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NHS must promote 'honest culture' to maintain quality of care


An open and honest culture that empowers staff to speak-up about concerns must be a priority to maintain and improve quality of care during the current NHS shake-up, a report has warned.

It is “critically important” the NHS thinks creatively about “better ways” of ensuring staff feel they can speak, according to the report from the NHS National Quality Board.

It states: “Healthcare professionals working at the front line are ultimately responsible for ensuring patients receive high quality care and how it is their professional duty to speak up if they have concerns.”

It adds: “NHS organisations should ensure that an open and honest culture, where all staff feel empowered to make improvements and feel able to raise concerns, prevails.”

The document – titled “Maintaining and improving quality during the transition” – is the first of a two part series of recommendations designed to help organisations protect patient care as reforms take place.

The board also intends to publish a leaflet to “remind staff of their responsibilities to speak-up” if they are concerned about quality of care.

The board – chaired by NHS chief executive David Nicholson – was established in 2009 to set targets for improving quality across the NHS. Chief nursing officer for England Dame Christine Beasley and Professor Hilary Chapman, chief nurse and chief operating officer at Sheffield Teaching Hospitals NHS Foundation Trust, are also members of the board.

The call for action on staff engagement comes just after publication of the latest NHS staff survey, which revealed the majority of NHS personnel do not feel included in decision-making by senior managers (page 5).

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Readers' comments (16)

  • Until staff are kept safe, they are committing professional suicide to speak out in the very dysfunctional workplaces, described as toxic in T Dennis’s insightful study Coping with toxic organisations (see
    If people dare to raise concerns the managers shut them up by suspending them, making unsubstantiated allegations against them.
    People like the NHS National Quality Board hear nothing about it because managers don’t have to report their actions to anyone outside their trusts. I challenge the NHS National Quality Board to use Freedom of Information to all trusts, to find out how many staff are currently suspended, for how long and why, to accept the truth of what I am writing.
    Until staff are truly protected and these actions can no longer take place without notification to an outside body such as the National Clinical Assessment Service (for doctors, dentists and pharmacists) then people like Sir David must stop putting the onus on staff.
    Do something with the managers first Sir David.
    Julie Fagan, founder member of CAUSE, Campaign Against Unnecessary Suspensions and Exclusions (UK) and if I sound rather angry about it all, it is the effect of reading people’s horror stories and their despair these last 8 years. Nursing Times articles about trailblazing staff and good practice in the well run organisations, keeps me sane!

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  • Hear Hear Julie!!!!

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  • michael stone

    This is a long-standing and known problem area - it will never be sorted out properly, until nursing staff are allowed to raise concerns anonymously (probably by e-mail) with some type of 'lay body' separate from their own managers.

    You need to have certain issues, which imply some degree of management inefficiency or culpability, to be examined by, and then progressed by, people who management have no power to discipline !

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  • Kadiyali Srivatsa

    Interesting article and nice to know your journal like BMJ advice staff to be honest and report wrong doing but do you know what will happens to a doctor who comes forward and reports wrong doing?

    I did and now wish I had walked out and immigrated instead of reporting un-ethical medical practice offered in the NHS. If your organisation is not capable of defending the members, please do not advice them to come forward and report. As members of medical profession it is our duty to alleviate pain and suffering and not inflict them.

    As doctors we believe in the self inflicted code of conduct that is well known as "Medical ethics" and so it is our duty to protect them in the interest of humanity.

    The Tokyo Declaration clearly state the doctors it is the privilege of the physician to practise medicine in the service of humanity, to preserve and restore bodily and mental health without distinction as to persons, to comfort and to ease the suffering of his or her patients. The utmost respect for human life is to be maintained even under threat, and no use made of any medical knowledge contrary to the laws of humanity.

    For the purpose of this Declaration, torture/harm is defined as the deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any authority, to force another person to yield information, to make a confession, or for any other reason.

    A physician we are said to have complete clinical independence in deciding upon the care of a person for whom he or she is medically responsible. The physician's fundamental role is to alleviate the distress of his or her fellow human beings, and no motive, whether personal, collective or political, shall prevail against this higher purpose.

    The GMC, WMA & BMA encourage doctors to do what you say but have no power to defend the doctors. Please, please do not encourage nurses or doctors to speak out, unless you can GARANTEE protection.

    My life and passion has been destroyed, but this does not stop me from warning my fellow human that "Whistle-blowing is injurious to your health and well-being".

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  • it is all well and good to publish reports on ideologies but what will change as a result of this. it seems so much money is spent on investigations and report writing in the NHS which could be better spent on caring for patients. Those responsible are not going to leave their own comfort zone to bend to the staff even though it is for the benefit of the healthcare professionals and for the good and safety of the patients. Nothing changes. where healthcare management is concerned, and people who have been accepted for such positions in organisations, should understand that this knowledge is fundamental and based on human decency.

    On my MSc Healthcare Management for clinicians course we were told that managers are generalists with a general knowledge of the area they are overseeing and are reliant on advice from the specialists in each division who are responsible for their own practice and meeting the needs of their patients. this (should I have to spell it out?) obviously includes ward based, and other, doctors and nurses!

    Kadiyali Srivatsa | 19-Mar-2011 8:58 am

    Your comments are interesting, helpful and useful to the current debate and it is excellent to see a medical practitioner broad minded enough to read a nursing magazine. although our hands are often tied behind our backs by management and the constrains of 'the system', we should all be working together to defend the interests of our patients, the well-being of our colleagues (which includes all in the organisation, which shouldn't need spelling out either as we are all, hopefully, working towards the same goals) and the future of healthcare service delivery to ALL patients in an effective, high quality and equitable manner.

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  • Professor Hilary Chapman should set foot on the wards of her own trust (Sheffield Teaching Hospitals) first, and read the many incident forms that have been written, before she lectures others on standards of care.
    Nurses morale there is at an all time low with recruitment freezes, no interviews for newly qualified nurses. So we have to provide even higher levels of care with less staff? It's a struggle to provide minimum standards as it is.
    Incident forms are completed but nothing changes.

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  • As a student Nurse, I raised some concerns regarding patient care and now face a disciplinary at uni. The reason the ward sister didn't like what I reported and the whole clic mentality of the ward wasn't happy. I wasn't rude and was very polite and asked why was it done in that way? To help me understand the logic behind it. The irony is the ward sister thanked me for raising my concerns and then complained to the uni and made false accusations and had me removed from the placement. This has made me question ward mentality and have decided not to work in a ward setting.

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  • everybody has a fundamental right to express themselves by questioning or voicing their opinions, and to speak out to defend themselves or others. They also have a right to be heard. There are no boundaries dependent upon who they are or their social status and this right must be recognized and respected by everybody else.

    It is sad and detrimental that such strange attitudes exist on wards especially as they are supposed to provide an educational environment for all staff involved, patients, families and students. if they are not willing or able to take on students they should be investigated by the schools of nursing or whoever is responsible for organizing the placements and withdrawn if necessary as a teaching unit or from offering placements. Such placements should be carefully scrutinised as to their suitability for prospective students because they will have a far reaching impact on the future of the students, their attitudes towards ward teams and their present and future colleagues, the area of specialization, the care they deliver and towards patients as well as on learning outcomes, results counting towards their final qualificationn and their future careers and how they deliver patient care.

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  • michael stone

    Most of the posters have got their own bad experiences of the consequences of raising an issue, or complaining - doubtless the response of 'the system {ie managers}' would be that such people are a self-selecting, and disgruntled, group.

    I am not a clinician, and my current interest in certain aspects of medical behaviour stems from the way I was treated by 999 when my mum died a couple of years ago: but as a layman, I have had experience of the way the NHS feedback & complaints process works (doesn't work, would be more accurate from my own experience). It is pretty useless if you are a patient or relative, as well as if one is a nurse or doctor.

    But, simply applying some logic, the reasons for this failure are obvious. Setting aside 'ad hominem' complaints, such as 'Fred is simply incompetent, and a danger to patients', many complaints, or 'issues', involve a criticism of 'how things are being done at present'. Usually 'management', at one level or another, set up 'how things happen now' - so, until complaints about 'structural failures and similar' can somehow be raised anonymously, things will be unlikely to improve: managers are unlikely to be keen to admit 'this problem was created by my 'plan' in the first place', are they ?

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  • michael stone | 19-Mar-2011 2:45 pm

    would the Telegraph,with a more general readership, rather than a nursing magazine be a more interesting and appropriate place for this and your other comments?

    'Quality and safety' at risk in NHS shake-up, officials warn
    Patient safety is at risk at an “extremely turbulent” time during which the NHS will be under “huge financial pressures”, an official document warns.
    By Martin Beckford, Health Correspondent 9:00PM GMT 18 Mar 2011

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