Meeting of the Parliament

Meeting date: Tuesday, September 27, 2016

Official Report 853KB pdf

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Topical Question Time

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National Health Service (Staff Concerns)

To ask the Scottish Government what action it is taking to ensure that NHS staff feel able to raise concerns about the service. (S5T-00099)

All staff should have the confidence to speak up and know that their whistleblowing concerns will be treated seriously and investigated properly. NHS Scotland already has robust whistleblowing procedures in place, and we have continued in recent years to put in place additional supporting measures, such as the national confidential alert line and non-executive board whistleblowing champions.

Work is under way to establish an independent national whistleblowing officer for NHS Scotland, which will complement our existing policies and provide an independent and external level of review on the handling of whistleblowing cases. This will further contribute to better patient safety and also encourage an open and honest reporting culture.

Year on year, the NHS staff survey has found that up to a quarter of staff do not think that it is safe to speak up or challenge the way things are done if they have concerns about quality, negligence or wrongdoing. If they do not feel that they will be taken seriously or that their issues matter, that will have a severe impact on their morale. We have seen in other public services, most notably in Police Scotland, how damaging that can be. If staff knew that the confidential alert line that the cabinet secretary described was a permanent fixture and not just one that is funded on a rolling, 12-month basis, would they be more willing to use it?

I agree with Alex Cole-Hamilton that the staff survey is an important way for us to hear the views and concerns of staff on the front line, and it is very important that we act on those. I think that the current alert line provides a good service. Of course, it does not stand alone but complements a range of whistleblowing mechanisms that have been developed through partnership work. I outlined some of that in my earlier answer.

We want to take further action, which is why we are working on the plans for an independent national whistleblowing officer and developing legislation for that role, which will provide further reassurance to staff. The independent national whistleblowing officer will have an important role and ensure that, in addition to the whistleblowing procedures that are already in place, the process is more robust.

On the funding, I am committed to ensuring that the alert line continues. We want to ensure that it continues to meet the needs of staff, which might mean that it will develop over time. However, I think that it provides an important function and I assure the member that I am certainly committed to its continuation.

I am grateful to the cabinet secretary for that assurance. The chief executive of NHS Scotland, Paul Gray, has said that staff wanting to raise issues have not done so because they fear the consequences or believe that it would be pointless as their concerns will not be acted on. We cannot afford for there to be even the perception of such a corrosive culture in our NHS. The staff need to feel reassured that they are part of a listening, transparent health service. One campaigner has called for a root and branch review of how the NHS reacts to justifiable criticism. Is that something that the Scottish Government has considered, given how much the Government appears to have already learned from the freedom to speak up review in England?

Paul Gray was quite right to give what I thought was a frank interview. He said that we have a number of mechanisms in place, including the alert line, and very clear policies at a local level that have been worked up in partnership with the unions and which provide a range of ways in which staff can give their views. Obviously, that may sometimes involve issues with a line manager, so there are procedures in place that enable staff to report concerns outwith the line management structure.

However, if we thought that enough had been done, we would not be working to establish an independent national whistleblowing officer for Scotland. As I said, that role will complement existing policies and provide an independent and external level of review of the handling of whistleblowing cases, which will add an important dimension. However, if there is more that we can do to contribute to having a more honest and open reporting culture, we will look at what that is. It is very important that staff feel able to give their views and raise concerns, not least because that can be very important from a patient safety perspective.

What steps is the Scottish Government taking to ensure that there is an independent and external review system in place for the handling of whistleblowing cases in Scotland?

As I said earlier, work is under way to establish an independent national whistleblowing officer. That role will provide a complementary service to existing policies as well as provide, importantly, an independent and external review of the handling of whistleblowing cases. We have considered the range of views that were expressed in the consultation and we want to continue to work with our partners to ensure that staff are protected when raising concerns. As I said, we want to encourage an open and honest reporting culture.

It is clear from Paul Gray’s statement that NHS staff still feel unable to speak up about concerns. What is the Scottish Government’s position on confidentiality clauses in staff contracts, which might be preventing employees from speaking up in public?

We have done a lot of work on confidentiality clauses. We have made it clear to boards that they should be used only in very exceptional circumstances and, if we look at the change in the use of such clauses, we see that far fewer are now used. A lot of work was done when concerns were raised previously about the use of confidentiality clauses. I will continue to keep an eye on that and I am happy to keep Donald Cameron informed. If he wants an update with some more detail on that, I am certainly happy to write to him.

First, I think that we should thank Paul Gray for his brave and honest intervention yesterday. I hope that, as a result, he gets understanding from the health secretary, rather than wrath.

The reality is that increased vacancies and cuts in our health service are only adding extra pressure to already overstretched NHS staff, one in 20 of whom are on sick leave at any one time. Surely that ratio would not be acceptable in our Parliament, and it should not be acceptable in our health service. NHS staff have a duty of care for patients, and I believe that we as parliamentarians have a duty of care for NHS staff. What additional steps will the cabinet secretary take post Paul Gray’s intervention yesterday?

Any fair person listening to the answers that I gave earlier—and Anas Sarwar, if he had been listening—would know that I agreed that Paul Gray was right to put his concerns on the record. Rather than chastising him or expressing wrath, I support what he said. Perhaps Anas Sarwar should listen more carefully to answers that are given.

Paul Gray, in his position of leadership, and I, in my position of leadership, have made it clear that we take seriously any staff member’s views or concerns and how they can articulate them. That is why, over the past few months and years, a range of opportunities has been put in place that enable staff to raise concerns, whether that is done through the alert line—they can do it anonymously—or through the structures that are in place in our health boards. All that has been done in partnership with the unions and we will continue to work in partnership with them.

However, if we thought that enough had been done, we would not be moving towards establishing an independent national whistleblowing officer. That has been taken forward after consultation about the best way to do it. If there are any further mechanisms that we can consider to develop and improve an open and transparent culture, we will consider them.

On what Anas Sarwar said about vacancies, I note that we have record levels of staff in our NHS—we have 11,000 additional staff. The fact that we have more posts sometimes means that we have higher levels of vacancies, because some of those posts are more challenging to fill.

In paying tribute to every single person who works within our NHS and care services, I say that, as far as I am concerned as Cabinet Secretary for Health and Sport, I will do what I can to ensure that we develop an open and transparent culture, and Paul Gray will do the same in his position.

What powers does the Scottish Government anticipate the independent national whistleblowing officer having? When will the officer be introduced?

We will use the findings of the analysis to further inform and refine proposals to ensure that the independent national whistleblowing officer is equipped to carry out the role effectively. We are clear that the INO should be able to provide independent challenge and oversight and have the powers and functions that enable it to do so.

We will introduce legislation to bring the role and functions into effect. As I said, that will complement policies that are already in place to promote, support and encourage whistleblowing and further develop that important, open and honest reporting culture in NHS Scotland. During the passage of that legislation through Parliament, members on all sides will be able to input to it.