Freedom to Speak Up Guardians: Not just a box ticking exercise

20th December 2016

NHS England has strengthened whistleblowing procedures in primary care by instructing every organisation to have a ‘Freedom to Speak Up Guardian’.

Primary care – which includes community pharmacists, opticians and dentists as well as GP practices – is a particularly sensitive area for whistleblowing. Unlike large hospitals, the intimate working environment of many organisations leaves little scope for raising concerns confidentially or anonymously. Primary care workplaces are also less likely to offer the protection of a trade union.

NHS England’s solution is for every primary care organisation to identify a named individual who is neither the employer nor a manager as ‘Freedom to Speak Up Guardian’. They have to be in place by September 2017.

While the intentions are good, the challenges in making this work are formidable. No doubt many organisations will embrace it as a valuable addition to existing policies aimed at ensuring their clinical services are safe, high quality and ethical. But with many thousands of employers involved, immense pressures on finances and staff time, a vocal minority of GPs routinely opposing virtually any centrally-led initiative, and a widespread feeling of regulator fatigue, there will be big variations in the quality of the arrangements. A significant weakness is that the NHS has no plans to offer confidential legal advice to staff who want to raise concerns.

A central issue is who to appoint as the Speak Up Guardian. Examples from NHS England include a member of the local clinical commissioning group or a professional network. These are likely to bring a degree of professionalism and independence. But it is all too easy to imagine nearby employers who know each other well simply setting up reciprocal arrangements as a box-ticking exercise, leaving their staff with little faith in their confidentiality and independence.

Good practice would be for employers to discuss the initiative with their staff, explain how they see such transparency and accountability as an important contribution to the organisation’s commitment to their patients, and consult them on who should be appointed guardian.

The idea of Freedom to Speak Up Guardians comes from the report by Robert Francis QC into NHS whistleblowing. Public Concern at Work offers tailored training on NHS whistleblowing.

By Richard Vize, PCaW Trustee.

Richard is managing director, media for Dods. Previously Richard was editor of the weekly magazine Health Service Journal and he also spent seven years editing Local Government Chronicle. He is a regular contributor to the Guardian on healthcare issues.

Follow him on Twitter @RichardVize