This site is intended for health professionals only

Whistleblowing at work

Francesca West
Policy Director
Public Concern at Work

Whistleblowing is a contentious topic and one that has attracted press attention, particularly with regard to cases of malpractice within the NHS uncovered by recent television documentaries such as Panorama

Physical abuse in the care sector is the top concern for workers, often nurses, who contact a dedicated charity advice line for whistleblowers. This is followed by failure to treat patients with dignity, and concerns about neglect, says Public Concern at Work, a charity that provides advice and support to NHS staff, and those in other organisations, who are worried about bad practice.

The charity runs an advice line to which, on average, 13% of calls are from the health sector each year, many of these from nurses.

A recent survey showed that nurses are very likely to speak up when they see something going wrong. It found that two thirds (68%) of nurses said they had a concern about a serious risk to patient safety in the last three years and almost all (87%) raised it.1 This is good news for patients - but how did it impact on the member of staff who dared to speak out? How does working as a nurse for the NHS compare to those working in other settings? The survey revealed fewer nurses working outside the NHS (30%) reported their serious concern being handled 'fairly' or 'well', compared to those within the NHS (51%). More said patient harm was caused (30%) than their NHS colleagues (20%) and twice as many (65%) reported suffering reprisals for speaking up (34% in the NHS).

Although nurses in and out of the NHS say the belief that nothing will be done is the strongest deterrent to colleagues speaking up, nurses outside the NHS identify fear of dismissal or discipline as a stronger deterrent than a worry about the reaction of other colleagues.

In the UK, much work has been done to produce guidance for NHS organisations on whistleblowing and in June 2010 the Department of Health published Speak up for a healthy NHS. This document advises employers how to implement policies that enable staff to report cases of bad practice.2 While the guidance is useful reading for any organisation, there is no specific advice available for healthcare organisations outside the NHS.

A third of calls to the advice line are from those working in health and social care. In the health sector 35% of calls related to public and patient safety; 13% financial malpractice; and 18% were ethical issues. This is perhaps an unsurprising split, but it shows a clear picture of what health professionals are worried about. A recent report, Speaking up for vulnerable adults: What the whistleblowers say, analysed some of the concerns faced by those working in the care sector in greater detail.1 These calls were mainly from care workers and nurses and are listed in Box 1.

It is vital that nurses feel they have a voice they can use to protect patients and feel confident that, if they speak up, they will be heard. Organisations should be prepared to listen and make it clear that reprisals against staff who raise a genuine concern will not be tolerated. Good organisations make it clear that, although they want to know about a serious risk at the earliest opportunity, they understand and want an individual to speak to their regulator if it cannot be raised internally. 

Beyond the risk to patients, a failure by organisations to handle whistleblowing well could result in a claim by a worker under the whistleblowing legislation, the Public Interest Disclosure Act 1998 (PIDA). If a worker is victimised or dismissed for raising a genuine concern, they can take a claim to the Employment Tribunal. PIDA supports a culture of responsible whistleblowing by encouraging individuals to first speak to their employer and then their regulator. PIDA also recognises that there are circumstances in which an individual should be protected for speaking to the media. However, although the law provides important protection, this should be a last resort and comes into play only when a worker has been damaged. As such, any rise in PIDA claims can be seen as negative. There are too many examples of public money being used in the defence of PIDA claims - whether they are valid or not. Ultimately, it has to be about how the risk can most effectively be addressed, organisations need to make sure that this is done at the earliest possible stage. If you have a concern and you are not sure how to raise it, don't hesitate to seek advice. Talk to a trusted colleague, your union, professional body, or Public Concern at Work.

Box 1. Concerns of adult social care workers (most frequent first)

  •     Physical abuse
  •     Failure to treat a service user with dignity
  •     Neglect
  •     Medication not properly administered
  •     Conduct of staff
  •     Verbal abuse
  •     Inadequate staff training
  •     Incorrect lifting
  •     Financial abuse
  •     Understaffing
  •     Illegal workers
  •     Health and safety of staff
  •     Sexual abuse

1.    Public Concern at Work. Speaking up for vulnerable adults: What the whistleblowers say. Available from:
2.    Department of Health (DH). Speak up for a healthy NHS: How to implement and review whistleblowing arrangements in your organization. London: DH; 2010.