The role of probing claims made by NHS whistleblowers could be taken out of the hands of hospital trusts, the head of a major government inquiry has indicated in an exclusive interview with HSJ.

Speaking ahead of the review’s official launch today, Sir Robert Francis QC said he aimed to extinguish a “climate of fear” in the NHS that had “victimised” whistleblowers, deterring others from raising concerns.

“If people aren’t coming forward with what is worrying them then nothing can be done about that,” he said. “It’s not a safe system. We need to learn how to do it better.”

In an early sign of the direction the inquiry could take, Sir Robert said whistleblower concerns should be subjected to outside scrutiny.

“In the same way I have suggested complaints from patients will often need a degree of external investigation and independent scrutiny [that] they haven’t had before, I don’t see why the same can’t be suggested for staff raising concerns,” he said.

While Sir Robert said such a step did “not necessarily” involve the creation of a new organisation, the inquiry would consider remedies for victimised whistleblowers which went “over and above what the law in theory offers”.

Robert Francis

All whistleblower cases should be properly investigated, Sir Robert Franics said

Sir Robert, who chaired the public inquiry into care failures at Mid Staffordshire Foundation Trust, said the review would examine whether hospital managers should be held more accountable for their involvement in cover ups.

“There should be consequences for that,” he added. “We should no longer tolerate people being in effect exiled from the health service because they have raised concerns,” he said.

Sir Robert told HSJ that questions should be raised about the quality of leadership at trusts which allow whistleblower concerns to become “swallowed up” by divisive disputes and protracted employment tribunals.

“The polarisation seems to get to the stage where no one will get out of the hole they have dug for themselves, and the question has to be asked if that organisation is being well led,” he said.

While accepting that some employers had to deal with vexatious whistleblowers, he said all cases should be properly investigated. “It is in the interests of the employer that they look into concerns properly and transparently and completely separately from issues they may have with any individual employee. At the moment I don’t think that happens as often as it should.”

While the introduction of a new duty of candour and fundamental standards of care would make it easier for staff to speak out, Sir Robert said a “significant number” of NHS staff still felt penalised for raising concerns. He said: “People say they have raised honestly held concerns and as a result have been victimised, sometimes to the point of being forced to leave the service or being dismissed.

The Freedom to Speak Up review

Sir Robert Francis has appointed a series of advisers to support his work: Norman Williams, former president of the Royal College of Surgeons; Peter Homa, chief executive of Nottingham University Hospitals Trust and Katherine Fenton, chief nurse at University College London Hospitals Foundation Trust.

The review will host a series of seminars in the autumn to explore key issues and solutions.

Two separate pieces of research into whistleblowing in the NHS and the views of NHS staff will be conducted at Middlesex and Greenwich universities.

The review secretariat will be led by Joanna Donaldson, the HR director of the Department for Business Innovation and Skills.

Take part in the review or email the secretariat

“For every one of those stories any number of people are deterred from coming forward to raise what they are worried about. By the time someone is labelled a whistleblower it is already telling you something has seriously gone wrong.”

According to the NHS staff survey this year, 90 per cent of respondents know how to raise concerns in public but only 44 per cent believe anything will be done. Almost 30 per cent said they would not feel safe at work if they did speak out.

The review, which launched today, has appealed for evidence from whistleblowers, managers and organisations across the NHS.

Sir Robert will also meet personally with selected whistleblowers, but will not make judgments on individual cases. He said all information would be treated in the “strictest confidence”. “We have gone to great pains to set up our website and emails so they are completely controlled by us and independent of any government organisations,” Sir Robert said.

The review’s final report will be published in November, a timeline Sir Robert admitted would be “tough” but necessary for it to be useful before the general election in May 2015.