What I wish I'd known, six months on as an FTSU guardian

Judith Graham

Judith Graham is the Freedom To Speak Up guardian (FTSU) at Rotherham, Doncaster, and South Humber NHS Foundation Trust. Judith is an advanced nurse consultant, psychotherapist, and the trust Listening into Action lead.

This is my second blog since starting as a FTSU guardian in May 2016. This time I wanted to reflect upon the National Guardian's Conference and the regional guardian networks. 

The first National Guardian's conference was held on 13 October 2016 in London. I was asked to present on “what I wish I had known having been a guardian for a few months”.  This made me reflect upon the huge amount of work that has been conducted since I have taken post, both nationally and within our trust.  I managed to condense how I felt in six points:

1) It's OK to have anxiety 
Talking about speaking up and associated concepts can cause a degree of anxiety in a workforce, which is normal. There are defining principles set out in the Freedom To Speak Up literature, however, when practising these, guardians need to be mindful that introduction of the concept and the role needs to be bespoke to each organisation, rather than prescribed. Considerations are needed concerning the organisation’s history, its past and current incidents, understanding what can be learned from previous whistle-blowing, and who are the key people who need engaging. 

2) There is a need to scope out what you already have, in order to plan what you need 
Prior to the FTSU role being introduced, organisations already had systems and processes in place regarding whistleblowing, harassment, bullying, and other concepts. There is a need for the guardian to both understand and incorporate these issues into the FTSU process, rather than having them as separate, as this causes confusion to everyone. It takes time to understand formal and informal ways in which people share concerns, these also need to be incorporated to make it as simple as possible for all staff.  

3) The need for space, supervision, and support 
The role can be stressful, especially as you may be juggling FTSU with other positions. There is a need to look after yourself, to have space to think, and consult others in your team about decisions, and also being able to have supervision to process some of the issues you discuss and decisions you have to make. Remember you are not immune - secondary traumatisation is not uncommon for people in such roles, and this can cause people to either be over-sensitised to potential difficulties, or numb to these. Guardians need to be self-aware and have supervision structures in place that mean they are supported, and monitoring is in place for these symptoms. 

I am fortunate to have a very supportive chief executive, HR director, and two non-executive directors that work in our FTSU team. I have however spoken to guardians who have different levels of support, due to rapidly changing leadership teams in the transformation process, they have expressed different levels of difficulty, and problems in conducting their role. 

4) The need to demonstrate emotional intelligence and build resilience 
Emotional intelligence can be defined as “The capacity to be aware of, control, and express one's emotions, and to handle interpersonal relationships judiciously and empathetically”. The NHS is currently undergoing significant amounts of change which affect everyone, including guardians. There is a need to be open and transparent, whilst also being organisationally aware, as people may bring you different difficulties which are not quite in keeping with FTSU principles. 

5) Confidentiality and record keeping  
Guardians need to be very clear with people about the boundaries of confidentiality, anonymity, and also the need to record concerns. Although anonymity is required in terms of some concerns raised, there is a need to ensure that there is appropriate response if immediate patient safety concerns are raised. The guardian needs to be fully aware of how to trigger these responses, and key members of the organisation need to be supportive (i.e. director of nursing). Keep a confidential record of all of the concerns raised. 

6) There is a need to keep grounded and contextualise your experience 
There are fabulous things happening in the NHS, and it is an institution to be proud of. This is the reason we all want to be guardians – to keep the NHS running as safely as possible. 

I feel that the guardian's conference was very positive, and there was a real sense of community concerning the growing FTSU network. It was really great to meet with Dr Henrietta Hughes and also Sir Robert Francis, and understand from a national perspective how the guardian’s role is shaping, developing, and support is being provided. 

The last thing that I wanted to talk about concerns the development of regional guardians networks. I am really excited to be arranging the first meeting for the Yorkshire and Humber network with Lisa Smith. We are due for our first meeting in December 2016. If there are guardians in the region who haven’t managed to make contact yet, please email me. 

For more information please contact Judith Graham via email on judith.graham@rdash.nhs.uk or tweet via @Jude_Graham_

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