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”
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.