Having a speaking up and listening culture is critical to enabling an open dialogue, including time for reflection and learning, when things go wrong. It is important for working in partnership with your staff to drive improvements.
This page outlines a number of key considerations, resources and case studies which will be useful to take into account when reviewing and developing local arrangements.
Having a policy
As of April 2016, all NHS organisations in England are required to adopt the Freedom to Speak Up: raising concerns policy for the NHS. Issued by NHS Improvement, the policy was brought in to help standardise and normalise the raising of concerns which are in the wider public interest (those that do not relate to personal employment issues). It is mandated within the NHS standard contract.
Visit our legislation and policy page for background information on the legal frameworks and policies that underpin raising concerns culture.
Read the Freedom to Speak Up: guidance for NHS trusts and NHS foundation trust boards produced by NHS Improvement and the National Guardian's Office. The guidance includes a self-review tool for Freedom to Speak Up guardians - helping organisations understand how effective their current practise is, and where improvements can be made.
Communicating the policy and engaging with staff
Staff should have a clear understanding of the definition and process of raising concerns. There are multiple ways organisations can ensure that this is the case. For example, posters and leaflets can be displayed around the building, in team meetings, or in designated staff areas.
We worked with the social partnership forum to produce downloadable raising concerns posters.
Each design can be customised by inserting your organisation's name and the contact details of your guardian in the free text boxes.
Organisations should also consider how they can assure themselves that all staff receive the same information and are clear about how to raise a concern and where to seek advice from, including those working across different sites, out in the community or who choose different working patterns (for example, shifts and working from home).
It is important to work closely with relevant parts of your organisation to better understand how effective local arrangements are in fostering a positive raising concerns culture. HR teams will find it beneficial to forge strong links with their Freedom To Speak Up guardian and wider management teams, to understand areas of concern and identify actions for improvement. Working in partnership with local trade unions and communication teams will be helpful to ensure all workers understand how to raise concerns they have, and the responsibility of managers to ensure they have a platform where concerns are listened to and responded to in an effective and timely manner.
Mandatory training should be provided to all staff so that they understand the organisation's policy and local arrangements. It should also be provided to those with responsibility for handling concerns so they feel confident and equipped to handle issues effectively. It is good practice to include the handling of concerns raised as part of any disciplinary and grievance training.
Health Education England (HEE) provide an online training package on raising and handling concerns in the NHS. The training package was produced in partnership with Protect (formerly Public Concern at Work) and can be used by staff and managers.
Supporting staff who raise concerns
Raising a concern can be a difficult and stressful process for all parties concerned. Employers should ensure staff understand where they can seek further help, advice and support from, at all stages of them raising a concern - to assure their health and wellbeing. The same level of support should be offered to individuals who have had concerns raised about them. In all cases, it will be important for managers to check in with individuals once an investigation into a concern has concluded, to make sure they have access any support they may need.
There are a number of resources available on our health and wellbeing pages which will be helpful for managers to refer to when supporting staff.
The role of the National Guardian's Office
The National Guardian's Office (NGO) provides leadership and support to Freedom to speak up guardians, including supporting regional networks and sharing good practice and learning from organisational case reviews.
Speaking up data - The latest figures on the number of cases reported to Freedom to speak up guardians.
Freedom to speak up index - An index monitoring Freedom to speak up culture in the NHS. It is based on four questions from the NHS staff survey including whether staff feel secure raising concerns.
Pulse surveys - A series of surveys that aim to better understand the impact that COVID-19 is having on Freedom to speak up.
Good practice case studies
Having a positive raising concerns culture does not lie with any single part of an organisation, it is part of a good, overall, organisational culture. The following case studies highlight how NHS trusts are improving their organisational culture by working with different parts of their organisations to engage with and support their staff.
If you have examples of good practice you would like to share with us, please get in touch by emailing the team at email@example.com