“If we can get the culture right, benefits will follow, including improving patient safety, innovation for improvement, retaining workers and making the NHS a great place to work,” says National Guardian in Annual Report

The Annual Report of the National Guardian for the NHS is today (16 November 2023) laid before Parliament, highlighting the work of Freedom to Speak Up guardians and the National Guardian’s Office. The report also shares learning which indicates that more work is needed for speaking up to be described as business as usual in the healthcare sector in England.

The laying of the report was a commitment called for by the Secretary of State in his response to the events at Gosport War Memorial Hospital as a means of holding the government to account on supporting the fostering of an open culture in the healthcare sector in England.

In her foreword to the report, the Parliamentary Under Secretary of State for Mental Health and Women’s Health Strategy, Maria Caulfield MP, said:

“The events surrounding the terrible crimes of Lucy Letby are an important reminder of how vital it is for organisations to have a culture in which workers feel safe to speak up about anything that gets in the way of delivering safe and high-quality care. Managers and senior leaders must be welcoming of speaking up and be ready to listen and act on what they hear.

“Freedom to Speak Up must be at the heart of our efforts to improve the culture, leadership and wellbeing of our healthcare workers.”

Dr Jayne Chidgey-Clark, National Guardian for the NHS, said:

“This year we have had stark reminders of why all efforts to improve the Speak Up culture in health, including the Freedom to Speak Up Guardian route, are so essential for patient safety.

“It is chilling to think of the harm that might have been prevented and lives which might have been saved if colleagues felt able to raise concerns, or had been listened to and appropriate action taken swiftly when they did.

“This report shares some of our learning. Freedom to Speak Up is more than an ‘initiative’, it is a social movement.”

The report features case studies from across England, illustrating the difference Freedom to Speak Up guardians are making and examples of how healthcare workers are being supported to speak up for patient safety and worker wellbeing. Case studies are included from: Dudley Integrated Care NHS Trust, East of England Ambulance Service Trust, East and North Hertfordshire NHS Trust, First Community Health and Care CIC and Leeds and York Partnership NHS Trust.

The network of Freedom to Speak Up Guardians continues to grow, with over 1,000 Guardians in place supporting healthcare workers in England to speak up about anything which impacts on their ability to do their job. The National Guardian’s Office has strengthened the training and support it gives Freedom to Speak Up guardians in order to ensure that they meet the needs of the workforce in this complex and wide-ranging role.

Over 25,000 cases were raised with Freedom to Speak Up guardians last year, a 25% increase on the record level set during the pandemic. Guardians have handled over 100,000 cases since the National Guardian’s Office first started collecting data in 2017.

Detriment for speaking up remains a concern. Although there has been a drop in the percentage of cases indicating detriment (to 3.9%), given the rise in numbers, this equates to 1,000 cases where people felt they were experiencing disadvantageous or demeaning treatment as a result of speaking up.

As part of its remit, the National Guardian’s Office shares learning and good practice in order to effect culture change in the healthcare sector, including through Speak Up Reviews. The report summarises the findings from its recent review of ambulance trusts which made recommendations applicable to all providers throughout the sector, and to its partners, NHS England and the Care Quality Commission.

This year, the National Guardian’s Office has worked with NHS England to publish the new and updated Freedom to Speak Up policy for the NHS and guidance for leaders of organisations providing NHS services. All NHS trusts and foundation trust boards have been asked to update their local policy to reflect the new national template by the end of January 2024. By this time, they should have also seen the outputs from using the self-reflection tool and provided at least one progress update.

Dr Jayne Chidgey-Clark said “This is an opportunity for leaders to look afresh at their arrangements to assure themselves that their workers have supportive routes available to them to speak up, and that, as leaders, they are listening and acting. If we can get the culture right, benefits will follow, including improving patient safety, innovation for improvement, retaining workers and making the NHS a great place to work.”

The National Guardian’s Office Annual Report 2022-23 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 2022/23
Making Speaking Up business as usual

ISBN 978-1-5286-4515-7 CP959 E03005055

Date: 16 November  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 1,000 Freedom to Speak Up guardians in NHS primary and secondary care, independent sector organisations, national bodies and elsewhere that ensure workers can speak up about any issues impacting on their ability to do their job.
www.nationalguardian.org.uk

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. Over four-fifths (82.8%) of those who gave feedback having spoken up to a guardian said they would speak up again.

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 including the ‘universal job description’.

Key data:

The report includes a summary the case data raised with Freedom to Speak Up guardians from 1 April 2022 to 31 March 2023.

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

• 25,382 cases were raised with Freedom to Speak Up Guardians, a 25 per cent point increase from 2021/22.

• Workers from a range of professional/worker groups spoke up to Freedom to Speak Up Guardians, registered nurses and midwives accounted for the biggest portion (29.0%) of cases raised.
  
  
• The proportion of cases reported as being raised anonymously continued to fall, 9.3% in 2022/23, down from 10.4 in 2021/22.
  
  
• Detriment for speaking up was indicated in 3.9% of cases, down from 4.3% in 2021/22 but higher than 2019/20 and 2020/21 levels.
  
  
• Over four-fifths (82.8%) of those 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 healthcare.

She has experience in the NHS, higher education, voluntary and private sectors, as a nurse, leader, board member – as director and non-executive director – and a Freedom to Speak Up Guardian.

Her specialist clinical area is end of life care in which she was awarded her PhD. She is the Independent Chair for the Oxfordshire Safeguarding Adults Board.