Anyone who has tried to wade through the 290 recommendations of the public inquiry on poor care at Mid Staffordshire Foundation Trust will be impressed with the concision of Sir Robert Francis’ review of NHS whistleblowing.

The review makes only two, relatively modest, recommendations requiring legislative change, and sets out 20 “principles” to guide the way NHS organisations and the wider system treat staff who raise concerns.


This brevity will for some be a virtue, for others a core vice.

Critics will argue that the recommendations lack teeth – Sir Robert rejected the idea of a new external body that could review the handling of individual cases, and there is no new law proposed to sanction bodies or individuals found to have mistreated whistleblowers.

‘The review’s brevity will for some be a virtue, for others a core vice’

Much of the good practice recommended in the report seems to depend on the good faith of organisations to be effective.

Some have expressed understandable doubt, for example, that Sir Robert’s proposed whistleblower “guardians” can be independent brokers, when they are to be appointed by trust chief executives.

Expanding the scope

But against these criticisms, Sir Robert makes the reasonable point that there has already been a huge, and ongoing, overhaul of NHS regulation in the wake of the Mid Staffs Inquiry.

“The stick,” he told HSJ, “is already there.”

‘The political response to the review will be a disappointment’

The CQC has powers to act where trusts are not well led, and an organisation that ignores staff who raise concerns is unlikely to be well led. He suggests expanding the scope of the new fit and proper persons regulations to address bullying of whistleblowers. On his analysis, the tools to tackle these problems are already there – what’s needed is the collective will to do so.

It is possible, therefore, that the report’s principal impact will come not from its recommendations but from its conclusion that poor treatment of whistleblowers is a present and serious issue in the NHS.

Sir Robert describes “shocking accounts” of the way some staff have been treated after raising concerns, of suicidal thoughts and suicide attempts.

The pain and distress he saw in those who gave evidence was, he says, “every bit as serious as the suffering I witnessed by patients and families who gave evidence to the Mid Staffordshire inquiries”. The suggestion that some whistleblowers have ulterior motives has “for too long been used as an excuse for avoiding a rigorous examination of safety and other public interest concerns raised by NHS staff”.

The blame game

He also recognises that poor culture in parts of the NHS has not grown in a vacuum.

The “political significance of almost everything in the system,” he writes, “does mean that there is often intense pressure to emphasise the positive achievements of the service, sometimes at the expense of admitting its problems.”

‘Neither political side seemed to note the irony of their positions’

For those who recognise the relevance of that argument, the political response to the review will be a disappointment. Labour leapt on figures from the review to issue the statement saying bullying of NHS staff had risen “over 50 per cent under Tory led government”.

Health secretary Jeremy Hunt responded to Labour criticisms by asking his opposition counterpart: “As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals?”

Neither side seemed to note the irony of their positions. But those who want to eradicate blame culture in the NHS must recognise it will be hard to do so while the service’s political masters still seek to blame each other for NHS failings.