NHS Staff Survey

What does the Staff Survey tell us about speaking up in the NHS?

The NHS Staff Survey results are a valuable resource for understanding the speaking up culture for organisational leaders, NHS leaders, regulators, the National Guardian’s Office and government. It is one of only a few datasets which provides information on NHS workers’ perceptions of how it feels to speak up in their organisations.

In 2021, the NHS Staff Survey underwent significant changes – in line with the People Plan. As a result, some of the questions which comprised the FTSU Index were dropped. In light of this, the National Guardian’s Office moved away from publishing the Freedom to Speak Up Index, and instead has been delving deeper into the results to share our analysis to inform and challenge the healthcare sector

The Staff Survey is not available to all organisations that provide NHS services, but the National Guardian’s Office would urge all organisations to adopt these speaking up questions in their own staff surveys to provide an understanding of the confidence in speaking up in your organisation.

About the Freedom to Speak Up sub-score

A Freedom to Speak Up sub-score (called the Raising Concerns sub-score in NHS Staff Survey reports) has been calculated since 2021 and can be used as a benchmark.

The sub-score is calculated as the mean where at least three of the four questions are answered. A higher score indicates a more favourable result.

The FTSU Index

From 2019-2021 the National Guardian’s Office brought together specific questions in the staff survey relating to speaking up to form a ‘FTSU Index’.

The four questions used in the FTSU Index were clinical and incident focused and did not have applicability to all staff groups and trust types. While they gave an indication of Freedom to Speak Up culture, a healthy speaking up culture is about more than speaking up about clinical matters. It is about anything which gets in the way of people doing their job, including suggestions for improvement or non-clinical concerns.

In 2020, a new question asking whether workers feel safe to speak up about anything that concerns them in their organisation was added. In 2021 it was accompanied by a new follow-up question: ‘If I spoke up about something that concerned me, I am confident my organisation would address my concern.’

With the inclusion of these questions, instead of publishing the FTSU Index, the National Guardian’s Office now looks at the results of these questions and others in the NHS Staff Survey as part of a broader and more holistic view of the speaking up landscape in healthcare.