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Call for Leadership to Prioritise Speak Up, Listen Up, Follow Up Culture in Healthcare: National Guardian Urges Action

Today (16 November 2023), the Annual Report of the National Guardian for the NHS has been laid before Parliament, outlining the work of Freedom to Speak Up guardians and the National Guardian’s Office. The report also shares learning which indicates that more work needs to be done for speaking up to be considered ‘business as usual’ in the healthcare sector in England.

In her foreword to the report, the Parliamentary Under Secretary of State for Mental Health and Women’s Health Strategy, Maria Caulfield MP, said:

“The events surrounding the terrible crimes of Lucy Letby are an important reminder of how vital it is for organisations to have a culture in which workers feel safe to speak up about anything that gets in the way of delivering safe and high-quality care. Managers and senior leaders must be welcoming of speaking up and be ready to listen and act on what they hear.”

Dr Jayne Chidgey-Clark, National Guardian for the NHS, added:

“This year we have had stark reminders of why all efforts to improve the Speak Up culture in health, including the Freedom to Speak Up Guardian route, are so essential for patient safety. It is chilling to think of the harm that might have been prevented and lives which might have been saved if colleagues felt able to raise concerns, or had been listened to and appropriate action taken swiftly when they did.”

The report features case studies from across England, illustrating the difference Freedom to Speak Up guardians are making and examples of how healthcare workers are being supported to speak up for patient safety and worker wellbeing. Over 25,000 cases were raised with Freedom to Speak Up guardians last year, a 25% increase on the record level set during the pandemic.

However, detriment for speaking up remains a concern. Although there has been a drop in the percentage of cases indicating detriment (to 3.9%), given the rise in numbers, this equates to 1,000 cases where people felt they were experiencing disadvantageous or demeaning treatment as a result of speaking up.

The National Guardian’s Office has worked with NHS England to publish a new and updated Freedom to Speak Up policy for the NHS and guidance for leaders of organisations providing NHS services. All NHS trusts and foundation trust boards have been asked to update their local policy to reflect the new national template by the end of January 2024.

Dr Jayne Chidgey-Clark concluded: “If we can get the culture right, benefits will follow, including improving patient safety, innovation for improvement, retaining workers and making the NHS a great place to work.”

The National Guardian’s Office Annual Report 2022-23 is available to download from www.nationalguardian.org.uk

Today (16 November 2023), the National Guardian for the NHS’ Annual Report has been laid before Parliament, to highlight the work of Freedom to Speak Up guardians and the National Guardian’s Office. This report follows a commitment from the Secretary of State in response to the events at Gosport War Memorial Hospital, to promote fostering an open culture in the healthcare sector in England.

The Parliamentary Under Secretary of State for Mental Health and Women’s Health Strategy, Maria Caulfield MP, highlighted the need for a culture in which workers feel safe to speak up about anything that gets in the way of delivering safe and high-quality care.

Dr Jayne Chidgey-Clark, National Guardian for the NHS, said: “This year we have had stark reminders of why all efforts to improve the Speak Up culture in health, including the Freedom to Speak Up Guardian route, are so essential for patient safety.”

The report features case studies from across England, illustrating the difference Freedom to Speak Up guardians are making and examples of how healthcare workers are being supported to speak up for patient safety and worker wellbeing. Over 25,000 cases were raised with Freedom to Speak Up guardians last year, a 25% increase on the record level set during the pandemic.

However, detriment for speaking up remains a concern, with 1,000 cases indicating people feeling they were experiencing disadvantageous or demeaning treatment as a result of speaking up.

The National Guardian’s Office has worked with NHS England to publish a new and updated Freedom to Speak Up policy for the NHS and guidance for leaders of organisations providing NHS services. All NHS trusts and foundation trust boards have been asked to update their local policy to reflect the new national template by the end of January 2024.

Dr Jayne Chidgey-Clark concluded: “If we can get the culture right, benefits will follow, including improving patient safety, innovation for improvement, retaining workers and making the NHS a great place to work.”

The National Guardian’s Office Annual Report 2022-23 is available to

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