14 August 2015

Wellington House
133-155 Waterloo Road
London SE1 8UG

Dr Minh Alexander
T: 020 3747 0000
E: enquiries@monitor.gov.uk
W: www.monitor.gov.uk

By email
minhalexander@aol.com

Dear Dr Alexander
Request under the Freedom of Information Act 2000 (the FOI Act)
I refer to your email of 17 July 2015 in which you requested information under the FOI Act.
Your request
You made the following request:
I write to request a copy of Monitors submission to the recent Department of Health
consultation on implementation of the Freedom to Speak Up Review by Sir Robert Francis.
I would be grateful for a copy of Monitors full submission. Please consider this a request
under the Freedom of Information Act 2000.
Decision
We hold the information that you have requested and have decided to release our
submission to the Department of Health consultation, a copy of which is attached to this
letter.
In relation to the Review, please note that although we have no role in resolving
whistleblowing concerns locally at trusts, we are a prescribed person to which a protected
disclosure can be made and where we receive whistleblowing concerns from NHS staff, we
carefully consider them and respond appropriately. If we consider that the concerns raised
are relevant to our role, and raise wider concerns about how a foundation trust is being run
which could indicate a breach, or potential breach of its provider licence, we may decide to
look into the matter further. This can include a variety of actions, including speaking to the
CQC and other partner organisations, or the trust itself. We then communicate the outcome
of our consideration to the whistleblower.
We were significantly engaged in the Freedom to Speak Up review as the sector regulator of
NHS funded healthcare and have always recognised the importance of whistleblowing to
improving the NHS. We attended two of the seminars hosted by Sir Robert Francis to further

our understanding of the experiences of NHS whistleblowers and to explain our role in
relation to whistleblowing. We were also fully engaged throughout with the compilation of
the response to the review. In addition, we have since strengthened our central team at
Monitor to deal with all complaints and whistleblowing concerns we receive, to further
improve the service we provide to individuals who raise concerns with us, as well as improve
how we use the intelligence they give us about the health sector
Review rights
If you consider that your request for information has not been properly handled or if you are
otherwise dissatisfied with the outcome of your request, I am happy to discuss it to try to
resolve any concerns informally. If you remain dissatisfied, you may seek an internal review
within Monitor of the issue or the decision. A senior member of Monitors staff, who has not
previously been involved with your request, will undertake that review.
If you are dissatisfied with the outcome of any internal review conducted by Monitor, you
may complain to the Information Commissioner for a decision on whether your request for
information has been dealt with in accordance with the FOI Act.
A request for an internal review should be submitted in writing to FOI Request Reviews,
Monitor, Wellington House, 133-155 Waterloo Road, London SE1 8UG or by email to
foi@monitor.gov.uk.
Yours sincerely

Tom Grimes
Head of Enquiries, Complaints and Whistleblowing

ANNEX
MONITORS RESPONSE TO DEPARTMENT OF HEALTH CONSULTATION ON THE
FREEDOM TO SPEAK UP REVIEW - 3 JUNE 2015

Response to Department of Health consultation

Monitor welcomes the opportunity to respond to this consultation. We were fully engaged
with the Freedom to Speak Up Review to which we provided evidence, and also with the
formulation of the consultation on the implementation of the recommendations, principles
and actions set out in the report of the Review. We have already given our in principle
support to all of the recommendations made.
In summary, we should like to strongly endorse the necessity for the NHS in England to have
a reporting culture where all staff feel safe to speak out about patient safety and for lessons
to be learned from experiences, both positive and negative. As David Bennett, Chief
Executive of Monitor, said in his letter of 11 February 2015 to all NHS managers at
foundation trusts emphasising the importance of the Review and encouraging them to
ensure their staff are enabled to speak up with concerns, the importance of listening to staff
cannot be over emphasised. When staff raise concerns, they very often know where things
are not working well and when care is not safe, so they can help enormously in improving
and ensuring acceptable levels of patient care. This is vital. It is also, of course, core to the
work we do at Monitor in our mission to make the health sector work better for patients.
As the sector regulator, how foundation trusts respond to concerns raised by their staff
forms an important part of our regulatory oversight. For example, in our recently launched
Well-led framework for governance reviews in which we provide a framework to support
trusts gain assurance that the effectiveness of their governance arrangements is both
maintained and developed, we set out a specific domain on capability and culture. The
aim of this is for trust boards to determine whether they are taking the necessary steps to
ensure they have the appropriate experience and abilities, now and into the future, and can
positively shape their organisations cultures to deliver care in a safe and sustainable
way. In addition, we set out a process and structures domain which helps ensure that
reporting lines and accountabilities support the effective oversight of the trust. A specific
question concerns whether the board actively engages patients, staff and governors and
other key stakeholders on quality, operational and financial performance. Boards are
guided to ensure that staff actively raise concerns and that those who do, including external
whistleblowers, are supported. Concerns should be investigated in a sensitive and
confidential manner, and lessons are shared and acted upon. Further, Boards are expected
to ensure the following:

There is an appropriate mechanism in place for capturing frontline staff

concerns. This includes a defined whistleblower policy/error reporting process
which is defined and communicated to staff; and staff are prepared if necessary
to blow the whistle, and that their organisations:
have considered and implemented the recommendations of the freedom to
speak up review into creating an open and honest reporting culture in the NHS.

Our Risk assessment framework is guidance for foundation trusts in complying with their
continuity of service and governance licence conditions. In this, we expressly state that
whistleblower concerns are examples of third party reports which are indicators of potential
governance issues and as such will be investigated as we deem appropriate.
In addition, we receive information about sub-standard governance arrangements or care
directly, for example, from staff or former staff of NHS providers which we review and may
use to help inform our assessment of foundation trusts. We have a good system by which
we work closely with the CQC in handing them concerns raised about quality of care which
as the quality regulator they are first placed to consider, and have recently expanded,
strengthened and centralised our internal management of all complaints and
whistleblowing at Monitor to ensure effective and prompt handling.
We should like to raise a specific point with regard to the Independent National Officer. To
assist the clarity and accountability of this role, we think it important to be express about its
reporting line. As the INO will be hosted at the CQC, we consider that the role should most
appropriately report directly into the CEO of the CQC. In addition, and again to ensure
accountability and very senior oversight, the Local Guardians should report into the trusts
CEO.

In conclusion, we would add that Monitor remains committed in this and all matters to learn
from experience and keep matters under careful review. Where we can improve our
approach in helping the necessary cultural change in the NHS - so that flagging up
problems, risks and mistakes as they occur and learning from them to improve patient care
becomes the norm - we will do so.