Blowing the whistle on whistleblowing

The NHS is still treating whistleblowers badly. An independent review, ‘Freedom to speak up’, has found ongoing issues with healthcare workers’ willingness to disclose genuine concerns with patient care, and that the response taken when someone speaks up is inadequate in many cases and downright vengeful in some.

Report author Sir Robert Francis paints a grim picture, with some NHS staff who have blown the whistle suffering victimisation, loss of employment and personal and family breakdown.

Francis was the obvious choice to head up the review of whistleblowing. He is well versed in the chronic problems within the NHS from leading the public inquiry into the scandal at Stafford Hospital. His latest report on whistleblowing comes two years after the damning ‘Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry’, known as the ‘Francis report’, which was published in February 2013.

Yet on the same day his whistleblowing report was published (11 February 2015), England’s Department of Health released its own document, ‘Culture change in the NHS’, which offers a somewhat rosier impression of the lessons learnt from Mid Staffs. It seems the government would prefer us to focus on the positives while glaring negatives remain.

The ‘Francis report’ found numerous areas of concern at Mid Staffs in the mid-to-late 2000s: the pervading culture tolerated poor standards of care, patient complaints were ignored and staff felt powerless to do anything about it. Bullying was rife. The hospital leadership’s dogged pursuit of foundation trust status, and the fiscal autonomy and kudos this afforded, meant that financial targets were prioritised over the quality of patient care. Furthermore, systemic failures in the healthcare system in England were discovered, including in NHS inspection regimes.

Francis made clear that the lessons from Mid Staffs should be considered by all bodies, and everyone, within the health service. And a consequent report by Don Berwick recommended ways to improve the culture of openness and learning within the NHS. However, the new whistleblowing review casts doubt on how well organisations within the NHS have heeded this advice. It is as if the scandal at Mid Staffs was far removed when it is clear that standards can, and do, slip on home turf.

A range of measures have been introduced in recent years, including a new statutory duty of candour, which places an obligation on NHS service providers to inform patients and their families when something has gone wrong. The inspection regime of the Care Quality Commission, the NHS regulator, has also been reformed. The effect of these actions is beyond the scope of Francis’s latest report, and a further review will no doubt be required to evaluate their success down the line.

Protection

It is alarming to learn that the NHS is still handling disclosures poorly and that some staff brave enough to speak up are suffering devastating effects on their well-being and career prospects.

Although not all problems raised by NHS staff are mishandled, Francis heard convincing evidence of serious concerns being dismissed by managers, and the people who broached them facing disciplinary action.

Under UK law, a worker cannot be sacked for whistleblowing if it is in the public interest. Those who are victimised or lose their jobs can take a claim to an employment tribunal. By that point, however, much of the damage will already have been inflicted. More needs to be done to encourage resolution of issues through informal channels and to ensure systems are in place that support and protect staff who see the need to speak up.

Moreover, it is possible for NHS recruiters to avoid appointing those who are known to have left a previous job after raising concerns; the law currently offers no protection for whistleblowers against discrimination when seeking future employment. Legal protections need to be expanded accordingly, and Francis has made such a recommendation to the government.

Francis is partial to making recommendations — there were 290 in the final Mid Staffs report. This time he recommends the adoption of 20 principles, with a total of 38 supporting actions.

Among them is a call for NHS staff to receive better training on how to raise and deal with concerns, which is welcomed. The proposal that each NHS organisation appoints a ‘freedom to speak up guardian’ makes good sense, too; people need someone they can go to for help. The appointment of an independent officer working at a national level is also proposed, and this person must have the power to scrutinise the handling of any concern.

But recommendations amount to nothing without the full support of the government, regulators, NHS service commissioners, providers and staff. Some progress has been made, and the Secretary of State for Health, Jeremy Hunt, has pledged to legislate to protect whistleblowers who are applying for NHS jobs, which goes some way to relax the forced smile of the ‘Culture change in the NHS’ report.

‘Freedom to speak up’ is a report for the NHS in England, but its messages should resonate more widely. All healthcare systems must make it easy and safe for members of staff to come forward if they believe the well-being of patients is at risk. An approach that seeks to get to the root cause of an issue rather than attributing blame will be most effective. After all, highlighting areas for improvement should be considered a normal practice within healthcare. As Francis suggests, staff who feel they are listened to will ultimately be safer in practice.