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Primary care organisations are among lowest to report work concerns via ‘speak up’ guardians

by Emily Roberts
21 July 2023

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Just 1% of cases raised with NHS Freedom to Speak Up (FTSU) guardians highlighting concerns from staff that affect how they are able to do their job came from primary care last year.

Across the NHS there was a record total number of cases, 25,382, reported by FTSU guardians between 1 April 2022 and 31 March 2023 .

A report published this month from the National Guardian’s Office (NGO), which trains and supports the network of FTSU guardians, has revealed that the number of cases handled in the past year represents a 25% increase compared with 2021/22.

The biggest portion of the total number of cases – 92% – came from NHS trusts, including hospitals. ambulance and mental health services.

And of the 1006 FTSU guardians that exist across the NHS as of March 2023, only 10% are within primary care spread across 15% of primary care organisations.

The role of FTSU guardians was established in 2016 following the events at Mid-Staffordshire NHS Foundation Trust and recommendations from Sir Robert Francis’ Freedom to Speak Up review. It was found that NHS culture did not always encourage or support workers to speak up, and that patients and workers suffered as a result.

The NGO’s report has said it is working with guardians based in ‘organisations that are not NHS trusts’, so including primary care, to support them in reporting cases since they were ‘still less likely’ to present data.

It is also planning to publish joint guidance with NHS England on the precise expectations of Freedom to Speak Up for primary care workers by the end of March 2024.

In addition, Integrated Care Boards (ICBs) have been asked to consider the arrangements in place to support primary care staff to speak up when they feel unable to do so by other routes over the next 18 months. These arrangements should include access to a FTSU guardian.

Last month, NHS England told ICBs that there are ‘relatively very few trained and registered Freedom to Speak Up guardians that support primary care workers’ and that where they are in place ‘levels of speaking up….remain extremely low’.

In terms of concerns and issues raised by staff to FTSU guardians over the past year, the NGO report found that:

  • The highest proportion of cases (30%) involved an element of inappropriate behaviours and attitudes.
  • One in every four cases raised (27.4%) involved an element of worker safety or wellbeing. Staffing levels and increased workloads were common themes here.
  • Just over a fifth (22%) of cases reported included an element of bullying and harassment.
  • A total of 19.3% of cases involved an element of patient safety/quality this year, slightly up from 18.8% in 2021/22.

Dr Jayne Chidgey-Clark, National Guardian for the NHS, said: ‘No one should be punished for doing the right thing. When people speak up it is because they want things to improve – whether that is for the safety and quality of care for patients or the working environment for colleagues.

‘Over four fifths (82.8%) of those who gave feedback to their guardian about their experience said they would speak up again. It is their comments which highlight why the Freedom to Speak Up Guardian role is so important and the benefits it can bring for worker wellbeing, staff retention and patient care.’