Janice Scott joined the East of England Ambulance Service trust as the Lead Guardian in 2020, at a time when the executive leadership team had acknowledged there were deep-rooted issues within the service, following a CQC inspection. The number of concerns raised increased by approximately 90% within the first reporting quarter and she spent her first year actively listening and speaking to staff about their experiences.
Within three years of the full time Guardian starting, the trust had one of the most overall improved scores for the speaking up questions in the NHS Staff survey. “This is a result of commitment from staff, volunteers and the executive leadership team” said Janice.
“When you are faced with a culture of distrust and fear based on workers’ previous negative experiences of speaking up and an environment where bullying and harassment was the norm, you have to go back to the basic principles of engagement. At EEAST, this meant committing to physically visiting as many of the 120 sites and stations to talk to staff and volunteers, whether that be the early hours in the morning, during lunch breaks or late at night. It meant meeting with managers to understand their frustrations and successes. More importantly, it meant holding honest, realistic and sometimes painful conversations with workers and managers.”
This work has been led by the Executive and Non-Executive Freedom to Speak Up leads who, together with the rest of the Board and the executive, have taken ownership of the cultural problems within EEAST. Their focus was on the potential irreparable negative consequences for workers of not tackling the challenges head-on.
The Lead Guardian feels encouraged and supported by the leadership team and has regular meetings to discuss themes and barriers to resolving concerns. This work has highlighted issues such as timely employee relations case handling and lengthy suspension times. Ensuring that core HR systems and processes worked effectively helped to build staff confidence.
Janice also presents a quarterly board report which shares the speak up data along with the current themes and patterns. She recently delivered a board development session on workers’ fear of suffering detriment for speaking up, which led to innovative solutions which are currently being implemented. The trust also developed a “Raising Concerns Forum” which collates and triangulates data from Freedom to Speak Up, employee relation cases, sickness and leavers data to identify themes, emerging issues, hot spots and potentially high-risk issues to patient and/or staff safety.
A number of the recommendations from the National Guardian’s Office Speak Up Review of ambulance trusts, have already been implemented in the trust. This included making the three speak up training modules mandatory, the recruitment of 3 full time Guardians through open, fair and transparent processes and the recruitment of ambassadors to further extend the reach of Freedom to Speak Up.
Tom Abell, CEO and Executive Lead for Freedom to Speak Up said: “This has fostered a sense of unity within the trust, where staff feel able to voice their ideas, challenges, and concerns, without fear of negative consequences or overall inaction. We recognise and celebrate our achievements but know we still have a way to go, particularly with reducing the fear of detriment when speaking up.”
As a result of this improved culture, the staff attrition rate has turned around, so that between 2021 and 2022 there was more than a 30% drop in staff leaving the trust in the same year they joined.
This 1 case study appears in the National Guardian’s Office 2022-23 Annual Report