Ellen McGreevy, senior solicitor at Bolt Burdon Kemp, calls for the duty of candour to be enforced and whistleblowers supported across the health service.
The rapid national investigation into NHS maternity and neonatal services announced in the Summer was welcome news; however, there have been concerns about how the government will urgently improve care and safety in this area of care. This isn’t an issue just impacting maternity and neonatal services, many have been worried about how the poor standards seen across the wider health service will be tackled too.
One essential part of improving care and safety in healthcare is by improving whistleblowing procedures and encouraging duty of candour. A health service that learns openly is inherently a safer one. The NHS can meaningfully promote a culture where healthcare professionals at all levels can openly and honestly speak out about concerns in patient care – it is only by doing this that lessons can be learned and standards improved.
However, that culture is lacking. The statutory duty of candour is applied inconsistently, and fewer than half of medical staff say they fully understand what it requires. Staff who raise concerns are often met with hostility rather than support. This discourages honesty and prevents the NHS from learning when things go wrong.
What a learning culture looks like
NHS England’s Patient Safety Incident Response Framework (PSIRF) encourages organisations to treat harm as an invitation to improve, with proportionate responses, meaningful involvement of those affected and clear oversight. The Learn from Patient Safety Events system now serves as the national reporting and analytics hub for safety incidents, helping trusts identify recurring risks and shape improvement.
These policy tools provide a solid foundation, but frameworks alone cannot build trust. That requires openness, protection for those who speak up and a shift in mindset, so negligence is seen as a trigger for learning rather than concealment.
The statutory duty of candour is intended to make transparency the default. Yet application across trusts remains inconsistent. A national review found fewer than half of respondents believe staff fully understand the duty, and many fear it is becoming a tick-box exercise rather than a genuine commitment to openness.
The Mid Staffordshire Public Inquiry, led by Robert Francis, stressed the need for statutory openness and warned against contractual clauses that discourage disclosures. When trusts fail to uphold candour, public confidence suffers and the opportunity to learn from mistakes is lost.
Speaking up is essential for patient safety. However, evidence shows that whistleblowers are often labelled as troublemakers, and organisations sometimes miss the chance to act on concerns.
The review at University Hospitals Sussex revealed a culture of fear, with staff reporting bullying, suppression of concerns and punitive treatment for those who raised issues. The NHS Ombudsman has also warned that a cover-up culture persists, with altered care plans, missing records and retaliation against those who speak up.
When harm occurs, the instinct in some parts of the NHS can be to deny, deflect or manage reputations. This deepens the distress for patients and families and obstructs organisational learning.
Early admission, honest explanation, focused learning and timely redress reduce harm to families and lower litigation costs. Major reviews such as the Ockenden Review have shown the devastating consequences of minimising or ignoring failures.
What needs to happen now
A true culture of learning requires honesty when things go wrong, strong protection for those who raise concerns and an attitude that treats negligence as a springboard for improvement rather than something to hide.
My firm, Bolt Burdon Kemp, recently launched its 2025/26 Manifesto for Injured People, focused on seven priorities that we believe are vital to improving the lives of those living with serious injury. Each priority sets out clear and practical policies to deliver real change, and we have launched this to ensure that injured people’s needs remain firmly on the political agenda at Number 10, in parliament and across government.
As part of our manifesto, we are calling for the NHS to enforce candour through clear policies, transparent metrics and consistent use of statutory powers; to protect whistleblowers with stronger board oversight, adequate support and independent checks; and to treat negligence as a trigger for learning through early resolution, open communication and sharing of lessons.
The NHS already has frameworks and data systems in place. While the rapid national investigation into NHS maternity and neonatal services is very much needed, what is now required is visible and consistent action, with candour enforced, whistleblowers supported, and learnings shared openly across the health service.
