Francis outlines plans to fix NHS treatment of whistleblowers

Every NHS trust in England should appoint a guardian to support whistleblowers, a review has concluded after hearing how NHS staff have suffered poor health and “felt suicidal” as a result of blowing the whistle on poor care.  

The review found a significant proportion of health workers are afraid to speak out about poor patient care and safety failures in the NHS either because they are afraid of the potential consequences, or because they feel nothing would be done.

Sir Robert Francis QC, who led two major inquiries into failures at Mid Staffordshire NHS foundation trust, was asked by Jeremy Hunt to recommend how best staff can be supported to raise concerns after a series hospital scandals suggested staff warnings were quashed.

One of the main concerns he identified was the treatment of "whistleblowers" with some having been ignored or having encountered bullying and intimidation.

"Time and time again people say to me they either want to complain about the behaviour of others towards them or, when they do raise a concern about the working environment or the way patients are being treated, the reaction to them has been one of being bullied," Francis told BBC Radio 4.

He added: “I've heard some frankly shocking stories about [staff] whose health has suffered, and in rare cases who've felt suicidal as a result of their perception of them being ignored or worse.”

In total, 612 people shared their experiences in the Freedom to Speak Up review, while another 19,764 people completed an online survey detailing their experiences of raising concerns. The vast majority are understood to be overwhelmingly negative.

One person quoted anonymously in the review said: “I have often been so depressed by this experience that I have often considered suicide. I live in fear that the hospital will carry out its threat to sue me and take my home from me.”

Francis said: “The evidence received by the review has confirmed that there is a serious issue within the NHS. This issue is not just about whistleblowing - it is fundamentally a patient safety issue.

“Everyone in the NHS needs to support staff so they have the courage to do the right thing when they have concerns about patient safety. We need to get away from a culture of blame, and the fear that it generates, to one which celebrates openness and commitment to safety and improvement.”

The review made several recommendations, including:

  • A "Freedom to Speak Up Guardian" to be appointed in every NHS trust to support staff.
  • A national independent officer to help guardians when cases are going wrong.
  • A new support scheme to help NHS staff who have found themselves out of a job as a result of raising concerns.
  • Processes established at all trusts to make sure concerns are heard and investigated properly.

The report found that some groups were particularly vulnerable when they raise concerns, including locums and agency staff, students and trainees, black and minority ethnic (BME) groups and staff working in primary care.

Students with previously good records were failed or criticised after speaking up, and Francis wrote that there was “a perception that BME staff are more likely to be referred to professional regulators if they raise concerns, more likely to receive harsher sanctions and more likely to experience disproportionate detriment in response to speaking up”.

Francis suggests that legislation should be considered to protect people who are seeking employment within the NHS from discrimination on the grounds that they are known to be a whistleblower.

Responding to the report, Rob Webster, chief executive of the NHS Confederation, said: “This report holds a mirror up to the NHS leadership - we need to look very carefully at what it shows. The poor treatment of some whistleblowers is a stain on the NHS. It undermines the great efforts of staff and the exceptional leaders we have in most of the service. Above all we need a set of leaders who will not stand for the ill treatment of genuine whistleblowers or for bullying in the modern NHS.”

He added: “In particular, we support the report’s recommendations that staff and managers should receive training to raise concerns - and that those who do raise concerns should be supported and given the recognition they deserve.”

The General Medical Council welcomed the report, saying that the NHS needs a culture where doctors and other health professionals feel empowered and supported when they speak up, but this is not easy to achieve.

Niall Dickson, chief executive of the GMC, said: “We have made it abundantly clear that doctors have a duty to act when they believe patients’ safety is at risk, or that patients’ care or dignity are being compromised. But this is not so much about requiring staff to speak up, as it is about creating the conditions where they feel comfortable and encouraged to do so. We have required doctors' leaders to support those who do raise concerns. Above all, changing the culture is a task for local managers and clinical leaders.”

Jeremy Hunt is expected to lay out the Department of Health response to the review in a statement to Parliament later today.

(Image source: Joe Giddens/PA Wire)

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