Sir Robert Francis has published his review of how whistleblowers are treated in the NHS. The health department has also published a its response, and a comprehensive update on other policy made in response to the Mid Staffs failures. HSJ will have full news, analysis and response.

Live logo

5.30pm: We wrap up today with this list of our nine stories on Sir Robert’s whistleblowing review:

5.28pm: New legal powers and regulations brought in over the last 18 months will provide ‘the stick’ to force the NHS to change the way it treats whistleblowers, Sir Robert Francis QC has told HSJ.


He also rejected suggestions his review of how the service deals with whistleblowers, published today, lacked the power to force change in the NHS. He argued it needed to be viewed in light of legal changes already made following his 2013 report into Mid Staffordshire Foundation Trust.

4.52pm: The chief executive of Monitor has highlighted the importance of Sir Robert’s whistleblowing review to NHS managers.

In a letter released this afternoon, David Bennett urges managers to ensure “all of your staff are made fully aware of the expectation that they will come forward, speak up and raise any concerns, and that they know how to do this outside their line manager relationship if necessary.”

“If at all possible I would encourage you to speak to each of them face-to-face,” he added.

4.46pm: The NHS Confederation has responded to Culture change in the NHS: Applying the lessons of the Francis Inquiry, a progress report published today by the Department of Health.

Chief executive Rob Webster agreed there was “much more to be done”.

“Greater transparency is essential to improving care for patients.

“The information we provide to patients needs to be meaningful and help them make decisions about their care.

“We need to ensure that measures to improve transparency provides a fair representation of the quality of care provided by our members and a proportionate response based on improvement and excellence.”

4.10pm: Earlier today health secretary Jeremy Hunt outlined the government’s response to Sir Robert Francis QC’s review into the treatment of whistleblowers.

Part of the response involved a call for hospitals found to have withheld important information from patients to be subject to financial sanctions from the NHS Litigation Authority.

The government began formal consultation on its plans today.

The Department of Health proposes four main options around how financial penalties could be levied.

Here they are:

  1. The NHSLA could charge trusts a fixed amount -up to £10,000 for example - when organisations cannot confirm they meet the statutory duty of candour to patients. Where no damages are payable in relation to a claim- such as, when organisations have not been negligent or candid - there would be no financial penalty.
  2. The NHSLA would charge a fixed amount for each breach of the duty of candour irrespective of the level of damages payable. This amount could be charged regardless of whether a claim was successful. So, for example, the NHSLA could charge £10,000 for every claim where the organisation was not able to confirm that it had complied with the statutory breach of candour.
  3. The NHSLA could charge an increasing amount based on the number of breaches of the statutory duty of candour by an organisation. This could be done on a sliding scale. For example, one breach in a financial year could result in a penalty of £10,000, the second breach a further £15,000, the third breach £20,000, and the fourth breach £25,000 and so on.
  4. Rather than charging organisations for each specific breach of the statutory duty of candour, the NHSLA could assess the number of past breaches of the statutory duty of candour for each member in each financial year and adjust the future contribution payable by that member for their indemnity cover to reflect the number of breaches.

4.02pm: The Care Quality Commission has championed Sir Robert’s recommendation to create “freedom to speak up guardians” and an “Independent National Guardian” to improve whistleblowing practices.

CQC chief executive David Behan said he looked forward “to contributing to the Department of Health’s consultation on this”.

“We strongly welcome the publication of the Freedom to Speak Up Review and the advice on how organisations and individuals can work together to create a more open and honest reporting culture across the NHS.

“We are pleased that the Secretary of State has accepted these recommendations in principle and will consult on how they could be implemented.”

3.45pm: HSJ reporter Will Hazell has been tweeting about the new Department of Health report, Culture change in the NHS: Applying the lessons of the Francis Inquiry.

Just over one year on from the report’s release, the health secretary says there is “much to celebrate- but also no reason for complacency”.

The report can be downloaded here and below are the Mr Hazell’s observations so far.

 

3.09pm: Nurses have welcomed Sir Robert’s whistleblowing report as a “timely and realistic”.

Royal College of Nursing chief executive, Dr Peter Carter, said there had been “too much inconsistency and unfairness in the treatment of staff who have raised concerns”.

“This comprehensive package of measures will go a long way towards redressing these issues.

“The vulnerable groups identified, like our student nurses who contributed to this review and who talked candidly and openly to Sir Robert about their experiences of raising concerns in the current culture, will be reassured that he has responded to their issues and taken them into account.”

3.01pm: The government will aim to get increased safeguards for NHS whistleblowers on to the statute books before the general election, Jeremy Hunt has said.

The health secretary said the government will consult on legislation to protect whistleblowers against discrimination from potential employer, our report reveals.

It also wants Monitor, NHS England and the NHS Trust Development Authority to provide “practical help” to whistleblowers seeking new employment.


Outlining the government’s response to Sir Robert Francis QC’s review into the treatment of whistleblowers, Mr Hunt said that the government accepts “in principle” all of the recommendations of the report.

2.41pm: Some 600 people told Sir Robert’s whistleblowing review team about they way they had been treated.

It heard some  ‘harrowing’ evidence, as our story shows.

“There were descriptions of what can only be described as a harrowing and isolating process with reprisals including counter allegations, disciplinary [action] and victimisation,” the report states.

One witness said their experience had been “horrific, protracted and detrimental to my family life, health and professional standing”.

 

 

2.24pm: Politicians’ use of Sir Robert’s whistleblowing report to score political points is causing some consternation on twitter. This salvo by Tory twitter account @Toryhealth:

Provoked the following response from HSJ editor Alastair McLellan:

And the behaviour of Labour politicians was no better, according to Mr McLellan.

2.11pm: Health secretary Jeremy Hunt has been tweeting his personal response to Sir Robert’s whistleblowing review:

 

2.04pm: NHS unions have welcomed the “damning” findings of Sir Robert’s whistleblowing report.

Its head of heath Christina McAnea said whistleblowing policies could only be effective “if concerns are taken seriously and investigated”.

“It is wrong that health workers are being persecuted, ostracised and left to suffer in silence after they’ve spoken out.

“Changing the culture and moving towards a no-blame environment cannot be achieved by ticking a box.

“Whistleblowers need help and support but the fact we still need them also means there remain fundamental issues to resolve within the NHS.”

1.56pm: NHS Providers has issued a somewhat lukewarm response to Sir Robert’s report.

Chief executive Chris Hopson said its members “recognise there is always scope for further improvement” but points out “it’s crucial that this report is placed in context”.

““Ninety-six per cent of staff told the most recent NHS staff survey that the last time they saw an error, near miss or incident that could have hurt staff or patients/service users either they or a colleague reported it.

“And 85 per cent of staff agreed that their organisation encourages them to report errors, near misses or incidents.”

“Whistleblowing needs to be seen in its proper context - these cases are exceptional and we must all work together to make sure that they remain so”.

1.44pm: The DH has said it will “shortly consult on” measures including “a new National Whistleblowing Guardian to protect those who speak up; practical help through Monitor, the Trust Development Authority and NHS England to help whistleblowers find alternative employment”; “a local whistleblowing guardian in every NHS organisation - reporting directly to the chief executive”; and “training for staff on how to raise concerns and protect others who do so”. This is in addition to some other measures outlined by the DH including new rights in the NHS constitution, sanctions under the duty of candour, and publication of new figures on avoidable deaths.

1.37pm: The full text of health secretary Jeremy Hunt’s full statement in the Commons this afternoon on the whistleblowing review has been published.

1.26pm: The government’s document Culture change in the NHS, which sets out “progress made in applying the lessons learned from the failings at Mid Staffordshire Foundation Trust” as well as responding to today’s recommendations from Sir Robert Francis. Follow HSJ Live for HSJ.co.uk for full news and analysis. The document is attached.

1.21pm: Lobby group Patients First will be holding ministers’ account for the measures they introduce to improve whistleblowers’ lot, it said in response to Sir Robert’s report.

Jennie Fecitt, lead nurse of Patients First, said it was pleased the inquiry had “vindicated the detailed evidence and testimony we provided”.

“We now call on health secretary Jeremy Hunt to immediately act to accept the recommendation in full and ensure all parts of the NHS act decisively on them,” she added.

“We remain concerned that significant number of employers remain in denial about the scale of victimisation of staff raising patients care concerns, and may not adopt and act on these recommendation in the spirit required.”

“We therefore seek further assurances from ministers that the sanctions outlined in this report will be enforced in a co-ordinated way by all parts of the NHS so that all organisations are held to account.

“The best interests of patients demand nothing less.”

1.08pm: Sir Robert has made a significant recommendation on transparency in his report.

Under “principle 13”, he suggests that “All NHS organisations should be transparent in the way they exercise their responsibilities in relation to the raising of concerns...including the use of settlement agreements [our emphasis].”

He suggests three actions to adhere to this principle: NHS organisations must publish “quality accounts” describing the number of concerns which have been reported formally; a requirement to report to the National Learning and Reporting Systems or new Independent National Officers any concerns and disputes; and that chief executives should personally review all settlement agreements that contain “confidentiality clauses”.

1.05pm: The Health Foundation has urged the government to “take stock” of NHS policies which keep tabs on quality and safety following the publication of the Sir Robert’s Whistleblowing report.

 Foundation chief executive Dr Jennifer Dixon points to the “bewildering array” of policies.  

“We need to understand which ones to prioritise and where there are gaps,” she adds.

 “There needs to be an assessment of the support available to people working at the frontline to help them improve the quality of care for patients.”

12.56pm: The British Medical Association has responded to Sir Robert’s whistleblowing reviewing.

BMA council chair Dr Mark Porter, BMA said the report had highlighted “the importance of cultural change in our health service, and creating a workplace across the NHS in which raising concerns is normalised and staff are supported to do the right thing for their patients”.

“Frontline staff often have the best understanding of what is going on when it comes to quality of patient care, yet those who raise concerns are too often ignored, or suffer professionally or personally.”

12.48pm: HSJ editor Alastair McLellan has flagged up a significant line from Mr Hunt’s response to the report.

 

12.45pm Health secretary Jeremy Hunt has accepted all Sir Robert’s recommendations in principle, he tells the House of Commons

12.39pm HSJ reporter Shaun Lintern points out that guardian role already being carried out in one trusts.

 

12.36pm: Labour has ferreted out figures from the whistleblowing report, apparently showing a rise in the proportion of NHS staff experiencing harassment, bullying or abuse from managers and other staff members between 2010 and 2013.

Jamie Reed MP, Labour’s shadow health minister, described the increase as “alarming”.

He flag’s up the following comments by Sir Robert in the report: “This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”

Mr Reed said ministers “will have to answer for this alarming rise.”

“This government has presided over a growing culture of fear and bullying.

This entry was amended at 1pm, to clarify that Sir Robert had identified the on-going problems of the NHS whistleblowing culture.

12.24pm: The NHS Confederation has responded to the whistleblowing report.

Chief executive Rob Webster said its members strongly welcomed the report.

“We need to look very carefully at what it shows. The poor treatment of some whistleblowers is a stain on the NHS.

“It undermines the great efforts of staff and the exceptional leaders we have in most of the service.

“Above all we need a set of leaders who will not stand for the ill treatment of genuine whistleblowers or for bullying in the modern NHS.”

12:13pm:We’ve more details on proposals to create “freedom to speak up guardian” in this story.

Under this recommendation from the whistleblower report, every NHS organisation to employ a full time officer to act in an ‘independent capacity’ to hear whistleblowers’ concerns and raise them at board level, as part of his review into creating an open culture in the NHS.


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.

12:10am: NHS England chief executive Simon Stevens has responded to Sir Robert’s whistleblowing report:

“As I’ve sat down and listened hard to whistleblowers over the past year, it’s blindingly obvious that the NHS has been missing a huge opportunity to learn and improve the care we offer to patients and the way we treat our staff.

“These important proposals – particularly for a new national office of the whistleblower - will provide clear new safeguards and signal a decisive change in culture in every part of the health service.”   

1202am: Here are some key lines from the Sir Robert’s letter the health secretary Jeremy Hunt:

“Handing of concerns is not easy for the employers”

  “Organisations which ignore staff concerns, or worse…are likely to be dangerous places for patients”

 

“There is a serious issue within the NHS. It requires urgent attention.”

 There is “near unanimity” among staff managers , regulators and leaders that action needs to be taken.

12noon: The Francis report has been released.

We will be live blogging the key lines, starting with our lead story:

A new national independent officer’s role should be created to oversee the investigation and treatment of NHS whistleblowers, Sir Robert Francis has recommended.

Unveiling his long awaited review of the issue this morning, Sir Robert said the evidence had left him in no doubt there was a “serious problem in the NHS”.

He recommended extending legal protection for staff who raise genuine concerns, including protection from discrimination when they are looking for new jobs, and creating a support service to help whistleblowers get back into NHS employment.

The former chair of the Mid Staffordshire public inquiry also said each NHS organisation should have a “freedom to speak up” guardian.

11.13am: HSJ in association with NHS Improving Quality had launched the second phase of its campaign to achieve better transformational change within the NHS.

Poor project management, undervaluing staff and adopting a low-risk approach to change management are some of the key blocks to achieving transformational change in the NHS.

These barriers were identified by hundreds of people responding to our on-going Change Challenge campaign.

The Challenge Top-Down Change initiative uses a crowdsourcing methodology, created by our partner Clever Together, to enable users to exchange and rate ideas.

 Launched last month by HSJ, together with its sister title Nursing Times and NHS Improving Quality, the aim is to identify the best ways to help the NHS drive real and sustainable change.

11.04am : The chief executive of Shrewsbury and Telford Hospital Trust has announced his retirement.

Peter Herring will step down from the Shropshire trust this summer, having led the organisation since September 2012.


Mr Herring’s career in the NHS has spanned 44 years, including 21 as a chief executive. He joined Shrewsbury and Telford from the Countess of Chester Hospital Foundation Trust, where he was chief executive for 12 years

10.46am: In other news, London Councils has asked the government to plough even more cash into health and social integration, following its announcement last month of a £37m pot to encourage the NHS and local authorities to work more closely together.

The lobby group claims the capital’s boroughs face a funding shortfall of £1.4bn in adult social care by 2020.

“it is becoming increasingly difficult to maintain social care services at their current level, and this will have a knock-on effect on other parts of the system,” Teresa O’Neill, London Councils’ executive member for health said.

10.30am: Here’s a story from today about the continuing fall out from the Mid Staff’s scandal. Surgical services and procedures requiring overnight inpatient stays have now been transferred from the former Stafford Hospital to Royal Stoke University Hospital and Royal Wolverhampton Trust.

Inpatient gynaecology, inpatient general surgery including breast, colorectal and upper and lower gastrointestinal tract surgery and inpatient emergency trauma were all transferred on Monday after the dissolution of Mid Stafforshire Foundation Trust last year.

10.23am: The Daily Mail kicks off its coverage of the Whistleblowing Review by reporting on comments by Healthwatch England chief executive Katherine Rake in its evidence to the Public Administration Committee.

Hundreds of thousands of patients are still too afraid to speak out about poor NHS care, it quotes Dr Rake as saying.

10.14am: Government has brought forward the timetable for its response to 12.30pm

10.05am: We’ve had three reporters at a media briefing on Sir Robert’s Whisteblowing report. Follow @ShaunLintern @sophieevebarnes and @whazell for updates.

We’ll be posting their reports at 12noon, when an embargo on the report lifts.

Health secretary Jeremy Hunt is due to give his response in Parliament at 2pm.

10am: Mid Staffs campaigner Ms Bailey is also quoted in the Times, with a similar line to the Daily Telegraph’s. She claims the NHS would return to “the bad old days of cover-up and denial” under a Labour government.

“We have no evidence that Labour have learnt the lessons… We believe they would take the NHS back to the bad old days of cover-up and denial about poor care, and put patients’ lives at risk,” she says.

9.55am: The BBC reports that review chairman Sir Robert Francis QC heard some “shocking” stories about staff who raised concerns being ignored, bullied or intimidated.

Review chairman Sir Robert Francis QC told the BBC a “significant proportion” of health workers were afraid to speak up.

9.50am: We’ve been taking a look at how national media have flagged up the Whisteblowing review. The Daily Telegraph leads on comments from Julie Bailey, one of the leading campaigners who exposed the Mid-Staffs scandal. She tells the paper that Labour cannot be trusted to run the NHS again.

Ms Bailey, whose mother died amid appalling failings in care in Stafford, said Labour had created a “rotten and toxic culture” which led to the bullying of staff who tried to warn of risks to patients, and would put patients’ lives at risk if they returned to power.

She made the statement as Sir Robert Francis QC, the barrister who led two inquiries into Mid Staffs, prepared to publish his verdict about the treatment of NHS whistleblowers.

7.00am: Good morning. Today Sir Robert Francis QC will publish his Freedom to Speak Up review into creating the open and honest reporting culture in the NHS. Check HSJ Live throughout the day for the latest updates and reaction to the review.

It was announced in June last year that Sir Robert had been appointed to lead a review of how whistleblowers are treated in the NHS.

The former chair of the Mid Staffordshire Foundation Trust public inquiry had been asked by the government to consider what further action is necessary to protect NHS workers who speak out in the public interest.

It followed calls for a public inquiry into whistleblowing in the NHS by a number of high profile whistleblowers and their supporters, including Patients First, a campaign group headed by former Great Ormond Street paediatrician Kim Holt, and GP and journalist Phil Hammond.

Speaking exclusively to HSJ ahead of the review’s official launch in August, Sir Robert said the role of probing claims made by NHS whistleblowers could be taken out of the hands of hospital trusts.

In an early sign of the direction the inquiry could take, he 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.

The review was originally due to be published last November, but it was postponed to this year due to the high number of contributions and evidence it had received.

Sir Robert said earlier this month he had completed the review and sent his final report to the health secretary. Jeremy Hunt is due to speak in the Commons at 12.30pm.

Related files/tables