Listening to workers: A Speak Up review of ambulance trusts in England (23 February 2023)

Summary

The National Guardian’s Office has published Listening to Workers – the report following its Speak Up review of NHS ambulance trusts in England. The review found the culture in ambulance trusts did not support workers to speak up and that this was having an impact on worker wellbeing and ultimately patient safety.

Content

The National Guardian’s Office undertook this Speak Up review as the speaking up culture in NHS Ambulance Trusts appeared be more challenged compared to other trust types.

The Speak Up review heard from a number of ambulance workers, ex-workers, managers and senior leaders of their experiences of a culture of bullying, harassment and discrimination which contributed to not feeling able to speak up for fear of retaliation. The fear of the consequences was one of the main barriers to people speaking up about anything getting in the way of delivering great patient care. Those who did speak up, often faced intimidation or inaction as a result.

The report summarises the key findings of the review into five themes:

• culture of ambulance trusts
• leadership and management
• experience of people who speak up
• implementation of the Freedom to Speak Up guardian role
• role of system partners and regulators.

The target-driven, command and control environment of ambulance trusts meant that Freedom to Speak Up – and by extension – workers’ wellbeing, was often not viewed as a priority by leadership.

One senior leader from an ambulance trust told the review: “When I first started, everyone I spoke to said we have a culture problem. Sexism, racism, homophobic, cliquey. We are going to fix it but not yet. We need to sort out other things like wait times.”

This was having a negative impact on the culture of ambulance trusts and workers’ wellbeing, including experiencing poor mental health and moral distress and injury.

It also found insufficient time and resources given to Freedom to Speak Up guardians which limited their ability to be effective .