Siobhan MeliaListening to Workers – A Speak Up Review of Ambulance Trusts in England was published in February 2023. I remember reading this when I was Interim Chief Executive at South East Coast Ambulance, and reflecting on the reality that further action was necessary. I was therefore pleased to read a recommendation in the report that there should be an independent cultural review undertaken across the country.

What I didn’t know was that a couple of months later, NHS England would ask me to lead that review.

Looking back, I am very proud and humbled to have been given the opportunity. As part of the review, I engaged with a wide range of stakeholders to arrive at a set of actions for NHS England, Integrated Care Boards (ICBs) and Ambulance Trusts. The emphasis being, there is opportunity to work together differently.

The review was published by NHS England on February 15th 2024 and contains six headline recommendations, which are summarised below.

1.Balance operational performance with people performance at all levels

  • NHS England to embed culture improvement alongside operational targets in planning and delivery oversight; and to work with the Association of Ambulance Chief Executives (AACE) to review the role they play in embedding culture improvement in the ambulance sector.
  • ICBs to review lead ICB commissioning arrangements.
  • Ambulance trusts to routinely review workforce culture alongside operational performance.

2.Focus on leadership and management culture and develop the ambulance workforce

  • NHS England to develop a bespoke leadership and management offer and review existing career frameworks to develop the ambulance workforce.
  • ICBs to enable cultural change through facilitating shared learning across ambulance trusts.
  • Ambulance trusts to develop clear vision and values, have a registered paramedic on the Board, and provide protected time for individuals to receive leadership and management training and development.

3.Improve the operational environment, line management and undergraduate training

  • NHS England to review health & wellbeing frameworks taking account of operational context.
  • ICBs to offer portfolio working opportunities to ensure paramedics are supported to work across organisational boundaries.
  • Ambulance trusts to review the paramedic operating environment and management models, and ensure all staff have access to line managers and health and wellbeing schemes.

4.Translate NHS Equality Diversity and Improvement (EDI) Improvement Plan into a bespoke Plan for ambulance trusts

  • NHS England to collaborate with AACE on a bespoke ambulance sector EDI improvement plan, identifying short, medium and longer-term actions.
  • ICBs to monitor the implementation of ambulance trust EDI plans.
  • Ambulance trusts to deliver EDI priorities, include tackling barriers to recruitment.

5.Target bullying and harassment, including sexual harassment and enable freedom to speak up

  • NHS England to monitor delivery of the national sexual safety charter, paying particular attention to the ambulance sector.
  • ICBs to monitor bullying and harassment including sexual harassment and take action where needed.
  • Ambulance trusts to uphold policies and provide training to all staff including managers, and ensure effectiveness of Freedom to Speak Up (FTSU) functions.

6.Prioritise, support and develop Human Resources (HR) functions

  • NHS England to partner with trade unions on a collaborative statement to support cultural change and empower HR functions.
  • NHS England/ICBs to develop a bespoke HR offer accounting for the cultural and employee relations challenges within ambulance services.
  • Ambulance trusts to implement appropriate infrastructure for effective speak up culture, including trained investigators for the most complex cases.

There is no doubt that since the Speak Up Review report was published a year ago, that progress is being made, but there is still a lot more work to do. Changing the culture of ambulance trusts will take time, commitment, energy, and action. Success will be measured through the lived experience of people who work in ambulance trusts, and a key element will be that more workers feel safe to speak up without reprisal. That alone will not be enough however, as organisations must then take appropriate, consistent, and decisive action to ensure that poor behaviours are no longer tolerated.

I hope that this review becomes a catalyst for lasting change.