More needs to be done to support Freedom to Speak Up guardians and improve speaking up culture in healthcare

Leaders at all levels urged to do more to support workers to speak up, by listening and following up

The Annual Report of the National Guardian for the NHS is today (12 January 2023) laid before Parliament, highlighting the work of Freedom to Speak Up guardians and the National Guardian’s Office in making speaking up business as usual.

The laying of the report, a commitment called for by the Secretary of State in his response to the events at Gosport War Memorial Hospital, had been delayed due to parliamentary changes and the death of Her Majesty.

There are now over 900 Freedom to Speak Up guardians supporting healthcare workers in England to speak up about anything which impacts on their ability to do their job. Over 20,000 cases have been brought to them last year, remaining at the record level set in 2020/21 (20,362, compared with 20,388 in 2020/21). Freedom to Speak Up guardians have handled over 75,000 cases since the National Guardian’s Office first started collecting data in 2017.

The report features case studies from across England and different healthcare providers, sharing the experiences of people who have spoken up and the difference Freedom to Speak Up guardians are making. In the words of one group of workers, “It finally felt that we were being listened to and our opinions and thoughts mattered.”

In her foreword to the report, the Parliamentary Under Secretary of State for Mental Health and Women’s Health Strategy, Maria Caulfield MP, said: “We know this is a challenging time for the NHS as we emerge from the pandemic. In such times, it is even more crucial we listen to the voices of those on the frontline by ensuring there is an environment in which staff feel confident they can speak up and that when they do, they will be heard and their concerns acted upon. This is an important priority for the government and for me personally.

“Through the work of the National Guardian’s Office, the Freedom to Speak Up guardians, and the commitment of NHS staff, I am confident that we can deliver an NHS where speaking up becomes business as usual as this will help the NHS to provide high quality and safe care to patients.”

Dr Jayne Chidgey-Clark, National Guardian for the NHS, said: “I am delighted to place our Annual Report before Parliament. The Freedom to Speak Up movement has been a catalyst for positive change but there is still much more to be done.

“This report outlines some of the work which the National Guardian’s Office has been undertaking across the healthcare system to ensure that Freedom to Speak Up is implemented consistently within organisations. This is a vital element to high quality, safe and effective care, and essential for the wellbeing and retention of workers.”

The report also shares intelligence and learning collated by the National Guardian’s Office, including speaking up data shared by Freedom to Speak Up guardians of the cases they receive. While levels of anonymity have decreased, (10.4% in 2021/22, down from 11.7% in 2020/21), reports of detriment were indicated in 4.3% of cases, up from 3.1% in 2020/21.

Dr Jayne Chidgey-Clark commented: “I am greatly concerned by the increase in reported detriment for speaking up, which had been reducing. When someone speaks up, it should be considered a gift – a gift of information which could prevent harm or lead to improvement. I expect leaders to role model this behaviour in their organisations, and send a clear message that treating people badly for speaking up will not be tolerated.”

The National Guardian’s Office Annual Report 2021-22 is available to download from www.nationalguardian.org.uk

For more information or interviews contact: comms@nationalguardianoffice.org.uk

>ENDS<

Notes for editors:

About this report

National Guardian’s Office Annual Report 2022
Making Speaking Up business as usual

ISBN 978-1-5286-3593-6 CP701 E02769666

Date: 12 January 2023

Available from: nationalguardian.org.uk

The publication and laying before Parliament of this report meets a commitment called for by the Secretary of State in his response to the events at Gosport War Memorial Hospital.

About the National Guardian’s Office

The National Guardian’s Office works to make speaking up become business as usual to effect cultural change in the NHS.

The office leads, trains and supports a network of Freedom to Speak Up Guardians in England and provides learning and challenge on speaking up matters to the healthcare sector.

The role of Freedom to Speak Up Guardians and the National Guardian were established in 2016 following the events at Mid-Staffordshire NHS Foundation Trust and recommendations from Sir Robert Francis’ Freedom to Speak Up Inquiry.

There are now over 900 Freedom to Speak Up guardians in NHS primary and secondary care and independent sector organisations, national bodies and elsewhere that ensure workers can speak up about any issues impacting on their ability to do their job.

About Freedom to Speak Up Guardians

Freedom to Speak Up guardians support workers to speak up when they feel that they are unable to do so by other ways. They ensure that people who speak up are thanked, that the issues they raise are responded to, and make sure that the person speaking up receives feedback on the actions taken. Guardians also work proactively to support their organisation to tackle barriers to speaking up.

Freedom to Speak Up Guardians are appointed by the organisation they support and abide by the guidance issued by the National Guardian’s Office. They follow the ‘universal job description’ issued by the NGO.

www.nationalguardian.org.uk

Key data:

The report includes a summary the case data raised with Freedom to Speak Up guardians from 1 April 2021 to 31 March 2022.

Freedom to Speak Up Guardians submit non-identifiable information to the National Guardian’s Office (NGO) about the speaking up cases raised with them.

Further information and data tables summarised in this report can be found on the NGO’s website.

• Between 1 April 2021 to 31 March 2022, over twenty thousand (20,316 cases were raised with Freedom to Speak Up Guardians.

• Freedom to Speak Up Guardians continued to support workers from all professional groups to speak up. Nurses and midwives continued to account for the biggest portion (28.5%) of speaking up cases raised with Freedom to Speak Up Guardians.
  
  
• Nineteen per cent (19.1%) of cases raised with Freedom to Speak Up Guardians included an element of patient safety/quality, a slight increase from 18% in 2020/21.
  
  
• Over a third (32.3%) included an element of behaviours, including bullying/harassment, a rise from 30.1% last year.

• 13.7% of cases had an element of worker safety. This is a new category which the NGO introduced in 2021/22, in response to concerns being raised during the pandemic. Throughout the year, an increasing proportion of cases were recorded as containing an element of worker safety, up from 12.5% in Q1 to 15.3% in Q4 2021/22.

• Ten per cent (10.4%) of cases raised to Freedom to Speak Up Guardians were raised anonymously. This continues the downward trajectory from 2017, when 17.7% of cases were raised anonymously.
  
  
• Detriment for speaking up was indicated in 4.3% of cases. Although this is down from 5.1% in 2017/18, this has risen since last year (3.1% in 2020/21).

• Feedback from workers on their experience was provided in 5,112 cases in 2021/22. Over 86 percent (86.7%) of people who gave feedback said they would speak up again.

About the National Guardian for the NHS

Dr Jayne Chidgey-Clark was appointed as National Guardian in December 2021.

She is a registered nurse with more than 30 years’ experience in the NHS, higher education, voluntary and private sectors. Prior to her role as National Guardian, she was a non-executive director at NHS Somerset Clinical Commissioning Group where she was also Freedom to Speak Up Guardian.

She is the Independent Chair for the Oxfordshire Safeguarding Adults Board. She also worked with the NHS England New Care Models Programme for three years as a Clinical Associate and has been working as a consultant and coach with and in the NHS since March 2015. Her specialist clinical area is end of life care in which she was awarded her PhD.