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Whistleblowing guardians 'to extend into primary care' with funding boost, says NHS chief

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GPs are set to be the latest group of employers to appoint whistleblowing guardians due to a funding boost by NHS England to expand the speaking up programme.

In addition, pressure will be applied by national body NHS England to independent providers of NHS services that do not currently have guardians in place, in order to ensure they are complying with contractual requirements.

“One of the things NHS England will be doing is tripling our funding contribution to freedom to speak up guardians next year”

Simon Stevens

NHS England will also look at whether to start collecting data that compares how far trusts have improved speaking up in their organisations, by creating an “index”.

Simon Stevens, chief executive of NHS England, said this week at a conference for freedom to speak up (FTSU) guardians that he would be tripling the amount of money his organisation provided to the national office overseeing the work, so that primary care could be included.

NHS England later confirmed to Nursing Times that its contribution to funding the National Guardian’s Office would rise to £1m next year, up from the current £330,000.

The office operates independently but its running costs are funded by NHS England, which currently provides a third of the budget, and the regulators the Care Quality Commission and NHS Improvement.

Since October 2016, it has been a contractual requirement for all 232 NHS trusts in England to have appointed a guardian, designed to encourage colleagues to speak out about problems in the health service.

The role was recommended following a review of whistleblowing in the NHS by Sir Robert Francis in 2015, which found there was still a “serious issue” with the treatment of people who raise concerns.

There are now more than 500 guardians in place, with at least one in every NHS trust. The first annual report by the National Guardian’s Office found nurses were raising more issues than any other staff group.

However, speaking at the FTSU conference in London on Tuesday, Mr Stevens noted that more organisations needed to support speaking up.

Despite it being a contractual requirement for independent organisations providing NHS services to have a FTSU guardian in place, “by no means all” had “done a good job responding to that,” he said.

NHS England

Simon Stevens

Simon Stevens

“So over the course of the next year, we at NHS England are going to get much more encouraging – verging on assertive – about reminding people of their contractual, legal obligations to have those freedom to speak up guardians in place right across the healthcare sector,” he said.

“We’ve got to extend our reach into the full family of organisations who are providing NHS-funded care,” he said. “As we do that, we cannot ignore the main foundation of care in this country, which is what is happening in primary care.

“One of the things NHS England will be doing is tripling our funding contribution to freedom to speak up guardians next year to enable the build up of further support across primary care,” he told delegates.

The NHS England chief executive later suggested he wanted to explore whether to create an “index” of how far trusts had improved speaking up.

This would be similar to the Workforce Race Equality Standard work, which compares the experiences of black and minority ethnic staff with white staff based on responses to the annual NHS staff survey, he noted.

“I think for freedom to speak up guardians in individual organisations that could be a very powerful tool, as an attention grabber for management and boards,” said Mr Stevens.

At the same conference, health secretary Jeremy Hunt told the guardians their work is at the “heart” of a change needed in the NHS to tackle a “profoundly flawed” culture around raising concerns.

Dr Henrietta Hughes, the national guardian for the NHS, said: “It is vital that everyone working in primary care has the same opportunities to speak up as in the rest of the NHS, knowing that the right actions will be taken as a result.

“In the last nine months, 4,600 cases have been brought to freedom to speak up guardians in NHS trusts and foundation trusts, which shows that this additional channel is needed for workers. We look forward to working closely with NHS England and our other partner organisations to make speaking up business as usual in the NHS.”

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