The Times 7 August 2014
I want to hear suggestions about how best we can encourage people to speak out
Many patients and those close to them came to the Mid Staffordshire inquiries to tell me about awful care and indignity at the hands of a service that was meant to be effective, safe and compassionate. Their stories had an incredibly powerful impact – not just on me but on everyone who read the reports.
Sadly, I was struck by the fear some staff had in coming forward to voice their concerns. One nurse I met in a corridor whispered “I cannot believe I am saying this” before outlining an innocuous suggestion for change. A senior consultant was so afraid that he insisted on meeting me secretly at his home. A brave nurse, Helene Donnelly, felt so unsafe after reporting unacceptable practice that she left to work elsewhere. I was approached by a trainee from a different part of the NHS who had been report made by a chief executive – for sharing her concern with the person chairing the trust when asked if she was worried about anything.
There are far too many reports of professionals reporting that they have been victimised or forced from their jobs because they spoke out. Only last week the public accounts committee report on whistleblowing concluded that “too often whistleblowers have been shockingly treated”. The fear generated by all this is very real. Fear feeds on fear, which inevitably deters others from coming forward.
Many recent initiatives should help replace this climate of fear with openness, transparency and a commitment to patients. Last month the Care Quality Commission launched consultations on the new regulations for fundamental standards, the duty of candour and the fit and proper person test for directors.
Taken together these measures should form the foundation that enables people to speak up, for concerns to be addressed, and for accountability where that is needed.
But we need to do more to ensure that staff who are worried that something is going wrong feel totally free to talk about it. I am open to any constructive suggestion about what can be done, but the areas I am interested in include:
• Making it easier for worried staff to raise important concerns with someone independent from their manager, or even their employer;
• Better recording of concerns raised and the action taken on them;
• Arms-length scrutiny where conflict arises when someone speaks up;
• Better procedures to ensure that honestly speaking up about important issues does not adversely affect careers without impeding the fair management of proper concerns about staff;
• Mediation or other assistance by third parties to help resolve disputes;
• Better means of retaining the services of those who have unfairly lost their jobs for doing the right thing.
That is why I welcomed the chance to undertake the Freedom to Speak Up review. We have to learn from all experiences, good and bad, of those who have raised serious concerns and identify confidence-building measures.
I want to hear ideas from all NHS workers, employers and representative organisations. Details of how individual submissions can be made are on our website (www.freedomtospeakup.org.uk, currently in development). I have commissioned research into the how well the current system for reporting concerns works, and I will hold a series of seminars so I can hear about possible solutions to the problems we face.
We must value those who are bold enough to speak out as celebrated champions of patients and the public interest, and ensure that those who do not feel confident become so. All staff should see it as both a right and a duty. If we can achieve this the prize is a safer NHS
Sir Robert Francis, QC, led the report into Mid Staffordshire