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Freedom To Speak Up!

Sir Robert Francis report on Whistleblowing


Freedom To Speak Up!

Sir Robert Francis report on Whistleblowing

Freedom to Speak Up – Report by Sir Robert Francis Feb 2015

Sir Robert Francis has published his findings and recommendations following the continuing disquiet about the negative ways in which some NHS organisations deal with concerns raised by staff about poor practice and the subsequent treatment of those staff who have ‘spoken up’ (whistleblowing).

The poor practices raised by staff relate to substandard and sometimes, unsafe patient care and treatment. Further issues have been raised, exposing the fact that in some cases, the organisation’s leadership have not been aware of poor practice or have not been made aware of poor practices. Staff have felt unable to speak up about their concerns or were ignored and not listened to when they did. Some staff felt they were treated badly as a result of speaking out and discriminated against, harassed and bullied to the point where their mental well-being was affected.

The 2103 NHS staff survey did show that 72% of participants in the survey did feel they could safely raise a concern but 28% felt they could not. As Sir Robert Francis explains in his executive summary of the report  “..failure to speak up can cost lives”.

The aim of the review and subsequent report therefore has been to to provide advice and recommendations so that NHS staff in England are able to confidently raise concerns knowing that they will be listened to and their concerns acted upon without prejudice or repercussions of doing so.

The report identifies five key themes which the NHS needs to act upon which are addressed through a set of principles designed to bring about the change required and the actions which should follow from each:

·         Culture change

·         Improved handling of cases

·         Measures to support good practice

·         Particular measures for vulnerable groups

·         Extending the legal protection





1. Culture Change

Principle 1 – Culture of safety: Every organisation involved in providing NHS healthcare should actively foster a culture of safety and learning in which all staff feel safe to raise concerns.


Principle 2 – Culture of raising concerns: Raising concerns should be part of the normal routine business of any well-led NHS organisation.


Principle 3 – Culture free from bullying: Freedom to speak up about concerns depends on staff being able to work in a culture which is free from bullying and other oppressive behaviours.


Principle 4 – Culture of visible leadership: All employers of NHS staff should demonstrate, through visible leadership at all levels in the organisation, that they welcome and encourage the raising of concerns by staff.


Principle 5 – Culture of valuing staff: Employers should show that they value staff who raise concerns, and celebrate the benefits for patients and the public from the improvements made in response to the issues identified.


Principle 6 – Culture of reflective practice: There should be opportunities for all staff to engage in regular reflection of concerns in their work.

Improved Handling of Cases

Principle 7 – Raising and reporting concerns: All NHS organisations should have structures to facilitate both informal and formal raising and resolution of concerns.


Principle 8 – Investigations: When a formal concern has been raised, there should be prompt, swift, proportionate, fair and blame-free investigations to establish the facts.


Principle 9 – Mediation and dispute resolution: Consideration should be given at an early stage to the use of expert interventions to resolve conflicts, rebuild trust or support staff who have raised concerns.

Measures to Support Good Practice

Principle 10 – Training: Every member of staff should receive training in their organisation’s approach to raising concerns and in receiving and acting on them.


Principle 11 – Support All: NHS organisations should ensure that there is a range of persons to whom concerns can be reported easily and without formality. They should also provide staff who raise concerns with ready access to mentoring, advocacy, advice and counselling.


Principle 12 – Support to find alternative employment in the NHS: Where an NHS worker who has raised a concern cannot, as a result, continue in their current employment, the NHS should fulfil its moral obligation to offer support.


Principle 13 – Transparency: All NHS organisations should be transparent in the way they exercise their responsibilities in relation to the raising of concerns, including the use of settlement agreements.


Principle 14 – Accountability: Everyone should expect to be held accountable for adopting fair, honest and open behaviours and practices when raising, or receiving and handling concerns. There should be personal and organisational accountability for:

• poor practice in relation to encouraging the raising of concerns and responding to them

• the victimisation of workers for making public interest disclosures

• raising false concerns in bad faith or for personal benefit

• acting with disrespect or other unreasonable behaviour when raising or responding to concerns

• inappropriate use of confidentiality clauses.


Principle 15 – External review: There should be an Independent National Officer resourced jointly by national systems regulators and oversight bodies and authorised by them to carry out the functions described in this report, namely:

• review the handling of concerns raised by NHS workers, and/or the treatment of the person or people who spoke up where there is cause for believing that this has not been in accordance with good practice

• advise NHS organisations to take appropriate action where they have failed to follow good practice, or advise the relevant systems regulator to make a direction to that effect

• act as a support for Freedom to Speak Up Guardians • provide national leadership on issues relating to raising concerns by NHS workers offer guidance on good practice about handling concerns

• publish reports on the activities of this office.


Principle 16 – Coordinated Regulatory Action: There should be coordinated action by national systems and professional regulators to enhance the protection of NHS workers making protected disclosures and of the public interest in the proper handling of concerns.


Principle 17 – Recognition of organisations: CQC should recognise NHS organisations which show they have adopted and apply good practice in the support and protection of workers who raise concerns.

Particular Measures for Vulnerable Groups

Principle 18 – Students and trainees: All principles in this report should be applied with necessary adaptations to education and training settings for students and trainees working towards a career in healthcare.


Principle 19 – Primary Care: All principles in this report should apply with necessary adaptation in primary care.

Extending the Legal Protection

Principle 20 – Legal Protection should be enhanced.


Recommendations stemming from the report

Recommendation 1:  All organisations which provide NHS healthcare and regulators should implement the principles and actions set out, in line with the good practice described in the report.

Recommendation 2:  The Secretary of State for Health should review at least annually the progress made in the implementation of these principles and actions and the performance of the NHS in handling concerns and the treatment of those who raise them, and to report to Parliament.


Sir Robert Francis believes that the principles and actions in his report should make it safe for staff/people to speak up. Guardians will be appointed to every NHS Trist and an Independent National Officer will also be appointed to provide support and ensure that any issues over patient safety are addressed. Legislation will be created to ensure that whistleblowers are not discriminated against or victimised and to encourage those who fear speaking up to speak out.

News Story

Sir Robert Francis has published his findings and recommendations following the continuing disquiet about the negative ways in which some NHS organisations deal with concerns raised by staff about poor practice and the subsequent treatment of those staff who have spoken up about it.