As part of a continued proactive approach in addressing the barriers to reporting incidents and raising concerns in the NHS, representatives from across the health regulators, health unions and representative professional bodies came together at a whistleblowing breakfast summit on 30 May 2012.
Opened with a keynote speech from Andrew Lansley, Secretary of State for Health, the key focus of the summit was on scoping the possibility of working collaboratively as national organisations to help bring about a culture of openness, reporting and learning in the NHS.
The summit was attended by representation from the following organisations:
- Academy of Medical Royal Colleges
- British Dental Association
- British Medical Association
- Care Quality Commission
- Council for Healthcare Regulatory Excellence
- Chartered Society of Physiotherapy
- Department of Health
- General Medical Council
- General Optical Council
- General Osteopathic Council
- General Pharmaceutical Council
- Health Professions Council
- Medical Protection Society
- Managers In Partnership
- National Voices
- NHS Employers
- Nursing and Midwifery Council
- Royal College of Midwives
- Royal Mencap Society
- Royal Pharmaceutical Society
- Society of Radiographers
A summary of the meeting is provided below.
Dean Royles, Director of NHS Employers
Dean Royles opened the summit by setting the scene, making reference to the latest NHS staff survey results showing improvements in staff understanding whistle-blowing procedures, however he noted that there remains a lack of confidence from staff that their organisation will support them and act upon concerns raised about patient safety or malpractice. Dean talked about the recent changes to the NHS Constitution as a good lever to help further address this issue but believing that collectively we can go further still if we are to encourage and promote a truly open culture and build the confidence of staff.
Dean reported that feedback received to date throughout the Mid Staffordshire NHS Foundation Trust Public Inquiry highlights that the NHS are missing opportunities to resolve issues at an early stage. Organisations must actively encourage early intervention and urge staff, patients and the public to raise concerns about risks to patient safety, rather than to wait for someone to whistleblow, which serves to report when things have already gone wrong.
In bringing representatives from the health regulators, health unions and representative professional bodies together, Dean saw this as a first step to explore what further action can be taken to collectively support employers in removing the stigma of whistleblowing, and influencing the culture of the NHS so that taking action is seen and accepted as part of the norm.
Rt Hon Andrew Lansley, Secretary of State for Health
In setting the political context, Andrew Lansley reinforced the Government's commitment to supporting the rights of staff, working in the NHS to raise concerns and their expectation of all NHS organisations to support staff that wish to do so. All NHS organisations are expected to have whistleblowing policies and procedures compliant with the Public Interest Disclosure Act 1998.
Since coming into power, Andrew Lansley stated that this Government has introduced a new contractual right to raise concerns and guidance for NHS organisations to support good practice. They have made changes to the NHS Constitution to include an expectation that staff will raise concerns, requires organisations to pledge that concerns reported will be acted upon and to give clarity around the existing legal rights to raise concerns. The Government also support staff wanting advice on how to raise concerns and employers to embed good practice through a free independent helpline.
Andrew Lansley noted that while there is a clear indication that organisations are signposting and promoting policies and mechanisms to report concerns with their staff (in reference to the staff survey results), there is still much more to be done to embed a culture of openness in the NHS. We are all human and mistakes happen but what makes us more human is how we respond to those mistakes, do we deny and blame others or do we admit and learn lessons. Andrew Lansley made reference to practices in other safety critical industries such as the airline industry where it is vital for people and organisations to admit mistakes and to learn from them. This cannot be done in a culture of blame and denial, instead what we are trying to create is a culture where safety and quality is at the heart of all we do.
Andrew Lansley closed his speech emphasising the importance of moving towards becoming learning organisations, organisations which listen and respond to the views of staff and patients and where the focus is on safety and quality. This cannot solely be achieved through policies but requires embedding an open and transparent culture. The Government, staff side and employers all have responsibility to create this culture.
Professor Jane Reid, Clinical Human Factors Group
Professor Jane Reid shared her expertise on the human factors and organisational conditions that facilitate speaking up and out as fundamental professional behaviours (professionalism, accountability and advocacy). Professor Jane Reid reported that whistleblowing is in the main a pejorative term and is viewed by many staff as something that is done when all else fails. She also argued that it has its place but we must get to a situation in the NHS where speaking up /raising concerns is the norm.
Download a copy of Professor Jane Reid's presentation.
Outcomes from the summit
Through discussion next steps were identified to begin influencing a cultural and behavioural change towards openness and learning within the NHS:
- agreement to produce a shared pledge - publicly committing the organisations in attendance to work together to tackle the issue of raising concerns in the NHS
- further exploration of the human factors and organisational conditions necessary to promote open cultures
- profiling what we mean by raising concerns and whistleblowing; championing positive examples
- mapping the responsibilities of health regulators, health unions and representative professional bodies.