Guardians will help whistleblowers speak out

The Director for Patient Experience, discusses the steps NHS England is taking to ensure primary care staff feel supported if raising safety concerns:

There is no greater insight in the drive for NHS improvement than that gained by listening to patients, families and staff.

It is now the norm for patients to be asked for feedback. Two-thirds of people with cancer complete the annual Cancer Patient Experience Survey and over 17 million pieces of feedback have now been given through the Friends and Family Test.

Complaints, too, can be gold dust for service improvement and last month NHS England and the Parliamentary and Health Service Ombudsman published a review of the quality of complaints handling in primary care, which demonstrated that outstanding practices are those which make it easy to complain and act on what they hear.

Now it is becoming easier for NHS staff to raise a concern about safety. Clinical staff already record incidents on a national reporting system, so that colleagues across the NHS can learn from them.

We know, however, that not all staff have felt completely confident in raising a concern with their direct managers. That’s why NHS Trusts have appointed Freedom to Speak Up Guardians, to ensure that issues can be flagged to senior managers in a variety of ways.

Today NHS England is starting a consultation on guidance for primary care organisations, on how they can encourage staff to share concerns. This requires each practice to identify a Freedom to Speak Up Guardian, either within the practice or within another local part of the NHS.

In addition, from 1 April, NHS England will become a ‘prescribed person’, which means that NHS whistleblowers who work in general practice, dentistry, ophthalmology and community pharmacy can raise concerns directly with us with potentially the same employment rights as if they make the disclosure directly to their employer.

These initiatives are the sharp edge of a bigger effort to promote working cultures in the NHS which are based on the principles of listening, learning and improving.

Healthcare can be a complex task, involving several disciplines at the leading edge of science and our goal must be to enable every member of the team to raise a concern at any stage, so that problems can be avoided and lessons learned. To truly adopt such a culture requires strong leadership and openness to what people are saying. Much of the feedback results in small, simple changes that can make a big difference to patients and their families. Sometimes, issues are raised which need a wider response, like what has happened to improve recognition and treatment of sepsis. Feedback can also reveal how the design of services needs to change, for example to better meet the needs of family carers.

Ultimately, the most powerful drivers of improvement are the conversations between NHS staff, patients and their families. The NHS is at its most effective when we are open and responsive to what people say.

Insight from patients, families and staff are driving improvement throughout the NHS but the approaches recommended in this new guidance will help us be the best we can be.

  • For more detail see GOV.UK website.
  • We recommend that anyone contemplating making a disclosure should first contact the NHS Whistleblowing Helpline on 08000 724 725 or Public Concern at Work on 020 7404 6609.


Dr Neil Churchill

Neil is Director for People and Communities at NHS England, having joined the NHS after a 25-year career in the voluntary sector. His work includes understanding people’s experiences of the NHS, involving people and communities in decision-making and leading change to improve the quality and equality of care. He has a particular focus on strengthening partnerships with unpaid carers, volunteers and the voluntary sector.

Neil has previously been a non-executive director for the NHS in the South of England, is a member of the Strategy Board for the Beryl Institute and Chair of Care for the Carers in East Sussex. He is himself an unpaid carer. Neil tweets as @neilgchurchill