There is a sense of déjà vu about the findings of Sir Robert Francis’s review into whistleblowing in the NHS. It is only six years since the Commons Health Select Committee, in an inquiry into patient safety, condemned the lack of support for staff who wished to raise concerns, and noted that the protections supposedly afforded by the Public Interest Disclosure Act were inadequate. The fact that little appears to have changed in the interim should be a matter for serious concern.
A proposal by Jeremy Hunt, the Health Secretary, to introduce “Freedom to Speak Up Guardians” is welcome, but as all parties acknowledge, transforming a culture of defensiveness among NHS managers and other senior staff is not straightforward. Indeed, the ever-growing importance attached to league tables and increased levels of competition between hospitals have encouraged the notion among managers that public reputation is defined by top-line results. That is not easily compatible with the creation of an environment in which criticism from staff is welcomed with open arms.
This is not to say that markers of performance should not be made public. Rather, the development and implementation of an effective whistleblowing policy should itself be given prominence among those indicators. Hospitals’ treatment of their staff is arguably as important as the treatment of their patients.
A large majority of patients experience high-quality care from the NHS. The results of Sir Robert’s Speak Up Review should not lead us to a contrary conclusion. The fact that staff occasionally wish to flag up concerns points as much to their desire for excellence as to any gross failures in treatment. Indeed, it is on the high expectations of staff that NHS quality should be built. That is only possible in a climate of transparency, in which concerns can be raised without fear and be dealt with fairly.Reuse content