I cannot believe it has been a year since I took up the role of National Guardian. This month I am reflecting on that first year, and also looking forward to what next year will bring.
As I stepped into the role in December 2021, the Omicron variant of coronavirus was beginning to take hold. The impact of Covid, both the virus itself and the continuing pressures as a result, continue to show how vital it is that people can speak up, whether that is for patient safety or for the wellbeing of colleagues, or for anything which gets in the way of them doing their job.
It is a privilege to lead the vibrant network of Freedom to Speak Up guardians who do so much to support workers. Over 20,000 cases were brought to them last year, and Freedom to Speak Up guardians have handled over 75,000 cases since the National Guardian’s Office first started collecting data in 2017.
The highlight of my year has been the opportunity to meet so many of them, whether virtually or face to face. I have been inspired as they have shared good practice and reflected frankly on the challenges they face.
I was delighted to lead our first virtual conference to bring Freedom to Speak Up guardians together for the first time since the pandemic began. Networking often begins with a single point of common ground. For guardians, that common ground is their commitment to their complex and challenging roles and passion for making a difference. To further support guardians and improve consistency in how the role is executed, new e-learning delivered Foundation Training has been rolled out for new guardians, which has also served as refresher training for existing guardians.
My heartfelt thanks to all Freedom to Speak Up guardians for the warm welcome and for all the work they do to help their organisations to learn and improve.
Yet Freedom to Speak Up guardians do not work in isolation. Leaders must set the tone when it comes to fostering a healthy speak up, listen up, follow up culture. In the 2021 Freedom to Speak Up Guardian survey, 11% of respondents said that their senior leaders did not understand the Freedom to Speak Up Guardian role. This remains of great concern to me.
So I am grateful to the leaders across the whole healthcare sector – in primary and secondary care, hospices, independents and national bodies – who have met with me. I have welcomed the robust conversations we have had of how they can support their Freedom to Speak Up guardians and the challenges of truly embedding a speak up culture.
Earlier this year we launched the third and final module in the Freedom to Speak Up elearning package, developed by the National Guardian’s Office in association with Health Education England. This can be used as a discussion starter for leaders to reflect on how they can improve their organisational response to workers who speak up and improve the listening behaviours in their teams.
This year, further high-profile reports and incidents have been published (for example, the review into West Suffolk; the second Ockenden Review of Shrewsbury and Telford Hospital NHS Trust; the Kirkup report ‘Reading the Signals: maternity and neonatal services in East Kent; the BBC Panorama investigation into mental health services at the Edenfield Centre, Manchester; and most recently the Newsnight investigation in to University Hospitals Birmingham). These underline what Freedom to Speak Up guardians are telling us: that not all workers feel safe enough to raise matters of concern or get a consistent high-quality response to the matters they raise, sometimes with serious consequences. We all have so much more to do to make Speaking Up business as usual.
Freedom to Speak Up guardians tell us that the main barriers which stop people from speaking up are a concern that nothing will be done (58.3%) and fear of retaliation or suffering as a result of speaking up (69%) and this is reflected in international research and the original Francis report.
These cases show why we must remove the fear and futility. We must take action when workers speak up, and prevent any detrimental outcomes which many have needlessly suffered when they have courageously spoken up. Data shared with us by Freedom to Speak Up guardians indicates an increase in the number of cases where detriment for speaking up is indicated, to 4.4%.
Working with NHS England colleagues, we have developed a universal Freedom to Speak Up policy and guidance which can be applied across all settings throughout the health and care system. Their publication provides an opportunity for every organisation to take a fresh look at their plans to improve their speak up culture.
Leading organisations have shown how Freedom to Speak Up can go beyond aspirations on a page to real, lived experience for everyone. The formalisation of Integrated Care Boards this summer, brings an opportunity for greater collaboration and sharing of learning to improve culture and behaviours
Integration brings with it the possibilities of integrating Freedom to Speak Up so that wherever someone works, across the patient pathway in health they can feel supported to speak up. This will unlock the benefits of fostering a Speak Up, Listen Up, Follow Up culture for us all – workers, leaders, patients, service users and society as a whole.
I look forward to working with you all to build upon the foundations of this first year, and wish you a peaceful holiday season and a happy new year.