If you silence whistleblowers, you will never work in the NHS again.

Wes Streeting, Secretary of State for Health

I’m determined to create a culture of honesty and openness in the NHS where whistleblowers are protected, and that demands tough enforcement. If you silence whistleblowers, you will never work in the NHS again. We’ve got to create the conditions where staff are free to come forward and sound the alarm when things go wrong.”

You cannot argue with the sentiments of this announcement by Wes Streeting.

There must be accountability for those who suppress people who speak up. Not just in the NHS either.

There is already recourse for action on people who deliberately victimize and retaliate against people who speak up. Every organisation’s code of conduct, including the NHS Freedom to Speak Up National Policy has a statement that detriment against people who speak up will not be tolerated. All acts of victimization against those who make public interest disclosures are illegal.

This month three former senior leaders from the Countess of Chester Hospital were arrested on suspicion of gross negligence manslaughter for failing to act on concerns raised about Lucy Letby, who is convicted of murdering seven babies. An example of existing legal consequences for failing to act appropriately on concerns raised.

What does “silencing whistleblowers” look like?

Detriment for speaking up is a slippery thing to define, let alone prove. I’m concerned that the burden of ‘proof’ will become just another hoop for people who experience it to jump through.

The 2023 evaluation report of NHS England’s Speaking Up Support Scheme shares the voices of people who have had lived experience of detriment for speaking up.

“They were making out that I was some kind of troublemaker.”
“They wanted me to break down.”
“Nobody would speak to me. Emails were ignored. I was excluded at work—and beyond, in my own community.”

Raising concerns did not just harm their careers,  it fractured their identity, their mental health, their very sense of belonging.

Patient Safety Learning recently synthesised these recurring patterns they heard in their recent podcast series into the Whistleblowers’ Playbook. It can be hard to define, because how do you articulate how  microagressive silences, or erosion of job roles make you feel? You may already feel isolated and fearful, unable to share how you’re feeling with others, and the silent treatment may feed your paranoia, which in turn is used against you as indication of instability.

If you feel victimized for whistleblowing, speak to your Freedom to Speak Up  Guardian if you work in the NHS in England, or contact the charity Protect

Demonising managers

Whistleblower retaliation is rarely the action of one single individual. For someone speaking up to be silenced, there needs to be complicity within the leadership of an organisation – not just executives but from functions like HR, communications, investigations.  Not one bad apple, but a whole barrel.

The demonizing of  managers asthese shadowy suppressors of the truth – is, I think, part of the problem.

It means, that if you are a leader in the NHS, you probably think that Wes Streeting is not talking about you. Leading in the NHS is complex. You’re a good person. Doing your best for the organisation and patients and staff. You justify to yourself that you’re doing what is right.

Speaking up, far from being trouble making, can be seen as a courageous form of loyalty. Challenging bad practice, raising concerns or sharing ideas for improvement, are the very behaviours leaders want to encourage to make organisations safer, more responsive, more productive, more innovative. Those who speak up are the  risk management, quality improvement, crisis prevention team. Why would you want to silence that?

Shooting the messenger

In order to eradicate retaliation, it’s important that we seek to understand what motivates people to silence those who speak up.

We know from research that we’re wired to “shoot the messenger”.  A 2019 study in the Journal of Experimental Psychology found that people react negatively to those who deliver bad news, associating them with the news. In one experiment, people even attributed malicious intentions to the bearer of bad news and questioned their competence.

Managers must train themselves to consciously challenge their own bias and focus on the message, not the messenger. To thank the person who speaks up, even when it’s something you don’t want to hear. This builds in time to pause, to reflect, to listen.

The perversion of targets

As Wes Streeting said: “Protecting the reputation of the NHS should never be put before protecting patient safety.”

History has shown that ultimately the damage to reputation caused by the cover up of concerns is far worse than if the concerns were investigated and remedied, even if made public. The proposal by Baroness Kramer of a legal duty on employers to investigate concerns in the Employment Rights Bill is welcome. However, the short-termism and corrupting influence of rewards and bonuses on ethical decision-making cannot be underestimated.

The government’s 10 Year Health Plan for the NHS sets outs out several incentives for ‘high -performing’ trusts, and while funding will be tied to achieving better health outcomes, rather than just activity levels, research shows that incentives may lead to unintended consequences.  As the Kings Fund in their analysis of the Plan writes:

“[It] signals a clear uptick in the use of financial incentives to reward or penalise organisations based on the quality of the care they provide or on the experience of individual patients. But history suggests the need for caution in this as it has proved difficult to design effective incentive schemes, and there is a danger that the extent to which either rewarding or punishing NHS organisations can lead to the quality of care becoming fundamentally inequitable.”

My concern is that this incentivises short-sightedness which contributes to what Guido Palazzo calls “ethical blindness”. This ethical blindness further deepens the biases which impede decision-making.

I would also like to quote from history, this time from Sir Robert Francis’s report of the Mid Staffs Public Inquiry over a decade ago.

“there lurks within the system an institutional instinct which, under pressure, will prefer concealment, formulaic responses and avoidance of public criticism; and an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern. “

Shifting from treatment to prevention 

Will the regulation of managers deter whistleblower suppression?  To borrow a metaphor from the 10 Year Plan – we want to move from treatment (disbarring managers) to the prevention of detriment in the first place.

Real progress won’t come from tougher enforcement alone, especially with the complex interplay between what leaders are being required to do, and the reality of leading in a service which seems to be in a constant state of “unprecedented change”.

Managers and leaders must be properly trained and accredited, with continuous professional development requirements. I am hopeful that the new college of executive and clinical leadership will include responding to concerns and supporting speaking up.

This includes cultivating organisations which operate to the highest ethical standards, and ways to prevent detriment from occurring in the first place.  

Preventing detriment looks like:

• Building psychological safety in real terms – not just with words
• Training managers to understand their biases, to interpret feedback, not take it personally, and support them in resolving concerns within teams
• Recruiting and evaluating managers and leaders for values, not just results
• In the NHS, providing meaningful support for Freedom to Speak Up guardians so that they themselves can be protected from retaliation
• Risk-assessing those who raise concerns for retaliation before it happens.

Leaders, take a pause.

Why would you victimise the very people who are giving you the gift of information you need to hear? If you silence one, the rest of your employees will fear speaking, and that silence will be dangerous.