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.[citation needed]
Francis outlined twenty principles and associated actions, then concluded by making just two recommendations:[3]
for all NHS organisations and regulators to implement all the principles and actions;
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.
Reactionsedit
Many campaigners claimed that the recommendations did not go far enough.[8][2]
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]
^"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)
^ abCampbell, Denis (11 February 2015). "NHS whistleblowers report offers no prescription for ending cover-up culture". The Guardian. Retrieved 9 January 2016.
^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.
^Baines, Emma (30 July 2021). "Nurse reports to guardian scheme increased during year of pandemic" – via Nursing Times.
^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.
^"Freedom to Speak Up Guardians need more support, study finds". NIHR Evidence. 31 August 2023. doi:10.3310/nihrevidence_59584. S2CID 261453359.
^"People at the Heart of Care: adult social care reform". 1 December 2021 – via GOV.UK.
^Patrick Sawer, Laura Donnelly The Telegraph (11 February 2015) Whistleblowing: 'It's still not safe for us to speak out'
^"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)