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‘Speaking up culture’ in healthcare deteriorating, suggests survey

‘Speaking up culture’ in healthcare deteriorating, suggests survey

Improvements to the ‘speaking up culture’ within the healthcare sector appear to be losing pace, according to a survey of Freedom to Speak Up Guardians (FSUGs).

Just 45% of respondents to a survey conducted by the National Guardian Office said that there had been an improvement around the speaking up culture within the healthcare sector in the past 12 months, down from 73% in 2021/22 and 80% in 2020/21.

Meanwhile, over a quarter (26%) said this culture had deteriorated – up from 5% in 2021/2022.

The results are based on a survey of 368 FSUGs carried out from 12 January to 9 February 2023 and come in a report published by the National Guardian’s Office earlier this month.

The guardian role was established in 2016 following the events at Mid-Staffordshire NHS Foundation Trust to support workers to speak up when they feel they are unable to do so in other ways.

Some 59% of guardian respondents said that the speaking up culture of their own organisation had improved in the last year, but this was still a significant decrease from the previous year when 75% said the same.

Meanwhile, 12% said that the culture had deteriorated in their own organisation in 2022/23 – up from 5% in 2021/22.

Among the guardians who responded to the survey, two-thirds (66%) identified futility as being a ‘noticeable’ or ‘very strong’ barrier to workers in their organisation to speaking up – up from 58% in 2021/2022.

One guardian told the survey that ‘it is hard in conversations with those who speak up about safe staffing levels as there isn’t the available staff and whilst short term fixes are generally found the bigger long-term issue is not addressed and… speaking up feels futile’.

Meanwhile, another 66% identified worries about retaliation and/or suffering as a result of speaking up, as a barrier.

FSUGs in primary care

Some 14% of FSUGs support primary medical services, however they only represented 5% of those responding to the survey.

According to the National Guardian’s Office: ‘Even where guardians are in place in primary medical services, levels of speaking up to them remains low.’

The office said it had been working with guardians and a group of integrated care boards to ‘better understand the successes and practical challenges of Freedom to Speak Up in primary care’. This work came ‘with a view to creating a menu of support for organisations and integrated care systems’, it added.

‘Based on this work, we plan to share further information by 31 March 2024 about the precise expectations of ICBs in regard to Freedom to Speak Up for primary care workers and across their system,’ it said.

Further survey results showed that 84% of respondents felt their organisation was taking action to tackle barriers to speaking up, a 9% increase compared to the previous year.

Three-quarters (75%) said that disadvantageous and/or demeaning treatment as a result of speaking up was not tolerated in their organisation and more than half (51%) said managers supported workers to speak up. A further 69% also said that speaking up was used in their organisation to identify learning and make improvements.

Dr Jayne Chidgey-Clark, National Guardian for the NHS called for ‘urgent action’ to help ensure that speaking up in the workplace was ‘business as usual’.

She said: ‘These results show that nurturing a speak up culture is a long game.

‘This survey highlights the need for continuous attention to nurturing a speak up culture.

‘This responsibility falls on everyone, requiring each conversation and action to contribute to fostering an environment where speaking up is highly valued and heard.’

A Department of Health and Social Care spokesperson said: ‘No one should ever be prevented from speaking up or face discrimination if they do.

‘Freedom to Speak Up Guardians are now established in every NHS trust in England to ensure workers who speak up are listened to, thanked and supported, and they have handled over 19,000 cases in the last two years.’

Last year, nurses and midwives accounted for the biggest proportion of cases raised to FSUGs according to the National Guardian Office, making up 29% of the 25,000 reported.

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