Office closure

Please note that our office will be closed on Monday 20 September for the public holiday.  Complaints can still be submitted via our online form but these will not be received by us until we reopen at 10am on Tuesday 21 September.

How can NHS staff raise concerns?

The launch of the INWO service and the National Whistleblowing Standards on 1 April 2021 created a new process for handling whistleblowing concerns about the NHS in Scotland.  

The INWO has developed a three stage process. The process for raising concerns is set out in the National Whistleblowing Standards (the Standards) (opens in new window). The first two stages of the process are for NHS organisations to deliver, and the INWO acts as a final, independent review stage. The process gives staff support and protection to feel confident in raising concerns if they see something wrong.

Take note of key details

If possible, make a note of key details, such as what caused your concern, when things happened and who was involved.  Such records will provide useful evidence, and will assist any investigation of the concern.

Raise the matter early

The earlier the problem is raised and looked into, the earlier any issue can be addressed and all involved assured that things are in order.  

It is also important to be aware that many NHS staff – such as doctors and nurses –have a professional obligation to raise any concerns they have about patient safety.

Access advice and support

It is important to get the advice and support you need to ensure you are able to raise the concern in a safe and effective manner, irrespective of the process being followed.

There are a range of options available, including designated confidential contacts within NHS organisations, unions, independent legal advisers, whistleblowing organisations like Protect, the whistleblowing charity.

More information about getting support (opens in new window)

The INWO Advice Line  can also provide information and signposting for those raising whistleblowing concerns.

Business as usual processes

In many cases, concerns can be resolved through informal conversations with colleagues and managers, and through ordinary or ‘business as usual’ processes (such as incident reporting systems). Concerns handled under ‘business as usual’ should be actively resolved without any detriment to the person who raised them. More information on raising concerns through business as usual processes (opens in new window).

While many whistleblowing concerns can be resolved in this way, it is clear that raising whistleblowing concerns can involve staff in potentially more complicated and difficult situations, where it is advisable to consider more formal options. 

Overview of the initial stages of raising a concern (opens in new window)

When to use the Standards

You should consider raising a concern under the Standards where business as usual processes have not worked, or are inappropriate. Likewise, if your concern requires investigation or is a serious matter that you think needs to be formally raised, then use the procedure in the Standards. 

An overview of stage 1 and stage 2 of the standards 

Who to speak to

In most cases, this will be your manager.  If you do not feel this is appropriate, you could contact a more senior manager, or your organisation’s designated confidential contact. More information on who to raise a concern with (opens in new window).

The arrangements within primary care, and for students and volunteers, may be slightly different.

Eligibility to use the Standards procedure

Whoever receives your concern will need to check whether it can be handled under the procedure outlined in the Standards. They are likely to discuss with you:  

  • Whether your concern fits the definition of whistleblowing i.e. is it in the public interest?
  • If it is being handled through a business as usual process already. The business as usual process should normally run its course to avoid duplication.
  • The outcome you are seeking. It may be that another process will get you a better outcome, for example, a grievance.
  • If the concern has been raised in time. It should normally be raised within 6 months of you becoming aware of the issue of concern.
  • If you want to use the Standards. It’s your choice. If you choose not to use the Standards the organisation will decide how to investigate.

More information about the initial discussion and what happens if your concern cannot be handled under the procedure (opens in new window).

Confidentiality, anonymity and unnamed concerns

People who raise concerns may be naturally concerned about being identified as someone who has spoken up.

The Standards require that your details are kept confidential and are not routinely shared, even if an investigation is required.  If there is a risk of your confidentiality being compromised then managers may be able to use discreet methods to gather information as part of an investigation, for example through an audit or staff survey. Data protection legislation also applies to how your details are stored on any system for logging concerns. This means that only people who need to access your details should be able to do so. Who will have access should also be discussed with you.  

Anonymous concerns cannot proceed under the Standards and they cannot be brought to the INWO for independent external review. Anonymous concerns limit your legal protections and your organisation's ability to provide feedback and offer support.  

Similarly unnamed concerns, i.e. where you ask for your name to be withheld from being registered with the concern, cannot proceed under the Standards or be brought to the INWO for review.

Remember that you are protected under the Standards from any potential victimisation.

More information about anonymous and unnamed concerns (opens in new window).

Stage 1 of the process involves little or no investigation, but does formalise the concern and allows for early resolution. The response will usually be a straightforward solution to the problem. You should get a response within 5 working days with an explanation of the outcome, and limited action might be taken in response to the issue you raised. You should also get details of how to raise your concern to stage 2 if you are unhappy with the response.

Stage 1 isn't appropriate for serious concerns or concerns that need detailed investigation.

More information about stage 1 of the Standards (opens in new window),

Stage 2 concerns are usually about serious risks or complex issues that need investigation. You can ask for your concern to be looked at under stage 2 if you think a full investigation is needed.

Whoever is handling your concern will acknowledge it within 3 working days and respond to you in 20 working days. If the investigation is complex and is taking longer, they may need to extend the timescale.
An independent senior manager will investigate your concern. You will get a written response and action may be taken on the back of your concern. The response should tell you how you can raise your concern to the INWO if you are unhappy with how it has been handled.

More information about stage 2 of the Standards (opens in new window).

You can contact the INWO at any time for advice if you are not sure about something.

The INWO will normally only investigate a concern after it has been through both stages of the local process. At this point of the process you should have a stage 2 letter which says that you can bring your concern to the INWO. A concern brought to the INWO is referred to as a ‘complaint’. You should bring your complaint to the INWO within 12 months of when you first became aware of the issue.

The INWO can consider complaints about:

  • Any actions taken by your organisation in response to your concern
  • Whether your organisation followed the process laid out in the Standards
  • How you were treated during and after you raised a concern
  • How the organisation supports a culture of speaking up

The INWO will investigate and come to a decision on your complaint. She can:

  • Refer the concern back to the organisation if it has not been fully investigated. If you remain dissatisfied with the organisation’s further response, the INWO can investigate the complaint.
  • Discontinue an investigation where an appropriate resolution has been agreed between the parties.
  • Uphold your complaint. The INWO can make recommendations to ensure that the situation doesn’t happen again. She can also recommend redress where people have been personally affected.
  • Not uphold your complaint.

If you are unhappy with a decision on your complaint, you will have an opportunity to provide comments and express why you feel the decision is not correct.

More information about independent review by the INWO (opens in new window).

More information about submitting a complaint to the INWO.

Other organisations who can receive whistleblowing complaints about NHS services in Scotland are noted below.

Healthcare Improvement Scotland

HIS is responsible for responding to concerns raised by NHS Scotland employees (or referred by another organisation) about the quality or safety of patient care delivered by NHS services.  Unlike the INWO, they can look into concerns raised anonymously with them.  Details on their process for handling whistleblowing concerns are available on the Healthcare Improvement Scotland website (opens in new window).

Professional regulators

Concerns about a medical professional, such as a doctor, nurse, dentist or pharmacist can be raised with the relevant regulator.  Each regulator’s website will have info about their process.

NHS Scotland Counter Fraud

You should raise concerns relating to fraud, embezzlement, theft, corruption and other irregularities against NHS Scotland with NHS Counter Fraud Scotland (opens in new window).  They provide a more appropriate route for these kind of concerns than the INWO.

The role of the confidential contact

Every NHS provider must ensure their staff have access to someone who can provide them with information about raising concerns, a safe space to discuss their concern, and assistance in raising their concern with an appropriate manager.  They might not always be called a ‘confidential contact’, but their role is the same.  The Standards state that the key elements of this role are to:

  • promote a culture of trust, which values the raising of concerns as a route to learning and improvement
  • through direct contact with frontline staff, ensure they are aware of and have access to the support services available to them when they raise concerns
  • assist managers in using concerns as opportunities for learning and improvement
  • (for NHS boards) work with the board’s Whistleblowing Champion to ensure that all staff are aware of the arrangements for raising concerns within their organisation
  • work with the chief executive (or equivalent) and those they have identified to oversee application of the Standards, to ensure implementation is functioning at all levels of the organisation.

This role requires excellent interpersonal skills, and the ability to work with people at all levels in the organisation.  Confidential contacts must have a good understanding of the barriers people may face in raising concerns, and be willing to work hard to overcome these barriers and enable staff, students and volunteers to raise concerns safely. 

More information on key roles and responsibilities (opens in new window).

Updated: May 24, 2021