Promoting partnership working in the NHS

Raising concerns (whistleblowing)

The SPF encourages open environments in NHS workplaces, where staff feel confident to raise concerns about poor quality care and this feedback is used to improve the services the NHS provides.

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.

The whistleblowers' support scheme, which was launched in November 2019, helps current and former NHS workers who are having difficulty finding suitable employment in the NHS as a result of raising a concern in the public interest.

The scheme is open to anyone who:

  • is an NHS worker, current or former
  • has raised concerns in the public interest about the NHS
  • can demonstrate sound performance prior to raising concerns
  • suffered detriment as a result of speaking up
  • has experienced difficulties staying in or finding suitable NHS employment since raising concerns in the public interest
  • is eligible to work in the UK
  • is looking for work in England.

Relevant information including a guide to the scheme and the application form is available on NHS England’s website

The scheme acts on the recommendations from the 2015 Freedom to Speak Up review and the learning from a pilot scheme.

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. 

On 1 April 2016, NHS England and NHS Improvement launched a national, integrated whistleblowing policy to help standardise the way NHS organisations support staff who raise concerns. 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 freedom to speak up guardian must to be appointed in every trust
  • concerns not resolved quickly through line managers involvement, will be investigated
  • investigations must be evidence-based and 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 are kept informed throughout the investigation process
  • boards are 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. The full consultation response document is available. 

Whistleblowing in primary care was reviewed separately and resulted in the production of specific guidance for primary care on freedom to speak up.

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 sets out 20 principles and actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future. These are designed to:

  • promote a culture in the NHS where staff feel safe and encouraged to speak up 
  • make sure all concerns are heard, investigated properly and the right support is on hand for staff
  • protect vulnerable groups, such as student nurses and medical trainees, from intimidation 
  • prevent discrimination against people who have been brave enough to speak up and help them get back into work.

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

Raising concerns at work: whistleblowing guidance for workers and employers in health and social care, published in 2014, set 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.

The Draw the line campaign, launched in February 2015 supports and enables managers to have open conversations about raising concerns. Campaign material includes resources for managers targeted at supporting implementation and embedding of frameworks that affect a change in culture. For more information see the NHS Employers website

New e-learning resources to support NHS staff to raise concerns on issues such as patient safety are being launched by Health Education England during October, to mark Speak Up Month, a campaign run by the National Guardian’s Office.

They include Speak Up, the first instalment of a three-part Speak Up, Listen Up, Follow Up e-learning programme for staff, volunteers and those in training, which explains how to speak up, and what to expect when colleagues do.

Watch this video to find out more about freedom to speak up guardians

The subsequent modules aimed at middle managers and senior leaders will follow by March 2021.