National Guardian’s Office: Listening to the silence - What does the Staff Survey tell us about speaking up in the NHS? (24 July 2024)

Summary

In this report, the National Guardian’s Office analyses questions relating to speaking up that were asked in the 2023 NHS Staff Survey. It highlights that while workers’ confidence in speaking up about anything which concerns them showed signs of improvement, the survey revealed a five-year low in the number of respondents who feel secure raising concerns about unsafe clinical practice.

Content

The report sets out that looking at the national picture, there has been minimal change in the perceptions of workers about Freedom to Speak Up. Its key findings include:

• Clinical practice questions are showing signs of decline or remain unchanged with ‘I would feel secure raising concerns about unsafe clinical practice’ now being at a five-year low. 71.3% of respondents said they felt safe to speak up about unsafe clinical practice and 56.8 per cent thought that their organisation would address such concerns.
• Questions about any concerns have stabilised and are starting to show improvements. 62.3% of respondents said they felt safe to speak up about anything and 50.1% thought that their organisation would address such concerns. This figure (50.1%) is the highest in the three years this question has been asked.
• In ambulance services, the Freedom to Speak Up sub-score has markedly improved from 5.83 in 2022 to 5.96 in 2023.
• Acute specialists are showing early warning signs of a declining speak up culture with the Freedom to Speak Up sub-score at the lowest since 2021 when the measure was introduced.
• There are signs of reducing confidence in speaking up for workers at Integrated Care Boards with 26 out of the 37 organisations that participated in both 2022 and 2023 surveys Freedom to Speak Up sub-scores deteriorating.
• Medical and dental worker confidence in raising clinical safety concerns has declined by around six (5.7) percentage points since 2021.
• The Freedom to Speak Up sub-score for the ‘general management’ occupational group has worsened for the past two years. This is despite workers indicating that they feel more supported by their immediate managers.
• The Freedom to Speak Up sub-score for workers with a long-lasting condition or illness (6.08) is markedly lower than for those workers who do not have a long-lasting condition or illness (6.60).

Related reading

• National Guardian’s Office: Fear and futility - What does the Staff Survey tell us about speaking up in the NHS (8 June 2023)
• We are not getting safer: Patient safety and the NHS staff survey results (Patient Safety Learning, 26 March 2024)