NMC Code Section 16: Act on Concerns and Safety Risks

Section 16 of the Code is the raising-concerns standard.

“Act without delay if you believe that there is a risk to patient safety or public protection.”

Sub-clauses:

• 16.1 Raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other healthcare setting.
• 16.2 Raise your concerns immediately if you are being asked to practise beyond your role, experience and training.
• 16.3 Tell someone in authority at the first reasonable opportunity if you experience problems that may prevent you working within the Code or other national standards, taking prompt action to tackle the causes of problem if you can.
• 16.4 Acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so.
• 16.5 Not obstruct, intimidate, victimise or in any way hinder a colleague, member of staff, person you care for or member of the public who wants to raise a concern.
• 16.6 Protect anyone you have management responsibility for from any harm, detriment, victimisation or unwarranted treatment after a concern is raised.

Section 16 is the Code’s response to the Francis Report and similar inquiries. It addresses the failures of voice that allowed sustained harm at Mid Staffordshire and other settings.

What it means in practice

Raising a concern has a defined route:

1. First level: line manager, ward sister, clinical lead. Most concerns resolve here.
2. Second level: senior nurse, matron, directorate manager. Used when first-level didn’t address the concern, or when the first-level person is the subject of it.
3. Third level: Freedom to Speak Up Guardian. Every NHS trust has one. They sit outside the normal management chain.
4. External: CQC, NMC, whistleblowing helpline (national or trust-specific).

The trust pathway should be followed where possible. External routes are appropriate when internal routes have failed or when there’s a credible reason internal routes won’t work (concern about the chief executive, for example).

Common breaches

• Failure to raise when something was clearly wrong.
• Inadequate escalation: raising once and accepting no response.
• Obstruction: actively discouraging colleagues from raising concerns.
• Victimisation of those who do raise concerns.

Section 16 breaches are sometimes hardest to identify because they involve things not done. The Robert Francis QC inquiry into Mid Staffordshire is the canonical example of systemic Section 16 failure.

CPD that maps to Section 16

• Freedom to Speak Up training (often mandatory in NHS trusts).
• Whistleblowing awareness.
• Raising concerns processes specific to your employer.
• Patient safety culture training.
• Just culture frameworks.

Common reflective account themes

Strong Section 16 accounts describe:

• A concern you raised and the outcome.
• A moment when you noticed concern wasn’t being taken seriously and the next step you took.
• A response you made to a junior colleague who raised a concern with you.
• A change in your willingness to speak up after a Freedom to Speak Up training session.

Where Section 16 connects to other sections

• Section 8 (cooperative working): raising concerns about colleagues’ practice.
• Section 14 (duty of candour): disclosure of harm goes alongside disclosure of risk.
• Section 17 (protect vulnerable people): safeguarding concerns are Section 16 concerns.

The next chapter covers Code Section 17 on protecting vulnerable people.