Trusts should employ whistleblower ‘guardians’, Francis says

The “freedom to speak up guardians” should give independent support and advice to staff who want to raise concerns and should hold the trust board to account if it fails to focus on a patient safety issue, he said.

They should be appointed by the chief executive of the organisation and could be a non-executive director of the trust or a newly appointed employee.

It was also recommended that organisations should provide training to all staff in how to handle whistleblowers’ concerns and on the trust’s whistleblowing policy. The training should be devised by NHS England and Health Education England.

Speaking at the launch of the report this morning, Sir Robert said: “Too often, honestly expressed anxieties are met with hostility and a breakdown in working relationships. Worse still, some people suffer life changing events; they lose their jobs, their careers, even their health… Sometimes no one looks properly at what worried [the whistleblowers] in the first place then patients are left at risk as poor practice goes uncorrected and lessons are not learnt.”

Sir Robert said that “there has been much progress” made since the 2013 Mid Staffordshire inquiry. But he added that “to bring about an open, honest and transparent culture” in the NHS “more needs to be done to ensure that the NHS truly values the knowledge, commitment and energy possessed by staff so that so that no one needs to be afraid of raising honestly held concerns and when they do concerns are investigated properly and appropriate action is taken”.

The report says trust chief executives should “personally review” all settlement agreements made with employees that contain confidentiality clauses to “satisfy themselves” that these are “genuinely in the public interest”.

It also said that confidentiality clause agreements are “often made at times of particular stress and anxiety” for the member of staff involved. Sir Robert described the “chilling effect” such clauses can have on those raising concerns.

These settlements should also be shown to the Care Quality Commission and should help inform inspectors’ decisions on whether an organisation is well led, he said.

The review recommends that all NHS organisations will have to include “quantitative and qualitative data” in their quality accounts that describe every formal reported concern as well as incident reports, the action taken and feedback on the outcome.

Trusts should report any formal reported concern to their commissioners, regulator and the National Learning and Reporting System or to a new independent national officer to review the handling of NHS whistleblowers. The report says the INO role should be created to provide national oversight of how NHS organisations are dealing with workers who raise concerns.

The system and the INO should publish regular reports on the performance of organisations in raising and acting on public interest concerns, it says.

Trusts should have a “clear process” for recording formal incidents or concerns and for sharing that record with the person who reported the concern.

The report also states that organisations should be rewarded for encouraging an “open and just culture”, which could “possibly” come in the form of “some financial incentive”.

When a formal concern has been raised trusts should instigate “swift” and “blame free” investigations to establish the facts. They should devise a system which allows these investigations to take place. This could be an external investigation “where appropriate”.