Sir Jeremy Heywood has written here before about the importance of whistleblowing in the public sector, how it can be an effective weapon against fraud, corruption and malpractice. He also believes that people who raise concerns deserve our support and protection. I want to share with you recent developments in our approach to whistleblowing in the NHS.
The first thing to say is that, day in, day out, thanks to staff dedicated to delivering the best for patients, standards of care in the NHS are consistently high. Ideally, public whistleblowing should be a last resort. We need robust internal procedures for raising concerns so that staff will use them, confident that effective action will be taken and without fearing they may be treated unfairly or risk their careers.
Recent steps to enable NHS staff to raise concerns include:
- guidance for NHS organisations states that all contracts of employment should cover staff whistleblowing rights
- staff terms and conditions include a contractual right to raise concerns
- the NHS Constitution highlights the whistleblowing rights and responsibilities of NHS staff and employers.
- employers are liable for any bullying or harassment of a whistleblower by a fellow worker
In addition, the Government intends to bring forward regulations to prohibit discrimination against whistleblowers when they apply for jobs in the NHS.
For staff seeking advice on how to report concerns and what protections they have, the Department of Health funds a free, independent and confidential helpline run by Mencap.
But we can and must go further.
Challenge to change
Freedom to Speak Up (FTSU), the independent review by Sir Robert Francis QC on creating a more open and honest reporting culture in NHS England, was published in February 2015. The review recommended that the NHS needs to move away from a blame and fear culture, to one that celebrates openness, where staff feel safe to register concerns, and where there is a universal commitment to safety and improvement. This is surely a challenge to change the culture across the whole public sector.
The FTSU recommendations were immediately accepted in principle and the full Government response was published on 16 July 2015 as part of ‘Learning not Blaming’. This included the commitment that an Independent National Officer for Whistleblowing, based in the Care Quality Commission, will be appointed by December 2015, and that all NHS organisations will be expected to appoint local Freedom to Speak Up Guardians. The full Government response is available here.
While patient safety has understandably been the focus of well-publicised whistleblowing incidents in the NHS, staff should equally feel empowered to report cases of suspected financial impropriety. To enable this, the Government created a dedicated anti-fraud unit in the Department of Health (DH AFU) in November 2014, which has already made a significant impact.
A key part of the unit’s work is raising awareness of types of fraud, encouraging staff to speak out when they suspect fraud or financial impropriety, and informing staff about how they can raise concerns. They can raise instances of potential fraud by contacting the DH AFU (tel. 0113 254 6053). Any information provided is completely secure and will only be supplied to the police or anti-fraud agencies.
It’s important that an open and honest culture in the NHS also includes improving how complaints from patients are handled. At the moment, most NHS organisations respond quickly and effectively to complaints, but others are not so reliable. Like any public service organisation, the NHS cannot be seen to close ranks against justified criticism from the people who use it. To do so would undermine gains made in more enlightened treatment of internal whistleblowers – these are two sides of the same coin.
Patients must feel they can complain about their care and be heard in a fair and open way, respectful of any emotional or physical pain they have suffered. The Government’s response to the public inquiry on the treatment of patients in Mid Staffordshire deliberately linked the handling of complaints to the importance of hearing the patient voice, so as to learn lessons and improve services.
As a result, the following changes have been implemented:
- expansion of the healthcare section of the Citizens Advice guide website, which now provides up-to-date information and guidance on how to navigate the health and social care complaints system
- the Royal College of Nursing has issued guidance on handling feedback from patients to help nurses and healthcare support workers understand how to deal with concerns, complaints and compliments
- Care Quality Commission inspections now include a look at how NHS providers handle and learn from complaints
I believe that the NHS’s experience of and approach to whistleblowing can provide valuable lessons to the wider public sector. Across public services, efforts are underway to bring whistleblowing in line with a user-focused culture of greater openness and transparency. This will help public services improve and bring an end to the perverse and indefensible situation where conscientious staff can be made to fear for their livelihoods when raising issues of concern.
I hope the NHS will be seen as leading the way in listening to and acting on the legitimate concerns of those closest to public services – the people who work within them and those who use them.
Comment by Daphne Havercroft posted on
Key things Dame Una overlooks:
1. Citizen whistleblowers who speak up for patient safety. What is the Department of Health doing to protect them from bullying and suppression? Would Dame Una like to meet some citizen whistleblowers to hear about the extent to which the the NHS persistently closes ranks against justified criticism from the people who use it? Probably not.
2. The Department's rejection of a whistleblowing recommendation from Bristol and its involvement in the failure to hold to account senior doctors who ignore whistleblowers:
See Appendix D
Someone in the Department's Professional Standards Unit recommended rejection of a Bristol inquiry's whistleblowing recommendations relating to raising concerns in another NHS Trust on the grounds that a merger was taking place. Nearly FIVE years later, that merger has still not been completed.
Specific failings/behaviour of the medical directors are mentioned and the question asked "Do you know whether local disciplinary or remedial action was taken as a result of this, for any of the individuals concerned. Or has the Trust/SHA raised it with the GMC or any other regulatory bodies?"
When asked under Freedom of Information Act what was the answer to that question, the Department of Health replied that it did not hold the information requested. Therefore it can be assumed that no local disciplinary or remedial action was taken against medical directors otherwise the Department would have held information about it.
Will the Department of Health ever stop being part of the problem and take the lead in being part of the solution or will it just carry on paying lip service to improvement?
Comment by David Drew posted on
In 2001 the Department of Health accepted Ian Kennedy's recommendation (Bristol Heart Scandal report) that it develop a safe NHS reporting culture. It failed to do that. A high % of NHS staff still fear being ignored or suffering retaliation if they report concerns about patient care. Fear that is well founded. In June 2014 I met Jeremy Hunt & Simon Stevens with 6 other NHS whistleblowers. We had all been dismissed after raising concerns about patient care. This meeting resulted in the Freedom to Speak Up Review led by Robert Francis. That review is a stark reminder that DoH failed to do as Kennedy recommended. That failure resulted in an unknown number of patient deaths and unnecessary suffering. If DoH had secured a safe reporting culture the Mid Staffs tragedy would not have happened & the Public Inquiry would have been avoided. If DoH had secured a safe reporting culture the NHS professionals who suffered the horrific victimisation described by Francis in his February 2015 report would have been spared their suffering. DoH plays lip service to their courage. In practice it never lifted a finger to help them. Una O'Brian is complacent in her comments. NHS whistle blowers are still being victimised for speaking out for their patients. There is not a scrap of evidence in this blog as to why anything should change. To the making of many policies there is no end and the art of ignoring them is never ending in the darker corners of the NHS. We need a Public Inquiry to analyse DoH failure, the responsibility for which is shared by professional and heath regulators, Royal Colleges etc. Without this patients & professionals will continue to suffer unnecessarily and victimising managers will continue to act contrary to the interests of both.
Comment by Mark Tattersall posted on
I agree 100% with Minh Alexander's comments, but he puts it more eloquently than I would!
Comment by Dr Minh Alexander posted on
I think Dame Una O'Brien must have sense of humour given that the Department of Health has spent over a year on a massive PR exercise that has left NHS whistleblowers in the same appalling position they were to start with.
The Freedom to Speak Up Review was constructed to obscure the root causes of dysfunctional NHS culture and to gloss over cover ups at the highest level.
Suppression by politicians and the most senior officials was not tackled, even though it is well known that "NHS cover ups go right to the top":
Robert Francis, the DH's chosen man said openly that he would only make recommendations that would be accepted by the government.
Extraordinarily, Francis did not even describe the gravity and scale of disclosures made to him, and thus failed to authoritatively demonstrate that his measures were proportionate.
There were about 600 whistleblowers submissions, and then there were whistleblowers who were too frightened to participate. The scale of serious patient harm disclosed to Francis will have exceeded that seen at Mid Staffordshire.
Accordingly, the superficial process has not resulted in any demonstrable, substantive learning. For good measure, the Freedom to Speak Up Review was also liberally peppered with Establishment-centric comments and analysis. It would not be too strong to say that it had a victim blaming undertone, whilst at the same time making unsupportable excuses for managers who had seriously victimised whistleblowers.
Francis' measures are not fit for purpose, but they suit a DH that has long avoided real transparency and which continues to exert an unhealthy grip.
Key technical details about why Francis' measures will fail, and are a smokescreen for DH, are explained here: http://bit.ly/1JLAuGK
In short, I congratulate Dame Una O'Brien on a job very well done, from Mr Jeremy Hunt's point of view.
We are currently seeing and will no doubt see more NHS scandals in the coming years, and this will not stop until the death grip of an unhealthy department and vested interests are finally addressed.
Dr Minh Alexander
NHS whistleblower and former consultant psychiatrist