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Francis to end 'climate of fear' as NHS whistleblowing review begins

The role of investigating claims made by NHS whistleblowers could be taken out of the hands of hospital trusts, the head of a major government inquiry has indicated.

Speaking as the Freedom to Speak Up review was launched yesterday, Sir Robert Francis said he aimed to extinguish a “climate of fear” in the NHS that had “victimised” whistleblowers, deterring others from raising concerns.

“If people aren’t coming forward with what is worrying them then nothing can be done about that,” he said. “It’s not a safe system. We need to learn how to do it better.”

“We should no longer tolerate people being in effect exiled from the health service because they have raised concerns”

Robert Francis

In an early sign of the direction the inquiry could take, Sir Robert said whistleblower concerns should be subjected to outside scrutiny.

“In the same way I have suggested complaints from patients will often need a degree of external investigation and independent scrutiny [that] they haven’t had before, I don’t see why the same can’t be suggested for staff raising concerns,” he said.

While Sir Robert said such a step did “not necessarily” involve the creation of a new organisation, the inquiry would consider remedies for victimised whistleblowers which went “over and above what the law in theory offers”.

Sir Robert, who also chaired the public inquiry into care failures at Mid Staffordshire Foundation Trust, said the review would examine whether hospital managers should be held more accountable for their involvement in cover ups.

“There should be consequences for that,” he added. “We should no longer tolerate people being in effect exiled from the health service because they have raised concerns,” he said.

Sir Robert told Nursing Times sister title Health Service Journal that questions should be raised about the quality of leadership at trusts which allow whistleblower concerns to become “swallowed up” by divisive disputes and protracted employment tribunals.

“The polarisation seems to get to the stage where no one will get out of the hole they have dug for themselves, and the question has to be asked if that organisation is being well led,” he said.

“By the time someone is labelled a whistleblower it is already telling you something has seriously gone wrong”

Robert Francis

While accepting that some employers had to deal with vexatious whistleblowers, he said all cases should be properly investigated.

“It is in the interests of the employer that they look into concerns properly and transparently and completely separately from issues they may have with any individual employee,” he said. “At the moment I don’t think that happens as often as it should.”

While the introduction of a new duty of candour and fundamental standards of care would make it easier for staff to speak out, Sir Robert said a “significant number” of NHS staff still felt penalised for raising concerns.

He said: “People say they have raised honestly held concerns and as a result have been victimised, sometimes to the point of being forced to leave the service or being dismissed.

 

The Freedom to Speak Up review

Sir Robert Francis has appointed a series of advisers to support his work: Norman Williams, former president of the Royal College of Surgeons; Peter Homa, chief executive of Nottingham University Hospitals Trust and Kath Fenton, chief nurse at University College London Hospitals Foundation Trust.

The review will host a series of seminars in the autumn to explore key issues and solutions.

Two separate pieces of research into whistleblowing in the NHS and the views of NHS staff will be conducted at Middlesex and Greenwich universities.

The review secretariat will be led by Joanna Donaldson, the HR director of the Department for Business Innovation and Skills.

Take part in the review or email the secretariat

 

“For every one of those stories any number of people are deterred from coming forward to raise what they are worried about. By the time someone is labelled a whistleblower it is already telling you something has seriously gone wrong.”

In this year’s NHS staff survey 90% of respondents know how to raise concerns in public but only 44% believe anything will be done. Almost 30% said they would not feel safe at work if they did speak out.

The review, which was officially launched today, has appealed for evidence from whistleblowers, managers and organisations across the NHS.

Sir Robert will also meet personally with selected whistleblowers, but will not make judgments on individual cases. He said all information would be treated in the “strictest confidence”.

“We have gone to great pains to set up our website and emails so they are completely controlled by us and independent of any government organisations,” Sir Robert said.

The review’s final report will be published in November, a timeline Sir Robert admitted would be “tough” but necessary for it to be useful before the general election in May 2015.

  • In 2013 Nursing Times launched the Speak Out Safely campaign to encourage healthcare providers to develop cultures that actively encourage staff to raise the alarm when they see poor practice, and to protect them when they do so.

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Readers' comments (18)

  • What about the thousands of agency workers providing NHS services? I am not talking about agency workers who do the odd shift in a Hospital setting - there are whole community-based care packages funded by NHS Trusts and managed exclusively by agencies / private companies (usually with staff on NHS-level pay). There is an anomaly here: the NHS Trust stipulates the care to be provided, the Agency (a private company) deliver the care. A nurse working for that Agency blows the whistle to both the Chief Exec. of the Health Board / Trust (decision maker for care provision) and the Agency (employer). The Health Board / Trust ignores the concerns, the Agency persecute the staff member. The Agency worker finds that they are unable to secure work with the Health Board / Trust. As things stand, the Health Board / Trust cannot be held to account for failing to listen, or later persecuting, an Agency employee who blows the whistle. Given that NHS care delivery is increasingly being outsourced to private companies, surely this is wrong? In order to improve care and protect genuine whistleblowers from harm, you need to look at protecting all staff providing NHS services, regardless of who pays their wage and who they are contracted to.

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  • Please please Sir Robert do not listen or let the RCN influence your final recommendations. The RCN and its cronies have totally destroyed real nursing.

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  • I really wish this is true and nurses can report abuse, poor standards, intimidation, bullying and harassment without fear of retaliation. Somehow I doubt it having suffered so much

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  • michael stone

    I do like Sir Robert - I'm sure he knows that you need to separate the person who raises the concern, from the concern, if the concern 'is a criticism of higher management policies'.

    I might look at the review stuff - but I'm sure he already knows, what I would be pointing out.

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  • Long, long overdue but breaking down the "barriers" will be an enormous task. Here's hoping for success, better patient care and major savings financially.

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  • I agree with the comment regarding the rcn
    The RCN positively discriminate against whistleblowers (nurses) and fail to support them in any sense either through negiotation and support or via the legal route
    The rcn was criticised in the mid staffs report and I hope this review looks at thier role in supporting whistleblowers more closely

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  • tinkerbell

    Sir Robert, who also chaired the public inquiry into care failures at Mid Staffordshire Foundation Trust, said the review would examine whether hospital managers should be held more accountable for their involvement in cover ups.

    Of course they should Sir Robert, they are a big part of the problem of preventing change for the better.

    You continue telling it like it is. Well done Sir Robert.

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  • He has done a good job but look who he has appointed....... Peter Homa, chief executive of Nottingham University Hospitals Trust and Kath Fenton, chief nurse at University College London Hospitals Foundation Trust, surely they are management positions. Will they be able to be impartial and distance themselves from influence by fellow managers?

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  • I raised concerns, made an error in judgement, was sacked, reported to the NMC and totally blacklisted, 75 job applications with no success. Would I whistle blow again, absolutely when it involved patient care, that is why I went into nursing. Managers should be held accountable and NHS money should not be spent on their excuses. If a trust has been seen to cover up. bully and harass and be down right corrupted they should be made to pay back the money spent on legal representation. Please Sir Robert do something about the length of time it takes the NMC to hear a case. Iv been waiting two years. If I committed a crime I would have been through the judicial system by now

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  • tinkerbell

    Anonymous | 9-Aug-2014 8:07 am

    Sorry you've had such a rough ride, about par for the course for whistleblowers, left hung out to dry, persecuted and hounded out of the profession, this must STOP!

    Hang in there! Good for you standing up and being counted and being prepared to do that same again. Wish you all success.

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  • I work as a HCA and have done for 23 yrs 8yrs in the 1980's then a further 15 since 1999. I feel staff at my level are not allowed to challenge Senior Nurses at unit level, let alone trust management, As soon as you open your mouth and make suggestions which go against their way of doing things or thinking, they jump on you like a ton of bricks. They prefer to pursue their own agendas and build their own little empires / cliques: And it will be these people who will get promotion based purely on personal relationships and not talent or innovative ideas, that is not what most NHS managers want they sycophants who will tow the Trust line & fit in,
    As a result only a few are prepared to stick their head above the parapet, in case they get their head shot off. I honestly believe most managers in the NHS do not want ideas from their staff let alone criticism. They in the main prefer their staff especially junior staff to put up n shut up. This stifles ideas & innovation from the Front line where a lot of experience resides. In general it is disregarded & wasted, as a result Oh and in between my stints in the NHS as a HCSW I got a 2.1 Hons degree in History & Geography so never assume that the person in the HCA uniform is a dimwit !!!

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  • michael stone

    Anonymous | 9-Aug-2014 10:39 pm

    'As soon as you open your mouth and make suggestions which go against their way of doing things or thinking, they jump on you like a ton of bricks.'

    Quite - that is the [fundamental] problem for everyone from HCA upwards: if the problem is something 'imposed from higher up, then 'higher up' frequently reacts badly if you raise a concern.

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  • Spot on Michael.

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  • I agree with the nurse who spoke about agency staff - I do agency nursing and I spoke up for a patient and the next thing I knew the agency rang and asked what happened I informed them but the agency said the surgery did not want me back. I feel this very unfair when I was supporting the patient ensuring the care given was of a high standard so by saying they did not want me back I was victimised so I can understand why some people will not say anything.

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  • I fully back this decision, but also feel that nurses who turn on their colleagues for whistleblowing concerns should also be held accountable for their actions. I don't think you should blame management totally. They deal with what they are told and from my experience the Human resource department make up a whole load of rubbish and lie to the managers, just so they don't show up their lack of experience.
    Plan:

    Independant review body who has legal training to support genuine whistleblowers.

    Review of Human Resource department to see if they are genuinely supporting staff or are just covering up mistakes.

    Victim support for all whistleblowers. It's tough to report problems, but with no support no wonder no one is reporting problems. The Police and Fire Brigade get it - why not nurses?

    Be honest when you make a mistake as a trust? Be prepared to admit when you need help. How will the Trusts in the UK ever learn when every time they screw up, they cover it up and the problem gets worse!!

    Learn to communicate not dictate!!

    Let us learn and stop the problems. I feel we are just re-inventing the wheel with the Bristol enquiry, the Francis Report, the Winterbourne House Scandal. No more!! Stop it. It's time to realise that we don't need these disasters to continue, we need them to stop. As a nurse or healthcare or anyone working in the caring profession, if you see poor practice, just go up and say stop!! If you can't empower yourself, how can you ever advocate for your patients.

    Be loud and be proud. Say 'No More' to poor practice and unacceptable patient treatment.

    I have, it does work!! You just have to be empowered!!

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  • How does one empower oneself when the people that hold the power of keeping or losing your job, support, wage are not only not supportive of your empowerment but are hostile towards that prospect. What if those people are not only hostile but unreasonable and cannot be reasoned with? How does one employ the next layer of management when they are also of the same mind and emotional IQ as your direct management? How about that together with a punative regulatory body and ineffective union, all with relationships that conflict with empowerment of the individual as they are in COI relationships with the management already?

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  • I am a HCA and I have been working for my local Hospital for 15 months.I raised concerns in 2013 over poor patient Care,neglect,My manager showed my concerns without my consent to my colleagues.This has resulted in a systematic Campaign of Harassment and bullying against me.I lodged a grievance in and now I am being Harassed from managers,HR Department and colleagues which is still ongoing.It has got to so bad I am now under the care of the Psychiatric Home team who visit patients in their own home as an alternative to hospital admission.I have been forced to take time off of work due to what is happening.My concerns up to now have still not been Investigated.I have applied for many Jobs in the NHS and have not been successful.I have suffered from detrimental Treatment,ongoing Harassment.I am a carer and I care about the patients.They are not statistics,Bed numbers.They are human beings with feelings and deserve to treated with dignity and Respect.I believe I am being hounded out of a Job I once loved.There needs to be more support for people willing to speak out concerning what they see.I am now being bullied by the HR department and my Manager has concealed Malpractice in the workplace and has refused to take my concerns seriously and is now responsible for harassing me and the HR Department has been doing the same thing.I dont know what my future holds for me at the moment.

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  • There needs to be a complaints board that is completely independant Nothing to do with NMC or RCN whose council members are intermixed.
    I complained about 2 cases of abuse at Sunderland Royal
    Case 1 An elderly man with Alzheimers was noisy, the ward was very short staffed. The F/T RGN persuaded an F1 to prescribe Midazolam 'to keep him quiet'
    Case 2 A pt with LD was in a side ward, not my pt. I checked on min his GCS was 7. The 2 F/T RGN refused leave the cons who was doing a round. They were full of self importance.
    I called the outreach team and his parents. The parents found that his medication was inaccurate and had not been given for 24 hours. The outreach team spent 4 hours before he was stable and checked every hour after.
    I complained and the complaint went as far as the Director of Nursing. I attended with RCN officer, who it turned out was a friend of DoN.
    It ended up me being told that as I was Bank, I would not get any further shifts and if I took the case further then the DoN would get Srs on various wards to make complaints about my care.
    This is the corruption whistleblowers have to put up with.
    I applied for a NH post utting the DoN as referee and she gave an excellant one. Twofaced or what

    I have had to put up with this treatment for 24 years when I have reported abuse in various forms. I have been the one to suffer, along with my family
    Those who report are vilified by colleagues, have false allegations made about them, asked to attend meetings which had been cancelled or asked why they did not attend meetings. i was even contacted 3 times on a weeks holiday being asked stupid things.
    A complaints dept must be outside the NHS were staff can be anonymouse

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