Speak Up review of ambulance trusts in England by National Guardian’s Office urgently calls for an independent cultural review with Ministerial oversight to improve the culture of NHS ambulance trusts.

The National Guardian’s Office has today (23 February 2023) 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.

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.

Leaders at all levels set the tone of a speak up, listen up, follow up culture. The review found significant variation among leadership and management in their support and understanding of their role in fostering that culture. It also found insufficient time and resources given to Freedom to Speak Up guardians which limited their ability to be effective.

Dr Jayne Chidgey-Clark, National Guardian for the NHS, said: “The continued pressures facing ambulance services and the impact on patients has been well documented in recent times. These pressures and the findings from the Speak Up review highlight why it is so important that leaders in ambulance trusts ensure their people are listened to and their wellbeing protected. Given the right time and resources, their Freedom to Speak Up guardians can help them improve. This, in turn, will protect patients.

“I fear that a focus solely on targets may inadvertently be having a negative effect on the culture of ambulance trusts – just as it did at Mid Staffs. Leadership throughout healthcare – including ambulance trust leaders and regulators - must do their part by listening to workers and treating their voices with the same respect as patients’.”

The Ambulance Speak Up Review Report is available to download from www.nationalguardian.org.uk

For more information or interviews contact: comms@nationalguardianoffice.org.uk

>ENDS<

Notes for editors:

About this report:

Listening to Workers: a Speak Up Review of ambulance trusts in England

Published: 23 February 2023

Available to download from https://nationalguardian.org.uk/wp-content/uploads/2023/02/Listening-to-Workers-Speak-Up-Review-of-Ambulance-Trusts.pdf

The National Guardian’s Office conducts Speak up Reviews to identify learning, recognise innovation and support improvement in the culture of the healthcare sector.

Our objectives in carrying out this review were:

• To describe the speaking up culture in ambulance trusts – including key challenges – and to understand why regulatory ratings did not seem to reflect the perceptions of ambulance trust workers.
• To identify areas for improvement for ambulance trusts and make recommendations which can also be applied to all organisations supported by Freedom to Speak Up guardians.
• To identify key areas for improvement to the regulatory and inspection regime.

The report makes 4 recommendations, which if actioned in full will be reflected in improved speaking up culture within the next three years:

1. Review broader cultural matters in ambulance trusts
2. Make speaking up in ambulance trusts business as usual
3. Effectively regulate, inspect and support the improvement of speaking up culture in ambulance trusts
4. Implement the Freedom to Speak Up Guardian role in accordance with national guidance to meet the needs of workers

To carry out the review, we heard from over 50 workers and collated nearly 600 lines of evidence.

About the National Guardian’s Office

The National Guardian’s Office works to make speaking up become business as usual to effect cultural change in the NHS.

The office leads, trains and supports a network of Freedom to Speak Up Guardians in England and provides learning and challenge on speaking up matters to the healthcare sector.

The role of Freedom to Speak Up Guardians and the National Guardian were established in 2016 following the events at Mid-Staffordshire NHS Foundation Trust and recommendations from Sir Robert Francis’ Freedom to Speak Up Inquiry.

There are now over 900 Freedom to Speak Up guardians in NHS primary and secondary care and independent sector organisations, national bodies and elsewhere that ensure workers can speak up about any issues impacting on their ability to do their job.

About Freedom to Speak Up Guardians

Freedom to Speak Up guardians support workers to speak up when they feel that they are unable to do so by other ways. They ensure that people who speak up are thanked, that the issues they raise are responded to, and make sure that the person speaking up receives feedback on the actions taken. Guardians also work proactively to support their organisation to tackle barriers to speaking up.

Freedom to Speak Up Guardians are appointed by the organisation they support and abide by the guidance issued by the National Guardian’s Office. They follow the ‘universal job description’ issued by the NGO.

About the National Guardian for the NHS

Dr Jayne Chidgey-Clark was appointed as National Guardian in December 2021.

She is a registered nurse with more than 30 years’ experience in the NHS, higher education, voluntary and private sectors. Prior to her role as National Guardian, she was a non-executive director at NHS Somerset Clinical Commissioning Group where she was also Freedom to Speak Up Guardian.

She is the Independent Chair for the Oxfordshire Safeguarding Adults Board. She also worked with the NHS England New Care Models Programme for three years as a Clinical Associate and has been working as a consultant and coach with and in the NHS since March 2015. Her specialist clinical area is end of life care in which she was awarded her PhD.