The way NHS organisations treat whistleblowers should be reflected in their inspection ratings, with the potential for a cash reward for best practice, says Sir Robert Francis.
The Care Quality Commission should look at how organisations handle cases as part of its assessment of leadership, and those with particularly good practice should be recognised, he concluded in his Freedom to Speak Up report, published earlier today.
At the same time, NHS settings which do not have an open and honest culture where staff feel safe to raise concerns should expect to be criticised and get poor ratings for leadership, he suggested.
“It is unlikely that an organisation which does not recognise the importance of instilling and maintaining this type of culture is one which is well-led,” he said. “Likewise any department or unit, such as a ward, exhibiting such deficiencies is unlikely to be well-led.”
To measure this, the assessment process should include a CQC analysis of data on raising concerns before inspection visits and questioning staff about policy and how easy it is to raise concerns while on site.
“Good practice should be viewed as a positive factor contributing to a ‘good’ or ‘outstanding’ rating”
The CQC told the review its inspection teams would be looking at whether leaders and staff recognised the value of raising concerns and whether appropriate action had been taken when concerns were raised.
Inspections could also include looking at settlement agreements for staff who can no longer work at an organisation after raising a concern. Sir Robert said all such agreements should be made available to the CQC to inspect.
Organisations that are good at protecting and supporting staff who raise concerns should be “recognised and celebrated” possibly through some kind of financial incentive, he added
“Good practice should be viewed as a positive factor contributing to a ‘good’ or ‘outstanding’ rating as part of their well-led domain,” he said.
His other suggestions included the creation of a national award scheme. This could be an annual award for the organisation that could demonstrate the best safety improvements achieved as a result of staff raising concerns.
“It might be possibly within the NHS to devise some financial incentive to organisations for outstanding practice in this area,” he added.
Overall, Sir Robert said he wanted to see regulators play a bigger role in supporting staff to raise concerns and he concluded there was scope for better co-ordination between the CQC, Monitor and NHS Trust Development Authority.
Together with NHS England, they should jointly create a fund a new national role to review the handling of concerns.
The Independent National Officer – another idea mooted by the report – would review cases, advise NHS organisations and promote good practice.