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It’s time to independently review Speak Up in the NHS

Protect’s Head of Policy, Andrew Pepper-Parsons, details our response to the shocking findings of the Ockenden Report and calls for an independent review of Speak Up in the NHS.

‘If I could say anything to the families it would be that there were people who tried to make changes, we tried to escalate our concerns and be heard but every process we used was set up not to acknowledge our voices or the problems we were highlighting. We were ignored and made out to be the problem but ultimately we failed to make ourselves heard….’   

This is the heart-breaking message from a member of staff of Shrewbury and Telford NHS Trust delivered via the Ockenden review to families of those who have lost loved ones. The review found hundreds of avoidable deaths within the trust’s maternity services after analysing the experiences of 1500 families between 2000 and 2019. Some families lost more than one child in separate incidents.  

The review team stated they struggled to speak to staff about their experiences of raising concerns within the hospital’s maternity department due to a toxic mix of fears: that staff may be identified that they may lose their jobs or that they may be investigated by the police. 

In a letter to the Secretary of State for Health on publication of the review, Donna Ockenden, who led the review, explained the difficulty for staff:  

‘In the final weeks leading up to publication of the report, a number of staff withdrew their co-operation from the report and therefore their content (or ‘voice’) was lost from the report. The main reason for withdrawing from the report as cited by staff was fear of being identified. This was despite our reassurance that staff would only ever be identified as ‘a staff member told the review team’.   

Even with such reassurance and an anonymised survey, many were too afraid to come forward.  This left limited evidence for the review to draw on to conclude what the whistleblowing or ‘Speak-up’ culture was like in the maternity services.   The anonymous “Staff Voices” survey created by the review team had only 84 responses, but this found: 

  • 62% of respondents had been concerned about patient safety.   
  • 57% of respondents when asked whether they had ever raised any professional or clinical concerns, said ’yes’. Of these, only half (52%) said there was a clear pathway to follow to escalate professional or clinical concerns.   
  • When asked ‘have you personally witnessed or experienced bullying in the workplace at the Trust?’ 65% of respondents replied with ‘yes’. Only 38% of those responding yes felt able to report it and of these, 33% felt it was adequately dealt with. 

The review paints a picture of a serious problem with bullying. It also reveals a poor whistleblowing culture, where staff within maternity services are often too scared to come forward and when if they did were ignored:  

‘The culture at [the hospital trust] is that if you have done something wrong, keep it in-house and we punish you for that, you know, whether that’s you’re investigated or whether that’s you’re moved on a change list or we make your life very difficult or you end up handing your notice in because you have been almost hounded in a way to the point where you have left because of your mental health, you become more and more reluctant to speak out and that’s the danger, isn’t it?’ 

This chimes with other data showing a poor whistleblowing culture may be evident across the hospital trust where in 2021 survey an NHS staff survey showed only 34.6% of staff were confident the trust would address their whistleblowing concerns, the average across the NHS was 47.9%. 

At Protect we are alarmed by the evidence that the Ockenden Review has found around the Trust’s whistleblowing culture – and particularly the evidence that fear of speaking up continues to date.   It is disappointing that little was mentioned in the report about the Freedom to Speak Up Guardian and the role that they can play, if adequately supported by a Trust. 

We share the sentiment of the National Guardian, Dr Jayne Chidgey Clark that if staff feel they do not have the freedom to speak up, it is impossible to learn and improve: 

“.. they will not feel they can unless they are shown in practice that their voices are welcomed. This means not only for leaders to say that they are listening but to show how they are taking action as a result.” 

What is truly disheartening is how familiar these failings are. We’ve seen horrendous mistreatment of whistleblowers so many times before in the NHS. In his report from 2013, Sir Robert Francis QC examined the negligent care provided by Mid Staffordshire NHS Foundation Trust which was found to have killed hundreds of people. He said: ‘While it is clear that, in spite of the warning signs, the wider system did not react to the constant flow of information signalling cause for concern, those with the most clear and close responsibility for ensuring that a safe and good standard care was provided to patients in Stafford, namely the Board and other leaders within the Trust, failed to appreciate the enormity of what was happening, reacted too slowly, if at all, to some matters of concern of which they were aware, and downplayed the significance of others.’

Compare this to the Ockenden findings that the Trust “failed to investigate, failed to learn and failed to improve and therefore often failed to safeguard mothers and their babies at one of the most important times in their lives”. The similarities are as uncanny as they are devastating.  

Time and again, we have been told “this must never happen again in the NHS”.  Failures in Morecambe Bay and in Mid Staffs were meant to herald a sea-change in NHS culture.  But unless Shrewbury and Telford NHS Trust is truly an isolated case, it appears wider problems remain with whistleblowing in the NHS. 

In 2014 Sir Robert Francis’ Freedom to Speak Up Review was published. This was an inquiry into whistleblowing across the NHS that led to the creation of Freedom to Speak Up Guardians (FSUGs) who are on-the -ground advocates in most NHS organisations.  FSUGs role is to facilitate disclosures from staff being made to the Chief Executive and the Board, and to improve Speak Up culture within their organisation.   We supported the introduction of FSUGs and the introduction of roles with a specific responsibility for promoting speaking up in the NHS.  Our research with YouGov shows health service workers are better informed than other sectors about speaking up and this is tribute to the work that many FSUGs have done.

Responsibility for setting expectations of FSUGs, process and training has been overseen by the National Guardian Office (NGO).   Each year they produce reports based on a survey of FSUGs.  The NGO have released for 2021 their annual survey that reveals a worrying decline in the confidence in the Speak Up system: 

  • The proportion FSUGs who reported a positive culture of Speaking Up in their organisation has dropped by five percentage points on last year, to 62.8%. 
  • The proportion of staff who say they feel safe to speak up about anything which concerns them in their organisation has also fallen by more than three percentage points to 62%. 
  • FSUGs who say that speaking up culture in the healthcare sector has improved has also dropped – from 80% in 2020 to 72% in 2021. 

It has been 7 years since the Freedom to Speak Up reforms were put in place across the NHS. Now is the time for a serious look at whether this system is working as intended.   Do FSUGs have sufficient resources for the important job they do?  How can the different parts of their role – both supporting individual whistleblowers and improving the Trust Speak Up culture – be developed?  And, perhaps most significantly, what is the role of Boards and Trust leaders in ensuring that speak up arrangements are working effectively?  While FSUG play a vital role, they alone cannot be expected to solve the deep-rooted cultural problems in the NHS, and the expectations on leaders and managers to support safe speaking up needs to be reinforced.

We are calling for an urgent review of speaking up in the NHS.  NHS staff should be enabled to come forward freely and talk about their experiences in detail.  In our experience, whistleblowers and would-be whistleblowers often have a clear insight into the problems, and potential solutions. Protect’s preference would be for the Health Select Committee to conduct this review, this could be done urgently, independent of Government and, if necessary, the use of Parliamentary privilege could be used to enable evidence and testimony to be gathered without legal repercussions for those involved. 

By the Ockeden’s reports own admission they’ve been unable to provide clear conclusions on the state of Speak Up culture within Shrewbury and Telford NHS Trust. What the review team has uncovered is terrified members of staff who feel unable to speak freely about their experiences. This alone should prompt further inquiry and investigation to discover whether this is the case in this one trust, something in maternity service or a problem across the NHS.