February saw the release of the much-anticipated sequel to Sir Robert Francis’ initial Mid-Staffs inquiry findings, this time focusing specifically on the lack of support for NHS staff wishing to “blow the whistle” on perceived poor care. Having been grimly primed somewhat by the first report, the findings of the second review are hardly unexpected – but the lack of shock does little to mitigate the seriousness of Francis’ conclusions.
Where the initial report identified weaknesses in the system allowing perpetrators of malpractice to act with impunity, this review tackles the culture of bystanding and fear which has tragically led to NHS workers keeping silent of their own accord or even being silenced by their superiors.
What makes this report especially pertinent is the deliberate inclusion of students and trainees working towards a career in healthcare. Previous legislation failed to classify students on placement as ‘workers’, thereby denying them statutory recognition and protection under the Employment Rights Act 1996. Following the extension of the definition of ‘worker’ in January 2015, students undertaking placements are for the first time officially recognised as members of the NHS workforce and their experiences have clearly informed Francis’ approach to his whistleblowing review. Indeed, he identifies them as ‘a fresh pair of eyes’ who are well-placed to offer constructive challenge based on current teaching in practice education. With this in mind, the student contributors’ experiences that follow are especially uncomfortable.
The report found that student nurses had been failed by their mentors after raising concerns, when there had previously been ‘no issues regarding their practice’, or else suffered bullying for the remainder of a placement following the concern being raised. Attempts to discuss concerns with colleagues in practice led to students being treated as ‘a nuisance’, and the eventual formal lodging of a concern in some cases resulted in the students losing their place at University. It comes as no surprise, therefore, that Francis identifies the powerful effect of students who had raised concerns and been dismissed dissuading other students from reporting their own concerns, thus perpetuating a culture of silence.
Of additional concern was the discovery that students were ‘continually being placed in unsuitable settings’ – for example with placement providers where previously-issued concerns had not yet been resolved. This is where innovative software solutions can add real value in HEI placement management teams. PEMS allows placement administrators to reflect the status of a provider in real-time – marking organisations undergoing investigation as ‘suspended’ will prevent them from being available for use in allocation.
Here at Oxinet, we are conscious of the need for our software to continuously adapt to industrial, cultural and legislative changes. Francis’ latest findings provide greater impetus for our existing plans to enhance student feedback functionality to include action plans on concerns raised via an evaluation form. This will provide a ‘formal mechanism throughout the process after raising a concern’, just as Francis recommends.
Whilst this latest report is no doubt unsettling to the practice education community, we know that the majority of HEIs are committed to supporting students in voicing and escalating their concerns. For this reason, PEMS contains facilities dedicated to enabling HEIs and placement providers to evidence good practice. Student pages can include the latest guidance on raising concerns, and the educational audit module prompts both Universities and practice areas to include evidence of their compliance with regulatory recommendations.
As a supplier to the industry, we remain steadfast in our collaborative approach to working with HEIs in order to ensure that current functionality is meeting our customers’ specific needs, and to develop new features to support robust evaluation of student placements. Francis leaves us in no doubt that the key to shaking up the culture of silence is through collecting and acting on feedback – and we are confident that software will prove central to driving these improvements.
 ‘Freedom to Speak Up: A Review of Whistleblowing in the NHS’. Sir Robert Francis QC, February 2015, p.180
 ‘Freedom to Speak Up: A Review of Whistleblowing in the NHS’. Sir Robert Francis QC, February 2015, p.177