As the pandemic reaches crisis levels with no let-up for healthcare workers, it is vital that staff have the freedom to speak up about anything which gets in the way of them providing great care, writes Dr Henrietta Hughes
Covid-19 has had an impact on everybody’s lives. As a GP, I have seen the impact of covid-19 on my patients and their families, as well as on my colleagues and the long-term effects it has had personally and professionally on all of us in the NHS. I am humbled and inspired by the incredible NHS workers who continue to deliver excellent care in extreme circumstances. In such circumstances, speaking up is now more important than ever.
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As covid-19 pressures continue to mount, we must learn from the lessons of the first phase of the pandemic and listen and act on what workers are telling us.
As the National Guardian for the NHS, I lead a network of Freedom to Speak Up Guardians in England so that people can speak up about anything which gets in the way of delivering great care. The National Guardian’s Office provides training, support and insights to the system.
Initially set up just for NHS trusts, the NGO’s public directory now includes guardians from the private sector, primary care and national bodies, such as the Care Quality Commission and NHS England/Improvement. There are now more than 600 guardians on the NGO directory, representing over 400 organisations.
Over the last three years, guardians have handled over 35,000 cases brought to them by healthcare workers and shared the themes of these cases with us. As well as helping us understand the types of matters being raised, the data also provides assurance that speaking up is happening. Numbers of cases have risen year on year since guardians were introduced.
At the start of the first lockdown, there were news stories about workers speaking up, and in some cases not being listened to, or worse still, being victimised and actively discouraged from talking about these issues openly. We felt it was important to gauge the impact of the pandemic on speaking up and understand the picture on the ground for guardians, so we launched a series of pulse surveys.
Between 1 April 2020 and 30 September 2020, a record number of speaking up cases were brought to guardians. A total of 9,754 speaking up cases were reported in this period – an increase of 34 per cent on the same period in the previous year
The feedback we received was mixed. In our first survey – conducted in April – some respondents told us that an established culture of speaking up made things easier, but others reported that they lacked the time to listen to everything workers were raising. There were reports of workers being advised not to speak to the media or use social media to post comments. With the CQC chief inspectors, I wrote to all trust CEOs and chairs to remind them about how important it was to maintain safe speaking up channels for their workers.
Our second and third pulse surveys showed an evolution in attitudes and perceptions as the first wave of the pandemic continued. Only 72 per cent of guardians who responded believed that workers continued to be encouraged to speak up in the first pulse survey; but by June, that figure had risen to 93 per cent.
Guardians reported that workers were speaking up about the provision of personal protective equipment, the impact of covid-19 on black, Asian and minority ethnic workers and social distancing concerns. But there was also a significant increase in the number of cases involving behavioural issues, such as bullying and harassment. This rose from 46 per cent in April, to 57 per cent in May and up to 74 per cent in June.
In these difficult circumstances, the expanding network of Freedom to Speak Up Guardians continued to listen and support workers in getting their voices heard. Between 1 April 2020 and 30 September 2020, a record number of speaking up cases were brought to guardians. A total of 9,754 speaking up cases were reported in this period – an increase of 34 per cent on the same period in the previous year.
To ensure that everyone has the tools to foster the speak up culture the NHS needs, we have recently launched a new e-learning package, in association with Health Education England. The first module – Speak Up – available for all workers, no matter what their contract terms, was launched in October and has already been completed by 800 learners. The latest session, Listen Up, which is aimed at managers at all levels, focuses on listening and understanding the barriers to speaking up. A final module, Follow Up, aimed at senior leaders – including executive and non-executive directors, lay members and governors – will be launched later in the year.
Now, the pandemic has reached crisis levels and there is no respite for healthcare workers. Workers continue to speak up about the availability of suitable PPE and access to vaccinations. Faced with post-traumatic stress disorder and burnout in an over-stretched service, it remains critical that these workers have the freedom to speak up about anything which gets in the way of them providing great care.
Freedom to Speak Up has come a long way since the Francis report was published in 2015. Through the uncertainty of covid-19 and beyond, healthcare workers must continue to be encouraged to speak up, to protect patients and each other. And they must be listened to. As the nation tries to minimise the spread, prevent more covid-19 deaths and roll out vaccinations, we cannot afford for them not to have that freedom. Speaking up, listening up and following up are fundamental in saving lives.
