16. Patients rely on their healthcare professionals to keep them safe, and in most cases this will simply involve the practitioner taking care when assessing and treating a patient.
17. There are multiple factors that can affect safe delivery of care, however, which may fall outside the individual practitioner’s control. These could be environmental (for example, health and safety issues with the premises or equipment) or other systemic issues (such as an organisational policy that has an adverse impact when implemented, or not being implemented correctly) or issues relating to another professional and their ability to provide safe care.
18. Patients will often be unaware of these issues and therefore will not be able to raise them, but the healthcare professional is in a much better position to do so and should speak up if they are concerned.
19. We recognise that there can be barriers to individuals speaking up. These include the following:
- uncertainty around whose responsibility it is to act when more than one person is involved;
- divided loyalties when speaking up may involve undermining or speaking out about the behaviour of a colleague, manager or employer;
- poor organisational culture which may lead to fear of personal repercussions for speaking up;
- concern about the impact on an individual’s career of speaking up; and
- structural inequalities (such as registrants with protected characteristics under the Equality Act 2010) and workplace discrimination impacting willingness to speak up.
20. It is important that everyone is aware of these potential barriers, many of which can be overcome by fostering a culture where everyone is comfortable to speak up. The remainder of this guidance will give information about ways to raise concerns constructively and about the protections there are for individuals that do so.
21. We would take very seriously allegations that anyone was being discouraged from speaking up or victimised or discriminated against for doing so. As well as being unlawful, this would amount to a breach of GOC standards that we would take very seriously.
 Some of these were identified in the Professional Standard Authority’s report in October 2013 entitled Candour, disclosure and openness: Learning from academic research to support advice to the Secretary of State.