HEALTHCARE DELIVERY


The next step towards an open reporting culture


The Clinical Services Journal reports on the findings of the recently published Freedom to Speak up review, which investigate the issues surrounding whistleblowing and the changes needed to create a more honest reporting culture in the NHS.


An independent review into the reporting culture in the NHS was requested by Jeremy Hunt, The Secretary of State for Health, in June 2014 to give recommendations that would help ensure NHS staff feel it is safe to raise patient safety concerns. The Freedom to speak up review was led by Sir Robert Francis. It sought a wide range of views from across the NHS, including first hand experiences from staff who had raised a concern and reported that they had suffered some form of detriment as a result of doing so; employers, professional and system regulators; and other professional bodies. The recently published Review concludes that there remains a culture, within many parts of the NHS, that deters staff from raising serious and sensitive concerns and which can have negative consequences for those that do raise concerns. Although many cases are handled well, too many are not, says the Review. This has a disproportionate impact on others who are deterred from speaking up by the fear of adverse consequences or the belief that nothing will be done. It puts patients at risk. It is important that all who raise concerns, and all who respond to them, behave with


empathy and understanding of others, focusing together on patient safety and the public interest.


The Review includes a list of 20


‘Principles and actions’, which it says should be implemented by all organisations that provide NHS healthcare and regulators. The Review also recommends that progress made in the implementation of these principles and actions and the performance of the NHS in handling concerns and the treatment of those who raise them should be reviewed, at least annually, by The Secretary of State for Health. The principles and actions are broken down within the Review into sections covering different areas, listing its findings and suggested actions.


Culture change One area relates to culture change and states that every organisation involved in providing NHS healthcare should actively foster a culture of safety and learning in which all staff feel safe to raise concerns. This, it says, should become part of the normal routine. The Review also acknowledges that freedom to speak up about concerns relies on staff being able to work in a culture that is free from bullying or oppressive behaviour. Bullying of staff should consistently be considered,


I am hopeful that we can legislate in this Parliament to protect whistleblowers applying for NHS jobs from discrimination by prospective employers.


APRIL 2015


and be shown to be, unacceptable. All NHS organisations should be proactive in detecting and changing behaviours which amount, collectively or individually, to bullying or any form of deterrence against reporting incidents and raising concerns. Having a champion, or guardian who


has lead responsibility for dealing with concerns raised, will be key to ensuring policies and practices are robust and staff are appropriately supported, listened to, and issues are resolved quickly and professionally.


The Review also recommends that


organisational boards and senior teams adopt and promote a zero tolerance approach to bullying, and for regulators to consider this as a factor when assessing whether an organisation is well led.


Better handling of cases The Review provided evidence to show that whistleblowing cases have a better outcome if concerns are handled effectively early on. Action needs to be taken to encourage


staff to raise concerns informally and work together with colleagues to find solutions. All NHS organisations need to devise a clear process for recording formal reports of incidents and concerns, and for sharing that record with the person who reported the matter, in line with the good practice


THE CLINICAL SERVICES JOURNAL 49


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