The Telegraph reports on these comments by Sir Robert Francis about the NHS: “I have learned from my son, and from other trainees, that we can learn a lot from the fresh eyes and idealism that doctors and nurses have when they start out. It is so important to exploit that, and not to crush it.” Sir Robert believes that many of the worst failings in the NHS occur when clinical staff become powerless — are left “shrugging their shoulders” rather than challenging poor care. He was encouraged, he says, by changes introduced by the Government to improve openness and transparency, including an overhaul of NHS regulation, ratings for hospitals and improvements to training of staff. But he feels more should be done. In particular, the leading QC wanted changes in the law to put the onus on staff to speak out if patient care is at risk – specifically a legal duty of candour to be placed on health professionals. “We do need to protect individuals by making sure they feel safe to report things to their employers,” he says. “I felt a statutory duty would have assisted that — too often those who raise concerns about things that go wrong become unpopular with colleagues and they need some form of protection.” I am not one to challenge Sir Robert’s judgment on such matters, but what a shame that it should take a statutory solution to derive the result he seeks. Around the world, there a few hospitals in which there is an environment within which such call-outs are encouraged. These are the leading institutions in quality, safety, process improvement, and transparency. They required no statutory approval to become learning organizations, in which all staff–regardless of rank or position–are encouraged and empowered to speak out when the situation arises. Admittely, the majority of hospitals fall into the other category. How many patients have been preventably harmed in those institutions? I suppose it is for the employees of those for which Sir Robert seeks regulatory protection, but what a tragedy–in the deepest sense of the word–that it should be necessary.