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'Every nurse should feel able to speak up'


Whistleblowers should be regarded as heroes, thanked and celebrated.

That’s the view of Margaret Heffernan, author of Wilful Blindness and Beyond Measure, who has researched cultures that dissuade people from speaking up. She was appearing last week at the launch of whistleblowing charity Public Concern at Work’s review of the first group of companies to implement the recommendations from its Whistleblowing Commission. See our story on this at

The launch came the same week as the whistleblowing policy – drawn up by NHS England, Monitor and the NHS Trust Development Authority in response to Sir Robert Francis’s Freedom to Speak up Review – was put out for consultation. The policy reassures staff who speak up that they will be listened to, their concerns will be investigated, and they will not suffer detriment.

These are laudable aims. But I am not convinced that one national policy peppered with a few local freedom-to-speak-up guardians answering to one national figurehead for concern-raising everywhere will do the trick.

The culture is so toxic in many NHS organisations that they refuse to listen to those who know best when problems arise. Staff are fed up of being ignored and bullied when they put their heads above the parapet, and are unlikely to do so just because the NHS has published a document saying they should. The NHS needs to celebrate staff who have saved lives and trusts by speaking up – and normalise the process of raising concerns.

Ms Heffernan argues that organisations should encourage staff to say the unsayable, and train and retrain their managers to hear the issues that are raised without becoming defensive.

That’s what we’ve been encouraging people to do through our Speak Out Safely campaign. We want employers to sign up to publicly demonstrate that they support staff who raise concerns. Despite numerous invitations, many have not yet felt the need to.

Check today whether your organisation is signed up at and let us know if they aren’t by emailing

Speaking up can save money in some organisations, but, in healthcare, it also saves lives. Every nurse should feel able to speak up as a matter of course.


Jenni Middleton, editor


Readers' comments (5)

  • michael stone

    This is a hugely important issue, and I agree with Jenni (although I think the role of local freedom to speak up guardians is crucial) - see my piece at:

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  • The phrase that stood out for me here "The culture is so toxic in many NHS organisations"
    This is my experience in many places and hence my anonymity at times. People in those cultures would be shocked to be named as toxic, there is so little insight and reflection let alone reflexion.
    Someone tweeted a very insightful phrase, 'culture eats strategy for breakfast'
    It is necessary to be more aware of personality theory and disorder in order to change this. It will not change until we change how we deal with this.

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  • Nurses are terrified of the ever increasing culture of blame and victimisation. Nurses who do speak up are treated in the most appalling way. They are isolated, gossiped about but this is minor to the false allegations that follow, the suspension that follows and even having to defend themselves against the lies and false allegations before the NMC
    The isolation, mental anguish, mental illnesses, financial ruin, family breakdown and even suicide ensues. The NMC refuses to accept a Duty of Care towards these nurses, there is no support for them, they are totally alone

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  • Thank you Jenni for being so honest about whistleblowing. You are absolutely right having doubts about the effectiveness of what is being planned to try and make whistleblowing safe. And the two people who have commented are also absolutely right. The Big Question page also showed how malicious allegations are being made against colleagues as an abuse of existing policies with no consequences for the people making them. And the disastrous policy of taking the view that a person is guilty until they can prove their innocence, with transparency as thick as treacle, continues to go unabated and uncorrected.
    There is no accountability, no collection of data regarding suspensions and investigations, no outcome measures and therefore life goes on but now in the increasingly dangerous world of understaffing and risk of mistakes. Sorry patients.
    The people contacting demonstrate no improvements either. Desperate.
    Julie Fagan, founder member of CAUSE – Campaign Against Unnecessary Suspensions and Exclusions UK

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  • Afterwards the world of ambiguous professional support, to feel like a ghost walking and no one to talk to when you really need it. Made to feel lonely. Moments of pure anger and management who see no shame and lack insight to what they've done. A stupid big hug makes all the difference.

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