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NHS staff need support to raise concerns about care standards. Our new handbook can help.

Roger Kline, 23 April 2013

What counts can’t always be counted, but the NHS and its staff unions have produced some rather shocking numbers recently.

Unison reported last week that only 31% of NHS nurses surveyed believe there are enough staff in their workplace to guarantee patients receive dignified, compassionate care, while 90% of seurveyed Royal College of Nursing (RCN) members said staffing levels are not always adequate to provide safe patient care, and almost a third said they were rarely or never safe.

The annual NHS staff survey showed that 28% fear the consequences of raising patient safety concerns, while 23% reported harassment, bullying or abuse from managers, team leaders or other colleagues over the previous 12 months.

Perhaps these results explain why, despite rising pressures on the service and growing awareness about the consequences of failure to report concerns, there were 100,000 fewer incident reports last year than the year before.

There are some numbers we still don’t know, such as how many millions have been spent on silencing, gagging, paying off, making redundant, paying sick pay or early retirement to hundreds of staff who raised concerns at work in recent years.

Nor can we quantify the human cost involved, but we do know that such staff -- whistleblowers -- are important and invaluable.

However, they are not the answer to the ‘culture’ problem highlighted by the Francis Report. Rather, they are a symptom of it.

The answer, as Francis said, is to create a healthcare environment in which everyone feels able to raise concerns, discuss them and learn from them without fear.

The NHS has no shortage of whistleblowing policies. Every trust has got one, and there’s post-Shipman guidance for GPs, “Speak up For a Healthy NHS” and “Speaking Up”. There are countless circulars from David Nicholson and Jeremy Hunt and his Ministerial predecessors. There’s the NHS Constitution and of course the Public Interest Disclosure Act (PIDA).

So why do the fear and bullying numbers persist, while concerns about standards remain high and the number of incident reports has declined?

As well as staff perceptions about the consequences for career and livelihood of speaking out, I believe another reason is that staff are unclear about the contractual implications of raising concerns, and whether they are protected, and if so how.

Many are unclear about the best ways of raising tricky concerns about excessive workloads, inappropriate skill mix, or an unsafe work environment or faulty equipment, and what to do next if no notice is taken, or if they are bullied instead of supported for raising concerns.

This is bad for patients as well as for staff, for the evidence is clear: organisations in which staff feel confident about raising concerns and admitting mistakes, where quality data is collected and openly shared, where professionals learn from mistakes and near misses, are much safer than those where that doesn’t happen.

So, with some wise advice from Shazia Khan and the help of Public World colleagues, I sat down and drafted a handbook. It helps staff understand precisely what their rights and duties towards patients and colleagues are, and provides practical guidance about how to raise and pursue concerns.

The handbook -- The Duty of Care of healthcare professionals -- is published today by Public World, and complemented by a website with loads of tools staff can download and use. It draws on work contained in my earlier book.

I’d really appreciate your views, reviews, commendations, criticisms. Above all, please have a look. It’s a free download or you can buy a hard copy. (Email for details.) And please spread the word!

If you’d also like to use the materials to undertake training in your Trust on these issues, for managers and staff, or for wider teams of union reps and officials, please get in touch, as we have a training package on offer. We could also produce a special version of the handbook for your organisation, profession or union. Drop me a line at

Numbers can be important. In this case lots of downloads would be a very good start. Constructive criticism a bonus!


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