Dignity at work: Policies and legislative framework

The National Health Service (NHS) is the third largest public sector employer in the world. There are 1.6 million employees who provide care for the population of the UK. The NHS in England forms the biggest part of the health service in the UK with more than 1.3 million staff which includes over 40,000 general practitioners (GPs), 351,446 nurses, 18,576 ambulance staff, and 111,963 hospital and community health service (HCHS) medical and dental staff. In addition, there are other non-clinical staff who play an equally important role in the functioning of the NHS. The NHS is currently undergoing major reforms and has become a focus of political debate. Many concerns have been raised about the pressures under which the staff have to carry out their duties, and links from this to patient safety risks. Reports such as the Francis review into Mid Staffordshire, the Berwick review into NHS patient safety, and the Keogh review to urgent care services all highlight the need to empower staff to raise concerns about patient safety. Many NHS Trusts have found themselves in focus for not being able to provide a safe working environment for their employees when they have raised concerns about the practices in their Trust. Concerns about bullying and harassment in the NHS and NHS culture have been prevalent for some considerable time and it has been named ‘the silent epidemic’. There are many reports that highlight the extent of bullying and harassment in the NHS. A 2014 GMC report found that 1 in 10 doctors reported to have been subjected to bullying and harassment in the workplace. The 2014 national NHS staff survey indicated that while more than 90% staff knew how to raise concerns about patient safety only 68% would feel secure in doing so about unsafe clinical practices and only 57% would feel confident that their organisation would address their concerns. These concerns led to the review into whistleblowing by Sir Robert Francis QC, who recommended a Duty of Candour to make it a legal duty for all staff to speak up against undesirable practices in the NHS which compromise patient safety, respect, and dignity. The review also recommended key tenets of a culture that promotes raising concerns: