‘Freedom to speak up?’ in the NHS: independent review

Sir Robert Francis QC is to chair an independent review into creating an open and honest reporting culture in the National Health Service (NHS).

It has been announced that the review will:

…provide independent advice and recommendations to ensure that:

    • NHS workers can raise concerns in the public interest with confidence that they will not suffer detriment as a result
    • appropriate action is taken when concerns are raised by NHS workers
    • where NHS whistleblowers are mistreated, those mistreating them will be held to account.

It will also consider independent mediation and appeal mechanisms.

Aerossurance welcomes the initiative, but does think it is perhaps unfortunate that the emphasis is on whistleblowing, the most extreme form of safety reporting, rather than routine, open and cooperative reporting.

Francis, a barrister specialising in medical negligence, previously chaired the Mid Staffordshire Inquiry into what have been described as ‘appalling’ standard of patient care at one the 260 NHS Trusts between 2005 and 2009 that is thought to be responsible for hundreds of deaths.  Francis has been described as ‘formidable’ and ‘forensically exceptional’ by solicitors who have hired him.

The Guardian has commented that Francis’ new report:

…needs to be short and punchy. It will only help change culture if everyone in the NHS can read and understand it; plain English, not lawyerly circumlocution, is required.

The NHS not only works in an a sector where there are large risk of human error resulting in fatalities but it is also the world’s fifth largest employer.

World’s Largest Employers (Credit: BBC)

UPDATE 11 Feb 2015: The report is published.  It recommends:

  • A “Freedom to Speak Up Guardian” to be appointed in every NHS trust to support staff, particularly junior members.
  • 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 Chief Executive of the NHS responded:

As a nation we can rightly be proud of the fact that NHS care is now the safest it has ever been. But as I’ve sat down and listened hard to whistleblowers over the past year, it’s blindingly obvious that the NHS has been missing a huge opportunity to learn and improve the care we offer to patients and the way we treat our staff.

These important proposals – particularly for a new national office of the whistleblower – will provide clear new safeguards and signal a decisive change in culture in every part of the health service.

UPDATE 16 July 2015: The Secretary of State for Health Jeremy Hunt announced that the recommendations will be taken forward as part of a package of patient safety improvements, releasing the report Learning not Blaming.

For expert advice on safety reporting and safety culture development, contact Aerossurance at enquiries@aerossurance.com

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