Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more


Kim Holt: ‘We want to make the health service safe for everyone’


Employers must understand that raising concerns is important and to be welcomed, says Kim Holt

Patients First is a network of health professionals and their supporters who are campaigning for openness and transparency in the NHS. We have active campaigners in England, Northern Ireland and Scotland.

It started with a few of us in December 2011 and is growing organically, building a network across the UK of nurses, midwives, doctors and managers – indeed, any health professional keen to bring an end to the defensive culture of the past 20 years.

My own experience spanned four years. I was excluded from my job and have now returned to it. It is possible to survive, and we hope that we can inspire others to feel confident to speak up. 

We have been instrumental in bringing to wider attention the links between bullying and the raising of concerns. In some places, it is seen as unacceptable to challenge the way things are done. 

Sadly, however, we continue to be contacted by health professionals attempting to challenge unsafe care or fraud, feeling ignored or victimised and unable to find support elsewhere.

‘If frontline staff are not supported and cannot find anywhere they can be heard, then we are very far away from the aspirations of the recent Berwick review into patient safety’

The pattern is nearly always the same. Employees raise concerns within their workplace about some aspect of patient care and, before they know it, they are being disciplined, threatened with dismissal or bullied to the point of depression or worse.

Dismissals are still taking place, as is gagging. In its Confidentiality Clauses and Special Severance Payments report issued in June, the National Audit Office confirmed that millions of pounds are being spent on severance agreements, but the government had no idea how many were linked to whistleblowers. This is now being looked at.

Retaliation against staff raising concerns about patient care, of course, breaches employment law, but a lone employee is rarely in a position to challenge such behaviour. There is little accountability for bullying, and union support – from any of the unions we are told – is often weak.

If frontline staff are not supported and cannot find anywhere they can be heard, then we are very far away from the aspirations of the recent Berwick review into patient safety.

People who contact Patients First are motivated by a desire to ensure patient care meets at least basic professional standards. When they have found themselves in trouble as a result of this, it is confusing, distressing and often traumatic.

It is the unhelpful response to raising concerns that Patients First is trying to change. We aim to do this by raising awareness and informing people of their rights, but also helping employers to understand that raising concerns is important and to be welcomed, and not punished. We want to make the health service safe for everyone.

I, as one person, cannot individually support all concerned who contact Patients First, so we are developing a network of professionals across the UK to attempt to fill this gap. Help and support can be obtained by contacting us via the website at We are always seeking more supporters to help.

There is advice on our website about how to raise a concern and where to go for help, and we try to signpost people. The impact of bullying is recognised and we would recommend that all of those who are feeling pressure and retribution seek professional psychological support.

Currently no one, from healthcare assistant to chief executive, is immune to being punished for raising a concern. We will continue to push forward with the campaign until we stop hearing stories of bullying responses and failures in the system.

We hope that nurses, midwives and HCAs around the country will sign up to support our campaign and we can bring about a cultural change on our frontline.

Dr Kim Holt is founder of Patients First


Readers' comments (2)

  • michael stone

    The DH published some guidance about responding to complaints a few years ago - it pointed out that concerns and complaints can, if approached with a neutral investigatory attitude, teach lessons which can then lead to service improvements.

    That is obviosuly true - but many organisations react entirely defensively to concerns and complaints, which prevents any learning and subsequent service improvement.

    This is not something that isn't known about - but it seems awfully difficult to cahnge that defensive attitude.

    Unsuitable or offensive? Report this comment

  • My understanding is that it is ultra vires for a health authority to use funds voted by parliament for one purpose (e.g. the provision of a health service) for any other purpose.

    A compensation payment as part of a termination agreement which includes a gagging clause presumably has some part of the payment attributable to the gagging clause.

    If the gagging clause is for the preservation of the reputation of individuals, they should either pay for that themselves, or the benefit to the NHS should be demonstrable.

    Could that be tested in the courts?

    Also, in Scotland, it seems to me that any gagging clause is in conflict with the Founding Principles of the Scottish Parliament.

    I know that ministers take the Founding Principles seriously. They do not of course apply to Health Authorities, only to the Parliament itself.

    In 1953, a friend then known as The Gannett for his dietary habits, and now more widely known as The Father of the Nation, shared with me his vision for a Home Rule parliament.

    "It would have principles", he said and moreover, a way of seeing to it that it stuck to them".

    44 years on, when he had progressed the Scotland Act through both houses of parliament, the cabinet, the law lords, a constitutional convention and a referendum, nothing of what Donald Dewar told me in 1983 had changed

    I had hoped by now that by the example of the Parliament itself, Openness would have in practice percolated down to agencies of the parliament, universities and the like and become normal behaviour.

    Maybe I will live to see the day when some journalist in England or abroad explains to his readers why things are the way they are, because that is the Scottish way, in accordance with the Founding Principles of their Parliament.

    I am aware of a situation where the Audit Committee of the Scottish Parliament accepted that they could not press for an answer from a trade union official because the member whom he represented was subject to a gagging clause.

    Had been a member of the Audit committee I would have been considering whether to rely on my out of date and insufficient information on the law on provocation as justification for assault.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.