Worries about wrongdoing, poor practice and dangerous understaffing in hospitals and other healthcare settings must never, ever be hushed up, so it is heartening that ministers are insisting personally on signing off all so-called "compromise agreements" negotiated by Scottish health boards with doctors, nurses and other staff.
The Health Secretary Alex Neil had previously warned health boards against gagging employees and in February announced he was removing confidentiality clauses from settlements with NHS staff so that there could be no room for misunderstanding their purpose.
This latest move goes further and suggests that the minister wants to ensure that compromise agreements are not drafted in any way that could deter the raising of professional concerns.
Loading article content
It is disappointing that such measures should be necessary - the principle that NHS staff should be able to whistleblow without fear for their careers ought to be taken as read - but recent events have shown that some health boards still struggle with the concept of openness, and so the minister is rightly responding.
Health boards claim they do not misuse the agreements, but consultant psychiatrist Dr Jane Hamilton begs to differ. Dr Hamilton spoke publicly earlier this year about her refusal a sign a compromise agreement with NHS Lothian containing a gagging clause, a move that risked her career and a six-figure settlement Dr Hamilton had raised concerns that the mother and baby unit at St John's Hospital, Livingston, was not functioning properly and even that somebody could die. Two mothers subsequently took their own lives.
In the compromise agreement offered to her, worries about the unit were classed as "grievances", included in a confidentiality clause, instead of "protected disclosures" which come with safeguards to protect whistleblowers. Had she signed, she would never have been able publicly to mention them again.
It is against the law to prevent staff from raising concerns about patient safety. Police are now investigating.
The NHS, like every organisation, is subject from time to time to complaints that are unfair or exaggerated and it is understandable that boards should wish to protect themselves from reputational damage that is unwarranted. But the NHS is not perfect either. There will inevitably be failings from time to time and sometimes those failings will create a real risk to patient safety. Health boards that are functioning at their very best are health boards that encourage staff to raise concerns wherever they observe poor standards of care, no matter which feathers are ruffled in the process, while never victimising them for doing so, or making them feel as if they are risking their careers.
The campaign group Patients First is calling for a fully independent watchdog body to protect staff and ensure quality of care for patients. Unless NHS boards can build public confidence in their own ability to handle complaints appropriately, this may indeed prove necessary.