National Guardian’s Office release Freedom to Speak Up Index

The National Guardian’s Office, an organisation that advocates for openness and transparency in the workplace, has released its annual Freedom to Speak Up Index (FTSU).

The NHS National Guardians Office was established in 2016, and since then has assigned 700 Freedom to Speak Up Guardians across 400 organisations in primary and secondary care. The FTSU Index only includes NHS trusts in its current format.

The Index is calculated through staff responses to four questions asked in the annual NHS staff survey, with a new question included this year, to understand the % of staff “agreeing” or “strongly agreeing” that they would feel safe to speak up about anything that concerns them in their organisation (question 18f). However the results were not included in the Index.

The list of the four questions used to calculate the overall score included:

  • % of staff “agreeing” or “strongly agreeing” that their organisation treats staff who are involved in an error, near miss or incident fairly (question 16a)
  •  % of staff “agreeing” or “strongly agreeing” that their organisation encourages them to report errors, near misses or incidents (question 16b)
  • % of staff “agreeing” or “strongly agreeing” that if they were concerned about unsafe clinical practice, they would know how to report it (question 17a)
  • % of staff “agreeing” or “strongly agreeing” that they would feel secure raising concerns about unsafe clinical practice (question 17b)

Dr Henrietta Hughes OBE, National Guardian for the NHS, commented on the release: “While we continue to see an upward trajectory of the FTSU Index nationally, I am concerned about the widening gap between the highest scoring organisations and the lowest. This disparity is why we remain relentlessly focussed on sharing good practice to support improvement.

“I welcome the new question which is more inclusive and relevant to a wider range of organisations. The pandemic has shown how vital Freedom to Speak Up is for all workers in health, not just to ensure that patients receive the best care, but also to retain and support workers. To do justice to the tireless dedication of those who have supported the nation throughout the pandemic, it is essential that organisations not only support their workers when they speak up, but also listen and follow up appropriately.”

Since the Index was started in 2017, the overall score of the FTSU index has risen 3.7 percentage points from in 75.5% in 2015, to 79.2% in the latest figures.

The gap between the lowest performing trusts and the highest is increasing, with a 21-percentage point gap between the highest performing trusts and the lowest performing trusts, which is an increase on the previous year.

Three trusts from the bottom ten ranked organisations have remained in the bottom ten from last year’s data. Ambulance organisations continue to be the lower ranked type of organisation, but are also showing the most improvement across the board.

North Cumbria Integrated Care NHS Foundation Trust had the greatest decrease in FTSU Index score from 80.2% to 75.4%, a drop of -4.8%.

The top ten performing trusts are listed below, 6 of them were in the top ten last year, and four are new entries. New entries are highlighted in bold.

  1. Cambridgeshire Community Services NHS Trust 87.6%
  2. Kent Community Health NHS Foundation Trust 87.0%
  3. Solent NHS Trust 86.9%
  4. Hounslow and Richmond Community Healthcare NHS Trust 85.9%
  5. Lincolnshire Community Health Services NHS Trust 85.5%
  6. Healthcare NHS Foundation Trust 85.5%
  7. Hertfordshire Community NHS Trust 85.0%
  8. Leeds Community Healthcare NHS Trust 84.9%
  9. Sussex Community NHS Foundation Trust 84.9%
  10. Liverpool Heart and Chest Hospital NHS Foundation Trust 84.7%

The FTSU Index scored trusts by region with the Southeast recording the highest score and the East of England region recording the lowest average scores across the NHS trusts.

Ethnic disparities were measured in the report, with 67.0% white respondents more likely to agree that they felt safe to speak up about anything that concerns them in their organisation, compared to 62.1% of black and minority ethnic groups.

The report on ethnicity was conducted in even more detail as the report split the following groups: Other ethnic groups, White, Mixed/Multiple ethnic background, Black/African/Caribbean/Black British, Asian/Asian British and analysed their responses; answering the question whether staff “agreed” or “strongly agreed” that they would feel safe to speak up about anything that concerns them in their organisation. 67% of white participants said they did agree or strongly agree that they would feel safe speaking up, compared to 57% of other ethnic groups giving the same answer.

Case studies

As part of the FTSU Index three case studies were released, where NHS trusts expanded on the work they had done to improve working culture. The three NHS trusts selected included Isle of Wight NHS Trust, East Midlands Ambulance Service and South Tees NHS Foundation Trust. The trusts were invited to explain in detail how they tackle barriers in working culture and any steps they had taken to improve their working environment.

Leisa Gardiner, FTSU Guardian, from Isle of Wight NHS Trust explained how the trust worked to improve their culture from the past year: “The past 12 months have proved challenging, coping with a pandemic, but by ensuring workers know how and where to raise concerns and that they are appropriately supported has led to deeper engagement.

“During October’s Speak Up Month, I hosted Microsoft Teams sessions for workers focusing on the importance of speaking up and patient safety. I felt this was crucial at that time due to the pandemic as workers naturally were concerned about patient safety and their working environment. Sessions included understanding how Freedom to Speak Up can influence an open and inclusive culture, psychological safety at work, and ‘silence isn’t safe’ – involving our people to inspire an open, honest and just culture.”