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‘Celebrate’ staff that raise concerns, Hunt tells NHS

Health secretary Jeremy Hunt has written to trusts warning them against having a “defensive culture” over patient safety and whistleblowing.

The letter was sent on Friday to the chairs of all NHS trusts and foundation trusts in England. In it, Mr Hunt stated that raising concerns “can be a brave thing to do, even in an open culture”.

“When our staff have the courage and professional integrity to raise concerns in the patient interest, we need to recognise and celebrate that behavior, listen to their concerns and take action to ensure any problems are properly addressed,” he said.

He added: “I would …ask you to pay very serious heed to the warning from Mid Staffordshire that a culture which is legalistic and defensive in responding to reasonable challenges and concerns can all too easily permit the persistence of poor and unacceptable care.”

The letter follows widespread criticism over the last few days of “gagging clauses” in NHS pay-off agreements that are designed to prevent staff speaking out. Such clauses are referred to in formal terms as compromise agreements for departing employees.   

The case of Gary Walker, the former chief executive of United Lincolnshire Hospitals Trust, has received widespread media coverage, after he chose to break his own gagging clause. He claims he was forced out of his job in 2010 for refusing to prioritise meeting targets at the expense of patient safety.

Mr Walker’s actions themselves came in the wake of the publication earlier this month of the Mid Staffordshire Foundation public inquiry report, which recommended the introduction of a legally enforced “duty of candour”.

Mr Hunt’s letter noted that the inquiry report had highlighted the “critical importance of fostering and sustaining an open culture in which concerns about care can be raised, investigated and acted upon”.

“Fostering a culture of openness and transparency is essential if we are to ensure we never repeat the mistakes of Mid Staffs – which means creating a climate where it is easy for staff, present and former, to come forward with any concerns they have relating to patient safety,” he wrote.

The health secretary reiterated that trusts should follow DH guidance dating back to 1999, which states that NHS trusts should “prohibit” the use of gagging clauses in contracts of employment and compromise agreements, which seek to prevent the disclosure of information in the public interest.

NHS Commissioning Board chief executive Sir David Nicholson wrote to trust chief executives in January 2012 on the same issue, highlighting that such clauses to prevent disclosures in the public interest were “contrary to policy on supporting whistleblowers”.

Readers' comments (14)

  • George Kuchanny

    About time this cultural problem was fixed. The old way of flannelling your way through problems is dangerous. Even more dangerous is modifying medical notes to fit the flannelling. It throws out the following treatment. All this should have gone with tweed, everything written in latin, endemic bum kissing and wild guesswork instead of clinically proven treatment. This kind of numbnuttery costs lives and lorries full of cash to the NHS. It is part of an antique covert culture that should have gone long ago.

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  • when the country is so overcrowded and increasingly short of resources how important are individual lives to any other than family, friends, club mates and perhaps colleagues? Are the authorities genuinely concerned? it seems people are merely statistics to be collected during certain life cycle events!

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  • michael stone

    Has this letter - a lot of which I think is quoted above - been published somewhere: i would like to retain it for my records, but so far have only found quotes from it.

    The fundamental solution to this one, is to set up a system so that staff can raise concerns 'indirectly' - in other words, that by the time the concern is passed to managers for a response, it is taken there by a representative (for example a representative of ward nurses) and not by an individual, because individuals 'can be picked off and bullied' by bad managers.

    Such a methodology has been used in the past, and it needs to be expanded and used in the future ! The start of a letter in today's Daily Telegraph:

    SIR - In the Nineties the medical royal colleges played a major role in inspecting hospitals. One reason they were so successful was that staff were interviewed individually, but in subsequent reports, criticisms were not attributed to individuals, so that they could not be harassed as whistleblowers.

    Written by Professor Charles Galasko
    Past chairman, Hospital Recognition Committee, Royal College of Surgeons Gatley, Cheshire

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  • Where I worked we were told that we the nurses couldn`t raise concerns as a group only as individuals.

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  • When I raised concerns in my locality - not mid staffs - I was branded as a trouble maker who has burnt her bridges. I also faced malicious allegations from collegues about my practice however once face to face with rcn regional representative, hr & ward manager it became clear that there was a leadership issue. My ward manager did not know anything about the acuity etc on each shift. I wasn't allowed my say until that meeting. The rcn were told by management half the story, the rcn regional representative spends 90% of their time at this hospital.

    As band a 5 staff nurse it is extremely difficult to voice concerns without being placed upon capability and having your incident forms being put in the bin.

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  • The rcn rep understood my situation. I had my say and stood up for myself, noone should have to experience this amount of stress. Isnt it ironic that its meant to be a caring profession however managers really do not care about their staff unless you are in their clique.

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  • If there is a major cause for concern document it and send a copy to Mr Hunt and Nicholson.

    They wont be able to wriggle out of that one.

    I do agree though, it is incredibly difficult as a band 5 especially when on the Nurse Bank to have your concerns listened to.

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  • Nurses need to be able to report concerns to independent bodies who have nothng to lose or gain by it. Instead they are told to take it up locally and follow internal procedures. This is ridiculous. If I want to complain about poor staffing and budget cuts, then I would be complaining to the person who was responsible for them in the first place. There is no way they are likely to be receptive as I would be threatening their position and therefore they become hostile and defensive and would brand me the troublemaker and look for ways to get rid of me.

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  • Tiger Girl

    Anonymous | 18-Feb-2013 4:13 pm

    Anonymous | 18-Feb-2013 4:23 pm

    I think that is why the points Agent made (DH Agent - as if ! | 18-Feb-2013 2:40 pm) are crucial here - concerns about thimngs like staffing numbers and systems, are complaints against things imposed from above - so concerns must be raised by someoen who is not the first person to mention the concern, or else it is all too easy for bad managers to pick off that individual.

    Cameron seems to be suggesting, from something I read today, that if the right regulations are put in place, 'whistleblowing' will become unnecessary - exactly the wrong approach, because it is formalised 'rules' for raising concerns that tend to create the problem.

    Anonymous | 18-Feb-2013 11:07 pm

    I agree about the 'independence' bit - but this also has to be looked at on the ground, locally, because bringing in people from the outside is too slow and too rules-bound and complex: that works okay for incompetent individuals, but it does not work for incompetent systems.

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  • I got burnt recently when i highlighted an unsafe area. It was very stressful and there are many senior staff who still refuse to speak to me despite agreeing that it had been an issue for some time which had not been sorted out and that patients were at risk.
    I went through the right process and the managers did nothing to change the situation. I escalated it and i was accused of going behind their backs and undermining them.
    As a very senior and experienced nurse i cannot imagine how hard it must be for a more junior member of staff to go through this. At one point i thought i would lose my job by continuing which i decided was a price worth paying.
    We have to make it easier. We have to support each other. We have to make it the norm to critically review what we are doing and the standard of care we are delivering. My preference would be less whistle blowing and more frank and honest conversations with managers about what we are encountering and what we can do about it.

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  • if there is a problem why not point it out to the person concerned first and support them in seeking ways to make amends.

    we all make mistakes and nobody is perfect.

    only when there is no foreseeable solution does one start slowly crawling up the management ladder, unless the problem is very serious or life threatening, and only then when reporting back the progress to the level below at each stage. one does not go behind peoples' backs and very often it is how the information is presented by you which is important - practical wisdom, common sense and social intelligence are all skills to be developed which includes the effect you have on others and how they might receive and deal with the information.

    don't forget you are not perfect, will also make mistakes which hopefully you will admit which often prevents escalation of the problem, feelings of guilt and further difficulties, and think how you would feel as a result of your own behaviour if you were in the shoes of the others involved!

    Some just enjoy bullying and throwing their weight around as a means of power by saying I reported so and so, and this and that and all and sundry!

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  • Yes But

    Anonymous | 22-Feb-2013 1:32 pm

    if there is a problem why not point it out to the person concerned first and support them in seeking ways to make amends.


    ______________

    Problems with individuals are different from problems with systems - they need different approaches.

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  • Yes But | 22-Feb-2013 2:30 pm

    Anonymous | 22-Feb-2013 1:32 pm

    I suspect it is more difficult to tackle a system than an individual as it is often very hard to find any one person who one can hold responsible for it.

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  • Mike, the letter is here
    http://tinyurl.com/afq4yap
    If you ever read an NT article that says so and so wrote a letter to such and such, the fastest way to find it is to go onto the DoH website, type "Dear Colleague" into the search box and that takes you to all the letters and circulars for all the professions - and just click on the one with the right title.
    And thanks for your comment on another thread about the MCA, that was just coming in at the time we were in our situation with dad. Very useful learning, thank you.

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