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Sir Robert Francis QC, Chair of the Freedom to Speak Up Review, recommends a package of measures to ensure in future NHS staff are free to speak up about patient safety concerns.

His report to Secretary of State for Health, Jeremy Hunt, identifies an ongoing problem in the NHS, where staff are deterred from speaking up when they have concerns and can face shocking consequences when they do.

Over 600 people shared their experiences with the review and over 19,000 staff responded to an independent online survey.

Sir Robert found NHS staff want to speak up and heard lots of examples of organisations supporting them to do so. But he heard that many staff are put off speaking up because they fear victimisation. Others don't speak up because they feel their concerns won’t be listened to. The review heard stories of staff that have faced isolation, bullying and counter-allegations when they’ve raised concerns. In some extreme cases when staff have been brave enough to speak up, their lives have been ruined.

Managers told the review that they can find it difficult to identify the people with genuine concerns from those who want to deflect from their own poor performance.

Sir Robert’s proposals include:

• action at every level of the NHS to make raising concerns part of every member of staff’s normal working life
• a Freedom to Speak Up Guardian in every NHS trust – a named person in every hospital to give independent support and advice to staff who want to speak up and hold the board to account it fails to focus on the patient safety issue.
• a National Independent Officer who can support local Guardians, to intervene when cases are going wrong and identify any failing to address dangers to patient safety, the integrity of the NHS or injustice to staff
• a new support scheme to help good NHS staff who have found themselves out of a job as a result of raising concerns get back into work. 

Sir Robert said

“Failure to speak up can cost lives. I began this review with an open mind about whether there are things getting in the way of NHS staff speaking up. However the evidence received by the Review has confirmed that there is a serious issue within the NHS. This issue is not just about whistleblowing – it is fundamentally a patient safety issue.

The NHS is blessed with staff who want to do the best for their patients. They want to be able to raise their concerns, free of fear that they may be badly treated when they do so, and confident that effective action will be taken. Unfortunately I heard shocking accounts from distressed NHS staff who did not have this experience when they spoke up.

Everyone in the NHS needs to support staff so they have the courage to do the right thing when they have concerns about patient safety. We need to get away from a culture of blame, and the fear that it generates, to one which celebrates openness and commitment to safety and improvement. If these things are achieved, the NHS will be a better place to work. Above all, it will be a safer place for patients.”

Sir Robert also proposes an overhaul of NHS policies so that they don’t stand in the way of people raising concerns with those who can take action about them and training for all NHS staff so they know how to raise their concerns and how to handle and act on them.

In his report Sir Robert sets out 20 Principles and Actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future. These are designed to:

• promote a culture in the NHS where staff feel safe and encouraged to speak up
• make sure all concerns are heard, investigated properly and the right support is on hand for staff
• protect vulnerable groups, such as student nurses and medical trainees, from intimidation
• prevent discrimination against people who have been brave enough to speak up and help them get back into work.  

NOTES TO EDITORS

The Report is published in full www.freedomtospeakup.org.uk

For media queries call Amy Key on 07824529689 or Eleanor Riches on 07585402878 or contact media@freedomtospeakup.org.uk

For tweets throughout the day follow @speakupreview Review hashtag #NHSspeakup

Background

The Freedom to Speak Up Review was announced by Health Secretary Jeremy Hunt in June 2014. Sir Robert Francis QC was asked to Chair the review and launched it with a call for contributions in August 2014.

The Review was asked for advice and recommendations to ensure that NHS staff feel it is safe to raise concerns, confident that they will be listened to and the concerns will be acted on.

Three advisors were appointed to assist the Review: Professor Sir Norman Williams, Professor Katherine Fenton OBE and Dr Peter Homa CBE.

Advice was also sought from Helené Donnelly OBE, a nurse who raised concerns at Mid Staffordshire NHS Foundation Trust and is now Ambassador for Cultural Change at Staffordshire and Stoke on Trent Partnership NHS Trust.

The review invited NHS staff, employers and others to share personal experiences and views via its website.

It received contributions from NHS staff, employers and a wide range of organisations such as professional bodies, lobby groups and regulators.

Inputs to the Review

• Evidence gathered by the Review included:
• 612 written contributions from NHS staff who wanted to share their experiences
• 43 organisations submitted their views to the review in writing
• 19,764 NHS staff responded to an online survey
• a small number of qualitative interviews with NHS staff and employers
• four seminars with selected contributors to the Review to consider different stages in the process of raising concerns and potential solutions
• meetings and workshops with a range of organisations and staff groups.

Overall Sir Robert met over 300 people during the course of the Review. 

Freedom to Speak Up Guardians

This proposal is modelled on the role performed by nurse Helené Donnelly OBE at Staffordshire and Stoke on Trent NHS Partnership Trust. Helene is an Ambassador for Cultural Change. Her post was established in response to the very low usage by staff of an external advice line for those considering raising concerns. The trust knew it had to do something to encourage people to speak up.

The purpose of her role is to support and help drive a programme of change in the trust so that it becomes an open and supportive place to work. She works independently and reports directly to the CEO on a very broad range of matters that staff bring to her attention, such as safety, quality, welfare and process. Importantly, if she doesn’t think that the trust is living up to its values, she is able to hold them to account.

Helené supports staff in raising concerns, offers reassurance to those reluctant to speak up, helps develop training and works across the organisation to make the trust a safer place for patients and a more open place to work. Since taking up the post, the number of incidents reported and concerns that have been raised has increased dramatically.

Helené was one of those brave enough to raise the alarm at Mid Staffordshire NHS Foundation Trust, and who gave evidence to Sir Robert’s public inquiries into the events there. 

Report