The Freedom to Speak Up review – whistleblowing post Mid Staffordshire

Extreme poor standards of care exposed at Mid Staffordshire NHS Foundation Trust in England made national headlines in 2009 and horrified the public and NHS staff alike. A report led by Robert Francis QC, a barrister with extensive experience of clinical negligence claims exposed appalling treatment of patients and high mortality rates at the hospital trust. The public inquiry heard recurrent themes of patients left lying in their excrement or vomit, call bells unanswered, food and drink which couldn’t be reached and incidents such as falls hidden from relatives. Many patients and their relatives reported being treated callously and with insensitivity by nursing staff.

It became apparent from Sir Francis’ report that although we proclaim openness and honesty in the National Health System (NHS) in the UK there still remains a problem when it comes to staff speaking out when wrong doing takes place – in other words ‘whistleblowing’.

‘Whistleblowing’ is when an employee reports suspected wrongdoing in their workplace and is concerned with making a disclosure which is in the interest of the public. The employee might notice something illegal, a person acting dangerously at work or someone neglecting their role. There may be a risk to someone’s health or safety, environmental damage, law breaking and illegal activity or the covering up of some wrong doing. Of the recommendations, arising from the public inquiry into Mid Staffordshire NHS Foundation Trust, a key area with most attention was encouraging staff to raise concerns or whistleblow. All of us are very aware of the catastrophic effects that might arise if concerns are not identified and acted upon. Whistleblowers continue to face problems if they speak out in the health service even though there has been a concerted effort to create an open and honest culture where whistleblowing is viewed positively. That said whistleblowers continue to face problems if they speak out in the health service even though there has been a concerted effort to create an open and honest culture where whistleblowing is viewed positively. See

Since Sir Francis’ report The Freedom to Speak Up review also led by Sir Robert Francis QC, was published on 11 February 2015 which explored the raising concerns culture in the NHS. Worryingly, as mentioned, there continues to be a problem and staff continue to feel intimidated and unable to speak out. If staff don’t speak out patient care may remain sub-standard. A Tweet just yesterday on Twitter from the Patients Association@PatientsAssoc reported:

Themes from our Helpline: ‘Patients want to be treated humanely, with compassion and listened to’:

The Freedom to Speak Up review makes a number of key recommendations under five overarching themes with actions for NHS organisations and professional and system regulators to help foster a culture of safety and learning in which all staff feel safe to raise a concern. It recognizes that since reporting on the failings at Mid Staffordshire, some progress has been made in the NHS but there is still much to be done if we are to continue building a culture of improvement and learning. Since the Freedom to Speak Up review the Secretary of State has committed to write to every NHS trust chair to buttress the importance of staff feeling safe to discuss concerns openly in teams, and for appropriate actions to be taken. Each organisation is to appoint a local guardian with direct reporting line to the chief executive, who staff can approach to raise concerns. There is also a national Whistleblowing Helpline which provides advice for staff on raising concerns. It is also available to employers for advice on policy and governance arrangements. Tel: 08000 724 725 or email

Protecting patients and staff from harm and ensuring dignity of care requires an open and transparent culture at all levels of the system, but getting it right is no easy task.

Other useful websites include: which offers guidance for employers signposting them to guidance, policy and legislative drivers realted to whistleblowing which offers guidance for staff about raising conerns Sir Robert Francis review of whistleblowing processes and the latest information about the ‘Freedom to Speak Up’ review tools and resources – free downloadable communication tools and frequently asked questions.




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