Review and the advice on how organisations and individuals can work together to create a more open and honest reporting culture across the NHS. We are pleased that the Secretary of State has accepted these recommendations in principle and will consult on how they could be implemented.

“In particular, we believe that the local ‘freedom to speak up guardians’ who Sir Robert has recommended should be appointed within every NHS trust could make a key difference to staff being able to raise concerns, as could an Independent National Guardian within CQC, who could support this network of individuals and encourage best practice on handling whistleblowing disclosures. We look forward to contributing to the Department of Health’s consultation on this.”

Niall Dickson, Chief Executive of the GMC

“Doctors are much more likely today to raise concerns about standards of care than they were a generation ago but, as Sir Robert has shown, in too many institutions and departments fear and hierarchy still inhibit honest and open reflection. And a system where staff are frightened to raise concerns is not a safe system.

“The answer is simple to say, less easy to achieve – a culture where doctors and other health professionals feel empowered and supported when they speak up.

“We have made it abundantly clear that doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity are being compromised. But this is not so much about requiring staff to speak up, as it is about creating the conditions where they feel comfortable and encouraged to do so. We have required doctors’ leaders to support those who do raise concerns. Above all, changing the culture is a task for local managers and clinical leaders.

“That said, while national regulators of healthcare professionals such as the GMC have a limited role, it is a significant one and we are determined to play our part.

“First we can help support doctors – our guidance for all doctors in leadership and management and our guidance for doctors in senior leadership roles spells out what we expect not just from front line clinicians, but also the doctors who manage them.

“Secondly, we have actively encouraged doctors in training to report safety concerns directly to us through our National Training Survey in which 98% take part and we make sure every concern is followed up. In 2012 we set up a confidential helpline for doctors who are worried about patient safety – next month we will launch new guidance setting out a professional duty of candour, spelling out their professional duty to be open and honest with patients when things go wrong.

“Thirdly, we have in place a comprehensive set of reforms to speed up our processes. The legislative reform we have been campaigning for, in the shape of the Law Commission’s Regulation of Health and Social Care Professions Bill, would help us to further reduce the stress of our investigations, and better support doctors who have their fitness to practise called into question.

“Finally, we have also commissioned our own independent examination to see what more we can do in this area – Sir Anthony Hooper, a former Lord Justice of Appeal, is looking at how we deal with doctors who raise concerns in the public interest. Sir Anthony has liaised with Sir Robert and will take into account the findings of today’s report in his review.”

Rob Webster, Chief Executive of the NHS Confederation

“This report holds a mirror up to the NHS leadership – we need to look very carefully at what it shows. The poor treatment of some whistleblowers is a stain on the NHS. It undermines the great efforts of staff and the exceptional leaders we have in most of the service. Above all we need a set of leaders who will not stand for the ill treatment of genuine whistleblowers or for bullying in the modern NHS.

“Our members across NHS organisations will strongly welcome this report, which recognises that more must be done to support some staff in raising concerns. The NHS treats more than one million people every 36 hours and the vast majority of NHS staff know how to report concerns and most feel safe to do so.

“In particular, we support the report’s recommendations that staff and managers should receive training to raise concerns – and that those who do raise concerns should be supported and given the recognition they deserve.

“Patient safety is paramount and this relies on staff having the confidence to report issues as early as possible. The report’s focus on early intervention and on the use of mediation where views become entrenched are particularly welcome.

“NHS Employers, part of the NHS Confederation, today launches a guide for managers on dealing with concerns that have been raised by staff and a toolkit for boards to evaluate how healthy their culture is around raising concerns. Both were commissioned by NHS England and are part of NHS Employers’ Draw The Line campaign to improve the way concerns are handled.”

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