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On setting up the NHS, its founder Nye Bevan is reported to have said if a bedpan was dropped on a ward of a hospital, the noise would reverberate all the way to the corridors of power in Westminster.

That may be so, but the level of control and secrecy in the NHS means the clanging sound is muffled from the public.

Ministers talk a lot about making the NHS transparent and open.

But it appears nothing could be further from the truth - as the debate over gagging orders prompted by the Gary Walker case demonstrates.

Mr Walker has told the 91�ȱ� he had no choice but to sign an agreement linked to a confidentiality clause in April 2011 after being sacked as chief executive of the United Lincolnshire Hospitals Trust

This issue is nothing new. It has been going on for years.

In 1998, the government of the day tried to stamp it out through the Public Interest Disclosure Act.

It is known as the UK's whistle-blowing law as it gives employees protection if they raise concerns.

'Isolated and fearful'

But as the years have gone by it has become apparent that within the health service it has not quite had the intended effect as the culture of secrecy has continued.

Staff who worked at Stafford Hospital, the trust at the centre of the scandal subject to a public inquiry, have complained of being bullied and silenced after trying to raise the alarm.

Another high-profile case involved the nurse, Margaret Haywood, who was struck off in 2009, after filming examples of neglect at Brighton's Royal Sussex Hospital for a 91�ȱ� Panorama programme.

She too complained of a lack of support from bosses.

from the British Medical Journal from 2010 showed that while most trusts do have whistle-blowing policies, many were written in a way that did not do enough to encourage staff to come forward.

Some stressed the threat of disciplinary action, while others did not even mention that staff would be protected if they came forward.

On top of that there is the issue of gagging clauses. By their very nature it is impossible to know just how many are in place.

British Medical Association leader Dr Mark Porter says part of the problem is that while the law is clear, in practice people can feel isolated and fearful.

"Lawyers may be involved and they are facing this big organisation and feel they can't speak out. We have to change that."

Stephen Dorrell, a former health secretary and the current chairman of the House of Commons' Health Select Committee, agrees there is a "core problem" which shows the "culture of the health service is wrong".

To be fair, the Department of Health has attempted to counter such secrecy.

Just over a year ago a free helpline for whistleblowers was launched, while the need for staff to report concerns and employers to act on them was written into the NHS Constitution.

And, of course, last week the public inquiry into the Stafford Hospital failings recommended a duty of candour to get staff to be open about mistakes, while with-holding information from regulators should become a criminal offence.

But it goes much wider than this.

Many compare the openness - or lack of it - in the NHS with what happens in local government.

The power devolved to councils and the presence of councillors willing to talk out means much more uncomfortable information tends to leak out of the system.

Over the years ministers have often talked about making the NHS more transparent by publishing more and more information.

And, yes, a whole mountain of statistics are now published on the NHS each month from waiting times to how many patients are kept on mixed-sex wards.

But the complex nature of the NHS means only half the picture emerges.

For example, while each hospital submits how it is doing against the four-hour A&E target that masks what is happening around the emergency department.

Ambulances can be queuing outside and delays can be experienced once a patient is admitted into the hospital. But none of this is properly reflected in the official statistics.

All this helps create a system that encourages silence rather than noise.