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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 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

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

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, Helen and Peter speak to Dr Jayne Chidgey-Clark, the National Guardian for the NHS about how to create organisational cultures where staff are safe, and feel safe, to speak up about concerns. They reflect on the results of the latest NHS Staff Survey and discuss some of the issues relating to NHS manager regulation. They also talk about how regulatory bodies and other national organisations can work together to streamline safety and improvement recommendations so that they are simpler for organisations to implement. Reflecting on the gap that exists between organisations identifying cultural problems and finding solutions that make a difference, Jayne describes the need for a multi-layered approach that places safety and quality on an equal footing with financial and productivity targets.  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

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. Peter and Helen speak to Martyn Pitman, who worked as a consultant obstetrician and gynaecologist in the NHS for more than 20 years. Martyn describes how grievances were raised against him by colleagues after he shared concerns about the safety of maternity services at the trust he worked for. He believes these complaints were raised as a response to him speaking up about his patient safety concerns and they eventually resulted in Martyn losing his job and career. Martyn describes the impact of his experience over the last few years on his mental health and highlights the unrelenting support he received from individuals he had looked after throughout his career as an consultant. He talks about how the current legal and regulatory framework is ineffective in protecting whistleblowers from retaliatory action. He also shares why we need more effective ways to hold NHS leaders and managers to account and describes the role that regulation might play in this. 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

In this 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 interview, Peter and Helen speak to Helené Donnelly OBE, who spoke up about unsafe care she witnessed while working as a nurse at Mid Staffordshire NHS Foundation Trust. Helené contributed as a witness to the inquiry led by Sir Robert Francis KC into failings at the trust and was also an advisor in the Freedom to Speak up Review in 2015, where she called for the creation of Freedom to Speak Up Guardians in the NHS. Helené explains why she decided to raise concerns about the quality of nursing care at Stafford Hospital A&E and describes the bullying and threats she received from other staff as a result. She discusses with Peter and Helen the barriers that still prevent staff speaking up today and what can be done to create a more open and responsive culture in teams and organisations. Helené highlights the need to reform how human resources departments respond to staff raising concerns and the vital role of embedding speaking up and organisational culture in the curriculum of all healthcare professional training courses. 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

Patient Safety Learning and retired urology consultant Peter Duffy have launched a new interview series, ‘Speaking up for patient safety’. Peter is an NHS whistleblower and Chair of the Healthcare Working Group at WhistleblowersUK. 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 someone who has spoken up about patient safety in healthcare, or who works to help staff raise concerns. In this blog, Peter and Helen explain the concepts of speaking up and whistleblowing and outline why creating a safe environment for speaking up is vital for patient safety. They share why they decided to produce the interview series and outline the impact they hope giving people who have spoken up a platform to share their experiences and insights will have. You can follow the interview series on the hub and by subscribing to the series YouTube podcast. "After I lost my own career as a direct consequence of whistleblowing, I found myself unemployed and prematurely claiming my NHS pension many years before I had ever anticipated stepping away from full-time work. As well as the personal cost, it meant that the unsafe care I reported went unchanged and opportunities to make care safer for patients were lost. It left me determined to prevent the same kind of catastrophic consequences and cover-ups happening to the next generation of patients and healthcare professionals, a cause that Patient Safety Learning is also committed to." Peter Duffy "I hear stories like Peter’s so often, it’s a pattern that is repeated across healthcare all the time. We need to expose the unfairness of doctors, nurses and other healthcare professionals being required to raise concerns, and then being vilified when they do so. The horrendous impact on their lives and careers when the system closes in on them is something we desperately need to address. Staff need to feel safe to share their genuine concerns and insights—and these must be listened to and acted upon to improve patient and staff safety. It’s vital we explore how we can make changes to legislation, leadership and management and culture so that we can stop this awful cycle repeating itself." Helen Hughes We decided to collaborate on a series of interviews that would draw together the voices of some of the people who have spoken up for safety and found themselves treated poorly by the organisations and systems they were trying to make safer. Speaking up, whistleblowing and patient safety People working in healthcare will sometimes see things at work that cause them concern. They might notice a situation or action that is causing or could cause harm to a patient, staff member or the public. For example, they might see a patient safety incident that isn’t dealt with properly or a risk that is not being taken seriously. They may witness dishonest behaviour, bullying, harassment or discrimination. When someone reports their concerns with the aim of making things better or stopping something from going wrong, they are ‘speaking up’. In some cases—but not all—when someone speaks up, it is also defined as ‘whistleblowing’. Although the two terms are often used interchangeably, whistleblowing refers to the sharing of ‘protected disclosures’ which have a specific legal definition, as outlined in the Public Interest Disclosure Act 1998 (PIDA).[1] Whistleblowing always involves a concern that is in the public interest to raise 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. PIDA was designed to offer some protection from retaliatory action for whistleblowers. However, many whistleblowers report that the reality of their experience was that there was little to protect them from retaliatory grievances and disciplinary action by their organisation’s management. The repercussions of speaking up act as a significant barrier to people sharing concerns about patient safety. Healthcare staff often fear that they will lose their career and that it will affect their work and personal lives if they step out and speak up. Many people decide it just isn’t worth the risk. But speaking up and whistleblowing are vital to improving patient and staff safety and standards of care. By raising concerns, staff offer their organisations opportunities to learn from things that could go or are going wrong, and mitigate risks. In addition, all registered healthcare professionals have a professional duty of care to raise concerns. Many people we interview in this series make the same comment; that in speaking up, they were just doing their job. For these reasons, it is vital to create a culture where staff feel safe and supported to fulfil their obligations to raise concerns without fear that it will affect their career prospects, working life and personal wellbeing. Creating this kind of environment contributes to what is sometimes referred to as ‘psychological safety’. While there are currently measures in place to encourage and support staff to speak up, they clearly aren’t working effectively—despite so many regulators, potential targets and available sanctions in the NHS, individual and organisational scandals in healthcare just keep happening. Candour, ethical behaviour and honesty are key things we need in place to maximise patient safety in the healthcare system. The importance of first-hand experience and insights Peter’s experience of speaking up is one of many that clearly demonstrates that the current system of regulation and safeguarding is not effective. We decided to start this interview series because we believe it’s time to identify and deal with the cultural and organisational issues that make it difficult for people to raise concerns about patient safety issues. The national NHS Staff Survey results tell us that too many healthcare staff are nervous to speak up when they see unsafe care or inappropriate behaviour. In spite of slight progress in some areas, 37% of all staff who responded still feel unsafe to speak up about concerns—that’s about 260,000 people. Almost 50% said they were not confident that their organisation would address concerns raised.[2] It’s so important that we hear the voices of people who have gone through the difficulty of speaking up or whistleblowing as they have unique and highly valuable insights. Their experiences of internal investigations, complaints processes and employment tribunals demonstrate that the systems that are supposed to support people who speak up often neglect their needs. The reasons for this include pressure from organisational leaders, a culture of not wanting to hear bad news and prioritising organisational reputation above patient and staff safety. It’s vital that we understand the cost individuals have paid for taking action that they believe to be right and that their professional standards require. During the series we speak to experienced and committed healthcare professionals who have received threats, abuse and gaslighting from their employers. Some have lost their careers as a result and many describe the significant impact on their work life, private life and health. The interviews are informal and although the interviewees will have a rough idea of where the discussions are likely to lead, we challenge and explore their opinions. Our aim is to draw out the details that might help us better understand the nature and extent of specific issues—from threats and retaliation from other staff to human resources practices and employment tribunals. We start each conversation by inviting our guest to share their own experience of whistleblowing or speaking up, or of working with people in that space. We discuss the consequences for whistleblowers, as well as for patients and families, when organisations fail to respond well to staff who raise concerns. We then invite each guest to reflect on any areas for learning that can be drawn from their experience and make suggestions of ways to better protect both NHS staff and patients. In some interviews we look at whether healthcare regulators and the legal system are appropriately designed or equipped to protect whistleblowers and staff who speak up, as well as the public interest. Amplifying voices for change If enough healthcare staff, patients, families and motivated members of the public take notice of the issues we’re raising, then the pressure for change can only increase. Our hope is that we can convince leaders across the sectors that real, profound and lasting progress will be in the best interests of all of us. We’d like to see changes to the way that safeguarding and whistleblowing are viewed within our political, judicial and regulatory systems. But to achieve this, we need to see more urgency from those who have the power to make real change. We are seeing some examples of positive movement, but this remains slow and patchy and there is resistance to change from parts of the legal profession and healthcare leaders. Towards the end of last year, the Secretary of State for Health and Social Care, Wes Streeting MP, launched a new consultation on government proposals to regulate health service managers, ensuring they follow professional standards and are held to account. As part of this announcement, he stressed the Government’s commitment to protect whistleblowers by introducing regulation for managers and enforcement measures to tackle managers who “silence whistleblowers or endanger patients through misconduct.”[3] We welcome this commitment, and Patient Safety Learning will be responding to the consultation. However, these words need to be accompanied by prompt and decisive action, or the gap between what many NHS organisations say to employees about speaking up and whistleblowing and what happens in practice will remain. The statistics that estimate the worrying extent of avoidable harm in the UK [5] need action right now, not in a year, or five, or ten. We believe any drive to bring these awful figures down needs to include a relentless focus on safeguarding, speaking up and accountability. Get involved 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. Listen to the interviews Helené Donnelly in conversation with Peter Duffy and Helen Hughes Martyn Pitman in conversation with Peter Duffy and Helen Hughes Jayne Chidgey-Clark in conversation with Peter Duffy and Helen Hughes Gordon Caldwell in conversation with Peter Duffy and Helen Hughes Bernie Rochford MBE in conversation with Peter Duffy and Helen Hughes Beatrice Fraenkel in conversation with Peter Duffy and Helen Hughes References 1 UK Government. Public Interest Disclosure Act 1998. Accessed 11 December 2024 2 NHS Staff Survey. NHS Staff Survey National Results 2023. Accessed 11 December 2024 3 Department of Health and Social Care, UK Government. New protections for whistleblowers under NHS manager proposals. 24 November 2024 4 J Elgot and D Campbell. Managers who silence whistleblowers ‘will never work in NHS again’, vows Streeting. The Guardian. 27 June 2024 4 J Illingworth, A Shaw, R Fernandez Crespo et al. National State of Patient Safety 2022: What we know about avoidable harm in England. Institute of Global Health Innovation, Imperial College London, 2022