Matt Asbrey, Head of Culture at Homerton University Hospital NHS Foundation Trust, was the Freedom to Speak Up Guardian at NHFT at the time of this HSJ Award submission. He said, “To keep everyone safe, everyone has to feel safe to speak up. Workers keep our patients and service users safe, and this is not possible if workers do not feel psychologically safe to speak up.”

The use of data played a major role in the Trust’s efforts to improve the speaking up culture at NHFT. By triangulating the data provided from speaking up cases raised, pulse surveys and the results of the NHS National Staff Survey, Matt was able to better understand the experience of workers and identify areas for learning and improvement.

The Freedom to Speak Up Index, a metric based on NHS Staff Survey results, measures the speaking up culture of an organisation. NHFT were ranked as the third-highest rated organisation in the 2020 Freedom to Speak Up Index report with an index score of 85.2 per cent.

Committed to continuous improvement, the Trust used this as an opportunity for further analysis. Using the Staff Survey results, Matt broke the data down to an index score for each service and worked with colleagues across the organisation including Human Resources, Patient Safety team, staff networks and Operational teams. Alongside other Staff Survey metrics, NHFT were able to identify where organisational support development needed to be prioritised.

The National Staff Survey also helped inform a change in service models across the trust. Workers in the Children’s 0-19 service approached Matt to raise a concern about increasing caseloads. Due to numerous vacancies in their team, workers were being asked to take on more responsibilities, consequently impacting on the service provided. Matt was able to cross-check this concern with data from the National Staff Survey and information on DATIX. This analysis indicated that the problem was not limited to just this team. As a result of these findings, the Head of Service was able to co-produce a revised service delivery model, working with commissioners to make changes that would improve the service for service users and their families, as well as improving the experience for workers.

COVID-19 and its challenges provide further opportunities for NHFT to adapt and improve as the pandemic progresses. When it was recognised that COVID-19 was disproportionately impacting on workers from an ethnic minority background, Matt worked with champions in the BME staff network to host regular listening groups to understand their needs and concerns. Direct feedback from these sessions led to strengthened Occupational Health team with more diverse resource, an increased number of Freedom to Speak Up Champions from ethnic minority backgrounds and a risk assessment for all colleagues. Matt also met weekly with the Trust’s Workforce Race Equality Standards Expert to establish a closer working relationship.

More diverse representation in the Freedom to Speak Up Champion network at NHFT has empowered more people to speak up. There are champions who provide support for ethnic minorities, workers with disabilities, working carers, the LGBTQ network, junior doctors, apprentices and more. An example of the success of this programme is the introduction of Career Development Workshops for specific underrepresented groups. One NHFT worker from an ethnic minority background said, “I am proud of speaking up about discriminatory practice, a step which encouraged other team members to voice their concerns too, leading to a positive culture shift.”

This is also reflected in the data reported to the National Guardian’s Office. The first quarter of 2020-21, right in the epicentre of the pandemic, saw the most cases ever raised to the Freedom to Speak Up Guardian at NHFT in a single quarter.

Improvements can only be made if there is buy-in throughout the organisation. Matt conducted internal case reviews of Freedom to Speak Up processes, modelled on the NGO case reviews, to understand worker experience and identify areas for learning. He presented his findings at the Quality and Governance Committee. There are also two ‘deep dive’ reviews for Freedom to Speak Up cases with leaders at NHFT each year. These review not only the data, but also the real-life examples behind the figures so that leaders understand the experiences of NHFT workers and are able to make improvements where needed. 

Matt said “Whilst the independence of the Freedom to Speak Up Guardian role is vital; it is essential to not be isolated from other parts of the organisation. There is so much data available and it is important that this is used to work with other colleagues and teams to understand what is going on a team or service and help make improvements that keep our staff and service users safe”.