• UK trained staff are much more likely than internationally trained staff to raise concerns. 71.0% of UK trained staff have highlighted race discrimination as an issue, compared with 53.1% of internationally trained staff.
• The most common reason for not raising a concern of race discrimination was not believing anything would change (75.7%). 63.5% of people who didn’t raise their concerns were worried about being seen as a troublemaker
• Of those staff who have raised concerns, only 5.4% said they were taken seriously and that their problem was dealt with satisfactorily.
• The most common outcome to a race discrimination concern was nothing happening (the outcome in 42.7% of cases). In one in five (19.1%) instances, claims of race discrimination were treated the same as any other workplace dispute and referred to mediation. In 5% of cases, the individual raising the concern were themselves disciplined.
• 41.8% of respondents left their jobs as a result of their treatment.

Further reading from Peter Duffy:

• Whistle in the Wind: Life, death, detriment and dismissal in the NHS. A whistleblower's story by Peter Duffy
• Smoke and Mirrors: An NHS whistleblower witch-hunt by Peter Duffy

Transcript

I'm Jane Somerville. I'm a retired professor of cardiology, having been on the staff of the Royal Brompton Hospital and Heart Hospital. I don't practise medicine anymore. I'm interested in whistleblowing doctors. 

I became involved because I went to a conference at the Royal Society of Medicine which unfortunately they wouldn't repeat, although they promised to do so, and I was horrified at what is happening to people in my profession who speak up for the safety of patients.

Firstly, they're supposed to speak up for the safety of patients, it's called our Duty of Candour, and secondly the treatment by the trusts, mainly managerial, is absolutely appalling, and I decided with my colleague David Ward that we really ought to work and do something. And why should we? Well, because I'm untouchable—they can't take my career from me, they can't prevent me doing anything, they can't do anything and I'm senior enough in the profession to be able to speak with some authority, at least about how medicine works. So I thought, nothing to lose and everything to gain for my profession.

Question: How are you supporting the work to protect doctors who speak up?

David Ward and I are working with Justice for Doctors and they include us in their meetings. We try not to get involved or allied with them but they know we're on their side and we speak out, and by virtue of our seniority we get to see people, make some sensible suggestions. Working with the excellent David Hencke who is writing Westminster Confidential— the actual facts. And he has brought the facts of the most horrible tribunal that's been going on with this Martyn Pitman, a distinguished and useful obstetrician and a gynaecologist doing good work, and the Royal Hampshire has behaved extraordinarily badly, in my view.

Question: Why aren’t existing systems in the NHS protecting doctors who speak up for patient safety?

The Freedom to Speak Up Guardians are usually not strong enough to bang and say to the CEO or the chief executives or the chairman or the board. They're just not strong enough to say, “This has to stop,” so who's to stop the trust managers or the trust managing executives (who could be doctors)? Who's to stop them if they want to persecute? It is part of the coverup culture that unfortunately exists since managers came into the health service. When I grew up, which wasn't yesterday, but also my younger colleagues, we didn't have all this until we had managers. Nobody regulates managers, they can just do what they like, they don't have a General Medical Council—they don't have anything! They have no code and lots of them aren't even educated to be a manager. It needs to be properly regulated and they need not to have both the money and the command, and our foolish profession has allowed both. They have control of the money—thousands of pounds are spent on legal fees of very expensive lawyers and it's a very unjust set of arms. The litigant or the complaining doctor has almost nothing unless he happens to be a rich consultant, and the trust has everything, with these managers in control. 

There's another side to this which is very, very serious, that I don't want really to touch on except to tell you and that is the question of employment tribunals. They manage to get these doctors to employment tribunals and it's not by chance that the respondents, the trusts, win 97%— that can't be justice, 97%! But I think the justice system has to look into the trouble of the employment tribunals, but it's very unjust on the doctors and very unfair ultimately for the patients.

Question: How widespread are the issues facing NHS whistleblowers?

Do I have any knowledge of how widespread it is? Answer, no. Why? Because they don't keep statistics in the Department of Health, We've asked them at quite a high level—no idea, thought it was a rather strange question. So we don't have statistics, complaints are not registered and you can't get information. And coupled with that is the improper making and signing of NDAs, which they do to the doctor and of course they're (the doctor) not allowed to go to the press, they're not allowed to speak to anybody and bad things happen even, I regret to say, suicides. To end how widespread it is, of course we don't know. It's more widespread than we think and there are more people who have suffered than we know—they're frightened to come forward. It's a culture of fear in a culture of cover up.

Question: What needs to be done to protect doctors who speak up for patient safety?

Key number one is stop persecuting doctors who speak up for the safety of patients. All that matters to us is the safety of patients and so therefore they must be given respect. They may not always be right, they may be saying silly things or they may be absolutely on the ball, but they must be listened to and they must not be persecuted by managers. 

Then next comes they (managers) must be regulated in their behaviour and I am hoping, although it is very serious, that something will come of this corporate manslaughter problem that is going to be brought up. That will concentrate the minds of the managers. They'll be a bit more careful automatically. So stopping the persecution should be automatic—ordered by the Government, ordered by the Prime Minister, ordered by whoever—but they have to stop it. 

Secondly, there's the question of the regulation of the funds used to have unequal arms—very expensive lawyers and leading QC's cost the Earth so the thing gets more and more and it shouldn't get to the employment tribunal. That needs looking into, but I don't think that's our business. Maybe employment tribunals do some good—not as far as the doctors are concerned. It's a very, very bad system. So let the judiciary get on and organise their own as we should organise our own medical aspects and concern ourselves about the safety of patients.

It really is urgent to do something about this in the health service. It's the sort of thing that is losing doctors and doctors in training—I mean who wants to go into a health service where the managers can treat you like dirt, and do. Safety within the health service, within the doctor's brief, is vital and absolute and primary.

Related reading

• Jane Somerville interview on staff speaking up: Transcript from Times Radio Breakfast (7 September 2023)
• The NHS whistleblowing crisis (8 February 2022)
• Westminster Confidential - Tribunal of the absurd: My verdict on the Dr Chris Day whistleblower case (David Hencke, 19 November 2022)

JS: Dr Jane Somerville (Emeritus professor of cardiology, Imperial College)

RW: One of the striking things about the Lucy Letby case was how doctors raised concerns but were told to, in effect, butt out by their managers. Now we know the Letby case was one-of-a-kind but a senior doctor has told The Times that the persecution of doctors who speak up is systemic.

Here’s Jane Somerville, Emeritus Professor of Cardiology Imperial College and one of the country's most renowned consultants. Jane, thank you for your time – explain if you can. Management in hospitals. Why is it that you believe that they’re failing to listen to anyone working in the hospital who raises concerns?

JS: Good morning, I think that the managers have power. I think they have a cover up culture which is very severe.  I think they want to stop people complaining. And they like persecuting the doctors.  So anybody who speaks up for safety of a patient – which is vital for a doctor to do – they will persecute.

We don't know how often this occurs. We do know the outcomes in many patients. It is extremely serious. They lose their jobs. They lose their livelihood sometimes, and they are persecuted by the managers (which also include their chosen doctors).

RW: Presumably  you are speaking about this from experience, having witnessed it?

JS: Oh yes I've witnessed it many times over the last four years since I've been interested in the problem rather than practising medicine. I’ve wanted to help them. I personally am involved in whistleblowing. I'm not a whistleblower – I escaped. I had plenty to talk about, but I didn't get involved as a whistleblower. Most whistleblowers that we know in Justice for Doctors have blown and have lost their jobs.

It's a very serious problem.  It's systemic in the National Health Service. It may not be in every trust – we don't know because they don't keep a record. It's a very serious problem because it ends up in the loss often of good consultants.

Recently in the press there has been the loss of an obstetrician in Hampshire, a maxfax (maxillofacial surgeon) in Bath, a cardiologist in Saint Helier (a disastrous trust for this) and you know about all the dreadful goings on in maternity – I don't need to repeat that. It's really very serious, and the managers must be regulated – they are an unregulated bunch.

RW: Jane, presumably when there is a problem there is a process in place for, let's say, a concerned doctor to be able to report it. What's wrong in that process do you think?

JS: Well, the first thing is it doesn't work in many cases. I'm sure there are many where it does, but it doesn't work in serious cases. A cover up process from the top to the bottom – or from the middle upwards, we don't know where – continues until finally the doctor may find himself in an employment tribunal. And that’s another set of disasters – the judiciary within employment tribunals. They should never get to that is the first thing. And when they get to that, 97% are lost by the litigant, by the complainant.

RW: The argument is great – changing culture and practice among trust managers and executives.

RW: Jane, thank you so much for your time. Jane Somerville,  a Professor of Cardiology at Imperial College. I must say that the paper (The Times) has reached out to the Department of Health and Social Care, and the Ministry of Justice for comments. For people reading online that story will be updated when we hear from them.

1. Organisations referring a doctor’s fitness to practise to the GMC should be encouraged to answer a written question the effect of which is to ascertain whether the doctor being referred has raised concerns about patient safety or the integrity of the system.

2. Organisations referring a doctor’s fitness to practise to the GMC should be encouraged to have the document containing the allegation signed by a registered doctor and to contain a statement by the doctor to the effect that: “I believe that the facts stated in this document are true”.

3. If the written document containing the allegation is not signed by a registered doctor and/or does not contain a statement to the effect that “I believe that the facts stated in this document are true”, organisations should be encouraged to explain why this has not been done.

4. If a doctor being referred to the GMC has raised concerns about patient safety or the integrity of the system with the organisation making the referral, then the necessary steps should be taken to obtain from the organisation material which is relevant to an understanding of the context in which the referral is made.

5. Investigators assessing the credibility of an allegation made by an organisation against a doctor who has raised a concern should take into account, in assessing the merits of the allegation, any failure on the part of an organisation to investigate the concern raised and/or have proper procedures in place to encourage and handle the raising of concerns.

6. In those cases where an allegation is made by an organisation against a doctor who has raised concerns, the Registrar should, where it is appropriate to do so, exercise his powers under rule 4(4) to conduct an examination into that allegation, including taking the steps outlined in my earlier recommendations and asking the doctor for his or her comments on the allegation and the circumstances in which the allegation came to be made.

7. Those who investigate allegations made against doctors who have raised concerns must be fully trained to understand “whistleblowing”, particularly in the context of the GMC and the NHS.

8. The GMC, together with healthcare regulators, professional organisations, unions and defence bodies, set up a simple, confidential and voluntary online system, run by an organisation independent of the regulators. The system would enable healthcare professionals to record electronically the fact that they have raised a concern with their employers, what steps they have taken to deal with the concerns, including details of when and with whom the concerns were raised. The date and time at which the healthcare professional made the entries would be recorded. Access to the record would be restricted to the professional or another person with his or her consent.

The scale of the problem

The hidden costs of stigmatisation of healthcare whistleblowers are immense. System-wide problems in this area of healthcare are reinforced by a lack of transparency and the failure of accountability. The consequences of this failure have been investigated many times over the years. A seminal case was that of the Bristol heart surgery scandal in the 1990s. This was brought to light by the anaesthetist Steve Bolsin and led to the implementation of a system of clinical governance.[1] This advance in measures to deliver quality, consistent and safe care remains as relevant today as it ever was. More recently, the investigation into the failings at mid Staffordshire[2] highlighted how a ‘good news’ only culture, where reputation management was placed above patient safety, is failing patients. Critically for me the shocking fact is that where staff who blow the whistle can't, or don't, speak out, are ignored or silenced, the onus to expose wrongdoing falls on patients and their relatives. This involves great personal cost.

The onus to expose wrongdoing falls on patients and their relatives. This involves great personal cost.

This shameful thread of patient-led whistleblowing goes back a long way and has not stopped. Examples where patients, carers or relatives have had to take the lead and blow the whistle include the death of Robbie Powell,[3] Elizabeth Dixon,[4] Oliver McGowan,[5] Claire Roberts and those who died in the Belfast Hyponatraemia scandal,[6] the Gosport War Memorial Hospital scandal,[7] and the investigation into maternity services in East Kent.[8] These patient safety scandals show no sign of abating despite the report on the failings at mid Staffordshire[2] and Sir Robert Francis’ major review into whistleblowing in the NHS.[9] This is reinforced by the 2023 Bewick Review,[10] which is the first of three planned reviews into University Hospitals Birmingham NHS Foundation Trust. This review was commissioned following repeated serious concerns relating to patient safety, leadership, culture and governance, which were initially downplayed or ignored. The full story behind these failings and their significance has yet to fully come to light.

Patients have to blow the whistle on unsafe care

A stream of healthcare scandals (too many to mention all of them here) have been exposed by members of the public. Key examples include the case of Robbie Powell who died of untreated Addison's disease in 1990.[3] Thanks to the tenacity of Robbie’s father (Will Powell) this led to the clarification of the absence of an individual legal Duty of Candour for healthcare professionals.[11] Despite numerous reports and failed investigations, including one of which put forward 35 suggested criminal charges, the Robbie Powell case remains open with the Crown Prosecution Service (CPS). In addition, the former Welsh Ombudsman and the English Ombudsman are both calling for a public inquiry into the case.[12]

Another case concerns those who died at Gosport War Memorial Hospital in the 1990s who were prescribed opioid medicines that were not indicated for their condition. This led to an Independent Review Panel,[7] which took four years and cost £14 million. The Panel found that 456 deaths in the 1990s had "followed inappropriate administration of opioid drugs". In 2019, Assistant Chief Constable Nick Downing, head of the Serious Crime Directorate for Kent and Essex Police, announced that a new criminal investigation into the deaths was to take place and the campaign for justice continues.

Other serious issues include premature deaths of people with learning disabilities and autism,[13] which led to the implementation of the learning from deaths programme. On average, the life expectancy of women with a learning disability is 18 years shorter than for women in the general population. The life expectancy of men with a learning disability is 14 years shorter than for men in the general population.[14] There are numerous individual cases that support this finding, many of which were first highlighted by parents, informal carers or relatives. In 2014, the Department of Health and Social Care published a report that found that almost two-fifths of people with learning disabilities died from causes "amenable to good quality healthcare."[15]

In 2022, a report by Dr Bill Kirkup into deaths in East Kent NHS maternity services[8] confirmed that the "onus was on patients to raise concerns" because the culture of fear prevented whistleblowers from speaking out. “In every case staff were aware of serious mistakes or wrongdoing but they were unaware of how to raise concerns because those who tried were subjected to peer pressure to be silent and everyone was afraid of the [personal] consequences.” These consequences were exemplified by the experience of the nursing director who was told that speaking up would harm her career.

Another significant report is that into the life and death of Elizabeth Dixon,[4] which contains recommendations that apply across the board:

"…6. Clinical error, openly disclosed, investigated and learned from, must not be subject to blame. Conversely, there should be zero tolerance of cover up, deception and fabrication in any health care setting, not least in the aftermath of error. (NHSE, GMC, NMC, MoJ)

7. There should be a clear mechanism to hold individuals to account for giving false information or concealing information relating to public services, and for failing to assist investigations. The Public Authority (Accountability) Bill drawn up in the aftermath of the Hillsborough Independent Panel and Inquests sets out a commendable framework to put this in legislation… It should be re-examined. (MoJ)

8. The existing haphazard system of generating clinical expert witnesses is not fit for purpose. It should be reviewed, taking onto account the clear need for transparent, formalised systems and clinical governance. (DHSC, MoJ)…"

The amount of evidence and the number of reports that were initiated thanks to the tenacity and courage of patients, relatives, carers and parents, is truly shocking.

How can we change this? How many more reports do we need? The only thing we can say with confidence is that lessons have not been learned.

Why don’t staff speak out?

I was recently asked ‘why don't staff speak out?’ There's very little rigorous research on whistleblowing in health and social care, so I can only offer my personal views on this apparent absence of ethical behaviour. I believe this quote from Margaret Heffernan (Professor of Practice at the University of Bath School of Management) goes some way to explaining this:

“I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS".[16]

If anyone has any doubts there are a string of high-profile cases to support it, including the cases of Steve Bolsin, Raj Mattu, Kim Holt, Peter Duffy and Chris Day.

When I was asked why staff stay silent my first thought was to say that those who would speak out have all left. Of course, this can't be the full story. So, what are the other reasons?

One possible reason is that people who are promoted to highly paid jobs attain these positions because they ‘toe the line’. Organisational psychologists talk about the role of enablers and ‘flying monkeys’ in maintaining this culture. A flying monkey is a psychology term that refers to an enabler of a narcissistic person, a henchman so to speak. Many staff keep their heads down and don't look too hard at what's going on around them. Some commentators see this as a behaviour that is supported by the promotion of toxic positivity. What I mean by this is a culture of talking-up successes, however small, completely ignoring failure, and therefore missing the learning that comes from failure. The widely used phrase ‘rock the boat but stay in it'[17] springs to mind here, especially the empty references to ‘radicals’ and ‘change agents’. This forms part of learning materials that are often accompanied by reams of management jargon and pseudo-science. This leads to a morally bankrupt approach where ‘all is well’ (‘nothing to see here’) and toxic positivity prevails.

The belief that no matter how bad a situation is, people should maintain a positive mindset, move on and not mention it, is a way of working that is directly contradicted in these wise words by the late Professor Aidan Halligan:

"Run toward problems, especially on a bad day."

My views may sound very harsh, especially coming from someone like me who left direct employment with the NHS in 2008. It's important to point out that I believe the vast majority of NHS staff, at all levels from clerical staff and porters to senior managers and chief executives, do their best to work around the bullying and toxicity to deliver safe care for patients. Doing their best despite the prevailing culture rather than being supported by it. Sometimes biding their time and subtly subverting directives that are not in patients’ best interests. For clinicians, the threat of being referred inappropriately to a professional body is ever present,[18] and an environment where the pressure of work is extreme, exhausting and unstainable are also major factors. For many, the prevailing culture also means that the careers of highly skilled accountable, ethical and caring staff are held back through denial of learning opportunities and promotion, and informal blacklisting which is commonplace.

There's an army of people ready for change, a huge informal network of highly motivated caring people, which is why I'm optimistic about the future.

Why have ‘speaking up’ reforms failed?

These are my personal views based on my experience and that of my colleagues.

Since Sir Robert Francis’ whistleblowing report[9] there have been several changes designed to improve the situation. These include Freedom to Speak up Guardians (FTSU), the introduction of an institutional Duty of Candour, the ‘Fit and Proper Persons Test'[14] for Board members and the NHS Whistleblower Support Scheme. In addition, the Health and Safety Investigation Branch (HSIB) was set up in 2017 and a National Patient Safety Commissioner was appointed in 2022.

Given all the above, why has there not been a reduction in high-profile healthcare failings? In my view there are several reasons.

Many believe, as I do, that the approach of the Care Quality Commission (CQC) to whistleblowing is part of the problem. We often learn from investigation reports that the CQC (and other regulators) had been listing problems in their reports for years and yet no meaningful action has been taken. ‘Regulatory capture’ is a serious problem, which is when regulators are adversely influenced by the people they are inspecting. This is often linked to the revolving door of staff who move from health and care employment to the regulators, and informal links which amount to cronyism. This behaviour is something that commentators have noted and which I have experienced myself.[20]. Patients suffer as a result.

The introduction of the National Guardian Office and Freedom to Speak Up Guardians in each NHS trust is also problematic. This initiative has an inbuilt conflict of interest, as the Guardians are employed by the trusts themselves. The All-Party Parliamentary Group on Whistleblowing (APPG) has heard from whistleblowers who have been failed by local Guardians, sharing their experiences that have included the disclosure of their identity to hospital management and boards, which resulted in retaliation. The APPG has also heard from local Guardians who were not supported and themselves the target of retaliation after supporting whistleblowers.[21] In addition, something which I find shocking is that the National Guardian Office appears to studiously avoid the word ‘whistleblowing’ in its material and outputs wherever possible. This adds to the stigma around healthcare whistleblowers and is inexcusable.

Another lesser-known initiative is the NHS Speaking Up Support Scheme[22] (originally titled the Whistleblower Support Scheme). There is not much information available on this scheme in the public domain. I became aware of the scheme when I was asked if I wanted to apply. Later I signposted several people to the scheme. I learned that although the scheme has benefited some people, for others it appears to have made their situation worse. Through a freedom of information request, and thanks to the intervention of my MP, I have managed to obtain a redacted copy of the evaluation of the pilot scheme which supports the view of mixed results.[23] Having read this report, it is unclear to me why it hasn’t been published and why it was redacted. Particularly as I think (I can’t be sure of course) that one of the redactions is a comment I made. A comment I wanted to be shared.

As for the other post-Francis review initiatives, the Kark Review in 2018 on the Fit and Proper Person Test (FPPT) is unequivocal in its findings:

"Essentially it [FPPT] does not ensure directors are fit and proper for the post they hold, and it does not stop the unfit or misbehaved from moving around the system."[24]

In addition, the statutory current Duty of Candour[25] seems, at times, to be little more than a tick box, with the responsibility for talking to patients often left to the most junior staff. A Duty of Candour is about simply telling the truth and is everyone’s responsibility, not a task to be delegated. The need for a legal duty of candour on individuals has been highlighted by Robbie Powell’s father Will Powell and links to proposals for a Hillsborough Law.

The HSIB and the National Patient Safety Commissioner initiatives have some built in limitations to what can be achieved. The HSIB’s remit does not include investigation of systemic problems. This limits the areas that they can cover. As for the National Patient Safety Commissioner, this is a new role which is very promising. Unfortunately, the scope of this role is limited, with the remit covering only medicines and medical devices. This means that these two initiatives are not able to tackle the systemic organisational cultural issues that are at the root of major patient safety failings.

One thing that stands out here is that none of the above measures specifically tackle the stigma around whistleblowing in healthcare. In fact, some reinforce the stigma.

 A way forward

Much has been written about healthcare whistleblowing and measures that have been implemented to promote positive change. Despite these, the victimisation of healthcare whistleblowers and the stigmatisation around whistleblowing in health and in social care has not abated. The measures introduced have so far achieved very little. In some instances, I believe, they have made the problem worse.

The Protection for Whistleblowing Bill,[26] which passed its second reading in December 2022, proposes the repeal of the current Public Interest Disclosure Act,[27] replacing it with an Office of the Whistleblower. This would prevent concerns of genuine healthcare whistleblowers becoming buried under an employment issue, and their original patient safety concerns being side-lined.

The Public Interest Disclosure Act is expensive, limited in scope and beyond the reach of most whistleblowers. It is also overly complex, with cases currently waiting for over 2 years to be heard. Employers game the system to run whistleblowers out of funds. Fewer than 12% of cases that go to the Employment Tribunal win.

It does not protect patients and is not accessible to members of the public who blow the whistle. Currently there is no statutory provision to investigate or address the wrongdoing highlighted by whistleblowers. Many whistleblowers have been denied any protection because they are not workers.

An Office of the Whistleblower would change this and help us identify the root causes of systemic patient safety failings.[26] I urge everyone with an interest in this subject to read the bill and watch the video of Baroness Kramer introducing the second reading of the Bill.[28]

For the first time in years, I am optimistic.

References

1. Department of Health. The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995: learning from Bristol (Cm5207(II)); 2001.
2. Department of Health. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry; 2013. 
3. Hartles S. Robbie Powell: Time for Truth, Justice and Accountability. Open University Harm & Evidence Research Collaborative; 2021.
4. Kirkup B. Independent report. The life and death of Elizabeth Dixon: a catalyst for change; 2020.
5. Ritchie F. Independent Review into Thomas Oliver McGowan’s LeDeR Process Phase two; 2020.
6. Department of Health, Northern Ireland. Report of the inquiry into hyponatraemia related deaths; 2018. 
7. Gosport Independent Review Panel Report. The Panel Report - 20th June 2018. 
8. Dr Kirkup B. Reading the signals: maternity and neonatal services in East Kent – the report of the independent investigation; 2022. 
9. Francis R. Report on the Freedom to Speak Up review; 2015.
10. Bewick M, et al. University Hospitals Birmingham NHS FT (UHB) Phase 1 Review by I4QU. Clinical Safety. iQ4U Consultants; 2023. 
11. Action against Medical Accidents. Robbie’s Law. The European Court Ruling in full: https://hudoc.echr.coe.int/fre#{%22itemid%22:[%22002-6998%22]}.
12. Parliamentary and Health Service Ombudsman. Radio Ombudsman: Will Powell’s 32-year quest for justice for son Robbie; 2022. 
13. NHS England. About LeDeR; 2023. 
14. NHS Digital. Health and Care of People with Learning Disabilities, Experimental Statistics: 2018 to 2019 [PAS]; 2020.  
15. Department of Health and Social care. Premature Deaths of People with Learning Disabilities: Progress Update; 2014.
16. Heffernan M. I have never encountered an organisation as vicious in its treatment of whistleblowers as the NHS. BMJ Talk Medicine Podcast; 2020.
17. Bevan H. Rocking the boat and staying in it: how to be a great change agent. Slide set; 2016.
18. Grossman D, Clare S. Birmingham hospital culture worrying - health secretary. BBC Newsnight; 2023.
19. Care Quality Commission. Fit and proper persons: directors; 2022.  
20. Clegg A. How cronyism corrodes workplace relations and trust. Financial Times; 2022.
21. WhistleblowersUK, Meeting with Dr Bill Kirkup CBE and the APPG for Whistleblowing: blog; 2022.
22. NHS England. Speaking up support scheme; 2022. 
23. Greenop D. NHSI Whistleblowers Support Scheme pilot. Final Evaluation (redacted); 2019. Obtained in 2022 following a Freedom of Information Request.
24. Kark K, Russel J. A review of the Fit and Proper Person Test. Commissioned by the Minister of State for Health; 2018.
25. Care Quality Commission. Regulation 20. Duty of Candour; 2023.
26. UK Parliament. Protection for Whistleblowing Bill [HL]; 2023. 
27. UK Government. The Public Interest Disclosure Act 1998 [PIDA].
28. Baroness Kramer. Protection for Whistleblowing Bill, 2nd Reading, Baroness Kramer 2022. Video recording of the House of Lords introduction.

Some of the benefits of the Protection for Whistleblowing Bill, from a healthcare perspective, include that the Office of the Whistleblower will be:

• Accessible to members of the public who blow the whistle.
• Providing support for genuine whistleblowers whoever they are e.g., clients, patients, carers, relatives, contractors.
• Providing mechanisms to ensure that the substance of whistleblowing reports is investigated.
• Ensuring the failings identified by the whistleblower are followed up with action.
• Provision so that the whistleblower knows the outcome.
• Scrutiny of the regulators’ approach to whistleblowing and related actions.
• Ensuring consistent use of accredited investigators and appropriately skilled expert witnesses.
• Enforcement powers.

From the outset, this system has attracted significant criticism and the APPG has heard from whistleblowers who have been failed by local guardians sharing their experiences that included the disclosure of their identity to hospital management and boards – resulting in retaliation. The APPG has also heard from Local Guardians who were not supported and themselves the target of retaliation after supporting whistleblowers. 

Local Guardians in East Kent were described as, “dishonest” and that the Guardian system had failed in every case that had been investigated throughout the UK. Further evidence was provided of a tick box approach to the Duty of Candour introduced by the former Secretary of State for Health. The APPG was told that both the Guardian and Duty of Candour systems are beyond resurrection and that across the NHS there is no ownership of problems. All attempts to encourage speaking up have been hindered by a failure to introduce an effective and safe whistleblowing regime across the NHS, resulting in the NHS being unsafe for whistleblowers, making it unsafe for patients. 

The APPG were told that, in over 50 years of investigation experience, little has changed, and that “these issues are not new, nor are they confined to a small number of rogue hospitals”. That league table results are inaccurate because of a flawed regulatory system with no ownership of the problems and where the regulators are “caught up in the fraud”. 

The APPG was provided with a series of examples of what were described as “deep seated problems” relating to teamwork and culture, which resulted in the failure to join up clinical and ethical responsibilities. These responsibilities were described as being on separate tracks and a failure by the regulatory regime to identify or report on the impact of this has significant consequences for patients, whistleblowers and the future of the NHS, as demonstrated by the case of the Bristol Children’s Heart scandal brought to light by Dr Steve Bolsin 30 years ago. Dr Bolsin was shunned for exposing the failures that resulted in the death of so many babies because funding the unit was more of a priority that the lives of the babies (he has since made a successful career in Australia).

In every case, a failure to listen to whistleblowers, followed by attempts to discredit the whistleblowers, and a deliberate cover up has proved in many cases fatal for patients. 

What has been proved time and time again is that The Public Interest Disclosure Act (PIDA) has made little or no difference to this failure to protect patients or whistleblowers or to learn and improve our NHS. Evidence provided to the APPG is of a lack of system-wide action and an absence of commitment to speaking up beyond excellent PR. It is unclear who, if anyone, is responsible for the monitoring and reporting on recommendations contained in investigation reports. In addition, there is no coherent process for triggering high-level independent reviews of major patient safety failings. This causes confusion, suffering and leads to missed opportunities.

Mary Robinson MP, chair of the APPG for Whistleblowing, said:

“We have a duty to support and protect whistleblowers because without them we cannot prevent more deaths like those in East Kent. My APPG is committed to making whistleblowing safe and will continue to press the Government to introduce the Whistleblowing Bill which will incentivise and normalise speaking up. I encourage everyone to write to their MPs and ask them to join the APPG and support the Whistleblowing Bill.” 

The Right Hon. Baroness Susan Kramer, said:

“Doing nothing is not an option that we can afford. It’s time to put an end to ‘tick box culture’ and turning a blind eye to whistleblowers. Whistleblowing law must be meaningful, easily understandable and enforceable. The Whistleblowing Bill will do this and in doing so will save lives and protect our NHS.”

Wendy Morden MP, member of the APPG for Whistleblowing, said: 

“I hear about problems when I am at the hairdresser because people are too afraid to speak up in their place of work. The Office of the Whistleblower will be the catalyst for meaningful change.”    

Dr Bill Kirkup, author of Reading the Signals Report, said:

“I support the proposals set out in the Whistleblowing Bill because the NHS urgently needs an effective early warning system.”