The Freedom to Speak Up Review, also known as the Francis Report, was a review into whistleblowing in the NHS in England. It was announced on 24 June 2014 and it was chaired by Sir Robert Francis.[1] The review was originally expected to report in November 2014 but took longer because of a huge volume of input material: 17,500 online responses and 600 postal responses.

The report was published on 11 February 2015.[2]

Recommendations

Francis outlined twenty principles and associated actions, then concluded by making just two recommendations:[3]

  1. for all NHS organisations and regulators to implement all the principles and actions;
  2. for the Secretary of State to review progress annually.

The twenty principles to allow a consistent approach to raising concerns, while still allowing some flexibility, included:

  • Culture of raising concerns - to make raising issues a part of normal routine business of any well-led NHS organisation.
  • Culture free from bullying - freedom of staff to speak out relies on staff being able to work in a culture which is free from bullying.
  • Training - every member of staff should receive training in their trust's approach to raising concerns and in receiving and acting on them.
  • Support - all NHS trusts should ensure there is a dedicated person to whom concerns can be easily reported and without formality, a "Freedom to Speak Up Guardian" .

There are now over 800 Freedom to Speak Up Guardians in over 500 organisations in the NHS and independent sector organisations, national bodies and elsewhere in England.

In 2020-21, over 20,000 cases were raised with Freedom to Speak Up Guardians - including nearly 6,000 by nurses and midwives.[4] An observational and interviewed-based study of more than 80 Guardians found that a lack of resources, especially time, reduced their ability to respond to concerns, and to analyse and learn from data. Guardians struggled to develop their role, and create a more positive culture in which staff felt free to voice concerns. Bullying and harassment was raised with them frequently. Guardians found their role stressful and received little psychological support.[5][6]

In December 2021, the UK's Department of Health and Social Care announced plans to explore ways in which Freedom to Speak up Guardians could be introduced in the social care sector.[7]

  • Support to find alternative employment in the NHS - where a worker who has raised a concern cannot, as a result, continue their role, the NHS should help them seek an alternative job.

Reactions

Many campaigners claimed that the recommendations did not go far enough.[8][2]

National Guardian

The National Guardian's Office is an independent, non-statutory body with the remit to lead culture change in the NHS, so that speaking up becomes "business as usual". The office is sponsored by the Care Quality Commission, NHS England and NHS Improvement.[9]

In January 2016 Eileen Sills was appointed as the first Freedom to Speak Up National Guardian for the NHS.[10][11][12] She resigned two months later, citing that she did not have sufficient time to combine this role with her other work.[13] Dr Henrietta Hughes was appointed as the second Freedom to Speak Up National Guardian in July 2016.[14]

Dr Hughes stepped down after five years in post in September 2021[15]

Dr Jayne Chidgey-Clark was announced as the third National Guardian for Freedom to Speak Up on 11 November 2021.[16]

See also

References

  1. ↑ "Freedom to Speak Up Review". webarchive.nationalarchives.gov.uk. Archived from the original on 18 February 2015.{{cite web}}: CS1 maint: bot: original URL status unknown (link)
  2. 1 2 Campbell, Denis (11 February 2015). "NHS whistleblowers report offers no prescription for ending cover-up culture". The Guardian. Retrieved 9 January 2016.
  3. ↑ Walsh, Peter (November 2014). "Francis's Freedom to Speak Up review: An openness and transparency revolution or just another report?". Clinical Risk. 20 (6): 128. doi:10.1177/1356262215575958. S2CID 57860342.
  4. ↑ Baines, Emma (30 July 2021). "Nurse reports to guardian scheme increased during year of pandemic" – via Nursing Times.
  5. ↑ Jones, Aled; Maben, Jill; Adams, Mary; Mannion, Russell; Banks, Carys; Blake, Joanne; Job, Kathleen; Kelly, Daniel (15 August 2022). "Implementation of 'Freedom to Speak Up Guardians' in NHS acute and mental health trusts in England: the FTSUG mixed-methods study". Health and Social Care Delivery Research. 10 (23): 1–124. doi:10.3310/GUWS9067. PMID 35995060.
  6. ↑ "Freedom to Speak Up Guardians need more support, study finds". NIHR Evidence. 31 August 2023. doi:10.3310/nihrevidence_59584. S2CID 261453359.
  7. ↑ "People at the Heart of Care: adult social care reform". 1 December 2021 – via GOV.UK.
  8. ↑ Patrick Sawer, Laura Donnelly The Telegraph (11 February 2015) Whistleblowing: 'It's still not safe for us to speak out'
  9. ↑ "Archived copy". www.nationalguardian.org.uk. Archived from the original on 29 October 2019. Retrieved 29 October 2019.{{cite web}}: CS1 maint: archived copy as title (link)
  10. ↑ Dame Eileen Sills Archived 2016-01-26 at the Wayback Machine Care Quality Commission website 7 Jan 2016
  11. ↑ CQC appoints first National Guardian for the freedom to speak up in the NHS Care Quality Commission website 7 Jan 2016
  12. ↑ The National Freedom to Speak Up Guardian for the NHS Archived 2016-01-26 at the Wayback Machine Care Quality Commission website 7 Jan 2016
  13. ↑ Quinn, Ben (7 March 2016). "NHS's first 'national guardian' resigns after two months" – via The Guardian.
  14. ↑ Care Quality Commission, New National Guardian appointed to lead the NHS in speaking up freely and safely, 7 July 2016
  15. ↑ Discombe, Matt (21 June 2021). "National guardian quits" – via Health Service Journal.
  16. ↑ Ford, Steve (12 November 2021). "Nurse chosen to be next 'national guardian' for raising concerns in NHS" – via Nursing Times.
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