Olwen Dutton outlines the key themes and practical steps for local government arising from Robert Francis QC's review of how to create an open and honest reporting culture in the NHS.
No part of the public sector can afford to ignore the repercussions of the failings of the Mid-Staffordshire Hospital; and the findings which emerged from the various inquiries.
Earlier this month Robert Francis QC published his independent review into creating an open and honest reporting culture in the NHS, Freedom to Speak Up. His report makes a number of key recommendations under five overarching themes with specific actions for NHS organisations and professional and system regulators to help foster a culture of safety and learning in which all staff feel safe to raise a concern.
As with his previous report, whilst the recommendations set out in the report are aimed at the specific challenges which face the NHS, its themes are also relevant to local government particularly in those areas where safety is in issue. As the introduction to the report states: "Common to many ... has been a lack of awareness by an organisation’s leadership of the existence or scale of problems known to the frontline. In many cases staff felt unable to speak up, or were not listened to when they did."
The latest review builds on the work which was begun following the publication of the Francis Report into failings at the Mid-Staffordshire Hospital – and a key aspect of that report was the difficulties around the implementation of an effective whistleblowing policy.
- Please click here to read our summary of the workforce aspects of the Francis Report.
- Please click here for background information on whistleblowing and a summary of the changes to whistleblowing following the Francis Report.
The Government has already issued its initial response – including announcing new 'whistleblower guardians'. It has said that it accepts all the review's recommendations in principle and will consult on a package of measures to implement them. With the growing integration of health and local government particularly around social care, likely to be taken to a new level over the next few years with the imminent implementation of the Care Act 2014 and its duties of integration, what does this mean for the local government, particularly around its public safety role which includes care for the vulnerable but also provides for public safety across other functions as well?
Local authorities will already have whistleblowing policies in place, and in most cases they ensure that these are regularly reviewed. However, considering the importance given to whistleblowing, we would advise that councils consider their policy and the way in which it is working in the light of the new report. In particular, the report stresses the importance of the responsibilities which lie at the top of the organisation, around the Board in the NHS, and around the chief officers and senior members in a council setting.
There are of course differences between the NHS and local authorities, but nonetheless senior council teams should consider what is said around the NHS and how this might apply to them. In addition, this is the second national report this month in which whistleblowing has featured, after the Casey Report into Rotherham Council, and so highlights the need for councils to be as sure as they can be that they have effective systems and processes in place, together with creating the right culture.
The review zeroes in on responsibilities at board / executive level. 'Principle 1' in the review is 'fostering a culture of safety' and this sets out that boards "must devote time and resource to achieving this change".
The review identifies some key actions for boards, including:
- Ensuring that a safe learning culture is measured and monitored on a regular basis;
- Considering and implementing ways in which raising concerns can be publicly celebrated;
- Ensuring that there are a variety of personnel to support staff who raise concerns, including a 'Freedom to Speak Up Guardian';
- Ensuring that responsibility for raising concerns policy and practice rests with the executive board member who has responsibility for safety and quality, rather than human resources;
- Visible leadership, particularly at board level, in respect of valuing and sharing the raising of concerns;
- CEOs / designated board members to be involved with, and regularly reviewing, all formal concerns, to ensure they are being dealt with appropriately and swiftly.
Councils should ask themselves if they are confident that they have the equivalent actions in place and that they are working.
Although the review focuses in large part on the importance of cultural change, Robert Francis also recommends that NHS England, NHS TDA and Monitor produce standard integrated raising concerns policy and procedure. However, having appropriate documentation is only the beginning; the emphasis in the review is on the importance of promoting a general culture of encouraging whistleblowing - research undertaken as part of the review highlighted the distinction between a strict procedural approach to whistleblowing and a more open-minded, less rigid approach which focused on resolution.
The review also focuses on the difficulties around investigations and suggests that disciplinary / performance action associated with a concern should be put on hold while the concern is investigated. In addition, the review stresses the importance "that investigations are seen to be done properly and that appropriate resourcing is provided". That said, the review also highlights that systems need to be simple, swift, and free from bureaucracy – a difficult balancing act to get right.
The review also recommends that every NHS organisation should provide training to every member of staff on how to receive and act on concerns. As part of this and bearing in mind issues highlighted in the recent Rotherham report it is essential that concerns should be taken seriously, regardless of who is raising them. The review also specifically recommends that all leadership and management should be given regular training on how to address and prevent bullying.
In summary, no council can afford to be complacent about its culture concerning whistleblowing, and both Francis and Casey give stark reminders about what can happen if a culture exists where whistle-blowers are ignored, discouraged or punished.