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HCSA calls for action on ‘cover-up culture’ fuelled by NHS leadership

HCSA has provided testimony to senior MPs over the culture of fear created by NHS managers trying to prevent doctors speaking up on safety.

It made the case for change in a submission to the Commons health and social care committee investigation into leadership culture.

HCSA warned that dysfunctional governance and a “cover-up” culture are being fuelled by a lack of transparency on director appointments and responsibilities and the absence of meaningful board-level scrutiny.

“When hospital doctors speak up, their concerns are disregarded,” the union stated, “and, worse, our members find themselves silenced and victimised to protect the reputation of the hospital.”

Research by HCSA revealed that 70 percent of hospital doctor respondents felt unable to raise patient safety concerns without career detriment and 93 percent of those who had spoken up were dissatisfied with the response.

Eighty percent reported that Freedom to Speak Up Guardians, a role brought in following the Francis Review into the Mid-Staffs scandal, did not give them greater confidence to speak up. One doctor commented that “the guardians are as effectively bullied as everyone else.”

HCSA urged the committee to consider a raft of changes to address systemic issues affecting the NHS and its leadership. It recommended:

1. An immediate review by all Trusts of their internal ‘speaking up’ processes.

HCSA wants to see an urgent drive to ensure that they are fit for purpose, transparent and that cases are being handled robustly without interference by managers.

2. The establishment of an independent statutory national whistleblowing body outside of the NHS.

This body would register potential or actual whistleblowers at the point of disclosure, to protect against recriminations, monitor the investigation into the original allegations and the actions of the regulatory bodies, as well as investigations into those who might have acted unlawfully against individuals who expose safety concerns.

HCSA is monitoring the implementation of the NHS-specific Independent National Whistleblowing Officer (INWO) introduced in Scotland, which is not an exact match for our proposal, however gives a blueprint for establishing such a body elsewhere.

3. A new criminal offence to protect those who speak up.

The creation of a new criminal offence of causing detriment to people who have made protected disclosures.

4. Reform of the Maintaining High Professional Standards (MHPS) process.

MHPS is the process by which doctors are investigated formally within NHS employers, which we see misused to victimise individuals who speak up. It needs reform to prevent its abuse by employers or use to make vexatious complaints.

5. A regulator for non-medical managers.

This would allow non-medical managers to be referred to the regulator for behaviours which contribute to a culture of silence. There is currently no accountability for non-medical managers’ professional conduct. The regulator could also take a firm position against abuse by managers of disciplinary procedures.

6. Allow hospital doctors to whistleblow to their trade union.

An extension to the government’s ‘prescribed persons and bodies list’ - those able to receive a formal whistleblowing disclosure – to include trade unions.

7. Stronger governance within the NHS.

All executive directors including non-executive directors should be held firmly to account for compliance with The Seven Principles of Public Life (“The Nolan Principles”).

Every NHS trust should have a board member with responsibility for whistleblowing, and all protected disclosures made under the Public Interest Disclosure Act 1998 (PIDA) should be reported to the board.

The board should have a duty to monitor the processing of all protected disclosures and a duty to make regular reports to and answer enquiries from NHS England, the Care Quality Commission and the independent statutory national whistleblowing body recommended in point 2 above.

8. New NHS England and CQC powers.

NHS England and the Care Quality Commission should each be given a responsibility auditing and acting (according to their respective regulatory responsibilities for the management and operational safety of trusts) upon unsatisfactory performance by trusts in the management of whistleblowing cases.


Read HCSA's full submission to the Health and Social Care Committee inquiry on NHS leadership, performance and patient safety.