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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 Rebecca Wight, a nurse consultant practitioner. Rebecca talks about her time at the The Christie, a cancer treatment centre in Manchester, and what happened to her when she tried to raise patient safety concerns about a colleague. Despite escalating these concerns to management and clinical leadership, Rebecca reported being ignored, having her concerns dismissed as a personal attack, and facing a "brick wall" from leadership. Rebecca reflects on the toll the process took on her and her family, her experience of going through an employment tribunal and why there needs to be more support for people who raise concerns within their organisation. Subscribe to our YouTube podcast to keep up to date with the latest episodes. Transcript of the interview Read a blog from Peter and Helen about the interview series

In this article, Patient Safety Learning reflects on the results of the NHS Staff Survey 2025, focusing on responses relating to reporting, speaking up and acting on patient safety concerns. On 12 March 2026 the NHS published the results of its 2025 staff survey.[1] 729,423 staff from 238 organisations took part in this survey, which provides a snapshot of their experiences of working in the health service. The survey includes several questions on reporting patient safety incidents and near misses, concerns about clinical safety and views on speaking up more broadly. As we set out in this analysis, unfortunately the Staff Survey results suggest there are little signs of positive progress across many of these areas. Reporting of errors, near misses and incidents A high number of survey respondents, 86.16%, answered that their organisation encourages staff to report errors, near misses and incidents. However, 40.71% of respondents (over 290,000 staff) subsequently answered that they were unable to say with confidence that their organisation treats them fairly if they are involved in an error, near miss or incident. Answers to both these questions in the Staff Survey have remained fairly consistent across the past four years, as illustrated by the table and graph below. These results suggest there persists a significant disconnect between what organisations tell staff about reporting patient safety issues, and how staff feel they will be treated if they actually raise concerns. 67.3% of staff said that when errors, near misses or incidents are reported, their organisation takes action to ensure that they do not happen again. Responses to this question have also remained fairly static for the past four years (within a range of 67-69%), with nearly a third of staff consistently feeling unable to answer this question with a positive response. Responses to this question also vary significantly according to Trust type, with Community Trusts scoring highest on average (75.91%) and Ambulance Trusts scoring lowest (54.79%). Connected to this, nearly two-fifths of respondents, 38.98%, 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 that their organisation acts on their safety concerns, it is understandable that they may be less motivated to report these. Concerns about clinical safety When asked about whether they would feel secure raising concerns about unsafe clinical practice, 71.1% of respondents answered this positively. Although this is quite a high percentage, the response rate in 2025 means that over 200,000 NHS employees, 28.9% of survey respondents, could not say that they would feel secure raising such concerns. When asked if they were confident that their organisation would address these concerns, 55.49% of staff responded positively. As illustrated by the table and graph below, responses to both these questions have remained fairly consistent across the last five years. Speaking up about concerns Turning to speaking up about concerns more broadly, 39.71% of survey respondents (over 280,000 staff) could not say that they felt safe to speak up about anything that concerns them in their organisation. As with the questions on reporting incidents, errors and near misses, again the average response varies significantly according to Trust type. When looking at Community Trusts, this figure drops to 30.2% but is significantly higher in Acute and Acute & Community Trusts (41.03%) and Ambulance Trusts (45.53%). When asked about their confidence in their organisation addressing their concern, just over half of all respondents did not express confidence that this would happen. As illustrated by the table and graph below, responses to both these questions have remained more or less consistent over the past five years, with a small decline this year. Safety culture in the NHS The 2025 staff survey results show no significant change in responses to questions on reporting, speaking up and acting on patient safety concerns in recent years. While the survey only provides an annual snapshot of experiences of working in the NHS, its findings suggest that a fear of speaking up and a lack of confidence that concerns will be acted on still persists in too many NHS organisations. These issues form a recurring theme across inquiries into major patient safety scandals.[2] [3] [4] They also can be seen reflected in the shocking experiences and testimonies of whistleblowers, such as those highlighted in our Speaking up for patient safety interview series.[5] Staff being able to raise concerns safely and effectively is essential for patient safety. However, as highlighted in a recent review shared by Roger Kline on the hub, the NHS continues to struggle with creating a culture where this happens reliably.[6] [7] Need for action It was notable that the need to tackle problems relating to safety culture was absent in the 10 Year Health Plan for the NHS, as highlighted in our response to this last year.[8] If the healthcare system is to truly be transformed over the next decade, then we cannot simply proceed by ignoring these issues or assuming they will resolve themselves. 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. Year on year we highlight the stagnant set of staff survey results in this area because we do not believe the lack of improvement in this area is acceptable. Too often, at a national level, it appears that the extent and persistence of blame cultures in healthcare, and the need to tackle this, are acknowledged but action is not taken to address these significant challenges. It is difficult to imagine that the scale evidence of an unsafe culture in other safety critical industries would be tolerated—where the consequences of not addressing the risk in incidents may also be serious injury or loss of life. We hope that the soon to be published new NHS Quality Strategy will reflect on the importance of this issue and that health system leadership will recognise this issue as an urgent priority.[9] References NHS Staff Survey. NHS Staff Survey National Results. 12 March 2026. The Mid Staffordshire NHS Foundation Trust Public Inquiry. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, 6 February 2013. 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. Independent Investigation into East Kent Maternity Services. Maternity and neonatal services in East Kent – the Report of the Independent Investigation, 19 October 2022. Helen Hughes and Peter Duffy. Key themes emerging from our ‘Speaking up for patient safety’ interview series. Patient Safety Learning, 14 May 2025. Roger Kline. Power and the sound of silence. Patient Safety Learning, 11 March 2026. Roger Kline. Patient safety and speaking up – learning from the literature. Patient Safety Learning, 11 March 2026. Patient Safety Learning. 10 Year Health Plan: Patient Safety Learning’s response. 14 August 2025. Patient Safety Learning and Aqua. Patient safety and the new NHS Quality Strategy. 25 February 2026.

In a review shared on the hub, Roger Kline, Research Fellow at Middlesex University Business School, explored the literature on patient safety and speaking up, arguing that staff being able to raise concerns safely and effectively is essential for patient safety, but the NHS continues to struggle with creating a culture where this happens reliably. In this blog, Roger reflects on some of the findings of his review. A critical characteristic of effective teams is whether every member is willing to speak up to share thoughts and ideas to improve processes, to raise concerns and admit mistakes. In healthcare, the failure of those to whom concerns are raised to listen and act on them decisively is a major factor in unsafe and suboptimal care delivery. NHS inquiry findings and recommendations are remarkably consistent on this issue. The Ely Inquiry (and other inquiries in the 1970s),[1] the Bristol Inquiry (2001),[2] the Mid-Staffordshire Hospital inquiries in 2010 and 2013,[3][4] and more recently Ockenden (2022),[5] all highlighted the failure to listen to staff who raised concerns and, worse, the victimisation of some of those who did raise concerns. Yet when the voices of healthcare staff are listened to and acted upon they can improve the safety and quality of services—as well as staff wellbeing.[6] Following the Francis Reports,[7] there was some limited improvement in NHS staff survey responses on whether NHS staff felt willing to raise concerns, whether they would be treated fairly if they did, and whether they felt their managers and employers would listen and act on those concerns. After Covid-19 that limited improvement stopped. Despite the raft of legislation, NHS regulation and exhortation, the 2023 National Guardian Office report entitled 'Fear and Futility' noted a “sharp decline in Freedom to Speak Up Guardians’ perception of the improvements in the Speak Up culture of the healthcare sector…” It noted that: “there is a growing feeling that speaking up in the NHS is futile – that nothing changes as a result.”[8] Staff safety is key to patient safety, so the fact that the majority of concerns raised are about staff safety is not a separate issue from patient safety but intimately linked.[9] So, when staff ought to—and often do—raise concerns what goes wrong? First, it has been repeatedly found by Francis (2015),[7] Kline and Warming (2024)[10] and others, that NHS staff are sceptical that raising concerns is effective and believe that by doing so it makes things worse for them personally due to victimisation.[11] Second, some staff groups are particularly sceptical of the effectiveness and/or safety of raising concerns. Kline and Warmington found that of Black and Minority Ethnic (BME) staff who did raise concerns, only 5.4% said they were taken seriously and that their problem was dealt with satisfactorily.[10] The most common outcome, in 42.7% of cases, to a race discrimination concern was nothing happening.[12] Begeny et al. (2023) revealed that within the UK surgical workforce, two-thirds of women medics (63.3%) had been subjected to sexual harassment, sexual assault and rape from colleagues, but only 16% of those impacted by sexual misconduct made a formal report.[13] Surviving in Scrubs (2023) noted a serious resulting risk to patient care from the silencing of female staff voicing concerns about such behaviours, as female staff reported that their clinical judgements were questioned, decisions were not taken seriously, clinical requests were ignored and referrals were refused.[14] Third, Mannion emphasises the importance of hierarchy in shaping behaviours: "Effective voicing of concerns is but the first stage in reshaping better safer healthcare: those with influence have to hear, and they have to act… In an intensely hierarchical organisation such as the NHS, entrenched status and power differences between professional groups can harm the development of open reporting cultures. Any attempt to address speaking up in the NHS must deal with the challenging organisational dynamic of resistance to bad news."[15] Reitz and Higgins (2020) suggest: "...power imbalance in organisational roles (as) perhaps the most important factor that makes employee silence such a common experience." They conclude that: “...instigating whistleblowing lines and training employees to be braver or insisting that they speak up out of duty, will achieve little therefore, without leaders owning their status and hierarchy, stepping out of their internal monologue and engaging with the reality of others."[16] Fourth, reputation continues to trump candour. Francis (2013) concluded that: “There lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism’; and an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern”.[4] Finally, alongside the refusal to adopt evidenced-based proactive interventions goes a lack of accountability for those whose power creates silence. Ministers have spoken strong words: “NHS managers who silence whistleblowers could be barred from working in the NHS, under proposals being announced this week.” [17] But such statements will only be effective if they are part of a wider evidence-driven strategy. In the meantime, victimisation of those raising concerns remains widespread, as recent reviews of the treatment of whistleblowers by both employers and the largest professional regulators have found.[18][19] Moreover, advice from professional regulators, as with NHS England, is very focused on individual professional accountability rather than system abuse of power.[20] Unfortunately, despite the best efforts of some NHS organisations, the conclusion Pope and Burnes reached a decade ago still stands: “The NHS exhibits too high a level of collective ego defences and protection of its image and self-esteem, which distorts its ability to address problems and to learn. Organisations and the individuals within them can hide and retreat from reality and exhibit denial; there is a resistance to voice and to “knowing.”[21] References Ely Hospital, Cardiff: Inquiry findings, Hansard, 27 March 1969. Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984 -1995. The National Archives, 2021. Mid Staffordshire NHS Foundation Trust Public Inquiry 2010. 24 February 2010. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry - Vol. 1: Analysis of evidence and lessons learned (part 1) HC 898, Session 2012-2013. Donna Ockenden. Ockenden Report: Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. 30 March 2024. Mannion R, Davies H. Understanding organisational culture for healthcare quality improvement. BMJ  2018;363:k4907. Freedom to speak up Review, February 2015. National Guardian Freedom to Speak Up. Fear and futility: what does the staff survey tell us about speaking up in the NHS? June 2023. Patient Safety Learning. Why is staff safety a patient safety issue? 3 September 2020. Written evidence submitted by Roger Kline and Professor Joy Warmington (NHL0074). March 2024. Correspondence. Sir Robert Francis’ Freedom to Speak Up review. 11 February 2015. Kline R, Warmington J. To hot to handle? Why concerns about racism are not heard... or acted on. January 2024. Begeny CT, Arshad H, Cuming T, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. BJS, 2023; 110(11): 1518–26. https://doi.org/10.1093/bjs/znad242. Cox B, Jewitt C, MacIver E. Surviving healthcare: sexism and sexual violence in the healthcare workforce. Surviving in Scrubs. November 2023. Mannion R, Blenkinsopp J, Powell M, et al. Understanding the knowledge gaps in whistleblowing and speaking up in health care: narrative reviews of the research literature and formal inquiries, a legal analysis and stakeholder interviews. NIHR 2018; 6(30). Reitz R, Higgins J. Speaking truth to power: why leaders cannot hear what they need to hear. BMJ Leader 2020; 10.1136/leader-2020-000394. DHSC. Press release. New protections for whistleblowers under NHS manager proposals. 24 November 2024. Patient Safety Learning. The whistleblower playbook. the hub. 26 June 2025. Nursing & Midwifery Council. Independent Culture Review. July 2024. General Medical Council. Speaking up. Pope R, Burnes B. A model of organisational dysfunction in the NHS. 2013. Journal of Health Organisation and Management, 2013; 27(6): 76-697. https://doi.org/10.1108/JHOM-10-2012-0207. Further reading on the hub: Patient safety and speaking up—learning from the literature (Roger Kline) Speaking up for patient safety: A new interview series about raising concerns and whistleblowing Top picks for staff psychological safety

Across healthcare, social care and countless other industries, safeguarding failures, misconduct and preventable workplace incidents are too often preceded by missed opportunities to act. Staff frequently suspect issues but feel unable or unsafe to speak up. Internal processes for speaking up fail to gain trust and inspection bodies rely on outdated ‘tick-box’ policies. The result? Blind leadership, compromised quality output, costly crises, avoidable trauma, damaged reputations and lost talent. In this interview, Shaun Keep and Paul Adams, founders of Say So, discuss from their experiences some of the reasons why staff don’t feel able to speak up and why and how we can change attitudes and patterns of behaviour in the workplace.

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