An expert has told BBC News that the protections for NHS employees to report wrongdoing may not be enough to stop another major scandal like the one at the Mid Staffordshire hospital trust.
More than ten years ago, Sir Robert Francis oversaw the investigation into hundreds of patient deaths at Stafford Hospital.
He claims that despite subsequent initiatives to promote whistleblowing, some people still face severe consequences for speaking out.
And the victimization deters others from speaking up.
Too many managers in the health system, according to NHS National Guardian Dr. Jayne Chidgey-Clark, still fail to protect those who raise concerns from victimization or bullying. Chidgey-Clark's position is to protect whistleblowers in England.
Last year, a record number of NHS whistleblowers—more than 25,000—came forward with concerns about bullying and patient safety, up by a quarter from the year before.
When Tristan Reuser, a senior eye surgeon at Birmingham's primary hospital trust, felt he had to use a non-medical colleague to assist with an urgent operation, he felt compelled to complain about a lack of nursing staff.
He tells BBC News that instead of dealing with the problem, management turned against him.
According to Mr. Reuser, criticizing systems—systems created by senior management—is the essence of whistleblowing.
So you criticize senior management, which is something you don't like if you're a senior manager. What can we do to address this, then?
After an investigation, Mr. Reuser was placed on administrative leave, reported to the General Medical Council, and that body determined there was no case to answer.
A later employment tribunal concluded that he had been fired unfairly.
When asked how he handled the emotional strain of the investigation, the GMC case, and the employment tribunal, Mr. Reuser seems to falter.
He admits, "It was pretty bad.". "And there were times when I believed it was over. ".
He pauses for a while to collect himself.
It's difficult and career-changing, he claims. "Sometimes, I'm sure, life-changing for some people. ".
When asked if he had ever considered suicide, Mr. Reuser replies, "Yup, I have had those thoughts, just like some other people who have spoken to BBC News. However, a devoted wife can make it go away. ".
According to a representative of University Hospitals Birmingham, the trust takes staff-reported safety concerns seriously.
It acknowledged the mistakes it had made in Mr. Reuser's case and offered an apology, but asserted that it had acted in the patient's best interests.
UHB employs freedom-to-speak-up guardians to help whistleblowers be heard, just like every NHS trust in England.
After the Mid Staffordshire scandal, which saw hundreds of patient deaths as a result of subpar care between 2005 and 2009, this system was put in place.
But when asked if he is confident it will avert another disaster, Sir Robert replies, "Am I confident, 100%? No.
"When pressures like those that existed at the time of Mid Staffs arise, there is a risk of it happening again.
"But I believe the best way to stop it is to constantly consider the culture, making sure it's welcoming, encouraging, and prioritizes the patient by paying attention to staff members' worries about them. ".
According to Sir Robert, ignoring employee complaints is frequently a sign of poor leadership.
"The leadership of the organizations," he asserts, "must buy into and understand what this is all about. By leadership, I mean the chief executive and the board.
And it's likely that people of a certain type at that level find it challenging to relinquish control, which is one benefit of allowing others to speak up. You don't have complete control. ".
Finding people who are willing to publicly discuss their experiences is one of the challenges journalists face when covering this story.
The majority of those who did speak with BBC News did not want their identities made public; instead, they described how they felt victimized and alone at work, as well as the possibility that, like Mr. Reuser, they might be reported to the medical regulator or lose their jobs and careers.
And many mentioned a fearful atmosphere.
Dr. A raised concerns about patient safety only to find themselves under investigation because they were so afraid of management retaliation that BBC News had to hide their identity.
"I've had trouble sleeping, and I've gone to counseling; it's been absolutely horrible," Dr. A says.
"It has really been a dismantling of me as a person; it has increased my fear and anxiety. ".
Additionally, "management by fear" is the best way to sum up the atmosphere in their hospital.
Dr. A says, "My concern about conducting this interview is that they would learn who I was and then the punishment that would come my way - because I'm positively certain punishment would come.".
"The executive team is the source; it comes directly from them.
"They have contributed to the problem, yet they are expected to try to solve it, which cannot be the case. ".
According to Dr. Chidgey-Clark, both NHS England and the primary healthcare regulator, the Care Quality Commission (CQC), could do more to safeguard specific whistleblowers and rein in dishonest managers.
She says, "I do call on them to do everything they can within their power to ensure there is accountability and these serious issues are looked into. Because if not, more high-profile cases will occur, potentially resulting in more patient harm and worker harm. And we don't want to see that in our society or in our healthcare system.
"Nobody should be punished for acting morally. ".
NHS England acknowledges that too many employees are still reluctant to voice concerns, but an official claims the organization wants all workers to feel like they are part of a place where their opinions matter.
While this is going on, the CQC tells BBC News that as part of its inspection process, it looks at how all hospital trusts handle whistleblowers, and any trust that attempts to censor this information is wholly unacceptable.