things: treating patients with dignity and respect; high quality nursing care; creating systems that prevent both error and harm; and creating a culture of learning from patient safety incidents, particularly events that should never happen, such as wrong site surgery, to prevent them from happening again.
5.3 NHS England’s objective is to continue to reduce avoidable harm and make measurable progress in 2015/16 to embed a culture of patient safety in the NHS including through improved reporting of incidents.
Chapter 2 – Overview of the legal aid policy context 47
2.5 National initiatives in raising
concerns
2.5.1 There are a number of recent, current or planned initiatives that will directly or indirectly have an impact on the climate surrounding or the process of raising concerns. Examples are:
• a ‘Speaking Up’ Charter56 launched in the summer of 2012 by NHS Employers, the organisation that represents employer bodies within the NHS. The Charter encouraged organisations to pledge publicly a commitment to help create cultural change including
continuous review and evaluation of raising concerns policies to ensure they remain effective.
• Caremakers – this concept was developed in December 2012 based on the 2012 Olympic and Paralympic ‘Games Makers’. Students and newly qualified nurses can become caremakers to promote health and well-being and restore morale and pride in nursing. They also promote the 6Cs – care, competence, compassion, communication, courage and commitment. Courage can include courage to speak up and courage to change, learn and challenge how care is delivered.
• The Sign Up to Safety Campaign launched in June 2014. This campaign’s three year objective is to reduce avoidable harm by 50% and save 6,000 lives. Organisations and individuals who sign up to the campaign commit to setting out actions they will undertake in response to the following five pledges:
1 Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.
2 Continually learn. Make their organisations more resilient to risks, by acting on feedback from patients and by constantly measuring and monitoring how safe their services are.
3 Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
4 Collaborate. Take a leading role in supporting local collaborative learning, so that
improvements are made across all of the local services that patients use.
5 Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.
• Commission on Education and Training for Patient Safety established by Health Education England in August 2014. It is chaired by Professor Sir Norman Williams, who is also acting as one of the Advisors to this Review. One of the Commission’s key strands of work will be to examine how to support all staff, through training, to raise and respond to concerns about patient safety. The Commission is due to report in autumn 2015.
• Safety Fellowships programme being led by NHS England, working with the Health Foundation. This is starting early in 2015 and aims to recruit 5,000 Safety Fellows by 2020. The intention is to recruit experts in quality and wider improvement as participants in the initiative. Participants will work collaboratively through networking and development activities to address a number of significant challenges to making care safer.
2.5.2 The Review also learned about many local initiatives to improve the raising of, and learning from, concerns. These included campaigns to encourage speaking up, cultural ambassador style roles to support staff raising concerns and a range of mechanisms to provide feedback to staff about concerns that had been raised and action taken as a result. Examples of local initiatives are included in chapters 5–7. These are welcome and will undoubtedly make a difference. The evidence in chapter 3 however, indicates that these are still at an early stage and not universal.
Freedom to Speak Up – A review of whistleblowing in the NHS
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2.6 Guidance and advice for staff
raising concerns
2.6.1 There are already several sources of guidance and advice for staff on how to go about raising concerns including:
• NHS terms and conditions of service handbook and NHS Constitution – section 2.3 mentioned that this handbook sets out the expectation that NHS employers should have local policies and procedures in place, and offers suggestions on what those policies should contain. It also noted that the NHS Constitution set out expectations in this area.
• guidance from regulators – many of the system and professional regulators provide guidance and advice relevant to staff considering raising concerns including their own roles, if any, within that process.
• guidance from professional bodies – a number of Royal Colleges and professional bodies provide advice and guidance to their members about where to go and the process to follow if they have concerns.
• Whistleblowing Helpline – commissioned by the Department of Health provides free advice and support to healthcare workers who are wondering whether or how to raise a concern at work, as well as to people who are further on in the whistleblowing journey. The Helpline also provides advice and training on best practice to NHS managers, employers, professional bodies and trade union representatives. In a typical month, it answers over 50 calls relating to the NHS and receives over 3,000 hits on its website. It is not a disclosure line and does not offer an advocacy service. Its website offers factsheets, toolkits and resources to inform staff and managers in a practical way about the 1996 Act and how to take a positive approach to whistleblowing. It published updated guidance in March 2014 for employers, managers and workers on raising concerns at work.
• Public Concern at Work – a charitable organisation that provides an advice helpline which extends to offering independent legal advice.
• Model policy – first introduced into the NHS in 2003 and published in guidance ‘Speak Up for a Healthy NHS’ produced by Public Concern at Work. The Whistleblowing Helpline published a revised model policy in its guidance ‘Raising concerns at work’ in March 2014 along with a flow chart to help staff and employers understand the process of raising concerns.
2.6.2 There is a risk that such a plethora of information, advice and guidance and the various ways it can be obtained may be confusing for NHS workers with concerns. They might not know where to go for the best advice or whether, having spoken to any particular organisation, they still need to report their concerns elsewhere; or whether even speaking to that organisation had affected their rights under the 1996 Act. There is also the risk of conflicting advice, including different definitions of the term ‘whistleblowing’.
Chapter 2 – Overview of the legal aid policy context 49
2.7 Conclusion
2.7.1 This brief review is not a detailed analysis of the legal and policy context, but is sufficient to illustrate the complexity of the current position. The quantity of activity in the fields of legislation, policy and guidance indicate a continuing institutional recognition that more needs to be done to support the freedom of staff to speak up, and concern that the measures already in place are insufficient. This has resulted in a somewhat piecemeal and reactive approach to this issue.
2.7.2 Particular issues are:
• the law seeking to protect whistleblowers is cast entirely in an employment context. It proceeds from an assumption that an exception needs to be made to a general requirement to keep the affairs of the employer confidential, rather than from an acceptance that all those providing a public service have a duty to raise concerns which affect the public interest. It is complex and offers limited retrospective remedies for victimisation
• all NHS employers are required to have policies which encourage or require their staff to speak up but there is no requirement for uniformity
• there are many sources of guidance, all expressing themselves differently.