Increase in NHS staff reporting inappropriate behaviour at work
The national guardian for the NHS has warned that internal culture is a “patient safety issue”, as a record number of Freedom to Speak Up cases now relate to inappropriate behaviours and attitudes of staff.
In total, over 30,000 cases have been brought to Freedom to Speak Up guardians throughout 2023-24, making it the highest number ever recorded.
“There is still a long way to go before we can say that speaking up is business as usual”
Jayne Chidgey-Clark
The National Guardian’s Office today published its annual speaking up report, which has summarised the key themes from data shared by Freedom to Speak Up guardians.
Freedom to Speak Up guardians support healthcare workers to speak out when they feel they are unable to do so by other routes.
The role of the guardians and the national guardian were established in 2016 following recommendations in the Francis Inquiry report, which examined failings in case at Mid Staffordshire NHS Foundation Trust.
There are now over 1,200 guardians working in NHS primary and secondary care, as well as independent sector organisation and national bodies.
The report out today showed that 32,167 cases were raised with Freedom to Speak Up guardians in 2023-24 – a 28% increase compared to last year.
Registered nurses and midwives accounted for the biggest portion of cases raised with the guardians (28%), followed by administration and clerical workers (21%), and allied health professionals (10%).
Of all the concerns raised this year, nearly two in every five cases (38.5%) involved an element of inappropriate behaviours and attitudes – an 8% increase compared to the previous year.
Workers reported a range of behaviours under this category, including incivility, favouritism, shouting, swearing and belittling of workers.
Cultural issues such as attitudes towards internationally educated nurses and discrimination towards protected characteristics were also raised.
One in every three cases raised (32%) with a guardian involved an element of worker safety or wellbeing, said the report.
Guardians noted that staffing levels and increased workloads were the two most common issues related to this category.
Meanwhile, 19% of cases involved an element of patient safety and quality. Examples included staffing pressures, lack of medication and equipment, unsafe working practices and ineffective handovers.
Unsafe supervision for new starters and lack of mental health training for workers to support patients with mental health conditions were also flagged as key issues.
The 2023 NHS Staff Survey found that worker confidence in raising concerns about unsafe clinical practice was at its lowest since 2019.
The new report said it was, therefore, “more important than ever” that healthcare workers knew how to contact their Freedom to Speak Up guardian if they felt they could not speak up in other ways.
Meanwhile, the report found that detriment for workers who had spoken out was indicated in 4% of cases (around 1,285 cases), which was the same as 2022-23.
Detriment can include being ostracised, given unfavourable shifts, being overlooked for promotion or moved from a team.
The proportion of cases indicating detriment was the highest in the second quarter of 2023, which the report said could be due to the high-profile reporting of the Lucy Letby case.
Jayne Chidgey-Clark
Commenting on the data, the national guardian for the NHS, Dr Jayne Chidgey-Clark, said: “More and more people are coming to their Freedom to Speak Up guardians.
“This is credit to the efforts made by guardians to foster trust and break down barriers to speaking up within their organisations.
“Culture is a patient safety issue. Every interaction – whether patient, family member, colleague or consultant – makes a difference to lives and outcomes.”
Today, Dr Chidgey-Clark announced an updated 2024 strategy to support culture change in healthcare settings and to improve worker experience and patient safety.
“While progress has been made, there is still a long way to go before we can say that speaking up is business as usual,” she explained.
“That is why for our strategic vision we want to move the dial on Freedom to Speak Up,” she said.
The new strategy has set out six goals to achieve the Dr Chidgey-Clark’s vision. These are:
- Continuing to improve resources and offer to Freedom to Speak Up guardians
- Developing additional support and guidance for organisational leaders
- Using the National Guardian’s independent voice to champion Freedom to Speak Up and challenge the healthcare system by raising awareness of issues which affect workers’ confidence to speak up
- Using the insight gathered by the National Guardian’s Office to drive recommendations to improve speak up measures and culture, for example through Speak Up reviews, and challenging organisations to do better.
- Improving partnership working with key organisations to deliver change
- Improve the organisational maturity and internal infrastructure of the National Guardian’s Office to support these ambitions
