Organisation objective

• Governance

Executive summary

This paper provides the annual report on internal Freedom to Speak Up (FTSU), recognising the vital work of our FTSU Guardians who support our staff to speak up. It sets out the key themes from the cases raised by our staff this year; the Guardians’ perspective on the learning and improvement; and their recommendations for 2023/24. It includes data from former NHS Digital and Health Education England.

Action required

The Board is asked to note the paper.

Background

1. Since last year’s report, work has been underway to support the development of a single FTSU system for the new NHS England. This has taken precedence over intended work to further improve arrangements, and so while some of the NHSE England Guardians’ recommendations from last year have been addressed, some have not been addressed, but will be incorporated into the new system. For example, greater FTSU Guardian involvement in corporate and local induction, and greater Guardian involvement in cultural development work.

2. The SRO for FTSU remains Richard Barker. Non-executive board oversight remains with Sir Andrew Morris. The new internal FTSU Team will be hosted by the Chief Delivery Officer.

Assessment of issues, including themes and trends

Summary of developments in 2022/23

3. Planned development of a small team dedicated to internal FTSU has taken longer than anticipated. Tom Grimes will fill the Lead Guardian role on an interim basis, and additional resource to support him is in place. As we progress with the organisational change, the amount of resource will need to be kept under review.

4. Towards the end of the year, the number of Guardians has reduced as a result of the organisational change. Capacity is being carefully monitored, but any decisions about recruiting new Guardians will be based on a new FTSU Strategy (see further below) and a decision about the most appropriate Guardian model for the new organisation.

5. Regular liaison between the FTSU leads from NHS England, former HEE and NHS Digital has been in place since the autumn of 2022 to enable understanding of the respective FTSU approaches and to share intelligence. This will continue, as we maintain three separate approaches to FTSU until we have a single robust system that builds on the best of all three organisations.

6. More Guardians and more promotion of FTSU and the diversity of our Guardian cohort has prompted more speaking up and more opportunities for improvement. NHS England saw a small reduction in the proportion of anonymous cases. However, from feedback we know that not everyone has a positive experience of speaking up to a Guardian. The reasons for this vary, including in some cases a potential misunderstanding of the Guardian’s role and the role of FTSU. This feedback is informing the development of the FTSU strategy for the new NHS England.

Themes and trends

7. For NHS England, the number of cases received in 2022/23 (208) was a third more than the previous year (152). For HEE, numbers were similar to 21/22. NHS Digital reporting cycle was different, but its numbers for Q3 and Q4 were similar to before.

8. It is difficult to infer too much from higher or lower numbers of cases. Higher numbers could signal a healthy confidence that staff have in speaking up as well as indicate that there are challenges. However, it is noticeable that cases peaked in Quarter 3 as the organisational change process was starting, but then reduced significantly in Quarter 4 as the organisational change process properly began. Q1 data indicates a similar trend, particularly for former HEE. There clearly remain barriers to speaking up, with NHS England’s staff survey showing that only 58% of NHS England staff felt able to speak up about anything that concerns them.

9. The strongest themes raised in 2022/23 across all 3 organisations relate to:

• Alleged bullying and harassment
• People and team management
• Alleged poor behaviours by line managers and senior leaders.

10. Whilst we have to acknowledge the current organisational uncertainty, it is important that we aim to address these themes as we build the new NHS England and focus on high quality orientation processes, training for and support from line managers, improving dynamic conversations and continuing to develop our EDI strategy to ensure that we are fully inclusive and that everyone can have a good experience of working for us.

Improvements from FTSU cases in 2022/23

11. Regular liaison between FTSU and senior leaders in HR & OD has been introduced in response to concerns from Guardians about long standing HR casework. This has enabled some qualitative triangulation of FTSU and HR concerns on a case-by-case basis.

12. Engagement with the staff network chairs has been improved by those chairs joining the FTSU Steering Group on a rotational basis, supporting further triangulation of themes. This is being built on as we develop a new FTSU approach, with Tom Grimes attending the EDI Advisory Group, and enabling staff network chairs to input into the FTSU strategy.

13. The FTSU Steering Group has also been working on how we address more strategic themes:

• Root-causes of issues even when individuals may move on (and so the ‘symptoms’ may no longer be apparent). This is critical, particularly at a time of high staff turnover, to ensure that challenges and risks are being addressed so that they don’t re-emerge later.
• How to pursue all opportunities for organisational learning before closing a case.
• Progressing cases in a timely manner, particularly those that might involve a range of stakeholders and so could more easily get ‘stuck’.
• Supporting exploration of ways for cases to move forward outside of traditional HR process, where it’s appropriate.

14. Improvement in capturing stories of speaking up, and most importantly the learning and improvement that results, has not happened in the way we wanted. This is partly linked to the point about route-causes (above) and will be a focus of the FTSU strategy for the new NHS England.

How FTSU is being developed for the new NHS England

15. A FTSU system for the new NHS England is being developed, with input from Guardians, staff networks and staff from across all 3 former organisations. A strategy has been drafted and is being consulted on with those stakeholders, which aims to ensure that in the new organisation:

People trust that they can speak up when they have concerns as part of normal, everyday practice, confident that learning will occur, and improvement will follow.

The strategy focuses on five areas:

• Improving awareness and understanding.
• Providing FTSU training and support.
• All staff have a good experience of our FTSU service.
• Improving leaders’ engagement in FTSU in a way that can be seen and felt (we want all executive directors to commit to their part in making FTSU effective).
• Systematic and open approach to learning and improvement.

Culture for the new NHS England

16. As part of ongoing work to shape the culture of the New NHS England, NHSE and former HEE and NHS Digital Guardians joined the HR and OD team for Culture connect sessions in 22-23 to discuss aspirations and behaviours for the culture of the new organisation and their expectations of leadership moving forward. It is intended that FTSU will feature prominently in the orientation for the new organisation and that themes from FTSU cases will inform specific aspects of training and development for managers.

Next steps

17. The next six months will be focused on:

• Developing and rolling out a single FTSU system – it is hoped this will go live in Q4, and by 1 April 2024 at the latest.
• Continued liaison with HR & OD.
• Supporting Guardians through the organisational change.

Appendix A: Former NHS Digital

Concern themes

The table below summarises themes for concerns raised with Guardians between October 2022 and March 2023. The former NHS Digital’s model also enables anonymised speaking up to non-Guardian subject matter experts. (Although these are not Guardian activity, they are included in the table to capture the full breadth of themes arising from speaking up). 

As with the previous reporting period, the number of concerns raised anonymously far outweighs those raised by colleagues wishing to share their identity (17 anonymous and 13 not). This indicates that having an anonymous route to speaking up enables the organisation to hear many voices that would otherwise go unheard. 

** All entries in this category subsequently re-classified as either bullying or a general concern.

Sub-themes raised via speaking up include:

• Adverse behaviours at different management levels perceived as transphobic, racist or ableist.
• VSM behaviours, and lack of action when these are spoken up about using the line management chains.
• Team culture, governance and safety.
• Bullying of individuals by line managers.
• The impact of a senior manager’s behaviours across a team.

Many concerns were raised about the voluntary redundancy scheme and the consultation process(es). These continue to be signposted to the appropriate function and are not included in the data. Any wellbeing concerns relating to these contacts were also signposted.

Steps taken after concerns were raised

It is vital that colleagues have confidence that when they speak up, their concern will be listened to and properly heard. Here we list some high-level descriptions of what happened after concerns were raised:

• In some cases, people just wanted a safe place to talk about an issue, seek advice or put a marker down in case what has happened is repeated.
• In other cases, having spoken up, individuals then acted themselves, for example by raising their concern with their line manager or a more senior manager in the management chain.
• Two referrals were made to mediation services.
• Whistleblowing concerns are now reported to NHSE’s whistleblowing team. Those live as of the merger were also transferred to the team.
• Other actions include seeking advice and input from the following sources:
  • Human Resources Business Partners about behaviours and organisational change
  • Staff Networks about matters related to protected characteristics
  • Business Lead for concerns about the wellbeing of others

Colleague feedback about speaking up

Colleagues are asked to submit anonymous feedback once their engagement with the speaking up process is complete. Summary results for the period are:

• 100% of colleagues felt listened to.
• 75% of colleagues felt their concern was dealt with in a timely manner.
• 100% of colleagues had trust in their Guardian/SME that their concern would be kept confidential.
• 50% of colleagues reported they got the outcome they were hoping for.

No colleagues reported experiencing any disadvantage as a result of speaking up. 

Appendix B: Former HEE 2022/2023

Appendix C: NHS England

Experience of speaking up

• 47% would speak up again
• 11% might speak up again
• 38% are unsure if they would speak up again
• 4% would not speak up again

Publication reference:  Public Board paper (BM/23/26(Pu)