HEALTHCARE DELIVERY
included, for the first time, questions about staff views relating to whistleblowing with a question that focuses on raising concerns about unsafe clinical practice. On the subject of raising concerns, the majority of NHS staff would know how to report any concerns they have about unsafe clinical practice (93%), 68% felt feel secure raising these concerns about unsafe clinical practice and 57% feel confident that their organisation would address their concern. Overall, 85% of staff felt encouraged by
their organisation to report errors, near misses and incidents with only 14% of all staff feeling that reporting of errors would lead to punishment or blaming of those involved. Sixty-two percent of staff felt that incident reporting was handled confidentially and 62% believed that action was taken to prevent similar errors occurring in the future. Although reporting rates were high, the percentage of staff that felt informed about errors, near misses or incidents was 45% (44% in 2013), and staff who felt that they were given feedback on changes made as a result of errors, near misses and incidents remains low, at 44%. Results for some key questions on job satisfaction were found to have declined, with only 56% of staff now recommending their organisation as a place to work (down from 58% in 2013), and only 41% feel that their organisation values their work. Less than one-third think there are enough staff for them to do their jobs properly. The NHS is not alone in facing the
challenge of encouraging an open and honest reporting culture. However, it is unique in a number of ways. It has a very high public and political profile. It is immensely complex. It is heavily regulated, and while the system consists of many theoretically autonomous decision-making units, the NHS as a whole can act as a monopoly when it comes to excluding staff from employment. The political significance of almost everything the system does can also further add to the pressure to emphasise the positive achievements of the service, often at the expense of admitting its problems. The Review concludes that the need to speak out is essential in any sector where safety is an issue. It says that, without a shared culture of openness and honesty the barriers to speaking up will persist and flourish. It is, therefore, vital that there is a more consistent approach across the NHS, and a coordinated drive to create the right culture. Confirming the need for change,
Jeremy Hunt commented that the findings of the Review confirm the need for further change. He said: “Sir Robert Francis heard horrific stories of people’s lives being destroyed because they tried to do the right thing for patients: people losing their jobs; being financially ruined; brought to the
APRIL 2015
Having a champion, or guardian who has lead responsibility for dealing with concerns raised, will be key to ensuring policies and practices are robust.
brink of suicide; and family lives being shattered. Eminent and respected clinicians had their reputations maligned. “There are stories of fear, bullying,
ostracisation, marginalisation as well as psychological and physical harm. There are reports of a culture of ‘delay, defend and deny’ with ‘prolonged rants’ directed at people branded ‘snitches, troublemakers and backstabbers,’ and then blacklisted from future employment in the NHS as the system closed ranks. “The only way we will build an NHS
with the highest standards is if doctors and nurses always feel listened to if they speak out about patient care. The message must go out that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.” Jeremy Hunt has accepted all of the
recommendations in the report, in principle, and will now consult on a package of measures to implement them. “I am hopeful that we can legislate in this Parliament to protect whistleblowers applying for NHS jobs from discrimination
by prospective employers. We will also be consulting on establishing a new independent National Whistleblowing Guardian within the CQC, as well as asking every NHS organisation to identify one member of staff to whom others can speak if they have concerns that they are not being listened to.”
Coinciding with the publication of
the Freedom to speak up review, The Department of Health has also recently published a document that looks at how it has been applying the lessons learned from the Francis Inquiries. ‘Culture change in the NHS’1
also references the
need for changes in the reporting culture. It states that ‘when NHS staff speak up, it is critical that the system listens with humility and responds with conviction.’ It also talks of a ‘new willingness at
the centre of the health and care system to hear the reality of failings, the voice of a substantial group of NHS people who have spoken up and suffered as a result has become all the more insistent.’ Since 2010, the Government has put in place a range of measures to strengthen the voice of people who speak up for patients, and the report acknowledges that the NHS has yet to turn the cultural corner and face up consistently and with humility to the hard truths spoken by its staff. ✚
Reference 1 Department of Health, Culture change in the NHS Applying the lessons of the Francis Inquiries (2015)
https://www.gov.uk/ government/uploads/system/uploads/ attachment_data/file/403010/culture- change-nhs.pdf (accessed 10.03.2105)
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