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  • Speaking up
  • Building trust
  • Transparency and accountability



The challenges of working in the ambulance sector are well known. Practicing emergency care often involves exposure to stressful environments, alongside difficult and demanding working conditions. In the most recent NHS Staff Survey (2023) just over half (51.6%) of ambulance trust workers said they felt safe to speak up about anything that concerned them in their organisation, compared to a national average of 63.5%.

East of England Ambulance Service NHS Trust (EEAST) is no exception to the rule and has faced cultural issues which previously discouraged staff from speaking out. Trust chief executive Tom Abell explains: "Staff often felt cases were handled poorly with issues not acted upon, and this acted as a barrier to staff voicing their concerns, and in turn creating an open culture. We have worked hard to shift the culture to one of honesty, transparency and inclusivity."


Taking ownership to build trust

To repair trust among staff, Tom has worked to demonstrate his ownership of problems and been honest and explicit about cultural issues within EEAST. Despite the potential reputational and regulatory risks of this approach, the trust board and executive team were primarily focused on the potential irreparable negative consequences for staff of not tackling the challenges head-on.

As a first step in 2021, an internal engagement campaign around the culture and approach to speaking up highlighted some of the bureaucratic issues and challenges the trust faced, such as timely employee relations case handling and lengthy suspension time. As a result, the trust initially focused on core HR systems and processes, ensuring they worked effectively in order to build staff confidence. In time, staff were able to raise concerns anonymously, receive timely support to progress concerns, and if there was any indication a member of staff was being disadvantaged for flagging a concern, it was to be escalated to the board. This initially resulted in a 900% increase in the first quarter in staff raising concerns through the trust’s Freedom to Speak Up Guardians scheme once the revised Freedom to Speak Up offer was in place.

A willingness from the very top of the organisation to listen to staff, explore problems and create time and space to work through difficult issues has developed a culture of ownership and accountability. This in turn is improving staff confidence in that the trust is taking action to ensure truly meaningful change and make EEAST a great place to work with improved staff engagement. As a result, staff turnover at the trust has decreased from a peak of 14% in 2020 to 8% in 2022, a significant drop, and markedly below the national turnover rate of 12.1% for all trusts (NHS Digital, 2023c).


Proactive engagement

EEAST hold fortnightly open Q&A sessions with a member from the senior executive team to enable an open exchange regarding any issues staff wish to raise. Although this can sometimes mean responding to difficult questions or even having heated discussions, it has helped embed a culture of transparency within the trust. In addition, Tom dedicates every Friday to visiting staff in different parts of the trust’s region, answering concerns and questions directly from staff, and following up on action taken to address issues raised.

Increasing time spent to proactively engage with staff and ensuring two-way feedback between workforce colleagues and the senior executive team has demonstrated the commitment of the trust to build a truly open and honest culture. Tom said: "This has fostered a sense of unity within the trust, where staff feel able to voice their ideas, challenges, and concerns, without fear of negative consequences or overall inaction."

As a result of this improved culture, the staff attrition rate has turned around, so that between 2021 and 2022 there was more than a 30% drop in staff leaving the trust in the same year they joined.



Fostering an environment where staff are actively encouraged to speak up with their ideas, questions and challenges creates a sense of belonging, and is key to improving staff wellbeing and workplace culture as a whole. Confidence that senior leaders will truly listen and act on concerns helps foster a safe, transparent environment for staff to thrive in and enhances satisfaction within the workplace.