Summary
I am delighted to be sharing our updated vision to improve workplace cultures, ensuring workers are confident to speak up, by providing expert support, guidance and challenge. This vision guides the updated strategy for the work of my office in the coming years.
I want to pay tribute to the work of Sir Robert Francis, my predecessors, Freedom to Speak Up guardians and the wider healthcare community for the improvements that have been achieved since 2016 to foster safer environments where workers feel they can speak up.
But we know there’s much more work to be done to realise the ambition of making speaking up business as usual. Inquiries and reviews and high profile cases continue to cause concern regarding the lack of consistency in fostering a speak up cultures. In too many organisations we are not seeing an improvement in confidence to speak up or that organisations will respond to what they are hearing from the NHS Staff Survey.
Of course workers should be safe to speak up – safety is the bare minimum – what we are aiming to achieve over the next few years is confidence. This comes when workers feel not only encouraged to raise matters, but vitally that appropriate and timely actions will be taken when they do.
Empowering Freedom to Speak Up guardians
Freedom to Speak Up guardians are integral to the success of this vision. They have provided critical support to over 130,000 cases which have been raised with them since the inception of the role. They have supported colleagues to ensure their voices are heard, and that harm, or further harm can be prevented. They have challenged their organisations to do better, to address the barriers to speaking up, sometimes themselves experiencing detriment for speaking truth to power.
We have listened closely to their feedback and core to this strategy is continuing to improve the resources and support we provide them. The Guardian role is complex, and the landscape in which they operate is evolving. As the role has become more trusted by workers, guardians must have the resources they need to meet the demands. That is not just improved support and guidance from the National Guardian’s Office, but also support from their leadership with time, resources and wellbeing support. We will be shortly taking a fresh look at the Universal Job Description and will continue to work in partnership with others to promote consistency across different organisations.
Leadership matters
It is of concern to me that this year’s NHS Staff Survey results show a lack of improvement nationally in the responses to the questions about speaking up. It is clear that to be effective, Freedom to Speak Up requires leadership support at all levels to treat speaking up as an opportunity for learning and improvement. To see speaking up as a tool for ‘problem sensing’ not to retreat defensively into ‘comfort seeking’.
Leaders set the tone for any workplace culture, but this is not just about individual responses. In the current environment, leaders themselves are under intense pressure to meet targets, to clear the back log, to prioritise the competing demands of a service under pressure. We recognise the need for greater support for leaders to foster a Speak Up, Listen Up, Follow Up culture. That is why we are looking to facilitate more tools, share our learning and expertise, to equip them with the skills and understanding to nurture Freedom to Speak Up within their organisations. Making speaking up business as usual is also about embedding Freedom to Speak Up into existing policies and processes: for feedback, for listening, for diversity and inclusion, for reward and recognition.
Collaboration is key
Just as guardians cannot achieve culture change alone, neither can the National Guardian’s Office. We are committed to working in partnership with DHSC, NHS England, CQC and other professional regulators and patient safety leaders. Sometimes that may mean difficult, challenging conversations. But we are determined to share the voices of workers, and building on our Speak Up Review of ambulance trusts, we will conduct further Speak Up Reviews to identify and address systemic challenges. These reports will not only raise awareness of critical issues but also recommend concrete actions for improvement, holding organisations accountable for positive change.
An independent voice for change
I believe that the way society treats people who speak up is changing. There is no longer the default to label those who speak up as ‘trouble makers’ when they raise a concern. But there remains inequalities of whose voice is heard and who is silenced. As the government looks afresh at legislation to protect those who speak up, we will lend our independent voice, our knowledge and expertise, to champion the voices of workers and Freedom to Speak Up.
A lasting cultural shift is needed to realise the ambition of making speaking up business as usual. This strategy will give the National Guardian’s Office the framework for us to provide the expert advice, support and challenge to help make that change. But we cannot do it alone. This requires support and commitment from everyone who works in healthcare to play their part.
With your help, we can create a healthcare system where workers feel confident to speak up, ultimately leading to safer workplaces and improved patient care.