In January this year, Dr Susan Gilby, previously a chief executive of the NHS Trust that employed Lucy Letby, was awarded £1.4 million in damages after an employment tribunal found she had suffered detriment as a whistleblower. The judge concluded that speaking up about her concerns had effectively ended her career in the NHS. While the details of this case, and that of Lucy Letby are complicated and contested, the broader story of how Gilby’s concerns were addressed, were familiar: issues are raised, organisational and interpersonal conflict follows, and organisational attention shifts from the issue of concern to the person raising it.
It is tempting to view whistleblowing as a unique phenomenon. Whistleblowers occupy a particular place in the public imagination. They are individuals who challenge the status quo, expose uncomfortable truths and, in doing so, place themselves at odds with powerful institutions. We often position the retaliation they experience to stem from the nature of what they have revealed – something criminal, sordid and often very damaging to an individual or organisation. Whistleblowing sems to be an issue of disclosure; what is disclosed, and who it casts doubt upon, but it is also an issue of organisational response. It spotlights a problem, which requires fixing, and subsequently draws attention to whether the organisation is willing or able to address the problem.
Every workplace, especially high-pressure contexts with small-to-no margins in terms of capacity, depend upon a degree of order and cohesion. Shared ideas of what needs to be done, and who should do what. Teams are expected to function smoothly, services must continue to be delivered, and managers are rewarded for maintaining stability. Problems arise when an individual, deliberately or otherwise, disrupts those arrangements. In the military, this principle is formalised through the Service Test, which asks whether a person’s behaviour has adversely affected, or is likely to affect, the operational effectiveness of the unit. Most organisations never articulate the question so explicitly. Nevertheless, it often lurks beneath workplace decision-making.
Viewed in this way, whistleblowers are not just identifying a problem, they are a problem. They are challenging because in flagging a concern, they create organisational disruption. The disruption consumes managerial attention, exposes tensions, generates conflict and forces organisations to confront issues they might otherwise prefer to ignore.
From my current research, I would argue that the same dynamic can be observed in the experiences of employees with long-term health conditions. They may request workplace adjustments including flexible working arrangements, periods of absence or changes to their established duties. None of these requests are intended to challenge the organisation, they are designed to enable the opposite, to enable them to work effectively. Yet requesting support has the potential to disturb existing routines, redistribute work and force difficult conversations about resources, capacity and performance, especially if those accommodations are not provided and the issue escalates.
The comparison becomes particularly instructive when viewed through the lens of Sara Ahmed’s work on complaint. In her work exploring institutional responses to racism and sexism, Ahmed argues that complaints are often treated as institutional disruptions rather than responses to existing problems. In this process, attention shifts away from the issue that prompted the complaint and toward the person who raised it. The complaint comes to be seen as the problem. In healthcare, whether the issue is a patient safety concern, a request for workplace support or drawing attention to the lack of support provided, the original problem gradually recedes from view. Instead, scrutiny becomes focused on the individual who has made the problem visible and their capability, conduct, credibility or professionalism can be questioned. As these situations escalate, the organisational response can look remarkably similar in the context of whistleblowing, complaining and/or asking for health-related needs to be met; meetings, investigations, grievances, disciplinaries, deteriorating wellbeing and the possibility that individuals leave, or consider leaving the service.
This issue is unlikely to be unique to healthcare, or just to those experiencing ill-health. Organisations across sectors have long struggled with individuals whose needs, concerns or complaints disrupt established ways of working. Whistleblowers in sectors as diverse as banking, aviation and public services have frequently described feeling targeted, marginalised, pushed out, or leaving their organisations after raising concerns, as have disabled people and those with long term health conditions.
The issue is particularly significant in the NHS though, it has an ageing workforce, high levels of sickness absence, and persistent staffing shortages. Many employees will require support, flexibility or workplace adjustments at some stage of their careers. In this context, retention matters just as much as recruitment. The question is not whether the NHS can employ workers who (will) need support. It already does. The question is how it responds when supporting those workers becomes ‘difficult’, and whether those responses risk contributing to the very workforce pressures the organisation is trying to address.
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Workers’ problems and problem workers in UK healthcare
by Jen Remnant Oct 21, 2026In January this year, Dr Susan Gilby, previously a chief executive of the NHS Trust that employed Lucy Letby, was awarded £1.4 million in damages after an employment tribunal found she had suffered detriment as a whistleblower. The judge concluded that speaking up about her concerns had effectively ended her career in the NHS. While the details of this case, and that of Lucy Letby are complicated and contested, the broader story of how Gilby’s concerns were addressed, were familiar: issues are raised, organisational and interpersonal conflict follows, and organisational attention shifts from the issue of concern to the person raising it.
It is tempting to view whistleblowing as a unique phenomenon. Whistleblowers occupy a particular place in the public imagination. They are individuals who challenge the status quo, expose uncomfortable truths and, in doing so, place themselves at odds with powerful institutions. We often position the retaliation they experience to stem from the nature of what they have revealed – something criminal, sordid and often very damaging to an individual or organisation. Whistleblowing sems to be an issue of disclosure; what is disclosed, and who it casts doubt upon, but it is also an issue of organisational response. It spotlights a problem, which requires fixing, and subsequently draws attention to whether the organisation is willing or able to address the problem.
Every workplace, especially high-pressure contexts with small-to-no margins in terms of capacity, depend upon a degree of order and cohesion. Shared ideas of what needs to be done, and who should do what. Teams are expected to function smoothly, services must continue to be delivered, and managers are rewarded for maintaining stability. Problems arise when an individual, deliberately or otherwise, disrupts those arrangements. In the military, this principle is formalised through the Service Test, which asks whether a person’s behaviour has adversely affected, or is likely to affect, the operational effectiveness of the unit. Most organisations never articulate the question so explicitly. Nevertheless, it often lurks beneath workplace decision-making.
Viewed in this way, whistleblowers are not just identifying a problem, they are a problem. They are challenging because in flagging a concern, they create organisational disruption. The disruption consumes managerial attention, exposes tensions, generates conflict and forces organisations to confront issues they might otherwise prefer to ignore.
From my current research, I would argue that the same dynamic can be observed in the experiences of employees with long-term health conditions. They may request workplace adjustments including flexible working arrangements, periods of absence or changes to their established duties. None of these requests are intended to challenge the organisation, they are designed to enable the opposite, to enable them to work effectively. Yet requesting support has the potential to disturb existing routines, redistribute work and force difficult conversations about resources, capacity and performance, especially if those accommodations are not provided and the issue escalates.
The comparison becomes particularly instructive when viewed through the lens of Sara Ahmed’s work on complaint. In her work exploring institutional responses to racism and sexism, Ahmed argues that complaints are often treated as institutional disruptions rather than responses to existing problems. In this process, attention shifts away from the issue that prompted the complaint and toward the person who raised it. The complaint comes to be seen as the problem. In healthcare, whether the issue is a patient safety concern, a request for workplace support or drawing attention to the lack of support provided, the original problem gradually recedes from view. Instead, scrutiny becomes focused on the individual who has made the problem visible and their capability, conduct, credibility or professionalism can be questioned. As these situations escalate, the organisational response can look remarkably similar in the context of whistleblowing, complaining and/or asking for health-related needs to be met; meetings, investigations, grievances, disciplinaries, deteriorating wellbeing and the possibility that individuals leave, or consider leaving the service.
This issue is unlikely to be unique to healthcare, or just to those experiencing ill-health. Organisations across sectors have long struggled with individuals whose needs, concerns or complaints disrupt established ways of working. Whistleblowers in sectors as diverse as banking, aviation and public services have frequently described feeling targeted, marginalised, pushed out, or leaving their organisations after raising concerns, as have disabled people and those with long term health conditions.
The issue is particularly significant in the NHS though, it has an ageing workforce, high levels of sickness absence, and persistent staffing shortages. Many employees will require support, flexibility or workplace adjustments at some stage of their careers. In this context, retention matters just as much as recruitment. The question is not whether the NHS can employ workers who (will) need support. It already does. The question is how it responds when supporting those workers becomes ‘difficult’, and whether those responses risk contributing to the very workforce pressures the organisation is trying to address.