Give him credit, Sir Robert Francis is trying to change a long-established culture of fear and disengagement. It will however take a lot more than he plans, and one suggestion from NHSreality is for routine exit interviews. In any large organisation these are done and felt to be useful especially at higher levels. In the NHS it would not be appropriate for the interviews to be done in-house and behind closed doors (unless the leaver wishes), and there should be the option to go public. Interviews should be conducted by the CQC (Care Quality Commission) and a depersonalised report published for each trust annually…. until the culture changes.
NHS whistleblowers could have their claims judged by independent regulators and be shepherded into new jobs under plans to end a “climate of fear” in the health service.
Sir Robert Francis, QC, is pledging to prise open an NHS “closed ranks culture” that harms patient care as he launches a review into staff victimised for speaking out. Today he urges doctors and nurses to tell him what is going wrong. Campaigners welcomed the pledge, saying it was vital to stop whistleblowers from being blacklisted and demanding the government takes responsibility for protecting them.
Writing on thetimes.co.uk today, Sir Robert says: “There are far too many reports of professionals reporting they have been victimised or forced from their jobs because they spoke out… The fear generated by all this is very real. Fear feeds on fear, which inevitably deters others from coming forward.”
Sir Robert chaired a public inquiry into the Mid Staffordshire scandal, where he concluded that appalling suffering had been inflicted on hundreds of patients by bullying managers who ignored the concerns of workers. He writes today that he was “struck by the fear some staff had to voice their concerns”, citing a consultant who insisted on meeting secretly at his home and a nurse whispering in terror at making an “innocuous suggestion” for change.
His review will scrutinise prominent whistleblowing cases from the past as well as exploring the experience of staff still working in the NHS in an attempt to make sure that doctors and nurses feel free to raise concerns, that they are listened to and that they are not victimised as a result.
“We need to do more to ensure that staff who are worried that something is going wrong feel totally free to talk about it,” Sir Robert writes, outlining a series of solutions he is considering.
These include making it easier for staff to raise concerns with someone independent and “arms-length scrutiny where conflict arises when someone speaks up” so that bosses are not marking their own homework.
Acknowledging that many whistleblowers struggle to find work again, he says there must be “better means of retaining the services of those who have unfairly lost their jobs for doing the right thing”, including mechanisms for staff who win tribunals to get back in to the NHS.
Cathy James, chief executive of the charity Public Concern at Work, said: “Getting jobs in the NHS is a key problem. Although there are lots of different employers, once someone is labelled a whistleblower that’s akin to a troublemaker and they can be blacklisted.”
However, Mark Porter, chairman of the British Medical Association Council, said: “Putting protections in place for staff who raise concerns is a vital part of the solution but it does not fix the underlying issue. It is in the interests of both staff and their patients to look much more closely at the culture across the NHS, which has left staff unwilling to provide feedback or raise concerns for fear of reprisals.”
Kim Holt, of the whistleblowers’ group Patients First, agreed that the “bullying culture” needed to be tackled at root, insisting that “things go wrong when concerns aren’t addressed early enough”.
Jeremy Hunt, the health secretary, said: “We still hear of staff concerns being ignored. That’s why I have asked Sir Robert to undertake this review, which will look at what more we can do to create an open culture where NHS workers are protected and encouraged to speak out in the best interests of patients.”