THE admission by the chief executive of NHS Scotland Paul Gray in The Herald today that too many staff feel unable to raise valid concerns about the service is a sign of progress on the issue of openness in the health service. Mr Gray says he wants every employee to be able to raise their concerns and feel confident that action will be taken – he also accepts that a perception persists that those who do complain may be victimised and that their careers will suffer. This is a perception, says Mr Gray, that he wants to change.

After several years in which whistleblowers have been victimised and bullied out of the NHS, Mr Gray’s intervention is extremely welcome. The chief executive has been speaking to staff around the country and seems to accept the basic principle that they should be able to talk honestly and publicly about any shortcomings without fear of reprisals. Only then can we have an honest discussion about how to run, and fund, the country’s most important and valued public service.

However, Mr Gray’s admission that change is needed is only the beginning. He does appear to genuinely want staff to be able to raise complaints when they occur, but is he really being honest enough about how hard it is in reality for them to do that? And is he yet willing to acknowledge the pressure there is on NHS managers to suppress complaints that might expose what is really going on in the service? Even staff with constructive complaints about the NHS have been sat on and silenced by managers.

The reality is that staff still do not feel able to speak up on issues of concern in the NHS and, while Mr Gray’s comments will help, more constructive steps are needed if the culture is to change. The good news is that there is now an independent helpline for people who feel the need to speak to a third party, but some staff have no confidence in it and an obvious flaw is the fact complaints cannot be made anonymously, which does not help if you are worried about reprisals from managers. Mr Gray suggests staff could use the Patient Opinion Scotland forum to complain anonymously, but the question he should really be addressing is why staff feel they need to complain anonymously in the first place.

Another ongoing problem is the gagging clause which is sometimes inserted in staff contracts and forbids employees from talking publicly about their concerns. It is hard to see how such a clause can ever be justified - raising concerns ought to be a normal part of working life, but it is particularly important in a service that deals with life and death. The Scottish Government promised to deal with the issue and there is supposed to be a presumption against the use of such clauses, but it is hard to see why we should not go further and simply ban them outright.

In his response on the issue of openness, Mr Gray says he wants to take action but public statements of intent are not enough. If the culture on the wards, staff rooms and managers’ offices is to change, then a review is required to determine exactly what is causing the culture and what could change it. Mr Gray has taken the first step in admitting there is a problem – his next challenge is to fix it.