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In 2015, few people had even heard of pelvic mesh implants, let alone the devastating complications they could cause. Women were told their pain was “normal,” their concerns dismissed, their injuries hidden behind a wall of medical gaslighting. But what began as a small group of women raising their voices against an invisible epidemic turned into one of the UK’s most powerful grassroots campaigns for patient safety and medical justice. As Sling The Mesh marks its 10th anniversary, it celebrates a decade of courage, compassion, and relentless campaigning that has changed lives – and policy – forever. Over the next decade, Sling The Mesh will: Demand proper aftercare and support for all mesh-injured patients. Push for accountability from manufacturers and regulators. Campaign for awareness around hernia and other less-recognised mesh complications. Advocate for safer alternatives and patient-centred decision-making. Empower the next generation of campaigners to keep raising their voices. Push for tougher regulations and oversight of medical devices. Lobby for Sunshine legislation for transparency around funding from industry to the healthcare sector which can bias prescribing and affect research integrity.

At the beginning of 2025 we launched our video interview series Speaking up for patient safety. The series is hosted by Peter Duffy, NHS whistleblower and Chair of the Healthcare Working Group at WhistleblowersUK, and Helen Hughes, Patient Safety Learning’s Chief Executive.  In each interview we hear from someone who has raised concerns about patient safety in healthcare, often at great cost to their own career and personal life. They share their story and their reflections on what needs to be done to improve organisational cultures so that when staff raise patient safety issues, their concerns are responded to appropriately and not dismissed because they are inconvenient to address. Alongside the thread of bravery and tenacity that runs through each contributor, a number of common themes come up time and again as people share their experiences. In this blog, Helen and Peter look at some of these themes and outline their implications for people who speak up or whistleblow. We are now three months into the series, which seems like a good time to stop and reflect on what we have learned so far. Our introductory blog about ‘Speaking up for patient safety’ explains why we launched the series and what we hope it will achieve. It also explains in more detail what we mean when we talk about speaking up and whistleblowing. Briefly, speaking up in healthcare is when a member of staff raises concerns about something that is worrying them to a manager or someone else within, or outside of, their organisation. In some cases—but not all—when someone speaks up, it is also defined as ‘whistleblowing’. Whistleblowing always involves a concern that is in the public interest and might relate to a criminal offence, health and safety risks, failures to carry out legal obligations, a miscarriage of justice, or an attempt to conceal and cover up any of these things. Three key themes from the interviews so far These are the top three recurring themes we have noticed coming up in the interviews so far. Other issues we have noticed include the lack of clarity about who should take responsibility for whistleblowing and the reality of threats and bullying, and we will continue to explore these issues going forward. 1. “I didn’t realise I was speaking up, I was just doing my job!” Perhaps the comment we have heard most frequently is that people didn’t realise they were formally speaking up or whistleblowing—they just thought they were doing their job. Every healthcare profession has a set of professional standards which all practitioners are expected to keep to. For example, the General Medical Council (GMC) states that all doctors have a duty to take action by raising concerns if they believe patient care or safety are at risk.[1] In addition, each healthcare organisation has a code of conduct, which will include requirements for staff to be honest, open and accountable for their work. For the interviewees we spoke to, to not raise their concerns would be a failure to fulfil their duty to both their patients and their organisation. When people speak up, they often find themselves in the middle of a process that they had no idea they were entering. This can be very disorientating and leave them unprepared for the path ahead of them. At the end of this blog, we share some advice from our interviewees about what to do if you find yourself in this position. 2. There is a whistleblowing ‘playbook’ Most organisations have policies and support in place to listen to staff members who raise concerns, including access to a Freedom to Speak Up Guardian. We have interviewed Jayne Chidgey-Clark, the National Guardian, who described the good practice that many are developing. However, we are hearing about several common tactics that some organisations use when dealing with people who speak up or blow the whistle. The experiences of our interviewees suggest that these approaches may be deliberately designed to disadvantage the individual throughout the process—from investigation through to employment tribunals. Some of the key activities we have heard about include: Organisations not responding—or responding at the very last minute—to communications from the staff member. Interviewees said they received emails with key information at 5pm on a Friday, which left them with no opportunity to ask questions or respond until the next working week. They expressed their belief that this may be a deliberate tactic to exert pressure on the individual speaking up, which amounts to emotional bullying. The use of occupational health as a way to cast doubt on the mental state of the person. Occupational health providers are often very supportive, but we are concerned that organisations are fishing for reasons to question the believability and motives of staff who speak up. Over-focus on HR issues, rather than focusing on the patient safety issues someone has raised. Mandated isolation from colleagues while investigations take place. This can have a very damaging effect on the person’s mental health as well as restricting their ability to source evidence from other staff in support of the concerns they have raised. We have heard examples of colleagues agreeing to provide supportive testimony, but then feeling pressurised to withdraw this support. Retaliatory referrals against the person speaking up to professional regulators, such as the General Medical Council and Nursing and Midwifery Council, which can have a detrimental effect on a healthcare professional’s reputation and career. Regulators are aware of how such referrals can be used to intimidate whistleblowers and discourage them from raising concerns. Some have approaches to ensure that fitness to practice concerns are appropriately addressed without unfairly impacting doctors who have raised whistleblowing concerns. We believe it is important to identify and call out these tactics so that people raising concerns are aware of them and can seek support and advice. Organisational leaders need to look at their own practice and recognise the ethics of their approaches and whether their actions match their stated organisational values. They need to be aware of the significant damage these tactics cause to people who raise concerns and the chilling impact it might have on their organisational culture, effectively preventing others’ raising concerns. 3. Employment tribunals are unfit, unfair and imbalanced Every person we spoke to who had attempted to pursue justice at an employment tribunal commented that the process was unfit for purpose and not the right place for whistleblowing cases to be heard. Employment tribunals take no interest in the safety issues being raised. The main issue we keep hearing is that the tribunal system is weighted in favour of whichever side has the most financial resources—which will almost always be the employer. A single individual who has lost their employment can rarely succeed against the millions of pounds that organisations are willing to spend on highly specialised lawyers who have tried and tested ways of winning. The playbook we identified above also runs into employment tribunals, with whistleblowers reporting: The employer and their legal advisers withholding key documents, and emails, minutes, notes and other vital information going missing. Key witnesses, often in senior leadership positions, being unable to recall events. Receiving last minute threats from their former employer to come after them for costs and often being given a limited time to consider signing a non-disclosure (NDA) to settle a case. If rejected, often the NHS organisation will seek the full costs from the whistleblower, including expensive external legal costs and internal staff costs, which can amount to thousands of pounds—few whistleblowers can afford to take this financial risk, even if they and their advisers think they have a strong case. Advice from our interviewees if you find yourself speaking up Reflecting on their experiences, our contributors have made some observations about how you can protect yourself when speaking up, should the issue escalate. Try to resolve issues locally first. This is not always possible, but if a concern can be raised and dealt with within a team or with a manager, in some cases this will prevent the situation from escalating to a formal process. Keep a record of concerns and events as they happen. This means you will have some facts and clear observations to refer back to, if the situation does escalate. Don’t go to meetings alone. Take a trusted colleague with you so that every conversation is witnessed. Get your union involved if you are called to meetings about your concerns or receive counter-complaints or accusations. Regulation of NHS managers Some of the interviewees highlighted that regulating NHS managers may be a potential means of tackling some of these issues. The Department of Health and Social Care recently held a public consultation on proposals that could see managers who use misconduct to silence whistleblowers barred from working in the NHS. Patient Safety Learning has formally responded to the consultation, stating that there is a clear case for the regulation of NHS managers, for the protection and benefit of both staff and patients. Everyone in healthcare should be honest and transparent when something goes wrong. Patient Safety Learning’s response expressed support for a professional register of NHS managers and the requirement for individuals in NHS leadership to have a professional duty of candour. These measures would be a positive step in increasing accountability for healthcare organisations in how they respond to staff raising patient safety concerns. But this is only one part of a much wider set of changes needed—significant cultural change also needs to take place in tandem with these reforms. Staff across many organisations are still afraid to speak up, as indicated by the most recent NHS staff survey results. Thank you to our contributors, and an invitation to get involved We’d like to take this opportunity to express our gratitude again to each person who has been willing to share their experiences and insights with us—it can be very difficult to retell traumatic events that have changed the course of your life. We are also aware that there are many other individuals who have experienced unjust treatment because they have spoken up for safety. If that’s you, thank you for your commitment to standing up for safe, ethical care. We invite everyone with experience in this area to contribute to this vital conversation. We would particularly like to hear from: Allied health professionals. Staff from Black and minority ethnic backgrounds Staff in non-clinical roles such as administration. If you would like to share your story, you can: Contribute to our community conversation (you’ll need to sign up first). Comment on any hub post (you’ll need to sign up first). You can find information about organisations that offer support and guidance for staff about speaking up and whistleblowing on the hub. Watch the interviews Helené Donnelly Martyn Pitman Jayne Chidgey-Clark Gordon Caldwell Bernie Rochford Beatrice Fraenkel References General Medical Council. Professional Standards: Raising and acting on concerns about patient safety, 13 December 2024

In this blog, Clare Wade, Patient Safety Learning's Director, draws attention to the impact toxic cultures have on staff and how, sadly, most often nothing is done about it. Clare shares her own personal reflections from past experiences in her career. There is a clear link between toxic cultures and patient safety, and while there are no easy answers these behaviours must be acknowledged, challenged and cured if the NHS is to survive. I’ve personally experienced toxic culture and behaviour on many occasions, but I found two examples particularly tough to navigate. The first was more than 20 years ago when I worked clinically in a trust largely staffed by the local population where most colleagues were either related or friends; I lived some distance away and commuted in. I’d witnessed troubling behaviour from one senior time-served nurse several times, but one day I heard a blatant, serious breach of patient confidentiality between her and another patient. I was shocked and initially didn’t know what to do. I raised it with the nurse involved who laughed at me, and then the sister in charge who told me to just forget it. After much deliberation, I went to the matron in charge of the department. Conversations took place behind closed doors and eventually I was hauled into trust HQ for a formal meeting, alone—the nurse was nowhere in sight. I was accused of causing upset and the nurse had denied any wrongdoing. In no uncertain terms it was made clear that I should keep my head down and mouth closed if I wanted to remain in post. From that day on my time was made miserable, colleagues closed ranks, stopped talking to me and I was ostracised until the day I left the trust. Later in my career, at a different trust, a new director was recruited to lead my department. From the start something felt off as several senior leaders quickly left their roles. It became obvious that the director was a bully; we largely worked in open plan offices, and the director thought nothing of shouting at and belittling people in front of everyone, even other directors and the CEO. It was impossible for senior colleagues not to know what was happening, but no action was taken. The situation worsened with many people taking sick leave or leaving the trust completely. I came under fire as the director didn’t agree with how I led my team or how we worked, even though our performance was excellent. An external consultant was brought in to identify issues with my practice and help build a case against me. The consultant admitted this to me and said they couldn’t find anything wrong to report back. At the time I had a mentor relationship with a senior board member, and I chose to confide in them with the hope of gaining some insight into how I might be able to better deal with the situation. I didn’t know until sometime later, but my mentor was informing the director about our conversations. As time passed, the behaviour worsened and, although many colleagues were experiencing it too, it was obvious I was on my own in wanting to speak up. I was encouraged to go to a senior HR colleague who would be empathetic, so I did and eventually the director agreed to mediation. I was so nervous ahead of the meeting, but it went ahead and to my surprise the director admitted to some of the allegations and agreed some actions. If I thought my treatment had been bad to this point, I had no idea what was to come. It felt like open season with the director’s full toxicity focussed on me. Derogatory rude emails would be sent daily, raising my anxiety as they landed in my inbox. Meetings where we were both present made me feel sick; they would think nothing of singling me out in front of everyone for their derision and nastiness. The barrage was constant and debilitating, affecting every part of my life and breaking my confidence. One day I couldn’t take any more so left work early and crawled into bed at home where I felt safe. I decided to call the senior HR colleague who had facilitated the previous mediation to ask for an update about the agreed actions. I was absolutely shocked to my core at their reaction, they shouted down the phone that I’d had my opportunity to air my grievances, nothing more was going to happen, the director wasn’t going to be held accountable for the agreed actions and I just needed to forget it and get on with my job. Was I naive to expect a different response? I hit rock bottom, felt scared to go into work and knew I had to get out of there for my health and sanity. Even when I left, the impact followed me to my next role; my confidence and resilience were shot and took a long time to rebuild. The director stayed in post for another couple of years until there were so many grievances that the CEO had to act. The sickening part is that after a period of ‘gardening leave’ the director secured another senior role in another trust in the area so will be perpetrating the same toxic behaviour onto others. I know there are thousands of experiences throughout the NHS just like mine and, unfortunately, in many organisations culture and behaviours aren’t improving. This problem is endemic and has decades of history behind it. There is a clear and acknowledged link between toxic cultures and patient safety. Within the NHS Patient Safety Strategy, NHS England states that: "positive patient safety and healthy organisational culture are two sides of the same coin. A culture in which staff are valued, well supported and engaged in their work leads to safe, high-quality care." In order to improve the care delivered to our loved ones, friends and ourselves, the NHS must take action to improve its culture. Forget the financial situation and the waiting lists, this is the most pressing and wicked problem facing our health service today; it permeates throughout everything and unless it is acknowledged, challenged and cured no other interventions will work. Money doesn’t solve toxic cultures, neither does restructuring the NHS for the umpteenth time. Sadly, some colleagues have taken their own lives because of the toxicity they have endured, this needs to stop now. There are no easy answers here but if we don’t put this right the NHS won’t survive. Share your story Have you worked in a toxic culture? Have you tried to speak up? Have you examples of a good team culture? Add your comment below (you will need to be a hub member and signed in) or contact us at [email protected] and we can share your story anonymously. Related reading on the hub Speaking up for patient safety: A new interview series about raising concerns and whistleblowing Speaking up as an agency nurse cost me my career My experience of speaking up as a healthcare assistant in a care home

In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, Beatrice Fraenkel, ergonomist and Non Executive Director at Stockport NHS Foundation Trust discusses the importance of understanding the issues that lead to poor culture and harm in healthcare organisations. She describes the Board's radical approach to establishing a Just Culture during her time as Chair of Mersey Care NHS Foundation Trust and the huge investment needed to build trust between healthcare staff and their employers. She also talks with Peter and Helen about the importance of understanding the needs, views and emotions of people in the wider community that each trust serves. They discuss the universal impact of fear and anxiety on human behaviour and the need to ensure lessons are really understood before attempting to put solutions in place to tackle issues, on any scale. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series

This conference brings together leading experts at the forefront of ensuring adherence to Martha’s Rule and offers a comprehensive and practical guide for clinical staff to seamlessly integrate Martha’s Rule into their daily practice. The conference delves into the caregiver’s perspective, principles and implications of Martha’s Rule, legal and patient safety considerations, effective communication strategies, and the use of technology in the adoption of Martha’s Rule. The conference will also discuss the new approach to managing acute physical deterioration through the prevention, identification, escalation, response – PIER approach which is currently being implemented Throughout the day, there will be interactive sessions, small breakout groups, and collaborative exercises, fostering a dynamic learning experience. Register Reduced rate places can be booked online with code HCUK195MRSO

This conference brings together leading experts at the forefront of ensuring adherence to Martha’s Rule and offers a comprehensive and practical guide for clinical staff to seamlessly integrate Martha’s Rule into their daily practice. The conference delves into the caregiver’s perspective, principles and implications of Martha’s Rule, legal and patient safety considerations, effective communication strategies, and the use of technology in the adoption of Martha’s Rule. The conference will also discuss the new approach to managing acute physical deterioration through the prevention, identification, escalation, response – PIER approach which is currently being implemented Throughout the day, there will be interactive sessions, small breakout groups, and collaborative exercises, fostering a dynamic learning experience. Register Reduced rate places can be booked online with code HCUK195MRSO

In this blog, Justean Winter shares her experience of working as an agency nurse in the NHS. She describes how she was told not to report patient safety issues she witnessed. After raising concerns about patient care, Justean received several accusations and was eventually blocked from working in the NHS. She outlines why she continues to try and raise awareness of the patient safety and organisational issues she witnessed. Patient safety issues and reporting I have been a nurse for 33 years, and worked for an NHS Health Board via an agency for a number of years. In the Autumn of 2022, I was working in the A&E department when we were told not to submit Datix reports without checking them with managers first. Datix is the incident reporting software widely used in the NHS for reporting patient safety issues. We weren’t able to report anything we saw, including short staffing, bullying and patients being left without treatment. When I or another member of staff asked about why we couldn’t report what we witnessed, we were told by the managers to stop asking and just get on with our job. Later that year, I was asked to work in paediatric A&E, but knew I wasn’t up to date with all the relevant training. I raised this but was told to go and do the shifts anyway. The atmosphere in the wider A&E department was one of keeping quiet about any concerns. If you raised concerns you were seen as a trouble maker. Some examples of issues I raised were patients being denied end-of-life medication, patients with diabetic ketoacidosis being left without treatment and nurses wearing name badges that didn’t belong to them. There were also some issues with staff conduct that could pose a threat to patient safety that I was told not to mention if I wanted to keep my job. At this point, I started reporting incidents anyway, as I was seeing patient safety issues that I just couldn’t ignore. Accusations and suspension In October, I was told by my agency that there had been a complaint against me, dating from that July. I asked to see the details, but they wouldn’t show me anything. I also asked why it hadn’t been raised with me sooner, but was just told there would be no statement needed and there would be no investigation. Then in March 2023, my agency contacted me to tell me about another complaint they had received against me. It turned out to be the same one they had mentioned before, but now the Health Board wanted a statement from me. I did the statement and nothing came of it again. I felt that something underhand was going on. Then in April, one of the nurse managers pulled me into an office and accused me of stealing cash from one of the patients. At this point, I felt I was being bullied because I was refusing to keep quiet about issues on the ward. There were other incidents of intimidation, such as being squared up to in the corridor by another nurse about whose care I had concerns. I was on holiday in May when I received a series of texts from my agency telling me all my shifts had been cancelled. When I came back I realised I was unable to book any shifts, and it turned out that I had been totally suspended by the Health Board. My agency then told me that I had been accused of stealing morphine back in January. Five months had passed and I was only being told about it now! I vigorously defended myself against these accusations. In June, I was called to a Zoom meeting to discuss my suspension. I wasn’t allowed to see any of the complaints or any evidence, but the accusation was used as the reason for my suspension. I asked them to check the CCTV and was told that there was no CCTV in the department. My contact at the agency told me they would be collecting more statements and coming up with a plan for a way forward. When I asked about what the process was, I received no response. After the meeting, I wrote a long email to the Health Board detailing all my concerns, including about the inability to submit Datix reports and inadequate care standards I had witnessed . I later wrote a further letter to 18 members of the Health Boards as well as the Senedd and Healthcare Improvement Wales (HIW), sharing my patient safety concerns but heard nothing back. The Senned Minister for Health and Social Services said that the concerns I had raised were employment concerns rather than safety ones but that they would keep the letter on file for 10 years. At this stage, life was really difficult. I couldn’t get any work—there was a red flag against my name so I was basically unemployable. I asked the agency what was going on, but again got no response. My career and life were being ruined and I hadn’t done the things I was accused of. The same day I delivered the letters, my agency phoned to tell me I had been referred to the Nursing and Midwifery Council (NMC). It wasn’t until December 2023 that I heard from the NMC. The referral stated that I lacked insight to reflect and had refused to do a communication course—no missing money or morphine had ever been mentioned in the referral. I was cleared by the NMC in January 2024. I later found out through court documents relating to my employment tribunal that seven managers and an entire health board were responsible for referring me to the NMC—ostensibly on the grounds of communication issues. It just doesn’t add up. Employment tribunals When I contacted ACAS in September 2023, they told me that I was within the timeframe for an employment tribunal. But three judges since then have told me I am out of date and have refused to read my evidence bundle because it was too long. One judge told me I should “Stop criticising the NHS” and accused me of having a personal vendetta. But all I want is for the truth to come out and to be able to resume my career. I am now on my fourth appeal to try and get my case heard at tribunal. I’ll continue to do everything I can to pursue justice. Vulnerability as an agency nurse I believe that my status as agency staff made me vulnerable to repercussions. There is no support mechanism or process to follow as an agency nurse when raising concerns, and as I wasn’t employed directly by the Health Board, I was more easy to falsely accuse and get rid of. The personal cost of my experience has been huge. We have had to put our home up for sale because I’ve been unable to work since May 2023. I have developed post-traumatic stress disorder and a fear of the NHS because of what I have witnessed. I believe patients are dying because they aren’t receiving the care they need, and that it is being covered up. There are so many issues that the public need to be aware of and that NHS organisations need to deal with to keep patients safe and protect staff. Related reading My experience as an agency nurse A dropped instrument, washed in theatre and immediately reused: a story from a theatre nurse Speaking up for patient safety: A new interview series about raising concerns and whistleblowing My experience of speaking up as a healthcare assistant in a care home Share your speaking up story If you have spoken up about unsafe care or have been a whistleblower in healthcare or social care, we would love to hear from you about your experience. You can: contribute to our community conversation (you’ll need to sign up first) comment on any hub post (you’ll need to sign up first) contact us at [email protected] and we can share your story anonymously. You can find information about organisations that offer support and guidance for staff about speaking up and whistleblowing on the hub.

In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, Peter and Helen speak to Bernie Rochford MBE, who spoke up while working as a clinical commissioner at a primary care trust. Bernie found serious issues and inaccuracies in records that posed a risk to patient safety—vital information about Continuing Healthcare patients (patients with significant ongoing care needs in the community) was missing from the system, and there were financial anomalies and serious governance issues. After raising her concerns and getting no response from her managers, Bernie found herself classed as a whistleblower and was isolated at work, eventually losing her job and going to employment tribunal. Bernie describes the serious impact this had on her health and talks about how she is now using her own traumatic experience to work for positive change for others who speak up. She discusses the complexities of regulating managers with Peter and Helen, and argues that we need to look at how people relate, rather than looking to technology, to provide a safer future for healthcare. Now a Principal Freedom to Speak Up Guardian, Bernie currently has a Churchill Fellowship award and is researching different global approaches to speaking up. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series Can you help? As part of Bernie’s Churchill Fellowship award she will be looking at speaking up and whistleblowing good practice and alternative approaches from around the world. She will be particularly focusing on approaches in Japan, South Korea, the USA and the Philippines. While her research is predominantly patient safety and healthcare focused, Bernie's interest in learning and sharing best practice goes beyond these areas, as we can learn from other industries and cultures as well. If you have any suggestions, ideas, best practice or experience that you can share with her, from anywhere in the world, please email Bernie. She will be very grateful to hear from you! How whistleblowers are passed around the system In the interview, Bernie talks about how she was passed from one person and organisation to another as she tried to raise her concerns. This diagram, which was included in the report of the Freedom to Speak Up review carried out in 2015 by Sir Robert Francis QC, shows the 54 people, teams and organisations Bernie approached to speak up about the patient safety issues she saw.

In this blog, Patient Safety Learning looks at the results of the NHS Staff Survey 2024, focusing on responses relating to reporting, speaking up and acting on safety concerns. We highlight that, alongside other evidence, the survey results point to a lack of progress in improving safety culture in the health service. In its major restructure of healthcare governance in England, Patient Safety Learning argues that the Government needs to prioritise decisive, practical action to create cultures in which staff feel safe to speak up. On 13 March 2024, the NHS published the results of its 2024 staff survey. 774,828 staff from 263 organisations took part and the results provide a snapshot of their experiences of working in the health service.[1] The survey included a range of questions specifically about reporting, speaking up and acting on patient safety concerns. Unfortunately, the responses show little positive progress on these areas from previous years, underlining the persistence of blame cultures and a fear of speaking up in significant parts of the NHS. Survey results Reporting of errors, near misses and incidents Two-fifths of survey respondents, over 300,000 NHS staff, were unable to say with confidence that their organisation treats them fairly if they are involved in an error, near miss or incident. This is set against a much higher number of respondents, 86.43%, who said their organisation encourages staff to report errors, near misses or incidents. Responses to both these survey questions have not significantly changed in the past three years. This demonstrates that staff see a significant disconnect between what their organisation tells them about reporting patient safety issues and how they feel they will be treated if they actually raise concerns. There is also a significant problem when it comes to what staff think about how their organisations respond to patient safety issues. 68.21% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again. It is a major concern that over 240,000 NHS staff feel unable to agree with this statement. Connected to this, nearly two-fifths of respondents, 38.71%, did not agree that they are given feedback about changes made in response to reported errors, near misses and incidents. When staff are unable to clearly see their organisation’s approach to learning and acting on safety concerns, it is understandable that they might not have confidence these are being acted on. This issue is likely to be amplified further for patients and the public who do not have an inside view of the NHS. We need to see action for improvement being shared transparently within organisations and with the wider public. Concerns about clinical safety and speaking up The percentage of staff who say they would feel secure raising concerns about unsafe clinical practice has changed very little in the past five years, hovering at just above 70%. The response rate in 2024 means that over 200,000 NHS employees, 28.47% of survey respondents, could not say that they would feel secure raising concerns about unsafe clinical practice. When asked if they were confident that their organisation would address these concerns, only 56.83% of staff responded positively, a figure very similar to last year’s results and down nearly 4% from 2020 (56.87% in 2023, 60.57% in 2020). When it comes to speaking up about broader issues, 38.18% of respondents, nearly 300,000 NHS staff, could not say that they felt safe to speak up about anything that concerns them in their organisation. When asked about their confidence in their organisation acting on any concerns, the picture looks worse, with half of all respondents not having confidence that their concerns would be addressed (50.48%). Published in July 2019, the NHS Patient Safety Strategy identifies a patient safety culture as one of the two foundations required in working towards its safety vision “to continuously improve patient safety”.[2] This ambition clearly remains a long way out of reach when, for four consecutive years, nearly two-fifths of NHS staff surveyed have said they do not feel safe to speak up about concerns. No signs of culture change The 2024 staff survey results show no significant change from recent years in responses to questions on reporting incidents, clinical safety and speaking up about patient safety issues. While the survey only provides an annual snapshot of what it is like to work in the NHS, its findings are reinforced by evidence elsewhere. Blame cultures are a recurring theme echoed across many different inquiries into major patient safety scandals.[3] [4] [5] By creating an environment in which staff fear retribution if they are involved in a patient safety incident, blame cultures encourage staff to cover up the causes of avoidable harm rather than reporting them. The shocking experiences and testimonies of whistleblowers in healthcare are further evidence of staff not feeling safe to speak up and suffering severe repercussions when they do. Too often, staff raising patient safety concerns to their organisation are met with a hostile and aggressive response, rather than one that welcomes challenge and scrutiny. Staff who speak up for patient safety often receive personal threats, vexatious referrals to regulatory bodies, pay cuts and demotions, disciplinary action and contractual changes. We are highlighting these issues as part of a new interview series, Speaking up for patient safety, in partnership with Peter Duffy, an NHS whistleblower and Chair of the Healthcare Working Group at WhistleblowersUK.[6] The series looks at how people who speak up in healthcare are treated by organisations, leaders and regulators, and how this acts as a barrier to staff raising patient safety concerns. In each interview, Peter and Patient Safety Learning’s Chief Executive Helen Hughes, talk to with someone who has spoken up about patient safety in healthcare or who works to help staff raise concerns. We need to move from ambition to action At Patient Safety Learning, we believe it is vital that we create a culture in healthcare that supports raising, discussing and addressing the risks of unsafe care. It is difficult to imagine that this type of evidence of an unsafe culture in other safety-critical industries—where the consequences of incidents may also be serious injury or loss of life—would be considered acceptable. Responses to patient safety questions in this year’s NHS Staff Survey were very similar to the 2023 results, which we analysed in our report, We are not getting safer: Patient safety and the NHS staff survey results.[7] This year’s survey results indicate that in too many parts of the health service, staff don’t feel safe to speak up and don’t have confidence that their concerns are being listened to and acted upon. These results support our view that the health service needs a more transformative effort and greater commitment to creating a safety culture. As detailed in ‘We are not getting safer’, NHS England has made some positive progress by introducing new guidance and information that aims to help develop a safety culture in the NHS.[7] However, there is little detail about how to effectively implement safety culture guidance and best practice across NHS-commissioned health and social care providers. There is also a lack of clarity about how improvements in culture will be monitored, evaluated and shared for wider adoption. The way that the NHS will operate in future years is currently subject to significant change. The forthcoming 10-Year Health Plan and the recent announcement that NHS England will be incorporated back into the Department of Health and Social Care are signs of significant structural change.[8] Patient safety must be at the centre of this new operating model, with organisations supported and held to account in creating a culture where staff feel safe to speak up. We need to move beyond rhetoric and into practical action. References NHS Staff Survey. Results, Last Accessed 13 March 2025. NHS England. The NHS Patient Safety Strategy: Safer culture, safer systems, safer patients, July 2019. Department of Health and Social Care. Independent review of maternity services at Shrewsbury and Telford Hospital NHS Trust. Ockenden Report: Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust, 30 March 2022. Department of Health and Social Care. Independent Investigation into East Kent Maternity Services. Maternity and neonatal services in East Kent – the Report of the Independent Investigation, 19 October 2022. The Mid Staffordshire NHS Foundation Trust Public Inquiry. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 6 February 2013. Patient Safety Learning. Speaking up for patient safety: An interview series with Peter Duffy & Helen Hughes, 15 January 2025. Patient Safety Learning. We are not getting safer: Patient safety and the NHS staff survey results, 26 March 2024. Department of Health and Social Care. World’s largest quango scrapped under reforms to put patients first, 13 March 2025