Recommendation F160: Training and training establishments as a source of safety information
From Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, published 6 February 2013.
Recommendation
Proactive steps need to be taken to encourage openness on the part of trainees and to protect them from any adverse consequences in relation to raising concerns.
In brief (written by this site)
In commentary from September 2024 published in February 2026, the Department of Health and Social Care and NHS England stated that the recommendation was implemented and ongoing, reporting that trainees can access Freedom to Speak Up Guardians and that awareness of speaking up processes is monitored through the annual National Education and Training Survey (DHSC and NHS England, Feb 2026). Earlier, in May 2024, the Thirlwall Inquiry legal team noted that the General Medical Council had published training standards requiring organisations to foster a culture where learners can raise concerns openly and safely without fear of adverse consequences (The Thirlwall Inquiry legal team, May 2024).
AI-generated summary of the record on this page, checked by a second model and automatic checks, 26 Sep 2026. The record below is the sources' own words.
About this summary
This recommendation asks for cultural or behavioural change, which is difficult to verify from published sources alone. The record reflects policy commitments rather than measured outcomes.
Government response
Accepted.
The General Medical Council has made clear its commitment to build on the progress to date in this area (the inclusion of a patient safety question in the National Training Survey, the development of new guidance on raising concerns and the introduction of a new confidential helpline for doctors), and recognises it needs to do more to raise awareness and encourage openness. Among other things the General Medical Council is running ‘professionalism’ events at all medical schools every year. The General Medical Council will also shortly be publishing a report highlighting the issue of bullying of trainees (which can lead to a culture in which trainees feel unable to raise concerns), illustrated by case studies showing the impact of such behaviour and how it can be tackled.
How this response relates to the recommendation
Site note: This is volume two of "Hard Truths: The Journey to Putting Patients First" (Cm 8777-II), the government's response to the Inquiry's 290 recommendations, published by the Department of Health on GOV.UK on 19 November 2013 and dated to that day here. The PDF the row links to is the accessible edition, whose title page reads "January 2014". The Department of Health has been the Department of Health and Social Care since January 2018. The volume says it includes accounts from each of the national organisations the recommendations name, but it does not mark which passage each organisation wrote, so every row is filed under the Department that published it.
Blanket government agreement does not establish acceptance or delivery by each addressee. Some response passages cover groups of recommendations.
Scope of the government response
Government responded via "Hard Truths: The Journey to Putting Patients First" (2014), a single document covering all 290 recommendations with a blanket acceptance. Individual recommendation responses were not broken out.
Delivery
DHSC and NHS England say in progress (27 February 2026)
Learners (students and trainees) are treated the same as all others in clinical environments. It is their duty to speak up and FTSU Guardians are there for all to access as needed.
Awareness of FTSU processes is asked as part of the annual National Education and Training Survey (NETS) including questions on learner awareness of how to access support from their local FTSU Guardian and whether they know how to raise concerns locally in their clinical learning environment. (please see response to Recommendation 159 on NETS).
NHS England provide some guidance to trainees, students and learners on raising and responding to concerns on their website.
The Guardian of safe working hours ensures that issues of compliance with safe working hours are addressed by the doctor and employer or host organisation as appropriate. They represent and resolve issues related to working hours for junior doctors.
Site note: DHSC and NHS England's own account of progress, supplied to the Thirlwall Inquiry in September 2024 and printed in the Inquiry legal team's Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version dated April 2025, published 27 February 2026). It is not a finding of the Inquiry. Their reviewed extent of implementation reads “Implemented – Ongoing”. Table row: section 18.2 No. 160, PDF page 501.
Department of Health and Social Care says in progress (11 February 2015)
The encouragement of openness in trainees and protecting them from the potential adverse consequences of raising a concern was included in the 2014 Health Education England mandate. Health Education England has established a project group to deliver this. An audit has identified that systems are in place across LETBs and HEIs to allow students and learners to feedback on their experiences. In some cases, they can use a central online space for all placement related information, allowing students, LETBs and educators to access key information about their experiences. Students have strongly fed back that they value the various routes they have to discuss issues with those supporting them in their learning and are keen to maintain a duty of candour. Work is currently underway to develop, test and agree a standard set of core questions to be used with learners and a national set of principles for data collection to provide further consistency. Health Education England has also strengthened the routes to provide learner/trainee related information to the Care Quality Commission inspections. Trainee/learner feedback is also shared at system-wide Quality Surveillance Groups on a regular basis, so this is considered alongside other quality and safety measures. Further discussions involve how Health Education England can improve opportunities for non-medical undergraduates and post-graduate medical trainees where they are not already included in existing systems used for other students. The project is also monitoring the progress of RCP-led work to develop a ‘trip advisor-style’ website to seek real time feedback from junior doctors that may provide additional information to triangulate with existing sources.
The General Medical Council’s review of standards of medical education and training, has considered this recommendation by developing the draft standards in a way that emphasise the importance of ensuring the learning environment has a confidential process for raising concerns about the safety of patients or learners.
It is very hard for staff to raise concerns where senior clinicians are dismissive, unsympathetic or worse. Doctors will be expected when they revalidate to demonstrate how they act on concerns raised with them, how they are reflecting on their practice and feedback from patients and colleagues, how they are fulfilling their professional duty of candour and supporting colleagues to do so too, and how their leadership skills and behaviours are contributing to creating an open safety culture that puts patients first.
Additionally, the General Medical Council has commissioned the Rt Hon Sir Anthony Hooper to undertake a review of how it deals with doctors who raise concerns in the public interest. The review is expected to make recommendations as to how the General Medical Council’s current guidance and processes might be adapted to reflect the needs of all doctors, including those in training, who raise concerns and ensure they, are appropriately supported. The review will hear the views of those who may have suffered as a result of raising concerns, as well as the perspective and experience of employers, trade unions and professional leaders. The review is expected to complete shortly.
Site note: This is the supporting annex published on 11 February 2015 with "Culture change in the NHS: applying the lessons of the Francis Inquiries" (Cm 9009), attached to the GOV.UK page as "Culture change in the NHS supporting annex". The annex has no title page; that title is GOV.UK's and the PDF's own. Its table has four columns (No., Recommendation, Hard Truths Government response, Progress update), and the row carries the Progress update cell. No column says which organisation wrote an update, so the row is filed under the Department of Health (now the Department of Health and Social Care), which published it.
Site note: The Inquiry addressed this recommendation to the General Medical Council, not to the Department of Health. The annex gives this update in the Department's publication and does not say who wrote it, so the row is the Department's report of the progress made on it.
What other bodies have found
In their own words. These do not change the delivery statement above.
Thirlwall Inquiry legal team (15 May 2024)
This recommendation was accepted by the Government.
In the January 2014 Hard Truths report, the Government said that the General Medical Council was running professionalism events at all medical schools every year. The Government also referred to the establishment of confidential helpline for doctors and the inclusion of a patient safety question in National Training Survey.
In the February 2015 Culture Change report, the Government said that the encouragement of openness in trainees and protecting them from the potential adverse consequences of raising a concern was included in the 2014 Health Education England mandate.
The General Medical Council published new standards for medical education and training in July 2015, which came into effect in January 2016. These included a requirement that “Organisations [ …] demonstrate a culture that allows learners and educators to raise concerns about patient safety, and the standard of care or of education and training, openly and safely without fear of adverse consequences.”
Site note: The Thirlwall Inquiry legal team's own notes on implementation, from its Review of Implementation of Recommendations from Previous Inquiries into Healthcare Issues (version of 15 May 2024). The review does not colour its Extent of Implementation cell for this recommendation green; it leaves the cell uncoloured where a recommendation was rejected, where evidence of implementation was insufficient, or where steps had been taken but implementation was not yet complete. Table row: section 16.2 No. 160, PDF page 468-469.
Source
Responsible bodies
Themes and tags
Who has spoken
- Department of Health and Social Care
Response, delivery statement - DHSC and NHS England
Delivery statement - Thirlwall Inquiry legal team
Finding