Freedom to Speak Up Review

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11 / 2 / 2015 4.06pm

Dear colleagues

The review Sir Robert Francis has undertaken over the last 7 months into whistleblowing and creating an open culture has been published today. As some of you know, I’m on paternity leave this week, but I asked the team to prepare this summary of the key points from the review and Government response for you to share with your board.

‘Freedom to speak up’ has been an in depth review, producing a comprehensive report which is a detailed description of what staff, employers, unions and national bodies have told the review team. It also includes the outcomes of research and international comparisons that have been undertaken. The report details some good practice that is taking place and also reveals how some staff have not been treated as we would want and expect.

To address the gap and variation, the report covers how organisations can create the right culture, how concerns should be handled and what is needed to make the system work.

It has two over-arching recommendations, 20 principles and 36 specific actions that cover local and national organisations and they have been grouped under five key themes. These are the need for culture change, improved handling of cases, measures to support good practice, particular measures for vulnerable groups and extending the legal protection.

The focus of the whole package is ensuring issues are dealt with as patient safety issues.

With many of the local actions, there is a parallel recommendation to system regulators about how they assess this against whether an organisation is well-led. We have extracted some of these here.

The two over-arching recommendations are:

1. All organisations should implement the principles and actions in the report in line with the good practice outlined.

2. The Health Secretary reviews progress at least once a year against the actions in the report.

Some of the specific actions task boards locally with the need to:

  •  assess progress in creating and maintaining a culture of safety and learning, ensuring the culture is free from bullying
  •  encourage reflective practice, individually and in teams, as part of everyday practice
  •  have a policy and procedure built on good practice
  •  talk about and publicly celebrate the raising of concerns
  •  ensure staff have formal and informal access to senior leaders. In this area, it also recommends:
    • a person is appointed locally by the chief executive to act as a 'Freedom to speak up guardian'
    • an executive director and non-executive director are nominated as individuals within your organisation who can receive concerns
    • a manager in each department to be nominated to receive concerns
    • staff have access to advice and support from an external organisation (eg, whistleblowing helpline).
The report also suggests the creation of an Independent National Officer. It is to be jointly resourced by the regulators and national bodies to be a support to the local guardians, advise organisations where good practice has not been followed and review the handling of cases when required.

It also asks HEE and NHS England to develop a training package and tasks each organisation with ensuring that every member of staff receives training in how you expect them to both raise and act upon concerns.

Government response

In his speech this lunchtime, the Health Secretary said we need to listen to staff when they speak out and take immediate and sustained action to eradicate bullying and victimisation of staff.

He has thanked the Freedom to Speak Up Review team and accepted all of the actions in the report. Consultation will now begin upon how they will be implemented.

Today, the Health Secretary will send a letter to every NHS trust chair and TDA/Monitor are also writing to every chief executive to re-enforce the importance of staff being able to discuss concerns openly in teams and for action to be taken.

He specifically stated that each organisation should act now to appoint a local guardian who staff can approach to raise concerns and who has a direct reporting line to the chief executive.

In addition, the Department of Health has also published a report today, Culture change in the NHS, covering all the progress on actions taken from the Francis public inquiry into Mid Staffs and the subsequent reports from Berwick, Cavendish, Clwyd/Hart and NHS Confederation. You may have also seen that that CQC published their new Fundamental Standards this week and the Department of Health published guidance on how the new criminal offence around False and misleading information will work.

The full Freedom to Speak Up report is now available to download. We will take time to examine it in detail and reflect upon the most effective way to represent your views as the recommendations are taken forward.

Draw the line campaign and new resources

We are also due to publish our new resources this week as part of the Draw the Line campaign. The resources have been developed with employers to support, guide and empower managers to have open conversations about raising concerns and improve the confidence of their staff. The resources include a self-assessment tool, template presentation and a manager’s guide for raising concerns. More information about the Draw the line resources can be found on our website.

Finally, we are planning a workshop in April to share good practice and explore ways of improving early intervention and resolution – further details will be included in the workforce bulletin at the end of the month.

I hope you’ll find this summary and our new resources useful.

Best wishes.


Daniel Mortimer
Chief Executive, NHS Employers

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