Promoting partnership working in the NHS

Raising concerns (whistleblowing)


The importance of raising concerns at work in the public interest is recognised by employers, staff, trade unions and the general public. The SPF believe that it is incredibly important that there is an open environment in NHS workplaces, where staff feel confident to raise concerns about poor quality care and that management, staff and their trade unions work together in partnership to use this invaluable feedback to improve the services the NHS provides. 


On 1 April 2016, NHS Improvement and NHS England launched the first national, integrated whistleblowing policy, that will help standardise the way NHS organisations should support staff who raise concerns. The policy was one of a number of recommendations of the review by Sir Robert Francis into whistleblowing in the NHS, to help to normalise the raising of concerns for the benefit of all staff and patients.

The policy sets out:

  • who can raise a concern
  • the process for raising a concern
  • advice and support when raising a concern
  • how the concern will be investigated
  • what will be done with the findings of the investigation.

The policy will ensure:

  • NHS organisations must encourage staff to speak up and set out the steps they will take in order to investigate their concerns.
  • A local Freedom to Speak Up Guardian must to be appointed in every trust, who will act as an independent & impartial source of advice for staff when raising a concern.
  • Any concerns that are not resolved quickly through line managers involvement will be investigated.
  • Investigations must be evidence-based & led by an independent figure in the organisation, with a subsequent report which focuses on the lessons to be learnt and the improvement of patient care.
  • Whistleblowers must be kept fully informed throughout the investigation process.
  • The organisations board are to be made aware of ‘high-level’ findings and the policy will be reviewed and improved on an annual basis.  

The full consultation response document is available. Over 165 responses were received from NHS staff members, whistleblowing organisations, trade unions, trusts, foundation trusts and clinical commissioning groups.

On the recommendation of Sir Robert Francis, whistleblowing in primary care was reviewed separately and resulted in the production of specific guidance for primary care on freedom to speak up

To promote the importance of staff raising concerns, NHS Employers has worked with its SPF partners to produce posters which encourage staff to report a risk, wrong doing or malpractice in their organisation. These posters can be downloaded from the NHS Employers website.

To help build on the good work already taking place, the SPF endorses the national Whistleblowing Helpline which provides free, confidential and independent advice for those working in the NHS and adult social care.

The helpline number is 08000 724 725, and advice can also be sought via email at

Prior to publication of ‘Raising Concerns at Work’, the Whistleblowing Helpline in partnership with the SPF ran the Bridging the Gap campaign. The aim was to explore why staff that were aware of their organisation’s whistleblowing policy still did not feel confident in raising a concern. The campaign found that whistleblowers commonly describe the experience in negative terms; actions were often not taken in response to concerns raised and there was a fear of reprisals and the impact that whistleblowing could have on an individual’s career. There were a number of recommendations set out in a report on the Bridging the Gap campaign to improve the whistleblowing process and the experience of the whistleblower. The SPF further recommends that health and social care organisations work in partnership with their staff trade unions to ensure policies and practices remain fit for purpose.

The national Whistleblowing Helpline published Raising Concerns at Work: Whistleblowing Guidance for Workers and Employers in Health and Social Care in March 2014. This guidance extends the scope of pre-existing guidance and sets a standard for whistleblowing/raising concerns policies in health and social care organisations. 

Key messages in the guidance include:

  • The importance of encouraging staff to raise concerns as part of normal day-to-day practice and how this can help employers identify poor practice and improve the quality and safety of care.
  • An outline of the legislation – the Public Interest Disclosure Act 1998.
  • A flowchart of the whistleblowing process.
  • Top tips for workers who wish to raise concerns and sources of advice and support.
  • Top tips for operational managers to respond positively when staff raise concerns.
  • At corporate level, the guidance sets national standards for whistleblowing policies for employers, together with a summary of their responsibilities.
  • Case studies of good practice, frequently asked questions, and further information and links.

In addition, the SPF recommends the importance of having robust and effective whistleblowing policies in every workplace, agreed in partnership between the employer and representative staff unions.

As detailed in the Francis Inquiry Report, Professor Michael West’s research and the recent IPA report, Meeting the Challenge: Successful Employee Engagement in the NHS, a growing body of evidence is emerging around the critical link between good staff engagement and patient experience and outcomes.

The NHS Constitution sets out the right of all staff, doing clinical or non-clinical NHS work to raise any concern with their employer, whether it is about safety, malpractice or other risk, in the public interest.

On 11 February 2015, Sir Robert Francis QC published his report on the Freedom to Speak Up review. The review was set up in response to continuing disquiet about the way NHS organisations deal with concerns raised by NHS staff and the treatment of some of those who have spoken up. The report makes a number of key recommendations to help foster a culture of safety and learning in which all staff feel safe to raise a concern, under five overarching themes:

  • culture change
  • improved handling of cases
  • measures to support good practice
  • particular measures for vulnerable groups
  • extending the legal protection.

The SPF responded to the report as part of a statement on the results of the 2014 NHS Staff Survey.

The 'Draw the line' campaign launched in February 2015 supports, guides and enables managers to have open conversations locally about raising concerns. The campaign includes the publication of a series of new on-line resources for managers.  All are targeted at supporting NHS organisations to implement and embed frameworks that affect a change in culture and raise awareness of the different approaches being successfully adopted across the country and across sectors. The SPF is fully engaged in the range of programmes that are underway to help influence the changes that need to happen to embed the right kind of culture and behaviours which enable NHS staff to raise concerns. Read more on our Draw the line web page.  

For further advice and support about raising concerns in your workplace, you may also want to contact your trade union or HR representative.