The Francis Report (2013), Keogh Review (2013) and Berwick Report (2013) all emphasise the need for healthcare providers to have open and transparent processes that promote a culture of listening to patients and staff and learning from situations that arise.
It is vital that staff feel empowered and supported to raise concerns safely, confidentially and that they feel confident their concerns will be taken seriously and action will be taken.
In their report Learning not Blaming, published in July 2015, the DH accepted a number of recommendations including one that there should be a ‘Freedom to Speak Up guardian’ (FTSUG) in every organisation with NHS funding.
Guidance published by NHS England in November set out what this mean for primary care providers. There is a summary of this guidance here on Medeconomics.
What do practices need to do?
Within primary care the requirements are as follows:
- Each NHS primary care provider should review and update their policies and procedures by September 2017 so that they align with the ‘Freedom to Speak Up in Primary Care Guidance’ (see link above - there is an example policy within the guidance).
- Each NHS primary care provider should name an individual who is independent of the line management chain and is not the direct employer as the FTSUG, who can ensure that policies are in place and that staff know who to contact if they have a concern.
Freedom to Speak Up guardians
The aim of the FTSUG role is to ensure that policies are in place and that staff know who to contact if they have a concern. The guidance says that some providers may want to go further and involve the Freedom to Speak Up guardians in offering advice and supporting staff that have concerns.
Some practices will want to appoint this role themselves, but it may be that the role is shared across a local area or across two or more practices. NHS England’s guidance suggests a range of options for primary care providers for filling this role, including the possibility that the CCG may appoint this role.
Whichever option is used in your area, the practice will be responsible for ensuring that all staff understand who this person is, what their role is and how they can get in touch with them if they want to raise concerns. You are also responsible for ensuring that information relating to the FTSUG role is included in your updated policy.
Advice to help practices
Since April 2017 I have been the appointed Freedom to Speak Up guardian at Rainbows Hospice for Children and Young People in Loughborough.
To provide some context for primary care teams who are starting to embark on the road to develop and embed the principles of FTSU, here is some information that the hospice has found invaluable.
Ensure that this incorporates the principles of FTSU and is widely disseminated for all staff to be aware of why the role is being established.
Infographics, posters and newsletter articles are all means by which the FTSUG role has been publicised across all teams at our hospice. It is important that information is available in bite-size, quick read formats for all staff to see.
I ran two awareness sessions for the organisation prior to the FTSUG role being formally established. These provided me with a forum to speak to all staff in the organisation emphasising the role and its relevance to all staff whether they are clinical or administrative.
I attend all hospice inductions sessions and provide a short talk about the FTSUG role. Linking with new staff ensures they are aware of the support available should they raise a concern.
Visibility is key to the role. Staff should understand the value of speaking up and see the person undertaking the role doing so actively. I speak to staff on a regular basis about FTSU, as I’m external to the hospice this needs me to book time to be onsite. If your guardian is a member of the team this should be easier to manage, but don’t forget branch surgeries if you are a larger practice.
Somewhere private to talk
Make sure that you have access to a free room in the practice, this is invaluable to help a person relax and discuss their concerns. Ensure you’re not disturbed and listen to the individual carefully before agreeing next steps.
Link to the senior management team
One of the main criticisms that the wider NHS has faced following recent public enquiries was the lack of linkage across the organisation. I regularly meet with and provide reports to the senior management team and the board of trustees at the hospice. Within your practice or area reporting arrangements need to be agreed so that the guardian knows where to go to action issues that relate to your practice.
Ensure that staff understand that any information they disclose will be treated with respect. Assurances of confidentiality cannot always be given, for example if a safeguarding concern is raised this must be taken through the appropriate channels.
All primary care providers will need to meet FTSU requirements. Link with practices locally and find out how they are approaching this and any hints and tips that they can share. The guardian role is only just developing in all healthcare organisations and so take a look at the work of the National Guardians office too (see below) as they will be providing periodic updates.
See this as an opportunity
Freedom to Speak Up is a requirement for primary care providers, but use the initiative as an opportunity to overhaul existing whistleblowing policies. Also consider the benefits of having a guardian in the practice for all staff to speak to who isn’t part of the management structure of the practice – this might enable the practice to resolve issues that couldn’t be dealt with by more traditional routes.
In summary the FTSUG role is fundamental to ensuring that staff voices and concerns are heard within your organisation. The requirements placed on primary care providers provide a real opportunity to excel and provide best practice support within the team to enable concerns raised to be dealt with positively.
- Tracy Ruthven is Co-Director at Clinical Audit Support Centre, an organisation that provides accredited training and project support in patient safety and quality improvement. For more information visit http://www.clinicalauditsupport.com/