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More NHS workers feel confident to speak up ... and are doing so

A new report by the National Guardian’s Office reveals that over the last year cases of NHS workers in Trusts speaking up to guardians have risen by 73%, compared to 2017/18. 


Of the 12,000 cases raised between April 1, 2018 and March 31, 2019, guardians reported that almost a third included an element of patient safety/quality of care, and just over 40% included an element of bullying/harassment. 


Freedom to Speak Up Guardians, introduced in the wake of the Francis Inquiry into Mid-Staffs, are now present in every Trust in England.


National Guardian for the NHS, Dr Henrietta Hughes OBE, says: “The confidence that NHS workers have in the ability of guardians to address the issues they raise is growing and more learning is being brought to organisations to help them improve. 


“Our goal at the National Guardian’s Office is to make speaking up business as usual, and while there is some way to go to achieve that, these latest figures are encouraging.” 


The percentage of anonymous cases is also falling - down to 12% in 2018/19 compared to 18% in 2017/18.


However, the report also reveals that while low, the number of workers who indicated they were suffering detriment as a result of speaking up has remained disappointingly static at 5%. 


There was also evidence that speaking up varied significantly from Trust to Trust, with the highest number of cases in a single Trust reported over the year being 270, while the lowest number was just one. 


“Measures like the level of anonymity dropping are good indicators to suggest workers feel more confident to speak up, particularly when considered in tandem with the encouraging increase in the overall number of cases,” says Dr Hughes. 


“However, it is important that each individual Trust looks at their data in context and tries to draw learning from it. Organisations where very few workers are speaking up or where levels of reported detriment are far higher than the norm should look to understand and address the issues that may account for that. 


“Encouraging workers to speak up, and removing barriers that may prevent them from doing so, is in the best interests of every organisation that wants to deliver the highest quality care possible. 


“We must never lose sight of the fact that while Freedom to Speak Up is there for workers, it ultimately all comes back to patients and service users - keeping them safe and treating them well.” 


Miriam Deakin, Director of Policy and Strategy at NHS Providers described the findings of the report as a "positive step" and commends the work that Trusts have done, but she says more still needs to be done. “While it is clear there has been further improvement, we know that there is more to do. The report from the National Guardian’s Office shows there is variation among Trusts. It is important to continue to support learning among Trusts, and share examples of good practise between organisations.”


Click here to download the report.


Key data: 

• Between April 1, 2017 and March 31, 2019, 19,331 cases were raised to Freedom to Speak Up (FTSU) Guardians in Trusts and Foundation Trusts 

12,244 cases were raised to FTSU Guardians in Trusts and Foundation Trusts between April 1, 2018 and March 31, 2019. 

• The total number of cases raised in 2018/19 was 73% higher than that raised in the 2017/18 reporting period 

• The number of cases raised in Q4 of 2018/19 was 38% higher than that raised in Q1 of the same year 


In 2018/19: 

• More cases (3,728, 30% of the total) were raised by nurses than other professional groups 

1,491 cases (12%) were raised anonymously, compared to 18% of cases the previous year 

3,523 cases (29%) included an element of patient safety/quality of care 

4,969 cases (41%) included an element of bullying/harassment • 564 cases (5%) indicated that detriment as a result of speaking up may have been experienced.