Dr Jayne Chidgey-Clark, National Guardian for the NHS, encourages all senior leaders to undergo training to understand their role in setting up a good speaking up culture that would promote organisational learning and improvement

An effective speak up culture is not just a “nice to have” – it is a cornerstone of a well-run organisation. It is an environment where workers can speak up about anything that gets in the way of them doing a great job, knowing that they will be thanked and listened to, and appropriate action will be taken.

A positive speak up culture contributes to organisational success. It protects workers and people who use services. Benefits include improved safety and organisational performance, harm and cost reduction, and worker wellbeing and retention. But the gifts which speaking up brings can only be realised if leaders at all levels listen up and follow up on what they hear, and results from recent national surveys give cause for concern.

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Listen up – early warning signs

There was a fall in the percentage of Freedom to Speak Up Guardians who responded to the National Guardian’s Office survey who said that their organisation had a positive culture of speaking up. This has dropped five percentage points from 2020 to 62.8 per cent.

Freedom to Speak Up Guardians support workers to speak up and work in partnership with others in their organisation to tackle barriers to speaking up. They are sensitive to changes in the cultural environment in which they work and the experiences of the workers they support.

Findings from the Freedom to Speak Up Guardian survey are echoed by the 2022 NHS Staff Survey. The proportion of staff who said they felt safe speaking up about anything that concerns them in their organisation also fell to 62 per cent, down more than three percentage points (2020: 65.6 per cent).

Freedom to Speak Up Guardians support workers to speak up and work in partnership with others in their organisation to tackle barriers to speaking up

Freedom to Speak Up Guardians responding to our survey identified various barriers to workers speaking up in the organisations they support, particularly the fear of retaliation or detriment for speaking up and the concern that nothing will change. The perceived futility of speaking up is also evident in the latest NHS Staff Survey, which found that less than half of respondents (49.8 per cent) were confident that their organisation would address their concerns.

Since the role was established, Freedom to Speak Up Guardians have supported workers in over 65,000 speak up cases. However, Freedom to Speak Up Guardians are one of many routes through which workers can speak up and they do not work in isolation. Freedom to Speak Up Guardians work within a wider organisational speak up culture, a culture that we all have a role in contributing to. Leaders set the tone for fostering a healthy speak up, listen up, follow up culture and behaviours.

Follow up – time for action

Freedom to Speak Up Guardians responding to our latest survey shared their perceptions of leadership support for their role and speaking up generally. In some areas, the results were encouraging. For instance, 81.3 per cent of respondents said they reported to their boards (or equivalent) in person, up 3.8 percentage points from the previous year. In other areas, however, the results suggested a decline in support from leaders:

  • 70.8 per cent said senior leaders supported workers to speak up, down 10 percentage points (80.2 per cent, 2020)
  • 81.9 per cent said they had direct access to the non-executive director (or equivalent) with speaking up as part of their portfolio, down five percentage points (87.7 per cent, 2020)
  • 83.1 per cent said they had sufficient access to the board, down 11 percentage points (94 per cent, 2020)

High profile cases highlight the consequences when leadership fails to respond in the spirit of the Freedom to Speak Up values. Most recently, the publication of the Ockenden report amplified the voices of workers who shared that they were fearful of speaking up about concerns with tragic consequences.

These survey results should act as early warning signs that action is needed so that confidence in speaking up, which had previously been improving, is not further undermined.

In collaboration with Health Education England, the National Guardian Office has launched a Freedom to Speak Up training programme - a suite of three training modules for everyone wherever they work in healthcare (aimed at workers, managers and senior leaders). The training explains what speaking up is and its importance in creating an environment where people are supported to deliver their best.

As a call to action, I encourage all senior leaders to complete this training to understand their role in setting the tone for a good speaking up culture and how speaking up can promote organisational learning and improvement.

Leaders should use their reflections from this training - as well as the results from these surveys - to pause and consider their influence in shaping the speaking up culture in their organisation. What more can be done to provide confidence to workers that when they speak up, they will be listened to, and actions will be taken? It is not enough to reassure people that their voice counts and is welcomed. We must demonstrate it by listening with curiosity to what is being raised, rather than who is raising it, and taking action by following up and feeding back.

Having regular conversations with their Freedom to Speak Up Guardian, can help leaders both ensure that guardians have the support and collaboration to do their job well, and gain further insights about the speaking up culture and behaviours in their organisations.

Boards, trustees, governors and those with an oversight and leadership role have a duty to assure themselves that the speak up culture in their organisation is operating as it should. Here, the insights of Freedom to Speak Up Guardians can act as an early warning system for leaders to understand where their challenges might be.

Freedom to Speak Up requires leadership commitment throughout the health and care system – not just from providers but also from national bodies, including regulators and professional bodies. In this way, we can foster the speak up, listen up, follow up culture, which will give workers, and ultimately those who use our services, the health and care sector they deserve.