Cultural issues related to allegations of bullying and harassment in NHS Highland: independent review report

36. Freedom and Safety to Speak Up

Discussion

36.1. While one would hope that the steps above would minimise the need, and that "whistleblowing" would be very much a last resort, further steps should be taken to provide a properly functioning, clear, safe and respected wholly independent and confidential whistleblowing or, more helpfully, "speaking up" mechanism, which presently does not seem to exist.

36.2. All staff should be aware of how to use this and in what circumstances its use is relevant, so that individuals with concerns are able to express these confidently in the future.

36.3. The expressing of serious concerns needs to be viewed as a good thing and acted on in a culture that is both supportive and safe. This must apply to concerns about staffing issues in addition to patient safety, realising that they are of course intimately linked. It is for consideration to what extent these matters can be addressed by internal provision and in what circumstances wholly external provision is essential.

36.4. Perhaps an internal safety valve (such as a dedicated confidential email address and telephone hotline), is necessary, with external provision if the internal function is not sufficient. Endorsement, oversight and support of, and tangible commitment to, the process from the highest board and management levels will build confidence.

36.5. In this context, provision of an independent, confidential, trained "guardian" or guardians seems essential both for those who experience and wish to report inappropriate behaviour and for those against whom such behaviour is alleged, and who feel that there is no other available resource. Such a facility could also be used to enable the current whistleblowers to address their concerns about future victimisation.

36.6. Such a person would address serious concerns and complaints and independently investigate and act on them, within a time scale. Appropriate feedback is important. Any actions should be anonymised and published.

36.7. I understand that the Scottish Public Services Ombudsman has worked closely with the Scottish Government as they develop plans for introducing the Independent National Whistleblowing Officer and on proposals for a National Whistleblowing Standard. It is to be hoped that the Scottish Government will move swiftly to implement a really effective mechanism.

The Francis Report

36.8. The content and recommendations in the Francis Report on "Freedom to Speak Up" provide a rich resource. Time should be spent considering and implementing recommendations in that report which are likely to be equally applicable to Scotland. Sir Robert refers to the Parliamentary and Health Service Ombudsman's (PHSO) vision for raising concerns in the NHS and provides an adaptation of a PHSO diagram to apply to staff raising concerns^[70]. I commend it.

36.9. I note the presence of Freedom to Speak Up Guardians in the NHS in England^[71]. I understand that, in one English trust, the FTSU guardians (as they are called) promote confidential disclosure of any issues and have open access to the Board and the executive in order to resolve concerns and issues as early as possible.

36.10. I am told that most issues can be resolved locally as misunderstandings, which would accord with adopting a preventative or "safety valve" approach in NHSH, and indeed underscores the utility of an early intervention mediation resource.

36.11. I note that Sir Robert Francis says he "gave serious consideration to recommending that the term 'whistleblower' should be dropped, and some other term used instead."^[72] Although he still had reservations about the term, he had been persuaded that it is now so widely used, and in so many different contexts, that this would probably not succeed. Instead, there should be a focus on giving it a more positive image.

36.12. I support his suggestion that the measures recommended in his report will do much to promote the acceptance of 'whistleblowing' as normal and positive behaviour in healthcare. This seems a sensible approach for NHSH to adopt.