This mornings news of the report by Robert Francis that potential whistle blowers within the NHS have not been heard needs to be understood within its context. The incidents and policies where people want to see change from the current practice or indeed where some senior employees are restricting better practice are very small in comparison to the vast majority of work that goes on within the many organisations that make up the NHS. However the difficulty of blowing whistles within this public service, paid for by you and I is something that could be replicated within any number of public sector organisations. It is also something that will be recognised within any other organisation where practice could be improved, but those able to make the changes find the challenges a threat to their own reputation or credibility. It is as true of the private sector and also of some charities. I have not yet read the Francis report so my reflections are based entirely on my own opinions and perspective. My view is that these problems are as a result of three factors. all of which are a great deal harder to fix than they are to identify.
The first is that within the current economic climate, particularly within the public sector, jobs, especially secure ones are very hard to find. This means that both those wanting to blow whistles and those who need to make the changes that would prevent the need for the whistle to be blown are fully aware that putting their heads over the parapet may mean their already insecure position will be lost, at a point where finding an alternative is probably going to be very difficult. Despite lots of rhetoric from the Government, although jobs have been created, few have any link to the actions of the Government and many jobs have been created as a result of intensely hard work by risk takers. Although the Government cut 1000’s of jobs with relatively little thought, using very crude actions, most new jobs are created within the SME sector and these take time and very hard work to be formed. The language used by our political leaders who as Claire Gerada GP expressed so well on yesterdays Inside Health on Radio 4 is prone to threaten and demoralise clinicians and administrative staff in equal measure every time they speak of the Health Service. The same could be said of all public services and often the charitable sector too. This simply piles on the sense of insecurity.
The second is that far too little is done to train and support those capable of making changes to implement what might be obvious to people on the front line, but that could seem bizarre and counter intuitive with boardroom type meetings when the change makers are forced to justify their actions to their own senior colleagues. Many people are elevated into positions of power and authority with far less preparation and education than might be hoped. This is particularly true at a time when training and particularly cross cultural training is seen as a luxury. There are also real questions about the suitability of some appointed to such roles. Some of these people have achieved their appointment or promotion, essentially because they are not boat rockers.
Finally we have an issue that is often the most important reason, yet is rarely one that is ever challenged. The governance of charities, public services and even many private businesses falls into the hands of people who are often very resistant to discovering that their way of doing things is not the best. A recent visit by Iain Duncan Smith to a Job Centre Plus office in Nelson, Lancashire was something of a challenge for him when an employee (someone who works for you and I, not Mr Duncan Smith) told him in no uncertain terms that the changes created by DWP were not achieving their desired outcome and were poorly though through. I may be being unduly pessimistic but my expectation is that Mr Duncan Smith will not call for a rethink, and that the brave young man who spoke out may not be promoted as a result of his desire to improve the system for people like you and me who may be claimants or tax payers, but in either case need people to speak out loudly and constructively.