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Francis: Student nurses should be trained in raising concerns


All student nurses should in future receive training in how to raise concerns about care as part of their course, a major review into NHS whistleblowing has recommended.

Whistleblowing training for NHS staff and students, an employment support programme to help those that speak up get back into work, and a national officer who reviews cases in which complainants have suffered harm are among the recommendations made by an independent review.

The Freedom to Speak Up Review, chaired by Sir Robert Francis QC – who also led the public inquiry into care failings at Mid Staffordshire Foundation Trust – found that there is still a “serious issue” around the treatment of whistle-blowers.

It calls for a change in culture within the NHS to ensure all staff feel safe to speak up and that raising concerns becomes a normal part of their routine.

Findings from the review’s survey of almost 20,000 NHS staff members, more than 30% who had raised a concern said they felt unsafe afterwards, while 15% of those who had not spoken out blamed fear of victimisation for not doing so.

The review recommends 20 actions that should be taken, which includes the creation of a support scheme for people who find it difficult to secure future employment in the NHS as a result of having spoken out.

“We need to establish everywhere a culture in which all staff feel safe to raise their concerns”

Robert Francis

This should be run by NHS England, the NHS Trust Development Authority and Monitor and should provide training or work experience for healthcare professionals who have been out of work for long  periods, assistance with job applications and encouragement for employers to view whistleblowing as a positive characteristic.

Training for students about raising concerns should be “embedded” within undergraduate and postgraduate courses. This should be implemented by regulators including the Nursing and Midwifery Council and workforce planning body Health Education England, says the review.

There should also be training for every member of staff about how to raise and handle concerns within their organisation, says the report, and this should be done face-to-face and preferably making use of role play.

Sir Robert has also called for the appointment of a “national independent officer” who can inform other bodies when whistleblowers may have been treated unjustly.

This officer should be jointly established by the Care Quality Commission, Monitor, the NHS TDA and NHS England and should be able to review how these cases have been handled and advise trusts on how to improve their good practice.

While this individual will not have the authority to investigate individual cases or have binding powers, Sir Robert said they should act as a conduit to other bodies – such as the CQC – to alert them to cases where a complainant may have suffered harm or good practice has not been followed.

A local equivalent of the INO – a Freedom to Speak Up Guardian – should also be appointed in every NHS trust who will provide independent support and advice to staff about raising concerns, says the review.

This full-time employee should also be able to intervene if the complainant suffers any harm, says the report,  and must be able to escalate concerns outside of the organisation to bodies, such as the CQC.

Former Mid Staffordshire whistleblower nurse Helene Donnelly, who was an advisor to the Freedom to Speak Up Review, already holds such a position. She is the ambassador for cultural change at Staffordshire and Stoke on Trent Partnership Trust.

Some contributors to the review wanted to see new measures introduced to ensure managers who fail to act when complaints are raised are held to account.

The report notes that the recently introduced Fit and Proper Person Test for directors of health service bodies – which aims to ensure no director is appointed who has been involved with previous misconduct or mismanagement – should go some way to improve accountability but needs to be kept under review.

Presenting his review findings this morning, Sir Robert said: “Taking into account all evidence obtained by the review, I’ve reached the conclusion there must be a change in culture.

“No amount of legal or regulatory change will make a difference to staff that raise issues unless there is a culture which encourages and supports them to do so,” he said.

He added: “We need to establish everywhere a culture in which all staff feel safe to raise their concerns [and that] speaking up about what worries them is normal part of their routine.”


What do you think?

Join us on Twitter at 1pm Wednesday 11th February to discuss the review and its implications.

Search for #NTtwitchat to follow the conversation and include this hashtag in all your tweets.


Readers' comments (14)

  • I don't think its so much to do with empowering students - they generally are very good at spotting it and raising the issue. it should be about alerting them to the support available should they need to raise concerns and more importantly to their tutors/managers to ensure that such concerns are investigated and not just attributed to student zeal.

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  • It will be interesting if this changes anything.
    One gets the feeling Francis is still skirting around the real root causes & issues

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  • hotshiningsun

    I am a 3rd yr student nurse and feel it's very difficult to raise issues ... I would worry that it would affect my future employment and I have heard 'horror stories' from students who have raised concerns

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  • maybe this is the time now to have cctv everywhere

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  • talking about concerns should be a normal part of any everyday conversation. you can't just continually mention the positive and hide the negative just for the benefit of your employers. in this way of open dialogue in a climate of trust issues are highlighted and addressed before they become huge mountains and more difficult to deal with. the whole attitude here is perfectly ridiculous and anyone choosing to work in healthcare should be focusing on the patients and not on other petty stories.

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  • michael stone

    Sir Robert spent some time explaining the complexity of the legal situation re 'remedies' and pointed out that legally, to use my phrase, 'protection for whistleblowers is relatively weak'.

    Almost every major report of this type, points at the need for 'a change on culture' - achieving that, is very difficult and not usually rapid.

    But Sir Robert has described the problems very well. And he has not 'glossed over' the difficulty of sorting this issue out, either.

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  • I pity the students - like lambs to the slaughter.
    My experience is that the same people who are promoting the Francis report and conclusions are currently telling us all to shut up and stop complaining.
    When is someone going to wake up and understand that there is an embedded culture of covering up these issues. Thats how the leaders of the services got to be in charge and thats how they will stay there? What we need is some honesty.

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  • michael stone

    Sir Robert does say the solution would require a 'culture change'. Principle 11 of the executive summary has got sections on 'Support' and these two sections strike me as being pretty clear:

    60 Some trusts have established a new role, sometimes known as a ‘cultural ambassador’ or ‘patient safety ombudsman’. Their role is to act as an
    independent and impartial source of advice to staff, with access to anyone in the organisation, including the CEO, or if necessary outside the organisation.
    They can ensure that the primary focus is on the safety issue; that the case is handled appropriately, investigated promptly and issues addressed; and that
    there are no repercussions for the person who raised it.
    They can also act as an ‘honest broker’ to verify that if there were pre-existing performance issues that were already being addressed, these should continue and cannot be portrayed as a consequence of speaking up.

    61 I believe such a role can make a huge
    contribution to developing trust within an
    organisation and improving the culture and the way cases are handled. I believe there would be merit in having similar roles in all NHS organisations, with a common job title such as Freedom to Speak Up Guardian, so that those who move between
    organisations know immediately where to go for help. They could also form a network to share good practice and to identify common issues and themes. I
    strongly encourage all NHS organisations to consider it. I have stopped short of recommending that all must adopt this model, as I believe boards should
    decide what is appropriate for their organisation. But as a minimum there needs to be someone to whom staff can go, who is recognised as independent and
    impartial, has the authority to speak to anyone within or outside the trust, is expert in all aspects of raising and handling concerns, has the tenacity to ensure safety issues are addressed, and has dedicated time to perform this role.

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  • offensive?
    michael stone
    michael stone | 16-Feb-2015 1:27 pm

    try making it a bit briefer!

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  • michael stone

    Anonymous | 16-Feb-2015 2:41 pm

    It was 'briefer' - I extracted some pieces of relevance from Sir Robert's Executive Summary, instead of 'quoting the whole report'.

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