Every NHS hospital must have a ‘Guardian’ who can provide independent support and advice to staff who want to blow the whistle on patient safety issues, and hold the board to account if they fail to act.
This is the key recommendation of the Freedom to Speak Up Review, chaired by Sir Robert Francis QC – who also led the inquiry into Mid Staffs.
The review finds that many NHS staff are put off speaking up about patient safety issues because they fear being ignored or victimised.
It recommends a package of measures to ensure that NHS staff are free to speak up about patient safety concerns.
The review heard stories of staff that have faced isolation, bullying and counter-allegations when they’ve raised concerns. In some extreme cases when staff have whistleblown, their lives have been ruined.
However, managers told the review that they can find it difficult to identify the people with genuine concerns from those who want to deflect from their own poor performance.
Over 600 people shared their experiences with the review and over 19,000 staff responded to an independent online survey.
Other review recommendations include:
– action at every level of the NHS to make raising concerns part of every member of staff’s normal working life;
– a National Independent Officer who can support local Guardians, to intervene when cases are going wrong and identify any failing to address dangers to patient safety, the integrity of the NHS or injustice to staff;
– a new support scheme to help good NHS staff who have found themselves out of a job as a result of raising concerns get back into work.
Sir Robert said: “Failure to speak up can cost lives. I began this review with an open mind about whether there are things getting in the way of NHS staff speaking up. However the evidence received by the Review has confirmed that there is a serious issue within the NHS. This issue is not just about whistleblowing – it is fundamentally a patient safety issue.
“The NHS is blessed with staff who want to do the best for their patients. They want to be able to raise their concerns, free of fear that they may be badly treated when they do so, and confident that effective action will be taken. Unfortunately I heard shocking accounts from distressed NHS staff who did not have this experience when they spoke up.
“Everyone in the NHS needs to support staff so they have the courage to do the right thing when they have concerns about patient safety. We need to get away from a culture of blame, and the fear that it generates, to one which celebrates openness and commitment to safety and improvement. If these things are achieved, the NHS will be a better place to work. Above all, it will be a safer place for patients.”
Sir Robert also proposes an overhaul of NHS policies so that they don’t stand in the way of people raising concerns with those who can take action about them and training for all NHS staff so they know how to raise their concerns and how to handle and act on them.
The review sets out 20 Principles and Actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future. These are designed to promote a culture in the NHS where staff feel safe and encouraged to speak up, and make sure all concerns are heard, investigated properly and the right support is on hand for staff. They also aim to protect vulnerable groups, such as student nurses and medical trainees, from intimidation.
The government has accepted in principle all of the recommendations, including proposed new legislation to protect whistleblowers who are applying for NHS jobs from discrimination by prospective employers.
The Freedom to Speak Up Review was announced by Health Secretary Jeremy Hunt in June 2014. Sir Robert Francis QC was asked to Chair the review and launched it with a call for contributions in August 2014. The Review was asked for advice and recommendations to ensure that NHS staff feel it is safe to raise concerns, confident that they will be listened to and the concerns will be acted on.