Steps are being taken to strengthen the speaking up culture in NHS Wales after cases like the conviction of nurse Lucy Letby in England have brought the issue into sharp focus.
The Welsh Government has published a new Speaking up Safely Framework and told all health boards to review and improve the processes they have in place for staff raising concerns.
“Speaking up and bringing issues and concerns into the open is a brave and vulnerable thing to do”
The framework has been produced in partnership between the government, NHS Wales, unions and employers.
In the introduction, it explains that the aim was to create a culture in NHS Wales “where individuals feel safe and able to speak up about anything that gets in the way of delivering safe, high-quality care or which negatively affects their experience”.
“This includes, but is not limited to, matters related to patient safety, safe staffing, the quality of care, bullying and harassment (and cultures which enable this), as well as financial malpractice or fraud,” it added.
“To support this, leaders and managers need to be willing to listen, and to be open to constructive challenge.”
The framework includes new toolkits for how organisations should build their speaking up cultures, and new requirements including for each health board to have both an executive and non-executive lead for speaking up.
Announcing the new framework, Welsh minister for health and social services, Eluned Morgan, said: “Recent events have been a stark reminder of how vital it is that everyone working in the NHS feel safe and confident to speak up about anything that gets in the way of delivering safe, high-quality care.
“Speaking up and bringing issues and concerns into the open is a brave and vulnerable thing to do and NHS managers must be willing to listen, deal with concerns appropriately and be open to constructive challenge.
“I am committed to creating a culture where speaking up is welcomed and seen as an opportunity to listen, learn and improve.
“The introduction of this framework will assist in driving this change and ensure that workplaces are safe, respectful and inclusive for all employees.”
“It is essential that our members feel safe to raise concerns without fear of repercussions”
The “recent events” referred to by Ms Morgan include the case of Letby who was recently jailed for murdering seven babies and attempting to kill six others while working as a neonatal nurse at the Countess of Chester Hospital, in the north west of England.
It has been reported that colleagues of Letby had raised concerns about her some time before she was removed from the unit and arrested. The way those concerns were handled is one of the key issues that will be looked at during an upcoming public inquiry on the case.
Revelations about the prevalence of sexual harassment, sexual assault and rape among the UK surgical workforce also spurred the work in Wales, as well as other cases of poor whistleblowing experiences in the NHS.
Nicky Hughes, associate director (employment relations) at Royal College of Nursing (RCN) Wales, welcomed the framework.
“In order to safeguard and protect patients, it is essential that our members feel safe to raise concerns without fear of repercussions and with confidence that improvements will be made,” she added.
“Support from the Welsh Government, NHS employers and boards, executive teams and managers is crucial for staff to feel safe and comfortable in reporting their concerns.”
She added that it was the RCN’s view that nursing staff “have the responsibility and the right to raise their concerns”, and that the RCN provided its members with guidance on doing this.
“It is welcoming that the Welsh Government are committing to creating a culture where these concerns will be taken seriously, heard fairly and will not result in personal repercussions,” said Ms Hughes.