Summary
Protect ambulance workers – protect patients, says National Guardian for the NHS
Speak Up review of ambulance trusts in England by National Guardian’s Office calls for an independent cultural review with Ministerial oversight to improve the culture of NHS ambulance trusts.
The National Guardian’s Office has today published Listening to Workers – the report following its Speak Up review of NHS ambulance trusts in England. The review found the culture in ambulance trusts did not support workers to speak up and that this was having an impact on worker wellbeing and ultimately patient safety.
The National Guardian’s Office undertook this Speak Up review as the speaking up culture in NHS Ambulance Trusts appeared be more challenged compared to other trust types.
The Speak Up review heard from a number of ambulance workers, ex-workers, managers and senior leaders of their experiences of a culture of bullying, harassment and discrimination which contributed to not feeling able to speak up for fear of retaliation. The fear of the consequences was one of the main barriers to people speaking up about anything getting in the way of delivering great patient care. Those who did speak up, often faced intimidation or inaction as a result.
The report summarises the key findings of the review into five themes:
- Culture of ambulance trusts
- Leadership and management
- Experience of people who speak up
- Implementation of the Freedom to Speak Up guardian role
- Role of system partners and regulators
The target-driven, command and control environment of ambulance trusts meant that Freedom to Speak Up – and by extension – workers’ wellbeing, was often not viewed as a priority by leadership.
One senior leader from an ambulance trust told the review: “When I first started, everyone I spoke to said we have a culture problem. Sexism, racism, homophobic, cliquey. We are going to fix it but not yet. We need to sort out other things like wait times.”
This was having a negative impact on the culture of ambulance trusts and workers’ wellbeing, including experiencing poor mental health and moral distress and injury.
It also found insufficient time and resources given to Freedom to Speak Up guardians which limited their ability to be effective .
Dr Jayne Chidgey-Clark, National Guardian for the NHS, said: “The continued pressures facing ambulance services and the impact on patients has been well documented in recent times. These pressures and the findings from the Speak Up review highlight why it is so important that leaders in ambulance trusts ensure their people are listened to and their wellbeing protected. Given the right time and resources, their Freedom to Speak Up guardians can help them improve. This, in turn, will protect patients.
“I fear that a focus solely on targets may inadvertently be having a negative effect on the culture of ambulance trusts – just as it did at Mid Staffs. Leadership throughout healthcare – including ambulance trust leaders and regulators – must do their part by listening to workers and treating their voices with the same respect as patients’.”
Chairman of the Association of Ambulance Chief Executives (AACE) Daren Mochrie QAM said:
“The Association of Ambulance Chief Executives welcomes this review, the greater insights it provides into the current workings of the Freedom to Speak Up culture, including the role of the guardians within NHS ambulance services, and the further opportunity it presents for comprehensive and consolidated improvement in this area for the benefit of staff and patients alike. Alongside and on behalf of our members, AACE will support and work with the National Guardian’s Office, NHS England and the Department of Health and Social Care to implement the recommendations and ensure that they have a meaningful and sustainable impact within the ambulance sector.”