The 2013 Francis Report on the care failings at Mid Staffordshire Hospital NHS Trust made difficult reading; as a nurse, I felt tarnished and ashamed.
Although individual nurses, as well as other clinicians, and senior management were held to account, searching questions were asked about the culture of the hospital.
Most who had spoken up had their concerns ignored and some were disciplined by management. The Nursing and Midwife council (NMC), Royal College of Nursing (RCN) and the General Medical Council (GMC) had patient safety concerns reported to them. How could such concerns go unheeded in a large public organisation when care practices were open and visible? The word whistleblowing became common parlance.
Now, Sir Robert Francis has just completed Freedom to Speak Up, an investigation into whistleblowing, as a consequence of his Mid Staff findings that indicated a need for an honest and open reporting culture. And this too, makes for uncomfortable reading.
Nearly 20,000 staff contributed with more than 600 whistleblowers providing evidence of their experiences – with the vast majority reporting it profoundly and negatively affected their professional and personal lives.
Francis voices his admiration of their bravery in taking action and reliving it again for his investigation, indicating the public owe them a debt of gratitude. Seventeen percent of trust staff said they had been victimised for speaking up, 19% had been ignored by management.
The report highlights four groups of staff who are more vulnerable when raising concerns and they all include nurses, students, agency staff, GP staff and those from black and ethnic minority backgrounds.
The use of agency nurses has increased by 150% since June 2014 when ward nursing ratios had to be reported, and their presence brings fresh eyes and the benefit of experience in a range of different environments.
However, they are not always aware of the reporting protocols and are fearful they may not be employed again, reported to their agency or given a bad reference.
Staff employed by GPs are particularly vulnerable as they are often employed by the person against who the concern is raised.
Healthcare students are vital in spreading good practice because they frequently move into different services and teams. But student nurses are reluctant to raise concerns as they are dependent on sign off/passing each of their placements. They reported being sent to known problematic placements, and petty victimisation after raising a concern.
Francis’s message is clear: the NHS has a moral obligation to support and encourage staff to speak out. The culture and threshold for raising concerns must change.
Freedom to Speak Up wants to make the need to whistleblow a thing of the past. So look out for:
- Mandatory training, in raising concerns for all healthcare staff and students available from the autumn.
- A Freedom to Speak guardian employed in every trust to independently advise and support staff.
- Responsibility for the policy and practice of raising concerns should not be in HR departments bit sit with the executive board.
- Whistleblowers should be kept informed of the investigation into their concern and staff should not have prolonged suspensions while it is being investigated.
- A support scheme for whistleblowers to return to work.
- Legislation to protect whistleblowers from discrimination when seeking future employment.
- An independent national officer to monitor whistleblowing cases and ensure staff are not treated adversely when they speak up.
Raising a concern should become a healthy, expected norm, not an act of bravery.
Francis R,  Freedom to Speak Up. DH London
BA(Hons) PGCE RN RM RHV FWT NP
Nurse Adviser and Independent Trainer
As well as working on the Nursing in Practice advisory board, Marilyn is also Lead Nurse for a teaching PCT, supporting nurse-led services and the development of practice nurses and healthcare assistants. She enjoys being a respiratory trainer and a nurse opinion leader and is passionate about expanding and blurring nursing boundaries in primary care.
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