12 February 2015
An independent review into the NHS’ culture on speaking out has found that staff members are still being bullied and penalised for raising concerns.
Many of those who wrote in for the Freedom to Speak Up review, headed by Sir Robert Francis, ‘described a harrowing and isolating process with reprisals including counter allegations, disciplinary action and victimisation. Bullying and oppressive behaviour was mentioned frequently, both as a subject for a concern and as a consequence of speaking up. They also spoke of lack of support and lack of confidence in the process.’ The cases that staff described were mostly recent or current, the report added.
It indicates problems at different stages – deterrents to speaking up in the first place, poor handling of concerns that are raised, and vindictive treatment of the person raising the concerns.
The current form of managing whistleblowing is inadequate across the board in the NHS and the Review has shown that ‘problems remain and there is an urgent need for system wide action’, Francis has stated.
Responding to the Review published by Francis, Secretary of State for Health Jeremy Hunt has said that ‘[the] message must go out today that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.’
He added that the report ‘is about tackling that culture challenge head-on so we build an NHS which supports staff to deliver the highest standards of safe and compassionate care and which avoids the mistakes that have led to both unacceptable waste and unspeakable tragedy.’
ICSA Head of Policy (Not-for-Profit) Louise Thomson FCIS commented that ‘in all organisations, the tone and values come from the top. NHS boards are working within a system that seeks out failure and penalises those found wanting’. As a result, she adds, it is not surprising that there continues to be a problem with the way whistleblowers are treated. A cultural revolution is required for true reform, which involves ‘all parts of the NHS system to ensure cohesive and constructive improvement to the quality and safety of patient care’.
Francis said that ‘no amount of legal or regulatory change will make it easier for staff to raise issues that worry them unless there is a culture which encourages and supports them to do so.’
For that to happen, a culture needs to be established in which, staff feel safe and lack fear that they will experience bullying and bad treatment in order to raise concerns; speaking up is a normal part of everyone’s routine; leaders welcome and encourage the raising of concerns; and that regular and effective training in raising and handling concerns is provided for all.
The Review also sets out proposals on how the NHS can move forward, among which is the recommendation that a freedom to speak up guardian is established in every NHS trust. This is a named person in every hospital to give independent support and advice to staff who want to speak up and hold the board to account if it fails to focus on the patient safety issue.
Membership body NHS Confederation Chief Executive said: ‘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’.
How do you achieve a trusted speak up culture? Governance + Compliance and Navex Global’s Ethical Intelligence initiative can help – visit our website.