Dr Henrietta Hughes urges all leaders within the health sector to ask whether staff feel safe to speak up in their own workforce surveys

This year a new question was included in the NHS staff survey asking staff if they feel safe to speak up about anything that concerns them in their organisation. Two thirds of staff agreed or strongly agreed that they did.

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We welcome the inclusion of this question, because Freedom to Speak Up is about more than the ability to raise concerns about patient safety. It is about being able to speak up about anything which gets in the way of doing a great job, whether that’s an idea for improvement, ways of working, or behaviours.

Freedom to Speak Up is for everybody who works in health. It includes primary and secondary care, independent providers, hospices and national bodies. It goes beyond those surveyed in the NHS staff survey and to be truly inclusive needs to work for locum and agency workers, junior doctors, students, volunteers, contractors and all workers who may face additional barriers to speaking up.

The inclusivity at the heart of Freedom to Speak Up is why I ask leaders to take this question and use it to listen to the silence, to reduce the disenfranchisement of workers seen so starkly during the covid-19 pandemic. Who is not represented in your survey responses? This may include workers identified by Sir Robert Francis as vulnerable groups: those who feel unable to speak up because they feel that to do so puts them at risk, whether due to their role, ethnicity or contract terms.

The responses to this question show a very strong positive correlation with the Freedom to Speak Up Index. This is a metric for NHS Trusts, drawn from four questions in the NHS Annual Staff Survey, asking whether staff feel knowledgeable, encouraged and supported to raise concerns and if they agree they would be treated fairly if involved in an error, near miss or incident.

Since the introduction of Freedom to Speak Up Guardians in 2015 following the Francis Freedom to Speak Up Review, the FTSU Index for NHS Trusts has improved and risen 2.5 percentage points nationally from 76 per cent in 2015 to 79 per cent in 2020. Our latest FTSU Index report will be published at the end of May.

Freedom to Speak Up Guardians work proactively to identify and tackle barriers to speaking up, working in partnership to promote positive speaking up culture and bringing themes and learning to senior leaders. The promoters and barriers to speaking up are common to all settings and organisations. Is it safe to speak up? Will I be listened to? Will positive action be taken or will I be victimised?

The universal nature of this new question is why I urge all leaders within the health sector with workers not included in the NHS Staff Survey to include this question in their own workforce surveys. This will help to understand more fully the picture of speaking up in health and develop principles which can be applied universally throughout the sector. And it will also provide a tool to help assure yourself that you are meeting the needs of all your workers.

As Integrated Care Systems are becoming established it is essential that speaking up arrangements are consistent so workers can be confident that when they speak up, they will be thanked, supported, listened to, and the appropriate actions taken. I call for all ICS’s to include Freedom to Speak Up in their constitutions.

A positive speaking up culture relies on listening up and following up. The Freedom to Speak Up e-learning modules we have developed in association with HEE on the e-learning for health platform, are free to access for all. These set out what speaking up is and its importance in creating an environment in which people are supported to deliver their best. The first module – Speak Up – is for everyone. The second module, Listen Up, for managers, builds upon the first and focuses on listening and understanding the barriers to speaking up. A final module, Follow Up, for senior leaders will be launched later in the year to support the development of Freedom to Speak Up as part of the strategic vision for organisations and systems.

The pandemic has shown how vital Freedom to Speak Up is, not just to ensure that patients receive the best care, but also to protect the safety of workers. The NHS staff survey also showed that 18 per cent were considering leaving the NHS altogether. Everyone who works in health has been under tremendous strain over the past year, under the most challenging of circumstances. As the sector rebuilds following the pressures of the pandemic, retaining these highly skilled, dedicated workers has never been more essential.

As a worker, whatever role you play in supporting the health and safety of the nation, you should feel confident that your voice matters and is valued by your organisation. That when you speak, your voice will be heard and that it will be responded to.

We need to work together to ensure that everyone feels safe to speak up, and that the right actions will be taken when they do. To do so shows through deeds, rather than words, that people and their wellbeing matters. Only by listening to the silence, can we work towards making speaking up business as usual.