There has been a decline in confidence to speak up about clinical safety issues among healthcare workers for the second year running, according to the National Guardian’s Office.
Its analysis of responses to the 2023 NHS Staff Survey found that medical professionals’ confidence to raise clinical safety concerns has declined by around six percentage points since 2021, to 69.4%.
This drop in confidence was evident across medics at all stages of their career, both those in training and consultants.
The NGO was set up in response to Sir Robert Francis’s ‘Freedom to Speak Up’ review in 2015, which revealed high numbers of NHS staff feeling concerned about their careers if they made protected disclosures about patient safety.
The review was commissioned after a series of failings were discovered at trusts including Mid Staffordshire NHS Foundation Trust, where it is thought that hundreds of patients died as a result of poor care.
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NGO’s staff survey analysis also found that the ‘freedom to speak up score’, which measures overall confidence in the NHS in making a disclosure, remained stable in 2023 at 6.46, compared to 6.44 in 2022.
Confidence has broadly improved since the review in 2015, but National Guardian Dr Jayne Chidgey-Clark said the deterioration in confidence around clinical practice has implications for patient safety.
“These figures must focus the minds of those who lead healthcare organisations,” she said.
“If your people feel they cannot speak up about matters affecting patient care, or if they do, nothing will happen, how can you be assured that you are delivering your best for patients?
“When workers have a good experience when they speak up, they share that experience and we will begin to change the conversation of what it means to speak up in healthcare. The NHS may be broken, but by listening to our people, we can begin to fix it.”
In some parts of the NHS, there have been improvements in worker perceptions of speaking up. In ambulance trusts, for example, the freedom to speak up score improved from 5.83 to 5.96.
Midwives also showed increased confidence to speak up, with their score rising to 6.30 from 5.94 in 2022.
A key finding of the NGO’s report was a “say-do gap”, where organisations enthusiastically encourage staff to report errors, near misses or incidents, but workers are not treated fairly if they do so or their concerns are not acted upon.
Although 86% of respondents felt that their employers encouraged them to report concerns, almost 50,000 felt they were not treated fairly if they were involved in such an incident.
Ongoing industrial action in the NHS has also given medical professionals a sense they have not been listened to, it added.
“My hope is that the new government will model the behaviour we seek from NHS leadership, and listen to the voices of all our colleagues who give so much to us as a society?” added Chidgey-Clark.
There are now over 1,200 Freedom to Speak Up guardians across NHS primary and secondary care organisations, which aim to support workers to speak up when they feel they are unable to do so in other ways, and that those who do speak up are recognised for it.
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