Kim Blakeburn speaks of her experience as a Freedom to Speak Up Guardian in South East Coast Ambulance Service NHS Foundation Trust (SECAmb), the most improved trust for speaking up.
In the healthcare system, silence can be deadly, and the decision to speak up can save lives. Every October, the National Guardian’s Office leads Speak Up month to raise awareness of the Freedom To Speak Up (FTSU) initiative. This is a vital mechanism for enabling staff to voice concerns affecting themselves or patients.
After Sir Robert Francis’ freedom to speak up review in 2015, the National Guardian’s Office was created and legislation was introduced to make it a requirement that all trusts appoint a FTSU Guardian. As of October 2024, there are over 1000 FTSU guardians, with over 32,000 cases raised in 2022/23, up from 20,362 the previous year.
Kim Blakeburn writes here of her experience as Freedom to Speak Up Guardian at SECAmb. The service covers Brighton & Hove, West Sussex, Kent, Surrey and North East Hampshire with over 4,000 staff working across 110 sites.
FTSU in SECAmb
I have worked as the FTSU Guardian for SECAmb for the last six years and have seen so much progression in the trust’s speaking up culture. I am particularly proud of the fact that in May this year we received the news that we were the most improved trust in the country on all speak up measures in the 2023 NHS Staff Survey.
Our chief executive really values Freedom to Speak Up and his support has permeated through the organisation, which sees FTSU as an active and lived process rather than a tick box activity. Together with the focus generated by the Speak Up Review into ambulance trusts, this has set the tone for cultural change.
In the NHS, ambulance trusts are not alone in being focused on operational performance statistics (for us, call response times are key alongside other quality indicators). We decided to use this expertise to develop a dashboard to track FTSU performance within the trust, and to help us analyse, share and discuss it with teams. This has helped us to support a culture where we view speaking up as an integral part of our performance and key to creating a psychologically safe environment for staff.
FTSU dashboard
Our color-coded FTSU dashboard tracks concerns, aiming for timely resolution. When concerns are raised, they are triaged as standard or priority, with priority indicating immediate safety threats. Priority concerns are addressed urgently, while standard ones have a 93-day timeframe, aligned with HR processes. The dashboard also highlights areas with varying levels of reporting, helping me to identify and address outliers.
The dashboard has enabled me to speak to leaders about FTSU in a language they understand, allowing us to regularly discuss FTSU and staff concerns in the same way as we discuss operational performance. Adequate resourcing has also transformed what we can achieve. I have two deputy guardians to support speaking up, which allows one of us to visit each part of the trust regularly to have these conversations.
We know that one of the barriers to speaking up is the belief that nothing will be done. We have tackled this by targeting improvement work based directly on what staff are telling us via FTSU.
Tackling detriment as a barrier to speaking
Suffering detriment can be a barrier to speaking up. To address the risk of detriment, we now discuss any possible or perceived detriment when a concern is first raised, aiming to provide support early and prevent it from occurring. If detriment due to speaking up has already been experienced, we hold quarterly meetings with a select group of the executive team to review these cases and determine the necessary support or actions. We’ve also introduced a manager's toolkit, which provides guidance on preventing staff from feeling they have suffered detriment after speaking up. This process is working well - at the start of our FTSU journey, 40% of staff concerns were flagged as having ‘detriment’. This is now only flagged for 14% of concerns. It is also encouraging to see how, over the last couple of years, the numbers of anonymous concerns have fallen as staff have become more empowered to report issues with their names attached.
Next steps
While we still have a lot of work to do, our progress has been incredibly encouraging. I believe it is imperative that we start viewing FTSU data in the same way as performance data; we need to be collecting as much data as possible and triangulating it to support our understanding of the culture of the trust and identify where improvement needs to be directed.
I view speaking up as a gift – it should be seen as a positive and helpful process to identify where there are opportunities to improve. Speaking up can genuinely save lives, and although it can be difficult for staff to speak up, and also to hear the concerns that have been raised, by properly embracing FTSU we can make both staff and patients safer.
NHS Providers Guide to Good Governance
The crucial importance of openness and creating a learning environment in which structural secrecy is identified and challenged at all levels is discussed in our Guide to Good Governance. This chapter (see ‘organisational culture: problem-sensing and comfort-seeking’), which was written and based on research by the THIS Institute, points to the role that boards and senior leaders play in ‘problem-sensing’: actively seeking out data and soft intelligence that offers challenge in order to make sound diagnoses of issues.
About the author
