Why Guardians should get involved as the ICS evolves

Freedom to Speak Up is about looking after our workers and keeping patients safe by ensuring everyone’s voice is heard, feedback is acted upon, and learning is used for continuous improvements. It is about the culture of candour of the organisation.

I have great interest and curiosity in the concept of what Freedom to Speak Up might look or feel like in Integrated Care Systems (ICSs). Reflecting from both a personal and professional perspective, as the Freedom to Speak Up Guardian in Cambridgeshire and Peterborough NHS Foundation Trust, the development of Freedom to Speak Up across ICS’s initially seemed daunting. Where does the conversation begin?

As the ICS development gathers pace across health and social care systems, where does Freedom to Speak Up fit into this seemingly complex and vast new landscape? Why does Freedom to Speak Up matter in ICSs? And who is best placed to decide what this looks like?

Establishing an ICS is a huge transformative process. Having a clearly articulated Freedom to Speak Up framework with sufficient speaking up resource will be needed more than ever. Effective speaking up arrangements will provide a safe and confidential route for feedback about care pathways, worker experience and patient safety. It will support the harmonisation of the transformation and ensure the experience of the workforce is at the top of the agenda.

My well established local Freedom to Speak Up guardian network in the Cambridgeshire and Peterborough area is an invaluable source of mutual peer support. It conveniently mirrors the footprint of the local ICS with the right cross-organisational connections among guardians already firmly in place.

Informal conversations in the network and with the local Clinical Commissioning Group highlighted that Freedom to Speak Up in the ICS has not, as yet, featured in any of the local or national agendas.

As Freedom to Speak Up Guardians, we all had varying levels of knowledge of the local ICS development, depending on our exposure to the subject and available resources to engage with the ICS developments. To address this, a session was arranged with the Director of Strategy of the Cambridgeshire and Peterborough ICS who shared key information such as objectives of the ICS, the structure, and the structure of service delivery through the different accountable business units (ABUs). There are six ABUs in the local ICS and some guardians in the network are employed by organisations identified as Lead Providers within these ABUs.

To explore what Freedom to Speak Up might look and feel like in the local ICS, we started by taking a focused look at the compositions of some of the Business Units. This helped us to identify the stakeholders we need to engage with in the future.

As an experienced Lead Freedom to Speak Up Guardian, I work in the lead provider in the mental health and learning disability collaborative in the ICS. Our Trust provides integrated physical health, mental health and learning disability services with established partnership working across the different agencies.

My discussions with a Trust Senior Leader of this ABU indicated there will be over 30 third sector providers of varying sizes. Currently there are two part-time guardians within this ABU, employed by the same trust, and none from the other providers.

The next development phase of this Business Unit will focus on building relationships between the different providers and the architecture of the governance structure.  Input from the guardians would be highly valuable in these discussions. It was also recognised that the input from the wider local guardian network in the development phase of this ABU will add extra benefits. This will ensure that Freedom to Speak Up Guardian knowledge and insight is shared both within this ABU and across the others in the local system.

By definition, the ICS structures will shift and extend the definition of its ‘workers’ and ‘organisation’ as most, if not all, ABUs will also include many third sector or voluntary provider organisations.

Several key issues about the Freedom to Speak Up functions in the ICS have emerged in our discussions.

These include

  • The potential impact on the current Freedom to Speak Up resource in each of the organisations
  • The mechanisms and resources required to collate and share Freedom to Speak Up themes and trends confidentially within and across Business Units to help make improvements and build a positive culture
  • How this aligns with other functions such as safeguarding, equality, diversity and inclusion, patient safety and patient experience.

Equally important is the question of how the Integrated Care Board will establish and develop its collective oversight of the Freedom to Speak Up feedback and learning.

We do not have the specific answers at this stage of its development, but the established local guardian network will undoubtedly be a helpful trusted forum for such future discussions.

Freedom to Speak Up must be a crucial component of the governance framework within the ICS. National inquiries have shown how failing to listen to workers speaking up leads to tragic consequences. Whilst the architecture of the local Accountable Business Units is being built, Freedom to Speak Up guardians are best placed to help inform what Freedom to Speak Up should look like in the ICS to support a framework of an open and compassionate culture.

Making great partners within the Integrated Care System is a key development element. Freedom to Speak Up Guardians are experts in relationship building. We should maximise our collective knowledge and voice by collaborating to forge local networks with guardians in our ICS and engage in the development of the Accountable Business Units to positively influence this development.

Guardians must get involved as the ICS evolves!