The health secretary has called for greater support to be provided to NHS whistleblowers, as part of an effort to foster greater trust in the health service – a move experts said would bring the sector into line with a wider push towards greater transparency in business.
In a speech to the Royal Society of Medicine, Matt Hancock said the NHS needed to accept that medical mistakes happened and “encourage whistleblowing” in order to learn from them.
He called for a change to the way whistleblowers were viewed within the system, “from a problem to part of the solution”, and said a “learn not blame” culture needed to be embedded in the service.
“Whistleblowers are doing the NHS a great service. Someone who has the courage to speak up and put their head above the parapet should be encouraged and embraced,” said Hancock. “Yet sadly, all too often, they’re ignored, bullied and worse, forced out.”
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“Making someone choose between the job they love and speaking the truth to keep patients safe is morally abhorrent and operationally foolish,” he added.
Beth Hale, partner and general counsel at CM Murray, said Hancock’s speech was indicative of a “general cultural push” across sectors to make sure whistleblowing was encouraged. “It goes beyond the NHS – there’s definitely a move to make sure people feel able to speak up where there are things that are not being done properly or things that are going wrong within organisations,” she said.
Hale told People Management there had been a “move towards transparency” within organisations for a long time, spurred on by the #MeToo movement and, in the case of the NHS, scandals that could have been avoided if individuals had the confidence to speak up.
“There’s a consciousness that bad practice, unlawful practice and dangerous behaviour shouldn’t just be brushed under the carpet,” said Hale. “For example, the Financial Conduct Authority is really pushing to say [whistleblowing] is a positive thing, we should be seeing it as a positive step to cleaning up our industry – and I think that’s true across the board.”
A failure to listen to whistleblowers – and, in many cases, a culture that punishes and sidelines them for raising concerns – has featured in a range of NHS scandals, including the shortcomings in care that led to hundreds of deaths at the Mid Staffs NHS trust and the jailing of disgraced surgeon Ian Paterson. The government-commissioned Freedom to Speak Up review made a range of recommendations to increase protections for whistleblowers in 2015, yet critics say this has too often not translated into genuine change to culture or process.
The remarks from Hancock coincide with the release of the Kark review, commissioned by Hancock’s predecessor Stephen Barclay, into the appointment of NHS directors in England. The report included a number of recommendations, including a new focus on the behaviour of directors and actions that may negatively affect whistleblowers.
“We think there should be a focus upon behaviour which suppresses the ability of people to speak up about serious issues in the health service, whether by allowing bullying or victimisation of those who ‘speak up’ or blow the whistle, or by any form of harassment of individuals,” the report said.
Hancock said he welcomed the recommendations in the Kark report, and called for wider reform of NHS leadership structure, including greater training and development. The health secretary said the rate of turnover at the top needed to be lowered, alongside better structures to “support and hold to account” directors.
In response to the speech, Danny Mortimer, chief executive of NHS Employers, said: “The recognition by the secretary of state of the steps the NHS must take to develop a just culture in which we encourage learning from mistakes will be welcomed by all of our staff.
“HR & OD teams will play a key role in supporting this within their local organisations, as will our national leaders and regulators who have also recognised that they must adopt a different approach too.”
Affecting cultural change is difficult in any organisation, but not impossible, added Hale. “Having that leadership right at the top of the organisation speaking out about this is absolutely crucial in making sure it filters through the whole organisation, and nowhere more so than in the NHS, which is such a big organisation,” she said.
Separately, a report released this week by consultancy Pulse UK called on the Care Quality Commission (CQC), the UK’s healthcare watchdog, to do more to quantify culture with the trusts it reports on. “Culture is a mainstay in all CQC reporting, yet it is not actively quantified,” the report said. “Culture can and should be measured.”
Dennis Bacon, Pulse UK executive chairman, added: “If ever there was a time for NHS providers, arms-length bodies and everyone across the health sector to get serious about workforce culture, it is now.
“We are calling on the system to stop confronting the symptoms of poor culture and start tackling the systemic root causes.”