Intended for healthcare professionals


NHS regulator plans to make it easier for doctors to raise concerns and break “mafia” code of silence

BMJ 2013; 347 doi: (Published 23 October 2013) Cite this as: BMJ 2013;347:f6428
  1. Adrian O’Dowd
  1. 1London

The main regulator of the NHS wants to help doctors come forward to raise safety concerns at work and break through a “mafia” code of silence that still exists in the health service, MPs have been told.

The leaders of the Care Quality Commission told MPs during a parliamentary health select committee evidence session on 21 October of their intention to make whistleblowing easier for all health professionals.

During the committee’s annual accountability hearing about the commission, MPs asked about whistleblowing in the NHS.

David Prior, the CQC’s chairman, giving evidence, said, “One of the things I’ve learnt over the past six months is to be a whistleblower you’ve got to be very, very brave. I’ve spoken to a couple of surgeons who are alpha male types whose careers have been severely limited because they expressed concerns about what was going on in their hospitals.”

David Tredinnick, a member of the committee and Conservative MP for Bosworth, said, “It’s about organisations closing ranks so tightly that if anybody steps out of line, they are finished. This is a type of mafia code—omerta comes to mind. That surely is something that has got to be broken?”

Prior added, “The most chilling phrase that came to my notice after the Francis report1 on Mid Staffs was a very distinguished clinician saying ‘Where were the doctors?.’

“For years this dreadful care went on and no doctor put his head above the parapet. Why is that? The answer, in part, is that they are frightened. Even if you are an alpha male surgeon, you are frightened.

“What we’ve got to do is to be absolutely sure, when we do an inspection, that hospitals have got proper whistleblowing raising concern procedures and the culture within that hospital is open and there is good clinical engagement.

“We’ve also got to have that safety net, which is that we need to be available to people like that at a much earlier stage so they can ring us up and get in touch and that can precipitate an inspection.”

Stephen Dorrell, the committee’s chairman and Conservative MP for Charnwood, said, “You have both committed the organisation to a process of renewal and raising of standards. What do you think we should be looking for to assess how successful you are being in delivering on those objectives?”

David Behan, the commission’s chief executive, also giving evidence, said, “Public, political and professional confidence has been shaken in the CQC so one of my measures will be a restoration of that confidence.

“We have reorganised at senior level, we are six inspections into 18 by Christmas. We are using that wave one to think our way into and challenge ourselves in the way that we are taking that forward. We are learning from every one [inspection] and tweaking the way we approach the learning we extract from each of those inspections.”

The commission intended that the reports, which would be published eight weeks after the inspections took place, would be easy to read and digest for anyone.

Prior added, “It’s very much work in progress at the moment. An assessment of those 18 inspections will be very important. The question is have we got underneath the skin of these hospitals?

“We are not going to pick up everything on every ward in every department in every specialty, but we do feel we will pick up systemic problems in those hospitals.”


Cite this as: BMJ 2013;347:f6428