Resolution: Are you empowered to speak up?

This resolution was passed by voting members at Congress 2024.

During the Francis Inquiry into care failings at Mid Staffordshire NHS Foundation Trust it became apparent that staff who had tried to speak up about their concerns had been ignored or victimised. Freedom to speak up guardians were established in England as a result. However, situations where concerns have been ignored and those raising concerns feel victimised do not appear to be unique to Mid-Staffs. Nursing staff are the largest workforce group and pivotal in ensuring patient safety, however as much as everyone has a duty to raise concerns the reality is that it’s not always that easy and support is often needed. 

Formal support differs across different NHS countries and in independent health and social care employers it is also varied. In England, NHS trusts have created freedom to speak up guardian roles, but the impact of this role has not been evaluated. With the roles being employed directly by each NHS trust, can they truly give the impartial support that may be required or escalate concerns that an organisation may not want to hear? 

Scotland has an independent national whistleblowing officer. This appears to be an improvement with its independence and there is a greater degree of transparency. 

In Northern Ireland, Wales and the crown dependencies it appears to be less clear if there is any external/independent support available for nursing staff who may have concerns.  

Within England the freedom to speak up guardian role is reported to have been strengthened following the Lucy Letby case, but how can a fellow employee of the organisation provide independent challenge to an executive board of their employing organisation? 

What is clear is that there needs to be support available for nursing staff in raising concerns to ensure that there are safe, effective and supportive ways that the health care workforce can raise concerns without victimisation and without them being ignored. 

It is important to identify what support all nursing staff require to ensure they feel safe and able to raise concerns, helping to ensure that lessons are learnt. 

The reading list for this debate is available here.

References

Devereux E (2023) Lucy Letby: ‘Defensive leadership culture’ stopped staff from raising concerns. Available at: https://www.nursingtimes.net/news/leadership-news/lucy-letby-defensive-leadership-culture-stopped-staff-from-raising-concerns-18-08-2023/ 

NHS England (no date) Freedom to speak up. Available at: https://www.england.nhs.uk/ourwork/freedom-to-speak-up/ 

Legal Advice Centre, Queen Mary University of London (2024) The Lucy Letby case: What does it mean for the United Kingdom’s healthcare system? Available at: https://www.qmul.ac.uk/lac/our-legal-blog/items/the-lucy-letby-case-what-does-it-mean-for-the-united-kingdoms-healthcare-system.html 

Scottish Public Services Ombudsman (no date) Independent National Whistleblowing Officer. Available at: https://inwo.spso.org.uk/ 
UK Government (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Available at: https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry