Promoting partnership working in the NHS

Raising concerns (whistleblowing)


The importance of raising concerns at work in the public interest is recognised by employers, staff, trade unions and the general public. The SPF believe that it is incredibly important that there is an open environment in NHS workplaces, where staff feel confident to raise concerns about poor quality care and that management, staff and their trade unions work together in partnership to use this invaluable feedback to improve the services the NHS provides. 


On 1 April 2016, NHS Improvement and NHS England launched the first national, integrated whistleblowing policy, that helps to standardise the way NHS organisations support staff who raise concerns. The policy was one of a number of recommendations of the review by Sir Robert Francis into whistleblowing in the NHS, to help normalise the raising of concerns for the benefit of all staff and patients.

The policy sets out:

  • who can raise a concern
  • the process for raising a concern
  • advice and support when raising a concern
  • how the concern will be investigated
  • what will be done with the findings of the investigation.

The policy ensures:

  • NHS organisations must encourage staff to speak up and set out the steps they will take in order to investigate their concerns.
  • A local Freedom to Speak Up Guardian must to be appointed in every trust, who will act as an independent & impartial source of advice for staff when raising a concern.
  • Any concerns that are not resolved quickly through line managers involvement will be investigated.
  • Investigations must be evidence-based & led by an independent figure in the organisation, with a subsequent report which focuses on the lessons to be learnt and the improvement of patient care.
  • Whistleblowers must be kept fully informed throughout the investigation process.
  • The organisations board are to be made aware of ‘high-level’ findings and the policy will be reviewed and improved on an annual basis.  

Partner organisations contributed to the policy through responding to a consultation, which ran from 16 November 2015 to 8 January 2016. The full consultation response document is available. Over 165 responses were received from NHS staff members, whistleblowing organisations, trade unions, trusts, foundation trusts and clinical commissioning groups.

On the recommendation of Sir Robert Francis, whistleblowing in primary care was reviewed separately and resulted in the production of specific guidance for primary care on freedom to speak up

To promote the importance of staff raising concerns, NHS Employers has worked with its SPF partners to produce posters which encourage staff to report a risk, wrong doing or malpractice in their organisation. These posters can be downloaded from the NHS Employers website.

Speak Up offers free, independent, confidential advice on the speaking up process for employers and employees in the NHS and adult social care. You can find more information on their website.

Raising Concerns at Work: Whistleblowing Guidance for Workers and Employers in Health and Social Care in 2014. This guidance sets a standard for whistleblowing/raising concerns policies in health and social care organisations. 

Key messages in the guidance include:

  • the importance of encouraging staff to raise concerns as part of normal day-to-day practice and how this can help employers identify poor practice and improve the quality and safety of care
  • an outline of the legislation – the Public Interest Disclosure Act 1998
  • a flowchart of the whistleblowing process
  • top tips for workers who wish to raise concerns and sources of advice and support
  • top tips for operational managers to respond positively when staff raise concerns
  • at corporate level, the guidance sets national standards for whistleblowing policies for employers, together with a summary of their responsibilities
  • case studies of good practice, frequently asked questions, and further information and links.

In addition, the SPF recommends the importance of having robust and effective whistleblowing policies in every workplace, agreed in partnership between the employer and representative staff unions.


As detailed in the Francis Inquiry Report, Professor Michael West’s research and the recent IPA report, Meeting the Challenge: Successful Employee Engagement in the NHS, a growing body of evidence is emerging around the critical link between good staff engagement and patient experience and outcomes.

The NHS Constitution sets out the right of all staff, doing clinical or non-clinical NHS work to raise any concern with their employer, whether it is about safety, malpractice or other risk, in the public interest.

On 11 February 2015, Sir Robert Francis QC published his report on the Freedom to Speak Up review. The review was set up in response to continuing disquiet about the way NHS organisations deal with concerns raised by NHS staff and the treatment of some of those who have spoken up. The report makes a number of key recommendations to help foster a culture of safety and learning in which all staff feel safe to raise a concern, under five overarching themes:

  • culture change
  • improved handling of cases
  • measures to support good practice
  • particular measures for vulnerable groups
  • extending the legal protection.

The SPF responded to the report as part of a statement on the results of the 2014 NHS Staff Survey.

In response to the Freedom to Speak Up report, NHS Improvement are working with a number of whistleblowers and NHS employers to develop a whistleblowers' support scheme for secondary care. For more information on this scheme, please see the NHS Improvement website.

NHS England and NHS Improvement have developed a pilot scheme to retain whistleblowers in the NHS workforce. The scheme has been designed with input from a range of stakeholders, including whistleblowers and aims to provide support and assistance to whistleblowers applying for jobs in the NHS, as well as offering guidance to employers to view raising concerns as a positive characteristic in a potential employee. For more information, download the pilot scheme slides

The 'Draw the line' campaign launched in February 2015 supports, guides and enables managers to have open conversations locally about raising concerns. The campaign includes the publication of a series of new on-line resources for managers.  All are targeted at supporting NHS organisations to implement and embed frameworks that affect a change in culture and raise awareness of the different approaches being successfully adopted across the country and across sectors. The SPF is fully engaged in the range of programmes that are underway to help influence the changes that need to happen to embed the right kind of culture and behaviours which enable NHS staff to raise concerns. Read more on our Draw the line web page.  

For further advice and support about raising concerns in your workplace, you may also want to contact your trade union or HR representative.

Every NHS trust and foundation trust should have a freedom to speak up guardian. Their role is to work with the board and the executive team to support an organisation be an open and transparent place to work. They should act in an independent and impartial capacity, listening to staff and supporting them to raise concerns.

The national guardians web pages on the CQC website include a national directory for freedom to speak up guardians.