Why do some people choose to blow the whistle?
England: patient queues, quiet reserve and the drinking of tea. Yet it is also home to scores of whistle-blowers determined to do the right thing whatever the cost. Given the repercussions they can suffer, why do they do it?
Jennie Fecitt had doors slammed in her face, her colleagues ignored her, and, she says, her daughter received a phone call threatening to burn her house down.
Why? Because the former Manchester-based NHS clinical co-ordinator had dared blow the whistle on a co-worker who had no proper training.
Putting her head above the parapet ended her previous career.
She remains a nurse, but is now with Patients First, a whistle-blowers' charity.
Are you a natural whistle-blower?
- Are you highly educated?
- Do you show good performance in your work?
- Do you think something can be done about the problem?
- Is your organisation seemingly responsive to complaints?
- Is the problem not widely known?
- Are you a dominant but not always the most agreeable of characters?
The more "yes" answers to the above questions, the more likely you are to blow the whistle, according to the British Psychological Society.
Cathy James, chief executive of whistle-blowers charity Public Concern at Work, claims most people will try "once or twice" to raise concerns and then give up if they do not get a "good response" from their employer.
Those who do persevere are usually highly educated, perform well in their jobs and believe the risks to themselves are outweighed by the importance of speaking out.
Yet according to the British Psychological Society, the whistle-blower is not the only one at risk. So too is the organisation - which risks becoming a less effective body if people cannot raise concerns - and the public at large.
The society's Dr Joanna Wilde said: "Nearly all whistleblowers report workplace bullying after speaking up.
"Retaliation is more extreme for favoured employees, indicating that those who are more likely to know what is going on are actually at greater personal risk if they take such action."
Steven Redfern, the former head of property at Corby Borough Council, spoke out after having concerns about a series of land deals.
After they were ignored by the authority itself, he raised them with the council's monitoring officer and then the Audit Commission.
The commission concluded one of the deals was "unlawful" and "resulted in a loss of between £4.2m and £9.5m" for the authority.
Earlier this month, a £1m lawsuit brought by Mr Redfern against his employers was settled out of court. He had claimed he was "bullied" after blowing the whistle - allegations the council had denied.
Speaking before the result of the case, Mr Redfern said whistle-blowing was a "sure way to terminate your career".
But he said it had been his "professional duty" to do so.
Would he do it again? "There is part of me which says no," he says. "You are not thanked for whistle-blowing, you are regarded as a trouble causer.
"But the other part says I could not live with my conscience if I had not whistle-blown."
In his letter to Jeremy Hunt, Gary Walker said he was dismissed from his job as chief executive of United Lincolnshire Hospitals Trust after warning senior health officials that patients would come to harm if it was forced to comply with NHS targets.
The letter sets out how he believes his actions were vindicated by events, as evidence grew of rising death rates and a high number of safety incidents.
But he said he had since been blacklisted by the NHS "despite a high achieving career".
"I would expect that whistle-blowers simply want an apology and a job that is comparable to the one they were forced from," he said.
George Harlock, a former bridge inspector from Milton Keynes, agrees.
Mr Harlock lost his job at Mouchel, which carried out bridge maintenance for Milton Keynes Council, after he raised concerns with the authority that his reports were being ignored.
He had found many of the bridges in the New City were suffering from "safety defects" and alerted his management.
When they did nothing, he sent the report to the council. A subsequent audit ordered by the authority found inspections had not been delivered according to contract and that reports had been insufficient and inaccurate.
Although Mouchel denied all the claims, Milton Keynes Council pulled out of a 12-year deal three years early.
By April 2011, Mr Harlock had lost his job. He claimed he had been dismissed, while Mouchel said he had been made redundant.
An employment tribunal ruled in his favour but Mr Harlock has not been able to find work since.
He is bound from talking about that case by a non-disclosure agreement, but said he never looked back and wished he had not whistle-blown.
Notable English whistleblowers
- Edmund Dene Morel, an English shipping clerk turned journalist, blew the lid on the brutal Belgian regime in the Congo Free State in 1893
- In 1984, Clive Ponting, a senior civil servant, leaked classified documents confirming the Argentine General Belgrano was sunk outside the exclusion zone during the Falklands War
- In 2003, Katherine Gun leaked details of an alleged plot to bug UN delegates before the Iraq war and was sacked from her job as a translator at GCHQ
"I could not have done anything else. It is part of my make-up," Mr Harlock said.
"I felt compelled to follow my conscience and professionalism."
He said he had been dependent on benefits in the run-up to the tribunal and suffered from "periods of stress and depression".
"I am still mentally and emotionally recovering," he said. "Five years on from when I blew the whistle I am still picking up the pieces."
Given the rationale of whistle-blowing is to raise problems for the common good, why are those who speak out treated in such a way?
Psychologists again claim to have an answer.
"Whistle-blowing may," says Dr Wilde, "be experienced as a form of treachery."
By speaking out, she says, the whistle-blower may be seen to have betrayed the group, triggering "the 'in group - out group' response".
The whistle-blower has not just raised a concern, they have turned themselves into the enemy.
"It is helpful to consider taking such action as an act of psychological suicide or martyrdom," says Dr Wilde.
James says whistle-blowers must not only be protected, but sanctions must be put in place against those who target them.
"No-one is really accountable for what they have done to a whistle-blower," she added.
"We are making some progress in breaking the culture of silence, but what has followed is the systematic refusal by employers to take these concerns seriously, creating a culture of denial."
So what is being done?
Earlier this year, the government said NHS trusts would have to appoint a guardian to help whistleblowers in England.
The decision follows Sir Robert Francis's Freedom to Speak Up Review which found NHS staff too often faced "bullying and being isolated" when they tried to speak out.
The British Psychology Society says whistle-blowing is an "after the fact" action, a cure for something wrong, rather than a prevention.
"Prevention of the need for whistle-blowing, through creating environments where people speak before there is a major problem," says Dr Wilde, "is clearly better than cure."