Require contractual stipulation for confidential, non-disciplinary reporting of sentinel events.

The Index has not yet recorded a verbatim government response to this recommendation.

The GMC and NMC developed joint guidance on the professional duty of candour in 2015 (updated in 2019) which makes clear that healthcare professionals must be open and honest with their colleagues, employers and regulators, raising concerns where appropriate and taking part in reviews and investigations when requested. It also states that professionals must support and encourage each other to be open and honest, and not stop someone from raising concerns.

The GMC updated Good Medical Practice guidance in January 2024. The guidance states that doctors must raise concerns promptly and includes a duty which says that doctors in management roles must encourage and support their colleagues to raise concerns.

The NHS Standard Contract was amended in 2019 to clarify employer duties and worker rights to speak up or make protected disclosures under the Public Interest Disclosure Act 1998 (PIDA). This includes a requirement for all NHS providers to include an express carve-out clause which makes it clear in any contract or agreement that a worker cannot waive their rights to speak up about or disclose any issue which would be a protected disclosure under current law.

Please see our response to Recommendation 116 above.

Freedom to Speak Up

In the case of concerns, NHS England has published a Freedom to Speak Up policy for the NHS which provides the minimum standard for local Freedom to Speak Up policies across the NHS. This is in addition to the professional Duty of Candour and all NHS organisations and others providing NHS healthcare services in primary and secondary care in England are required to adopt it to normalise speaking up for the benefit of patients and workers. This is embedded in the NHS Standard Contract.

Care Quality Commission will consider whether arrangements for speaking up are sufficient and working well as part of their Well-Led assessment of health services.

In its January 2002 response, the Department of Health said it agreed in principle with this recommendation, unless a criminal offence had been committed. The Department said it would explore, through the work of the Chief Medical Officer’s Committee on Clinical Negligence, how this could be introduced.