Our NHS Wales workforces are delivering such superb everyday work, their dedicated efforts and commitment to services is inspirational. Yet there are times when things just don’t go right, where there are issues or concerns. There is a fear for patient care and colleague wellbeing. The need for speaking up safely is a vital component for any NHS organisational culture and highlighted in recent reports from Francis (2015) and Ockenden (2022).
The Francis report highlighted the need for:
Every organisation involved in providing NHS healthcare should actively foster a culture of safety and learning in which all staff feel safe to raise concerns.
Raising concerns should be part of the normal routine business of any well-led NHS organisation.
Freedom to speak up about concerns depends on staff being able to work in a culture which is free from bullying and other oppressive behaviours.
All NHS organisations should ensure that there is a range of persons to whom concerns can be reported easily and without formality. They should also provide staff who raise concerns with ready access to mentoring, advocacy, advice and counselling.
How to Speak Up Safely In Your Organisation
Organisations across NHS Wales are committed to embedding speaking up safely as part of their cultures. It is recognised that to enable this, various methods and means will be utilised to ensure staff feel safe and comfortable in speaking up. This will vary across organisations as they implement local methods to support this agenda. There will be transparency where possible, on any actions taken because of staff speaking up to show they have been actively listened to.
The need for speaking up safely to be firmly embedded into everyday life and cultures across NHS Wales is a priority. The way and means of doing this will evolve with new initiatives added to ensure that issues can be safely explored.
Culture change is not a one-off event, but requires constant attention and development.
Speaking Up Safely Process
Click on the highlighted parts of the diagram for more information.
Accessible version of the process 
Frequently Asked Questions
Staff should be able to raise concerns with their line manager in routine discussions on service delivery and patient care, (e.g. problem-solving, service review, performance improvement, quality assessment, training, and development) as these are the most effective mechanism for early warning of concerns, wrongdoing, malpractice or risks. Our Line managers are accordingly best placed to act on, deal with and resolve such concerns at an early stage.
However, in some circumstances, this may not be appropriate and there are other methods you can use to raise a concern if you cannot speak to your line manager. Your local organisation will have more specific advice on what support you can obtain when you want to raise a concern and some examples are listed below.
Trade/professional unions (TUs) - provide support, advocacy and representation at all stages if required by the member/employee Wellbeing support- refer to your local policies on accessing wellbeing support
Well-being support – refer to your local well-being support services within your organisation, which can be found on local intranet, or via your line manager/TUs/HR department
Independent Member (IM)/Non-ExecutiveDirector (NED) – IMs and NEDs provide scrutiny and seek assurance that the speakingup culture is working in an organisation. You can speak to an IM/NED about speaking up but they won’t advocate or represent you on your specific case. However they may advise you of the best way to get support in raising your issue. Your local organisation will have more specific advice on what support you can obtain when you want to raise a concern.
Your local organisation will have more specific advice on what support you can attain when you want to raise a concern.
You do not need to have absolute proof of the activities you want to report; a reasonable belief is sufficient. We encourage all individuals to raise their concerns as early as they can. Any evidence that you do have such as letters, memos, diary entries, etc. will be useful to assist any further investigations.
No, your concern will be investigated by a nominated individual.
Once an individual has told someone of their concern, whether verbally or in writing, the information will be assessed to see what action should be taken. This may involve an informal, review or a more formal investigation.
The individual will be told who is handling the matter, how they can contact them and what further assistance may be needed. If there is to be a formal investigation the manager to whom they have reported their concern will appoint an Investigating Officer.
If an internal investigation takes place this will be undertaken thoroughly and as quickly as possible (usually within 28 days) considering the matters to be investigated. At their request, the individual will be written to summarising their concern and setting out how it will be handled along with a timeframe.
The individual raising the concern will be entitled to a verbal response, as a minimum Where appropriate detail may need to be given as a written response if you have not wished to remain anonymous.
The person responsible for providing this response will be either the manager to whom the concern was addressed, or the individual identified to provide such responses in any local processes in place to ensure that concerns can be raised.
If you feel that your concern has not been dealt with appropriately, please contact your local Workforce & OD team for more information on how to escalate your concern.
Individuals are encouraged to raise concerns openly. However, there may be circumstances when individuals may request that their identity is not revealed. In this case, the organisation will not disclose their identity without their consent unless required to by law.
There may, however, be times when the organisation may be unable to resolve a concern without revealing the individual’s identity, for example where personal evidence is essential. In such cases, the organisation will discuss with the individual whether and how the matter can best proceed.
Where the concern is a matter of staff or patient safety in line with Duty of Care, there may well be a need for escalation and anonymity may not be able to be maintained. Where this cannot be avoided, however, this will be made clear to the individual who has raised the concern.
We acknowledge that in a very small number of cases, allegations may be malicious. Making allegations that are known to be false will be considered a serious matter. If it is concluded that an individual has deliberately made false allegations maliciously or for personal gain, then the organisation will begin an investigation under the Disciplinary policy and procedure.
Whistleblowing is the term used when a member of staff raises a concern about a possible risk, wrongdoing or malpractice that has a public interest aspect to it, usually, because it threatens or poses a risk to others (e.g., patients, colleagues or the public).
This may include:
- Systematic failings that result in patient safety being endangered, e.g., poorly organised emergency response systems, or inadequate/broken equipment, inappropriately trained staff;
- Poor quality care;
- Acts of violence, discrimination or bullying towards patients or staff;
- Malpractice in the treatment of, or ill-treatment or neglect of, a patient or client;
- Disregard of agreed care plans or treatment regimes;
- Inappropriate care of, or behaviour towards, a child /vulnerable adult;
- The welfare of subjects in clinical trials;
- Staff being mistreated by patients;
- Inappropriate relationships between patients and staff;
- Illness that may affect a member of the workforce’s ability to practise in a safe manner;
- Substance and alcohol misuse affecting ability to work;
- Negligence;
- Where a criminal offence has been committed / is being committed / or is likely to be committed (or you suspect this to be the case);
- Where fraud or theft is suspected;
- Disregard of legislation, particularly in relation to Health and Safety at Work;
- A breach of financial procedures;
- Undue favour over a contractual matter or to a job applicant has been shown;
- Information on any of the above has been / is being / or is likely to be concealed.
For More Information
If an individual needs further advice, they can contact the charity Protect on 020 3117 2520, or by email at whistle@protect-advice.org.uk.
Protect can advise individuals how to go about raising a matter of concern in the appropriate way at protect-advice.org.uk .
There are prescribed bodies for Whistleblowing in Wales. You can find more information in stage 4 of the All Wales Procedure for NHS Staff to Raise Concerns . Namely these prescribed bodies include but are not limited to, Health Inspectorate Wales (HIW), Audit Wales, the Police and the Health and Safety Executive.
Alternatively, the Department of Health also provide a free, independent confidential advice service for NHS and Social Care employees and employers in England and Wales known as Speak Up. They can be contacted on 08000 724 725 or via their website at Speak Up. They can be contacted on 08000 724 725 or via their website at speakup.direct .
