NHS must end culture of secrecy, says Health Secretary

Victoria Atkins insisted medical staff must feel free to speak up about patient safety concerns 'without fear of recrimination' - Shutterstock

The NHS must end its “culture of closing up when things go wrong”, the Health Secretary has warned, as she ordered an investigation into its handling of whistleblowers.

Victoria Atkins said speaking up about patient safety concerns must become “the norm, not the exception”, and that medical staff must feel free to do so “without fear of recrimination”.

Writing in The Telegraph, Ms Atkins said she had asked officials in the Department of Health and Social Care to look into the issue of whistleblowers being targeted by NHS managers.

The Telegraph has unearthed evidence that doctors and nurses are paying a heavy price for fulfilling their duty to raise any concerns they have about patient safety. In some cases they are bullied, harassed and eventually leave the medical profession in despair as managers try to avoid scrutiny over patient deaths or avoidable harm.

Millions of pounds are being spent by the NHS to investigate the whistleblowers themselves and to fight legal battles with them rather than trying to fix the problems they identify.

Ms Atkins said she had been “shocked” to read The Telegraph reports about the treatment of whistleblowers, adding that: “It cannot be right that NHS management spends millions of pounds fighting doctors who have concerns over patient safety.”

Protestors outside the Royal Society of Medicine at a conference to discuss whistleblowers and patient safety - JULIAN SIMMONDS for the telegraph

NHS trusts already have to employ a Freedom to Speak Up Guardian, whose job is to ensure whistleblowers are listened to and treated appropriately, but Ms Atkins concedes that there is still more to be done.

Doctors’ groups want changes in the law to give further protection to whistleblowers, including a new criminal offence of causing detriment to whistleblowers. Justice for Doctors, a self-help group, also wants the DHSC to require hospitals to bring in an independent medical expert to assess whether a whistleblower has a case.

Ms Atkins said treating patients was the focus for the vast majority of workers across the NHS, including managers, “but the culture of closing up when things go wrong must end”.

The law that is meant to protect whistleblowers is the Public Interest Disclosure Act 1998, under which workers have the right “not to be subjected to any detriment by any act…by his employer done on the ground that the worker has made a protected disclosure”.

Many doctors say it is inadequate and does not prevent hospital managers from effectively marking their own homework by investigating whistleblowers’ complaints internally.

The British Medical Association also warned this week that senior managers “are more concerned with protecting personal and organisational reputations than they are with protecting patients”.

The Telegraph has spoken to 52 whistleblowers who between them say they have raised concerns about more than 170 patient deaths and almost 700 patient harms, though the true number of avoidable deaths is “astronomical”, one consultant has said.

The doctors and nurses who spoke to The Telegraph described tactics being used against whistleblowers that included being suspended from work, sometimes for years, while their own behaviour was being investigated.

It is vital that we protect whistleblowers and put safety first

Victoria Atkins

The NHS sees 1.6 million people every day. The vast majority receive good, safe, quality care. But when standards fall short, staff must be able to blow the whistle and the NHS must listen, then act.

I will never put protecting reputations ahead of protecting patient safety. Every concern should be investigated, and every staff member should be free to raise them without fear of recrimination or damaging their career.

That is why this government is building an NHS that encourages speaking out, protects whistleblowers, and always puts patient safety first.

We have all been shocked to read the reports published this week in The Telegraph. It cannot be right that NHS management spends millions of pounds fighting doctors who have concerns over patients’ safety.

That is money that would be better spent on the front line of healthcare, treating patients.

For the vast majority of workers across the NHS - from porters to consultants and managers - that is their focus.

But the culture of closing up when things go wrong must end.

Fortunately, that is changing, and we are making it easier for staff to speak up when things look like they are going wrong.

Every one of England’s NHS trusts now has a Freedom to Speak Up Guardian – a dedicated member of staff who lends an ear to colleagues who want to speak up and supports them to do so.

They have already handled more than 100,000 cases, and we can take confidence from the fact that more than 8 in 10 staff who spoke out to give feedback said they’d feel comfortable doing so again.

Speaking up will become a routine part of business

Understandably, many NHS staff feel more comfortable talking to someone outside of their trust or hospital. So, we have established an independent National Guardian to help drive positive cultural change across the NHS so that speaking up becomes a routine part of business. This includes the introduction of ‘Speak Up Direct’, which is a confidential, independent national helpline where they can turn to for guidance.

Support is of course helpful, but blowing the whistle still requires a huge amount of bravery and whistleblowers deserve to be protected. That’s why, in 2018, we enhanced legal protections for whistleblowers to prohibit discrimination against job applicants on the grounds that they have spoken up in the past. This ensures whistleblowers are better protected throughout the hiring process, so they have the freedom to get on with their careers and lives.

A safety-first culture starts at the top, which is why we have introduced new, standardised background checks for NHS board members, preventing irresponsible leaders from covering their tracks by jumping between organisations.

I have asked my officials to look closely at these NHS whistleblower cases to identify the common themes and to consider what possible action could be taken to address the issues. This is to ensure a positive culture that encourages speaking out within the NHS becomes the norm, not the exception, across England.

This Government has continued to make improvements to the whistleblowing framework to make it more robust and increase support for whistleblowers, but we know there is more work to be done.

This is why we last year announced a review of the whistleblowing framework, which will examine its effectiveness in meeting its intended objectives, which are to enable workers to come forward to speak up about wrongdoing, to protect those who do so against detriment and dismissal, and support wider cultural change, in which the benefits of whistleblowing are recognised and lead to action among employers and others.

The evidence for this review is being gathered externally, using a broad range of perspectives, views and experiences surrounding whistleblowing to inform the research.

The Government will consider the findings and implications for whistleblowing policy, with a view to publish the evidence and next steps in due course.

This Government will always protect whistleblowers and put safety first. A safe and supportive environment is the bedrock of our plan to deliver a faster, simpler, and fairer NHS for patients and staff.

Victoria Atkins is the Health and Social Care Secretary

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