Review supports speaking up about poor care

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Sir Robert Francis's review of whistleblowing, published last February, shows that NHS staff are still afraid of raising concerns about poor care. Most of the participants claimed they experience isolation, reprisals and oppressive behaviour.

Among the suggested actions to tackle the issue, the review recommends the introduction of a "freedom-to-speak up guardian" - a person who can provide independent support to staff who want to report concerns and make sure relevant action is taken. Howard Catton, RCN head of policy, says the figure of an external guardian can be very positive. Yet, he warns about the necessity to appoint right candidates. "They need the gravitas to speak to the executive board; if it is just providing emotional support then it won't go far enough".

Attention was also drawn on the difficulties of vulnerable groups within NHS staff, particularly students, non-permanent staff and ethnic minorities. Students had the chance to make their voice heard during an RCN event last October, where they claimed they don't receive enough advice and support on reporting concerns. Mr Catton encourages the involvement of younger people, as they "bring a fresh pair of eyes to an organisation and can often be the first people to see a problem". He also adds that other vulnerable groups are genuinely concerned that whistleblowing might have significant repercussions on their position and careers.

A 2013 report by Macmillan highlights the importance of staff welfare. Jagtar Dhanda, Macmillan Head of Inclusion, explains how poorer staff wellbeing is connected with poorer patient experience being reported, which in turn links with clinical outcomes. Mr Dhanda welcomes the review's focus on raising concerns, yet he claims that the figure of the "guardian" might not be successful. Steps should be taken first towards a cultural change, encouraging reflective discussions around the level of practice within individual trusts. "If you have this culture of permission to speak out then it shouldn't be necessary to make such a big leap to whistleblowing".

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