Abstract
On 11 February 2015, Sir Robert Francis published his “Freedom to Speak Up” report on whistleblowing in the NHS. The review was undertaken as an additional piece of work following the Mid Staffordshire Public Inquiry. The Government had not been able to accept all of the inquiry recommendations on whistleblowing, and wanted a fuller report on the issue. Sir Robert spoke to hundreds of NHS whistle-blowers and managers as part of his review. He considered nearly 20,000 submissions. No doubt mindful of criticism over the inquiry resulting in so many recommendations (290), he neatly packaged his call for action to 20 key principles (with actions attached) and just two recommendations:
For all NHS organisations and regulators to implement all the principles and actions. For the Secretary of State to review progress annually.
Neat!
The most eye-catching of the recommended actions are to create whistle-blowing ‘guardians’ in each NHS organisation and also a national guardian. The local guardians would be modelled on the position held by the ex Mid Staffordshire nurse and whistle-blower, Helene Donnelly. Someone within the organisation who staff can safely turn to to raise concerns and with a specific remit to ensure concerns are dealt with appropriately and staff raising them supported. In other words, to support learning and improvement and prevent staff having to become ‘whistle-blowers’. The national position, it is recommended would be created by the Care Quality Commission, NHS Trust Development Authority and Monitor. It would be independent and be able to review cases.
Other notable and welcome recommendations include taking disciplinary action against managers or staff who bully or intimidate others raising concerns; regulators assessing more rigorously how organisations listen and support staff raising concerns; an initiative to help whistle-blowers back into employment; and making it illegal to discriminate against staff on the basis of them having been a whistle-blower.
It seems to me if all the actions were implemented, and implemented well, especially alongside the Duty of Candour which has already been created, this would represent a much needed revolution in openness, transparency and fairness in the NHS. However, there is an “if”. Secretary of State, Jeremy Hunt, immediately stated he supported all the recommendations but only ‘in principle’. It will take a large investment of time, effort and money to bring these changes about in a meaningful way, and rigorous enforcement by regulators.
Of course, the report could have gone further. Things I would have liked to have seen included a review of all existing disciplinary cases being brought against whistle-blowers and a statutory right for staff to have their safety concerns investigated. The way that the Duty of Candour is being implemented (without as yet any concerted effort to raise awareness, train and support staff) leaves a lot to be desired. However, the opportunity is there, should the NHS and Government be committed to taking it, to bring about a real revolution of openness, transparency and fairness.