The care failings and appalling practice at Mid Staffordshire Hospital brought to light the systemic breakdowns in identifying early warning signs and inconsistencies in the reporting culture that sometimes exist within the English National Health Service (NHS), especially when it comes to raising concerns against poor care and unprofessional behaviour. The Francis public inquiry report stresses the importance of transforming culture and attitudes, developing robust safeguarding strategies and implementing effective complaint handling and recording systems. The report also calls for an end to the "gagging clauses‟ that limit public disclosures, and instead to foster a culture of openness, transparency and legally binding duty of candour1. The Department of Health has commissioned Donald Berwick to lead a review and report on making "zero harm‟ a reality within the NHS.
If we are to effectively improve existing national and local whistleblowing procedures, there is merit in learning from good practices in other health care systems and utilising this learning to inform health policy and practice. For example, whistleblowing procedures in Norway have helped to create a culture of openness and transparency, where health professionals are empowered to raise concerns with minimal fear of reprisal and a strong trade union voice is present at board level with an equal vote on all board decisions. This briefing will outline the mechanisms (system, organisational and legislative procedures) behind this reporting culture in Norway and identify lessons in effective complaint handling that will be useful for England.