Public Concern at Work
Suite 301
16 Baldwins Gardens
London EC1N 7RJ
Tel. 020 7404 6609
Is whistleblowing working in the NHS?
The Evidence
May 2003
Executive Summary and Recommendation
Findings in Context
Section 1 Background to Whistleblowing in the NHS
Section 2 HSC 198/199
Section 3 Analysis of calls to Public Concern at Work’s helpline from health sector workers
Section 4 Public Concern at Work’s Summary of Cases under PIDA
Section 5 UNISON and the Duty of Care
Section 6 CHI: Emerging Trends from 175 Clinical Governance Reviews
For a copy of the survey questionnaire and/or survey results please contact Public Concern at Work
on 020 7404 6609.
Executive summary and recommendation
The public hear about whistleblowing in the NHS when it all goes wrong - either when a public
inquiry reveals that staff concerns had been stifled or ignored or when the media report claims that
a whistleblower has been victimised.
But with one million staff across the NHS, what is the picture day in, day out? Is there a culture of
silence or cover-up in your local hospital? Have things improved at the coalface?
As part of its Duty of Care Campaign, UNISON the public service union, teamed up with the
whistleblowing charity, Public Concern at Work, to conduct the first survey of its kind and asked
2000 NHS staff is whistleblowing working?
The key findings are that 
90% had blown the whistle when they had a concern about patient safety

50% did not even know if their Trust had a whistleblowing policy

33% say their Trust would want them to blow the whistle even if it resulted in bad publicity
2

30% say their Trust would not want to be told there was a major problem and

25% say the culture is improving
Of those who had blown the whistle on a patient safety concern

One-third said they suffered some personal comeback

One-half said their concern was dealt with reasonably

Where a whistleblowing policy was used, no staff reported reprisals and two in three said
the concern was reasonably dealt with.
These findings suggest that, whilst substantial improvement is still needed, NHS staff are
increasingly willing to speak up for patient safety, even at some personal risk. However across
much of the NHS it seems that this welcome change is in spite of, not because of, management
action or encouragement.
The survey demonstrates beyond doubt the value of whistleblowing and its importance has been
underlined by government policy over the past decade. Ministers have demonstrated commitment
to making whistleblowing work, and have sought to communicate reassurance on reprisals to all
staff. Yet somewhere along the line, this information is not getting through. It appears that where
staff are responding to central government policy, too many Trusts are not. This is simply
unacceptable. Introducing a whistleblowing policy makes sense and whistleblowing must be
promoted across the entire NHS including Trusts, executive agencies, private contractors, and PFI
schemes.
Public Concern at Work and UNISON call on the Government to remind all NHS health care
providers - public and private - of the need to introduce and promote a whistleblowing policy
to their staff.
Findings in context
Ninety percent of staff who had a patient safety concern blew the whistle. All raised their concern
internally, with two-thirds reporting no reprisal and half stating that the concern was dealt with
reasonably. The survey canvassed the views of almost the entire NHS team including nurses,
therapists, caterers, IT managers, clerical staff, porters, and scientists. Whether medically trained or
not, staff are telling their managers when they think something is going wrong. This is great news
for patients. The Government and the public should be proud of the high level of commitment
demonstrated by NHS staff. Whistleblowing is beginning to work on the ground and staff are
increasingly prepared to take the risk to speak up when it comes to patient safety.
A third of staff who raised a concern reported some form of reprisal or grief. While there is nothing
in the data or the responses to suggest that the reprisals were serious or lasting enough to warrant
complaint, this is contrary to the new culture of openness Ministers promote, and may well stop
some staff from raising concerns. From a patient perspective, the key is that despite the grief, the
majority of staff are not deterred and will speak up when the concern is about patient safety.
Half of those who blew the whistle said that, in their assessment, the concern was dealt with
reasonably. This is a positive finding showing that in those Trusts, their concerns are valued and
valuable. Public Concern at Work know from their helpline (i), that it is simply not realistic to assume
that every time the whistle is blown there is, in fact, a serious problem. What is important is that
each concern is assessed on its merits and that staff are not victimised for raising it. For the 50% of
staff who said their concern was not addressed effectively, a whistleblowing policy would have told
them where they could have pursued the concern, if they thought that justified.
3
Making whistleblowing work in the NHS requires a conscious effort - encouraging staff to raise
concerns, and considering each issue on its merits. Anything less and patients are at risk. The
potential value of whistleblowing in the NHS is massive; for morale, patient safety, and saving public
money. Yet it is clear that the public still has to rely on the bravery of individual staff members to
take the risks because so many Trusts either do not have whistleblowing policies or keep them
secret.
Twenty-five percent of staff say the culture is better now than it was three years ago. At the same
time, the majority of staff say their Trust would want them to raise any serious concern which could
affect the service and half of these said this would still be the case even if it resulted in bad
publicity. Again, this is welcome news. But a third of staff believe their Trust would not want to know
about a serious problem affecting services. In light of all the work that has been done at the central
level, this is a damning reflection of local culture and requires urgent action. Fortunately, the
evidence is that when it comes to patient safety, few staff are now willing to stay silent. But what
about other issues?
Staff said they would worry most about raising concerns about unsafe staffing levels, government
targets/waiting lists, risks caused by other staff, and a bullying culture. Clinical governance, which is
central to the improvement of health care standards, is not just about direct patient care but
includes all aspects of health service delivery. This is a view endorsed by the Commission for
Health Improvement (CHI) which specifically tests the level of staff awareness of and confidence in
whistleblowing during its clinical governance reviews. It is clear that some Trusts are doing it
properly, encouraging staff to blow the whistle on anything that might put patients, colleagues or the
service at risk. Other Trusts appear to be doing nothing at all.
After conducting 175 Clinical Governance Reviews, CHI highlights staff fears of reprisals if they
reported something going wrong as a key emerging trend which causes them concern (ii). This
finding reflects a serious lack of commitment of many Trusts to manage risk effectively - a key
component of clinical governance. Government can no longer reasonably rely on those enlightened
Trusts who know whistleblowing helps deliver high standards and must drive the message through
the NHS.
It is simply unacceptable that fifty percent of staff do not know if their Trust has a whistleblowing
policy. This is evidence of a communication breakdown between central government policy and
Trusts that mirrors that between so many Trusts and their staff. When the Public Interest Disclosure
Act (PIDA) came into force in 1999, the NHS Executive issued practical guidance to all Trusts in
England and Wales (iii)stating that they should implement whistleblowing policies. Since 1993 there
have been three separate NHS whistleblowing initiatives. Government commitment, ministerial
statements, public inquiries to learn the lessons when things go wrong, are all in vain if 50% of staff
do not even know if their Trust has thought about or addressed whistleblowing. Those Trusts who
have a policy but have failed to promote it should realise it is not worth the paper it is written on.
Public Concern at Work’s experience on their helpline confirms that staff are most reluctant to ask
about a whistleblowing policy when they have a concern they are worried about raising. The
Government needs to ensure that all Trusts and NHS health care providers have introduced a
policy and are promoting whistleblowing to their staff.
When a whistleblowing policy was used, no staff reported reprisals and two in three said the
concern was dealt with reasonably. Staff are more likely to seek advice from their UNISON
representative when there is a whistleblowing policy in place (50%) than when there isn’t (33%).
These findings suggest that where a whistleblowing policy is implemented and promoted to staff,
concerns are more likely to be raised and addressed effectively.
4
Section 1: Background to whistleblowing in the NHS (iv)
1 Overview
Whistleblowing in the NHS was first addressed by the NHS Executive in 1993, and then by the
Audit Commission in 1994. Its significance was given strong endorsement by the 1995 Nolan
Report which observed that the result of failing to provide an effective system for raising concerns of
wrongdoing ‘is ironically to encourage anonymous disclosures’. Subsequent recommendations of
the Nolan Committee (and the Government’s acceptance thereof) provided a standard of good
practice for whistleblowing policies by the 1997 election. That September, the new Government
reminded NHS Trusts of the need to have effective local procedures and of forthcoming legislation
on the issue. This referred to Mr Richard Shepherd’s Public Interest Disclosure Bill, which - with
strong support in and outside Parliament - was enacted in July 1998. The legislation came into force
in July 1999 and in September the Department of Health supplied all NHS Trusts with a Policy Pack
(produced by Public Concern at Work) which contained practical guidance on the new legislation,
promotional material and a model policy. Additionally, UNISON produced a guide to whistleblowing
for its members called Speaking Out Without Fear.
By 1997 it was accepted good practice that a whistleblowing policy should include a clear signal of
what external disclosures could properly be made, that it should be well promoted and that it should
be of a different character from a grievance procedure. By then, an early confusion between
confidentiality (where the identity of the whistleblower was known but respected) and anonymity
(where the whistleblower did not identify him or herself to anyone) had been clarified.
2 Sources for the policy
The 1993 NHS Guidance
Published on 5 June 1993 and sent to Trust Chief Executives, this Guidance was the first concerted
attempt by a UK employer to address the issue of whistleblowing. While the approach was cautious
(in part because there had been some political and protest whistleblowing against the NHS
reforms), the Guidance was a welcome development. It stressed that there should be full local
consultation on any policy and it set out an option for designated officers as an alternative to raising
the issue up the management line. The strong and justified emphasis the Guidance gave to raising
concerns internally was, however, coupled with warnings of the risks of making outside disclosures.
This and the absence of any clear or safe line of outside accountability led to criticism of the
Guidance in and by the media as a “gaggers’ charter”. Following criticism from the Select
Committee on Public Expenditure, the Chief Executive of the NHS wrote on 7 September 1993 to all
Trust Chief Executives clarifying that the Guidance does “not prevent staff from seeking the advice
and guidance of their MP, as a constitutional right, at any time.”
The Nolan Committee: 1st report
The First Report of the Committee on Standards in Public Life (v)addressed the issue of
whistleblowing in Quangos and the NHS. Commenting of the 1993 NHS Guidance, the Committee
noted that the Audit Commission had found that none of 17 NHS bodies they visited had promoted
a whistleblowing scheme and that a third of NHS staff they interviewed would not raise a serious
concern because of fear of losing their jobs. The then Chief Executive of the NHS, was quoted as
recognising that ‘a sustained effort is required to ensure that these guidelines are properly carried
through, both in spirit and detail at local level’ (vi).
The Committee recommended that each NHS body “that has not already done so should nominate
an official or board member with the duty of investigating staff concerns about propriety raised
confidentially. Staff should be able to make complaints without going through the normal
management structure and should be guaranteed anonymity (vii). If they remain unsatisfied, staff
5
should also have a clear route for raising concerns about issues of propriety with the sponsor
department.” (viii)
Nolan and Audit Commission recommendations
In late 1997 the second Nolan Report was published which included its full recommendations on
whistleblowing (ix). The specific points were that an effective whistleblowing system should include:

a clear statement that malpractice is taken seriously in the organisation and an indication of
the sorts of matters regarded as malpractice

respect for the confidentiality of staff raising concerns if they wish, and the opportunity to
raise concerns outside the line management structure

penalties for making false and malicious allegations

an indication of the proper way in which concerns may be raised outside the organisation if
necessary.
Public Concern at Work developed a whistleblowing policy checklist which was endorsed by the
Nolan Committee and the Audit Commission. In Ensuring Probity in the NHS (x), the Audit
Commission had recommended that Trust “Boards should periodically review attainment in their
organisation of [this] good practice.” The checklist included the advice to “Remind [staff] of external
routes if they do not have the confidence to raise the concern internally, such as District Audit or the
police.”
For completeness it may also be noted that the Nolan Committee subsequently recommended that
a whistleblowing policy should allow access to the district auditor and, separately, to some other
external body such as an independent charity (xi). Finally, in 1997 the Committee stressed that “It is
important that all Departments, executive NDPBs and NHS bodies should institute codes of practice
on whistleblowing, appropriate to their circumstances, so as to enable concerns about malpractice
to be raised confidentially inside and, if necessary, outside the organisation. It is important that
these arrangements are well publicised within organisations so that staff are left in no doubt about
the avenues open to them” (xii).
Government initiatives
The Policy refers to the White Paper - The New NHS - of December 1997 which cited to the steps
being taken to “to make sure that staff can speak out when necessary, without victimisation”. We
understand that this refers to the letter of 25 September 1997 from Alan Milburn - then Minister of
State - to Trust Chairs entitled ‘Freedom of Speech’. This mentioned the Government’s support for
the draft legislation and urged Trusts to act in advance of it to ensure that NHS staff feel “able to
raise their concerns about health care matters in a responsible way without fear of victimisation”.
The Minister looked to Trust Boards “for assurance that the [1993 Guidance is] incorporated into
your local employment policies and practices”.
Public Interest Disclosure Act
The legislation, known as the “whistleblowers law” came into force on the 2nd July, 1999. The aim
of the legislation was to promote and protect responsible whistleblowing by making it clear to staff
that there were safe alternatives to silence and by making it clear to organisations that they should
not deter or discourage staff from raising concerns about wrongdoing. While the legislation takes up
the approach of the Nolan recommendations it also closely follows the jurisprudence on public
interest disclosures under the law of confidence.
Briefly it encourages NHS staff to raise concerns internally or with the Department of Health as
there they have the strongest protection. It also protects disclosures to prescribed regulators such
6
as the Audit Commission and Health and Safety Executive where the worker has good evidence to
support his/her concern. It also protects wider disclosures where they are justified by one of four
circumstances and the particular disclosure is reasonable. One of these circumstances is where the
worker reasonably believes he will be victimised if he raises the matter internally or with a
prescribed regulator. In considering whether the disclosure was reasonable, regard is had - inter
alia - to the identity of the recipient, the seriousness of the matter, patient confidentiality and
whether a whistleblowing policy should have been used.
These disclosures are only protected if they are made in good faith. The legislation also
discourages anonymous disclosures in that to invoke the protection the whistleblower must show
that he was victimised by his employer because he had blown the whistle. If the disclosure was
anonymous then to win any claim the individual will additionally need to prove that his employer
knew it was him.
In September 1999 the Policy Pack was sent out to all Trusts in England with HSC 1998/198 which
stated that all Trusts should implement local whistleblowing policies and procedures. In the wake of
the Inquiry into the baby heart deaths at the Bristol Royal Infirmary(xiii) John Hutton, Minister of
State, restated the government commitment saying “Ministers expect a climate of openness and
dialogue in the NHS which encourages staff to feel able to raise concerns about healthcare matters
sensibly and responsibly without fear of victimisation.”
Clinical Governance and whistleblowing
In the wake of a number of serious health care scandals - most notably the Bristol baby deaths
case (xiv) - and in a welcome desire to drive up standards and promote a more open and learning
NHS, the Department of Health made clinical governance central to policy development and clinical
practice. Clinical governance is defined as,
“a framework through which organisations are accountable for continuously improving the quality of
their services and safeguarding high standards of care by creating an environment in which
excellence in clinical care will flourish.” (xv)
An effective whistleblowing policy is key to ensuring effective clinical governance. This is reflected
time and again in CHI Clinical Governance Reports (xvi) where staff confidence in raising concerns
is tested on the ground and found seriously wanting in too many instances. Whistleblowing ensures
that where there are clinical governance problems, staff have an alternative route to flag up serious
concerns so that they can be addressed effectively.
t is in this context, for example, that UNISON has, and will continue to, support members like senior
manager Julia Wassell who recently highlighted concerns over the treatment of patients at
Broadmoor Hospital. Ensuring staff can speak up for patients and are heard is also an important
motivating force behind UNISON’s Duty of Care Campaign(xvii).
Section 2: HSC 198/199
To see a copy of Health Service Circular 198/199, please click here.
Section 3: Public Concern At Work’s helpline clients working in the health sector - 1993 to
2002
Between the start of the helpline in late 1993 through to the end of 2002, Public Concern at Work
received 3,310 public concerns. Of these, 448 were from people working in health (e.g. nurses,
doctors). The table below breaks this down by year.
Year
Number of clients
As % of all clients
7
1993/94
1995
1996
1997
1998
1999
2000
2001
2002
61
16
18
36
24
63
70
87
73
11%
5%
8%
17%
17%
16%
14%
14%
13%
The figures for 1993/1994 reflect all calls received by the helpline, both public and private concerns.
The following graphs show these figures over time.
Section 4: Public Concern at Work’s Summary of PIDA Cases(xviii)
Bright v Harrow & Hillingdon NHS Trust (2000)
Qualifying disclosure: nun wearing a habit not a PIDA concern; Media disclosure unreasonable & no
substance to concern
Bright, a consultant psychiatrist, raised a concern internally about a nun who visited psychiatric
patients in the community while wearing her habit. Bright did not think the Trust took the concern
seriously and went to the national media, asserting that it was for her, not the Trust, to decide what
was in the public interest. Bright’s contract was not renewed and she brought a PIDA claim. ET held
the concern about a nun wearing a habit was not a qualifying disclosure, and that in any event [a]
Bright did not believe the risk to the nun was substantially true or genuine, and [b] her disclosure to
the media was not reasonable in the circumstances.
Hittinger v St Mary’s NHS Trust & Imperial College (2001)
Worker with two employers
Hittinger was the clinical governance manager for the Trust and had been introduced and supplied
to do the work by Imperial College. On a preliminary point, both respondents had said Imperial
College had determined her terms of engagement and hence it alone was the employer for PIDA.
8
ET held both respondents were Hittinger’s employer within PIDA, as section 43K(2) expressly
states employer ‘includes’ not ‘is’.
Kay v Northumberland Healthcare NHS Trust (2001)
Public disclosure: reasonable to go to media with NHS concern, role of whistleblowing policy,
Human Rights Act
Kay managed a ward for the elderly. Kay internally raised concerns about bed shortage but was told
there were no resources. The problem worsened and some elderly patients were to be moved to a
gynaecological ward. Kay wrote a satirical open letter to the Prime Minister for his local paper. With
Trust’s agreement, Kay was photographed for local press. When letter published, Trust gave final
written warning for totally unprofessional and unacceptable conduct. Kay won as the disclosure was
protected because [a] 43G, balanced with freedom of expression in the Human Rights Act; [b] Kay
did not know of Trust’s whistleblowing policy; [c] no reasonable expectation of action following
earlier concerns; and [d] it was a serious public concern.
Llewelyn v Carmarthenshire NHS Trust (2002)
Interim relief: no reasonable prospect
Llewelyn, a consultant at the Trust, became concerned at the increasing use of nurses in his care to
deliver expert services to GPs. A panel was set up to review the relevant services. This concluded
in May 1999 finding that Llewelyn was primarily responsible for the irretrievable breakdown in his
unit and should be replaced. Meanwhile a second panel had been set up under the auspices of the
Royal College of Physicians. In November 1999 this concluded that Llewelyn was unsuitable to
function as a consultant. After a period off sick, Llewelyn was suspended in June 2000 and
dismissed in March 2001. In November 2000 Llewelyn had contacted the Audit Commission about
his own position being a waste of public money and about other concerns. Llewelyn brought a claim
for interim relief which failed. The ET held that on the level of evidence available to it, Llewelyn had
no prospect of being able to dislodge the causal connection that his dismissal was due to the
findings of the two reports rather than to his disclosures.
Mounsey v Bradford NHS Trust (2002)
Public disclosure: reasonable to go to media to defend colleague against unfair media coverage.
Mounsey was medical secretary to a consultant, P, who was concerned about quality of breast
cancer services. Mounsey shared and adopted these concerns through and from 1999. In 2001
Mounsey was interviewed on Yorkshire TV and said that in her view P had been made a scapegoat.
For giving this interview, the Trust instigated disciplinary proceedings and Mounsey then resigned.
At the ET once the Trust learned that Mounsey had agreed to do the interview to counter media
coverage about P which she thought had been unfair, the Trust conceded that Mounsey had made
a protected disclosure. Award to be decided.
Section 5: UNISON’s duty of care campaign
UNISON commissioned Public Concern at Work to undertake this whistleblowing survey as part of
its “Duty of Care” campaign.
The campaign was launched because of members’ concerns that a clear framework was needed to
address excessive workloads, inappropriate delegation of work, unsafe working practices and a
bullying culture within parts of the NHS. The campaign was also launched to provide a positive and
safe framework to address the modernisation of health care services.
The campaign has so far produced a widely read manual The Duty of Care, a dedicated web page
at www.unison.org.uk/healthcare/dutyofcare and is intended to provide an authoritative framework
for discussion locally on safe working practices within healthcare, including advice on what to do if
concerns do arise.
9
The campaign builds on UNISON previous work such as its “Be Safe” campaign and UNISON’s
previous handbook on whistleblowing “Speaking out without fear” (UNISON 1999).
Section 6: CHI - Emerging themes from 175 clinical governance reviews (xix)
An analysis of CHI’s first 175 clinical governance reviews, the bulk of which have been of acute
trusts, has found that hospitals in the north and midlands have better working arrangements to care
for patients than those in the south and London.
Specifically, trusts in the north and midlands have fewer ‘areas of concern’ highlighted in their CHI
reports, and higher overall clinical governance scores. Because there have been fewer reviews in
Wales it is not possible statistically to draw comparable geographical conclusions.
The findings do highlight some concerning trends that can be seen in both England and Wales. In
more than 80% of NHS organisations reviewed the following themes emerged:

NHS organisations are reactive rather than proactive - they respond to problems when they
happen rather than anticipate them and so potentially avoid them

There is a lack of organisation wide policies. In many cases, where policies do exist, they
are not implemented or different departments have different policies on the same issue

Learning is not shared between and across organisations

Communication is not effective and there is a lack of sharing from strategic to operational
level, for example, between senior managers and those providing services, or between
doctors and nurses.
The findings also show that of the seven components of clinical governance, four are more likely to
stand out as causing concern. These are:

Risk management: Many trusts are poor at managing potential risks to patients and many
staff would fear reprisals if they reported things going wrong. The risks to patients are made
worse by staff shortages and poor attendance on mandatory training courses.

Staffing and staff management: Trusts have poor workforce planning, there is a need for yet
more creative ways of recruiting and retaining staff and trusts are poor at providing career
opportunities. Many staff are working longer hours than recommended, there is poor
management of locum and bank agency staff and widespread failure to regularly check
professional registration.

Patient involvement: Very few trusts are routinely involving patients and relatives in the
development of services and policies. There is a general shortage of information for
patients on their care and what there is often not accessible. Many barriers still exist to
patients and staff making complaints.

Use of information: Doctors and nurses often do not have ready access to the information
they need to treat patients effectively. There is poor use of information and complaints data
and there are too many breaches of confidentiality guidelines.
The remaining three components of clinical governance are: clinical audit, research and
effectiveness; and education, training and continuing professional development. It has long been
recognised that the NHS is far from perfect, but it is by no means all bad news. From the reviews
we have carried out so far we have been able to identify a considerable amount of innovative
practice. Among the many examples are:
10

Dewsbury Healthcare NHS Trust whose telephone reporting system for serious incidents is
convenient for staff to use. Their analysis of serious incidents is also thorough and steps
are taken to prevent recurrence.

North Bristol NHS Trust whose nurses use a special pen to record the care levels needed
by patients on bar codes above their beds, so the trust can adjust staffing levels
accordingly.

Leicestershire Partnership NHS Trust who use a white board to record discussions between
patients and staff on ward rounds. Patients can then receive a printout of the discussions
that took place.

North Durham Healthcare NHS Trust use an electronic system that enables x-ray images to
be accessed by wards and clinics around the trust.
These are just a few of the many examples of notable practice that if shared with other NHS
organisations could be the solution to common problems.
Overwhelmingly, the CHI score received most often in the published reports, across all the
components and all geographical areas, was two, the score that indicates worthwhile progress and
shows some development of the clinical governance agenda. The allocation of the third score,
indicating good implementation of clinical governance, was far less common. Very few trusts have
received the fourth score for excellence.
These findings show that there is still some way to go. We can also see that real progress is being
made and we are moving in the right direction with many examples of good practice existing that
could be shared across the NHS.
In time CHI will have a database of evidence on individual organisations that will detail emerging
themes from its inspections. This will provide an opportunity for the NHS to access information on
good practice for research purposes or to learn from the experience of others, within similar fields of
work. Until that time CHI will report regularly on what it finds. It is hoped that these findings both
good and bad will really help drive change in the NHS so that it is constantly learning and constantly
improving.
i.
Section 3 sets out a brief analysis of calls to Public Concern at Work’s helpline from health
sector workers.
ii.
See Section 6 on CHI’s report Emerging Trends from 175 Clinical Governance Review. For
more information on CHI and its work, see www.chi.nhs.uk
iii.
See Section 2 for the full text of HSC 198/199
iv.
Note from Public Concern on NHS whistleblowing initiatives.
v.
Cm 2850-I, May 1995, page 90-91
vi.
Ibid, paras 113 and 115
vii.
This confusing reference, for which we are largely responsible, to anonymity when
confidentiality was meant was remedied in subsequent reports.
viii.
Supra, note 6, page 92
ix.
Cm 3270 -1 (May 1996), page 22
x.
Protecting the Public Purse 2 Audit Commission, 1994 ISBN 011 886 146 8
xi.
Cm 3702-I (July 1997), page 49
11
xii.
Nolan Review: Fourth Report (Nov 1997), page 23
xiii.
Learning from Bristol: The Report of the Public Inquiry into Children’s Heart surgery at
Bristol Royal Infirmary 1984-1995. Department of Health, July 2001
xiv.
Ibid.
xv.
A First Class Service: Quality in the new NHS. Department of Health, 1998.
xvi.
See www.chi.nhs.uk
xvii.
See Section 5 UNISON and the Duty of Care
xviii.
These NHS case summaries are excerpted from PCaW’s Whistleblowing Case Summaries:
Notable decisions under the Public Interest Disclosure Act, released April 2003 and
available at www.whistleblowing.org.uk.
xix.
This document can also be found on the Commission for Health Improvement’s website
www.chi.nhs.uk.