Dr Henrietta Hughes on fostering a culture in which workers are supported to speak up and why it’s important for organisations to use data to develop new insights into their own speaking up culture
I am humbled and inspired by the amazing work that is being done in these unprecedented times and I would like to thank everyone in the NHS. As the Covid-19 situation evolves, it is even more essential that we have the freedom to speak up. Speaking up, and listening up, is critical in times of challenge, when workers are stretched to their very limits.
Over 19,000 cases of speaking up by NHS workers in trusts have been handled by Freedom to Speak Up Guardians over the last two years. In the last year, cases have risen by 73 per cent, compared to 2017-18.
Of the 12,000 cases raised between 1 April 2018 and 31 March 2019, guardians reported that nearly one in three included an element of patient safety/quality of care, and just over one in four included an element of bullying/harassment, according to a report published by the National Guardian’s Office which analyses the speaking up data submitted by guardians.
Freedom to Speak Up Guardians were established in every trust in England in the wake of the Francis Inquiry into the events at Mid-Staffordshire Foundation Trust, and guardians themselves believe that the perception of the speaking up culture in health is improving.
We must never lose sight of the fact that while Freedom to Speak Up is there for workers, it ultimately all comes back to patients and service users – keeping them safe and providing the highest quality care
According to a survey conducted by the National Guardian’s Office of those in speaking up roles, 76 per cent think their work is making a difference, compared to 68 per cent last year. They also reported that awareness of the guardian role is improving. This is also mirrored in the views of the workforce in the NHS Staff Survey, as reflected in the Freedom to Speak Up Index, published last year. This will be available on the culture and engagement page of Model Hospital, which is currently under development.
The confidence that NHS workers have in the ability of guardians to address the issues they raise is growing and more learning is being brought to organisations to help them improve.
Our goal at the National Guardian’s Office is to make speaking up business as usual, and while there is distance to go to achieve that, these latest figures are encouraging. I also encourage organisations to use data to develop new insights into their own speaking up culture and to learn from those who have made substantial improvements.
The data report revealed that the percentage of cases reported as anonymous is falling, down to 12 per cent in 2018-19 compared to 18 per cent in 2017-18.
However, the report also shows that the percentage of cases reported as suffering detriment has remained disappointingly static at five per cent. There was also evidence that the number of speaking up cases varies significantly from trust to trust, with the highest number of cases in a single trust reported over the year being 270, while the lowest number was just one.
Measures like the level of reported anonymity dropping are good indicators to suggest workers feel more confident to speak up, particularly when considered in tandem with the encouraging increase in the overall number of cases.
However, it is important that each individual trust looks at their data in context and tries to draw learning from it. Organisations where very few workers are speaking up or where detriment is reported should look to understand and address the issues that may account for that. I am delighted that the Care Quality Commission will be looking at this when evaluating how well-led organisations are.
Fostering a culture in which workers are supported to speak up and removing barriers that may prevent them from doing so, is in the best interests of every organisation that wants to deliver the highest quality care possible.
We must never lose sight of the fact that while Freedom to Speak Up is there for workers, it ultimately all comes back to patients and service users – keeping them safe and providing the highest quality care.
Freedom to Speak Up Guardians remain available to support the amazing NHS workforce to speak up safely.