The publication of Commission for Health Improvement (CHI) reports in recent years have revealed that employees attempted to blow the whistle on abuse, corruption or malpractice but were largely ignored by senior members of staff. The CHI report into the North Lakeland National Health Service (NHS) Trust (November 2000), for instance, states that an initial failure among management to listen to the concerns of student nurses led to the sustained abuse of patients. To protect patients from incompetent and unethical practitioners and improve standards of care, an environment needs to be created where health care professionals feel able to express legitimate concerns openly and honestly to senior staff, safe in the knowledge that senior managers will take their concerns seriously and act accordingly. The government has pledged to create an ‘open culture’ in the NHS to encourage staff with genuine concerns to speak out. This can only be achieved if the current leadership culture characterized by conflict avoidance, blame and hierarchical control is replaced with openness and accountability. To produce the desired changes in culture and attitudes, the NHS needs strong leaders capable of challenging the existing social equilibrium.