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The right to raise concerns

The RCM’s Denise Linay looks at the new Section 21 of the NHS terms and conditions of service handbook and NMC guidance about raising concerns at work and where to seek advice.

Midwives magazine: Issue 2 :: 2011

Midwives have a professional duty under The code: standards of conduct, performance and ethics for nurses and midwives (NMC, 2008) to protect the interests of people in their care and to make representations if they believe that women are being put at risk by staff shortages, inappropriate skill mix and/or poor practice. The term ‘whistleblowing’ can often invoke negative connotations, ranging from the derogatory way the term is used by the tabloid press (think Wikileaks) to the experience of the dinner lady, who lost her case at an employment tribunal because she went to the press over her concerns. Health professionals can often feel that they are being placed in a precarious position. Are they risking their employment to fulfil their professional obligations or do they risk their NMC registration by turning a blind eye? Those that ‘bite the bullet’ often report that their concerns have not been taken seriously or are even criticised for doing so.

In November 2010, the NMC published guidance on this very issue entitled Raising and escalating concerns. This guidance sought to clarify the rights and responsibilities of midwives and nurses in raising a concern, the process to be used and where additional advice can be sought. Around the same time, the NHS terms and conditions of service handbook (NHS Employers, 2010) was updated to include a new section 21 entitled Right to raise concerns in the public interest (whistleblowing). This new section starts with a very clear statement that ‘all employees working in the NHS have a contractual right and a duty to raise genuine concerns’ (NHS Employers, 2010: 21.1).   

Both the NMC guidance and section 21 are complementary to each other and will hopefully address those concerns that have been raised by RCM members. For example, the right to have your concern taken seriously and investigated promptly and be ‘protected from unwarranted criticism or actions’ (NMC, 2010: 16). Section 21 provides for appropriate systems to be in place that are developed and signed off in partnership with local staff representatives (NHS Employers, 2010: 21.4). 

What is particularly welcome in the NMC guidance is the advice to those who ‘hold a position where others may bring their concerns to’ (NMC, 2010: 16). This will include not only midwifery managers, but also supervisors of midwives and clinical leads. Managers in such posts can often feel unsupported when such representations are made to them. The guidance provides clarity on what their responsibilities are and where they can access additional advice.

The independent whistleblowing charity Public Concerns at Work (PCaW) is referenced in both the NMC guidance and section 21. The PCaW has a duty to those individuals that contact them to provide legal advice that is subject to legal privilege, which means it cannot be disclosed in any subsequent court proceedings.

Additional information is also available on the RCM website including an updated Notice of Unsafe Conditions for Practice form, to assist midwives when raising a concern. There is also advice for midwifery managers and supervisors of midwives who are in receipt of a completed form. 


NMC. (2008) The code: standards of conduct, performance and ethics for nurses and midwives. www.nmc-uk.org/Nurses-and-midwives/The-code (accessed 12 January 2011).

NHS staff council. (2010) NHS terms and conditions of service handbook. Pay circular (AforC) 4/2010: amendment number 19. NHS Employers: London. See: www.nhsemployers.org/Aboutus/Publications/PayCirculars/Pages/PayCircularAfC42010.aspx (accessed 11 March 2011).

NHS staff council. (2010) NHS terms and conditions of service handbook. Part 3: Terms and Conditions; Section 21: Right to raise concerns in the public interest (whistleblowing). NHS Employers: London. See:

www.nhsemployers.org/SiteCollectionDocuments/AfC_tc_of_service_handbook_fb.pdf (accessed 14 February 2011).