On paper, whistleblowing is protected by law, written into all NHS trust policies, and supported by various bodies such as Public Concern at Work and the National Patient Safety Agency. Putting it into practice, however, is a different matter. Trusts write their own policy documents, and a recent BMJ analysis of the whistleblowing policy documents valid up to November 2009 from 118 of the 122 NHS foundation trusts shows widely differing approaches.

The BMJ obtained the policy documents from trust websites or through requests under the Freedom of Information Act. The documents were then compared against six standards set out in the Whistleblowing Best Practice guide produced by Public Concern at Work, an independent authority on public interest whistleblowing that also runs a helpline for NHS staff.1The standards are

• The organisation takes malpractice seriously, giving examples of the type of concerns so that staff can distinguish a whistleblowing concern from a grievance

• Staff have the option to raise concerns outside of line management

• Staff are enabled to access confidential advice from an independent body

• The organisation will, when requested, respect the confidentiality of a member of staff raising a concern

• Details are given of when and how concerns may properly be raised outside the organisation (for example, with a regulator)

• It is a disciplinary matter both to victimise a bona fide whistleblower and for someone to maliciously make a false allegation.