BBK Manifesto 2025 : Implement a culture of learning in the NHS
A health service that learns openly is inherently a safer one. BBK has long maintained that real progress depends on genuine transparency, timely learning and honest engagement with patients and families.
That’s why we’re campaigning for a frank and open culture that protects whistleblowers.
What a learning culture looks like
NHS England’s Patient Safety Incident Response Framework encourages organisations to treat harm as an invitation to improve, with proportionate responses, meaningful involvement of those affected and clear oversight. The Learn from Patient Safety Events system now serves as the national reporting and analytics hub for safety incidents, helping trusts identify recurring risks and shape improvement.
These policy tools provide a solid foundation, but frameworks alone cannot build trust. That requires openness, protection for those who speak up and a shift in mindset, so negligence is seen as a trigger for learning rather than concealment.
Fully enforce the duty of candour
The statutory duty of candour is intended to make transparency the default. Yet application across trusts remains inconsistent. A national review found fewer than half of respondents believe staff fully understand the duty and many fear it is becoming a tick-box exercise rather than a genuine commitment to openness.
The Mid Staffordshire Public Inquiry, led by Robert Francis QC, stressed the need for statutory openness and warned against contractual clauses that discourage disclosures. When trusts fail to uphold candour, public confidence suffers and the opportunity to learn from mistakes is lost.
Protect staff who speak up
Speaking up is essential for patient safety. However, evidence shows whistleblowers are often labelled as troublemakers and organisations sometimes miss the chance to act on concerns.
The review at University Hospitals Sussex revealed a culture of fear, with staff reporting bullying, suppression of concerns and punitive treatment for those who raised issues. The NHS Ombudsman has also warned a cover-up culture persists, with altered care plans, missing records and retaliation against those who speak up. This climate discourages honesty and delays improvement.
Change the attitude toward negligence
When harm occurs, the instinct in some parts of the NHS can be to deny, deflect or manage reputations. This deepens the distress for patients and families and obstructs organisational learning.
BBK argues early admission, honest explanation, focused learning and timely redress reduces harm to families and lowers litigation costs. Major reviews such as the Ockenden report have shown the devastating consequences of minimising or ignoring failures.
What needs to happen now
A true culture of learning requires honesty when things go wrong, strong protection for those who raise concerns and an attitude that treats negligence as a springboard for improvement rather than something to hide.
We believe the NHS must:
- Enforce candour through clear policies, transparent metrics and consistent use of statutory powers.
- Protect whistleblowers with stronger board oversight, adequate support and independent checks.
- Treat negligence as a trigger for learning through early resolution, open communication and sharing of lessons.
The NHS already has frameworks and data systems in place. What is now required is visible and consistent action, with candour enforced, whistleblowers supported and learnings shared openly.
This blog is part of our 2025/26 Manifesto for Injured People. At Bolt Burdon Kemp, we support injured people not only by winning their cases but by driving change. Guided by our clients’ experiences and partnerships with charities across the UK, we are raising awareness of the change we need to see to better support injured people. We will continue working with politicians from all parties to ensure injured people’s needs are not overlooked in Westminster or beyond. You can read our full manifesto here.
