Francis' whistleblowing inquiry is just the tip of the iceberg

The Francis report, the Keogh review and the Berwick review all emphasised the importance of workplace cultures where staff are supported, treated with respect and are able to raise concerns freely and without fear of bullying.

It should be easy. 

‘Sir Robert needs to treat with scrutiny and scepticism the narratives from those responsible for whistleblowers’ treatment’

Health secretary Jeremy Hunt’s decision to commission Sir Robert Francis to lead an independent review into the treatment of historic whistleblowing cases is a helpful first step to examine this issue, though it does not go far enough in the eyes of many campaigners.

Nevertheless it is a step in the right direction, especially if Sir Robert treats with careful scrutiny and scepticism the narratives he will receive from those currently responsible for the treatment of whistleblowers.

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Protection premium

He will doubtless be told that things are getting better, that all trusts have good policies and procedures in place, that regulators have improved and that whistleblowers get much better support than they used to.

Indeed, visit the websites of NHS Employers, professional regulators, individual trusts, the Department of Health and even trade unions, and there no shortage of good advice, but real support or protection is still at a premium.

‘There no shortage of good advice, but real support or protection is still at a premium’

Well after the final Francis report, the most recent NHS National Staff Survey, published in February, reported that 71 per cent of staff felt safe raising these concerns, 54 per cent felt confident that their organisation would address them, and only 44 per cent of staff felt they were given feedback on changes made as a result of errors, near misses and incidents.

Research last year analysed 1,000 whistleblowing cases across all sectors received by whistleblowing charity Public Concern at Work and concluded that:

“From our research we know that the typical whistleblower is a skilled worker or professional who has been working for less than two years, who is concerned about a wrongdoing that is ongoing, affects wider society and has been occurring for less than six months.

“The concern is raised at the organisation at most twice with line then middle management, and the whistleblower is most likely to experience no response from management (either negative or positive). Where management do respond the most common response is a formal reprisal.

“The most likely response to the concern is that nothing is done. Junior staff are more likely to be ignored than those in senior positions, who are more likely to be dismissed. 

Executives are much more likely to resign - 30 per cent. Where they do not, their position worsens as matters progress, and they are eventually silenced - 50 per cent - or move on - 50 per cent.”

Just the tip of the iceberg

This research found that of those who raised concerns in healthcare, 67 per cent felt their position at work worsened as a result of raising concerns, 11 per cent resigned, 7 per cent decided to say no more and not one employee reported their position had improved.

We have found that too many employers still turn patient safety or other public interest concerns into employment issues, ignore the concerns raised, and victimise the person raising the concerns.  

We do not suggest this is what happens to all staff who raise concerns, but none of these are isolated examples as some suggest.

‘The Francis reports did not address the problem of bullying within the NHS’

The high profile cases of Shiban Ahmed, Sharmila Chowdhury, David Drew, Jennie Fecitt, Kim Holt, Ed Jesudason, Narinder Kapur, Raj Mattu, Gary Walker and many others are the tip of an astonishing iceberg.

We were disappointed that the first and second Francis reports did not address the problem of bullying within the NHS.

Patients First believe that a public inquiry into whistleblowing is needed, and we have the deepest concerns about the ongoing victimisation of whistleblowers.

If the latest Francis review is to be successful it must understand how the law fails to protect genuine whistleblowers, how bullying responses can silence concerns, and how the broader system needs an overhaul to ensure that there is somewhere for concerned staff to go.

Most importantly, patient safety matters need to be addressed in a timely way, not left to fester in employment courts.

The Health Select Committee was right to say, in its response to the Francis report, that: “Disciplinary procedures, professional standards hearings and employment tribunals are not appropriate forums for constructive airings of honestly held concerns about patient safety and care quality.”

The best trusts are pressing ahead with serious culture change, safety ambassadors and ombudswomen, and real openness and transparency. But too many are simply not yet making those changes.

Almost 18 months after the Francis report we still have a serious amount to do.

Our campaign sadly continues to be needed and will be needed until we no longer hear from traumatised people whose only concern was the safety of patients. That is the challenge Sir Robert faces.

Dr Kim Holt is founder of Patients First and a consultant paediatrician, and Roger Kline is research fellow of Middlesex University Business School and a director of Patients First