HEALTHCARE DELIVERY
highlighted in the Review. This is considered critical in helping to build staff confidence in local systems and in encouraging others to speak up. The Review also recommends that chief executives, or other designated officer in organisations, should be involved and have responsibility for regularly reviewing all concerns that have been formally recorded, to ensure local procedures are effective, and to identify areas for improvement.
Measures to support good practice The Review suggests that all members of staff should receive training in their organisation’s approach to raising concerns and in receiving and acting on them. This training should comply with national standards, based on a curriculum devised jointly by Health Education England and NHS England. All NHS organisations need to ensure
that there are suitable people available to whom concerns can be reported easily and without formality. They should also provide staff who raise concerns with ready access to mentoring, advocacy, advice and counselling. There is also a need for greater transparency in the way organisations exercise their responsibilities in relation to the raising of concerns, including the use of settlement agreements. The Review also highlighted the
importance of offering support to find alternative employment in the NHS for any workers who raise a concern which might result in them not being able to continue in their current employment. It should be the responsibility of NHS
England, the NHS Trust Development Authority and Monitor to jointly devise and establish a support scheme for NHS workers and former NHS workers whose performance is sound who can demonstrate that they are having difficulty finding employment in the NHS as a result of having made protected disclosures. In addition, all NHS organisations should actively support a scheme to help current and former NHS workers whose performance is sound to find alternative employment in the NHS.
Measures for vulnerable groups The Review found that certain groups of staff are particularly vulnerable when raising concerns because of the nature of their terms of employment. It is essential that employers consider how they engage, communicate and support all workers in their organisation on issues relating to raising concerns. This should include students, volunteers, temporary, and permanent staff. The review advises that professional
regulators and Royal Colleges, in conjunction with Health Education England, should ensure that all students and trainees have access to policies, procedure and support compatible with the principles and good practice highlighted in the Review and that all training for those working towards a career in healthcare should include training on raising and handling concerns
Extending legal protection The review found that legal protection for NHS whistleblowers is not considered to be adequate and that this needs be reviewed. It recommends that the Government review the protection afforded to those who make protected disclosures, with a view to including discrimination in recruitment by employers on grounds of having made that disclosure as a breach of either the Employment Rights Act 1996 or the Equality Act 2010. It was also advised that the list of
persons prescribed under the Employment Rights Act 1996 should be extended to include all relevant national oversight, commissioning, scrutiny and training bodies including NHS Protect, NHS England, NHS Clinical Commissioning Groups, Public Health England,
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.
50 THE CLINICAL SERVICES JOURNAL
The NHS has yet to turn the cultural corner and face up consistently and with humility to the hard truths spoken by its staff.
Healthwatch England, local Healthwatch, Health Education England, Local Education and Training Boards and the Parliamentary and Health Services Ombudsman.
Great courage “It takes great courage for health professionals to raise concerns about care and so they must be reassured that when they do come forward that they will not suffer as a result,” said David Behan, chief executive of the Care Quality Commission. “No one should be punished for acting in the public’s best interest. As the Freedom to speak up review highlights, while there are some services that are reporting and acting on concerns as a matter of routine, we know that this is not happening all of the time. This means that vital information about patient safety is going unreported and risks can remain. Every organisation needs to create and nurture an open and transparent culture of safety and learning. “From our inspections, we know that
progress has been made in building this. Every planned inspection investigates how well services handle complaints and concerns as it can be an indicator of the quality of the service’s leadership and a reflection of how safe and responsive its culture is. “We have found care services that
support staff in raising their concerns, confident in the knowledge that they will be listened to and that action will be taken. It is important that services can learn from those that do this well, so that this can become a reality across the care system.” The CQC feels strongly, in particular, that the local ‘freedom to speak up guardians’ recommended by the Review could make a big difference to staff being able to raise concerns, as could an Independent National Guardian within the CQC, who could support this network of individuals and encourage best practice on handling whistleblowing disclosures. The Picker Institute Europe also welcomed publication of the Review. A spokesperson said: “NHS staff are the backbone of the service, and their experiences are known to be related to the quality of patient care.” The National Staff Survey 2014 survey
APRIL 2015
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