Blog post

Freedom to Speak Up: breaking down barriers

NHS national guardian Dr Jayne Chidgey-Clark explains why breaking barriers is the key focus for Speak Up Month 2023.

16 October 2023

Workforce leaders and managers have a central role in helping to foster a culture which makes our NHS a great place to work. While there is no single measure of culture, I believe a key test is the impact it has on what conversations ‘feel like’ around your organisation.

We know barriers can exist which may silence people. If they fear losing their job or being ostracised or bullied, they may stay quiet when they see matters that need addressing. And we know that concerns which could have been dealt at an early stage can potentially lead to harm.

Transforming organisational culture begins at the top, with the willingness to listen to what workers are saying and an open mindset to use what is heard to take action and make improvements.

Every month is Speak Up Month

Each year in October we celebrate Speak Up Month – a month to champion speaking up in the NHS and make speaking up business as usual for everyone.

This year’s theme is Breaking Barriers. By raising awareness of some of the main barriers to speaking up, we hope to give people the confidence to overcome them.

Being afraid of what might happen or feeling you won’t be listened to can stop people using their voice. Staff may be worried because of their background or heritage. They may feel they won’t be listened to because of lack of seniority, their circumstances or job role.

We all have a responsibility to encourage an environment where speaking up and feedback are part of everyday life in the NHS. 

A voice that counts

The NHS People Promise states ‘we each have a voice that counts’. Yet in the 2022, NHS Staff Survey, only 61.5 per cent felt safe to speak up about anything that concerns them and we saw a drop in staff feeling confident that if they did speak up their concern would be addressed (from 49.8 per cent in 2021 to 48.7 per cent in 2022).

Those from minority ethnic backgrounds, with long-term health conditions and bank workers feel even less confident.

Many working in the NHS do continue to speak up, especially when they see the impact of poor culture on colleagues and patients. But we have seen the terrible consequences that can happen when concerns are not listened to, or action is not taken.

It is vital for the quality of patient care and retention of our workforce that when people speak up, about patient or colleague safety and wellbeing, or ideas for improvement, appropriate and timely action is taken. That means listening to understand, offering support and investigating with impartiality.

The role of leaders

Raising awareness of the barriers to speaking up is also an opportunity for us to think about the barriers we may be inadvertently constructing. It could be the language we use, our unconscious biases, complex processes or opaque policies.

If we understand what stops people feeling heard, we can work to address and remove them.

HR directors, workforce leaders and mangers have a key role in fostering a culture where freedom to speak up is encouraged and supported, and in creating environments where equality, civility, respect and belonging is valued.

This Speak Up Month is an opportunity to highlight how much employee voice is valued in your organisation. Seek out your freedom to speak up guardian, find out more about the role and how they can best be supported to address people’s concerns and act on ideas for improvement.

Speaking up enhances all of our working lives and improves the quality and safety of patient care. Listening and acting upon matters raised means we can realise the benefits that freedom to speak up can bring.

If we can get the culture right, benefits will follow, including innovation for improvement, engagement and retention of workers, and making the NHS a truly great place to work.

For more information about the work of the national guardian and Speak Up Month 2023, see the National Guardian's Office website.