Introduction

In 2015 Sir Robert Francis published his Freedom to Speak Up eview, which highlighted the importance of enabling NHS workers to raise concerns in their place of work without fear of reprisals. The review recognised that after speaking up some workers were leaving NHS employment, to the detriment of them personally and the organisations they worked for. This caused a significant adverse impact on NHS workers and a loss of expertise and resource to the NHS.

Following this, in 2019 NHS Improvement (now part of NHS England) launched a Whistleblowers’ Support Scheme to implement the recommendations under principle 12 of this review, which helped current and former NHS workers who had raised concerns to remain in or get back into NHS employment.

The previous scheme in 2019 found that people experienced challenges in moving forward in their professional and personal lives and required support with their health and wellbeing, career coaching and personal development.

Following a review, the Whistleblowers’ Support Scheme was redesigned and renamed as the Speaking Up Support Scheme. This new scheme was aligned to the NHS people promise which states that “we each have a voice that counts”. It was launched in 2022 and offered 10 past and present NHS workers who had spoken up, a structured programme of support aimed at enabling them to move forward in their professional and personal lives.

This report is an independent evaluation of the 2022 Speaking Up Support Scheme. It will consider how well the Speaking Up Support Scheme enables participants to move forward in their personal and professional lives. It will identify learning outcomes to help improve the scheme, as well as learning outcomes for NHS organisations to better support those who have spoken up.

Executive summary

The scheme provided 10 places to participants’ who had experienced adverse impact in their professional and/or personal lives following a formal speaking up process.

The scheme included 1:1 psychological support, group sessions, career coaching and professional development workshops over a period of 9 months.

Key findings

1. All participants who engaged in the scheme to the end have improved levels of hope, self-belief, resilience and optimism which many attributed specifically to the scheme.
2. The scheme helped reduce the negative impact on individuals who have spoken up, even in cases where they have experienced significant personal or professional setbacks.
3. While each participants’ experience is unique, there are several common organisational themes across their experiences, which include perceptions of human resources and a misuse of hierarchical power among leaders.
4. When asked how likely they would be to recommend the scheme to others who have spoken up, participants gave an overall rating of 4.75 out of 5 (from 8 ratings).

Summary of learning outcomes

Analysis of the findings revealed learning outcomes across four themes: NHS organisation, scheme design, scheme onboarding and application to the scheme. A summary of the findings are outlined below.

• The psychological safety of people who speak up must be protected. Human resources departments should improve their levels of support and ensure Freedom to Speak Up guardians have the autonomy and independence required to fulfil their role.
• The Speaking Up Support Scheme should be extended to more participants to meet demand for the scheme. Where demand outstrips supply, a waiting list should be introduced. Communication for applicants should be clearer and a review of application questions should be carried out to ensure they are essential to assess the scheme criteria.
• 1:1 psychological wellbeing session options should be extended from 6 to 8 to maximise their positive impact. Group sessions should be carefully planned to ensure maximum attendance and engagement.
• Longer gaps between coaching sessions are recommended in future schemes. This will enable participants to make the most of the opportunity by engaging in their development actions between sessions.
• Consider including financial support for professional development funding. This will help to account for the gaps in continued professional development experienced by many who have spoken up.

All stakeholders should carefully consider these learning outcomes and take the necessary actions to implement them. Priority should be given to NHS organisational learning outcomes, to prevent the negative experience of speaking up within the NHS.

About the scheme

Scheme eligibility criteria

Applicants to the scheme had to meet the following criteria at the time of application:

• A current NHS worker or a past NHS worker who had worked for the NHS within three years of the scheme beginning.
• Had been through formal processes of raising concerns in the NHS and suffered significant adverse impact as a result.
• Had been through formal processes of raising concerns in the NHS which potentially impacted on safety, posed a risk or presented as malpractice or wrongdoing.
• Had made reasonable attempts within their organisation to resolve matters.
• Could demonstrate how the scheme would benefit them to move on personally and professionally.
• Open to participate in all the scheme aspects. Had not taken part in any previous related NHS Speaking Up Support Schemes including the pilot scheme.

Scheme design

The scheme was designed to support individuals to move forward with their lives both professionally and personally. Participants on the scheme had access to a structured programme of support which included:

• Scheme induction session
  • To launch the scheme, participants were invited to a half day induction. This gave participants the opportunity to meet each other and the scheme managers. They got to hear from a high profile speaking up advocate (Helene Donnelly) at the session. It gave them an opportunity to ask any questions and to understand more about the scheme.
• Health and wellbeing session
  • Each participant was offered a health and wellbeing session provided by HelloSelf.
• 1:1 psychological wellbeing support
  • Each participant was offered 5 1:1 psychological sessions provided by HelloSelf.
• Personal development workshops
  • Participants attended three personal development workshops titled, your story, your journey and your potential.
• Group psychological sessions
  • A range of practical support was provided through group sessions. These focused on psychoeducational topics such as sleep, meditation and wellbeing. These were provided by HelloSelf.
• Coaching support
  • Six hours of career coaching was offered to each participant, provided by Working Transitions.
• Scheme team check-ins
  • Regular 1:1 check-ins with the scheme manager gave an opportunity for participants to provide feedback about the scheme, and for scheme managers to check in on the general wellbeing of participants.

To apply for a place on the Speaking Up Support Scheme, applicants were required to complete an application form. The scheme had ten places available and those shortlisted during this process were asked to attend an informal discussion with the scheme managers, to explore their application further.

Evaluation design

There were two parts to the evaluation design. The first focusing on current participants of the scheme, the second focusing on those who applied but were not offered a place on the scheme.

Participants

Baseline 1:1 semi-structured interviews

An independent organisational psychologist led semi-structured 1:1 interviews with each of the participants to gain a baseline measure of psychological capital and hopes for the scheme.

Mid-term survey

Participants were invited to complete a short mid-term survey. The purpose of the survey was to gain early insights as to how the scheme was supporting the participants.

End of scheme 1:1 semi-structured interviews

The same independent organisational psychologist led semi-structured 1:1 interviews at the end of the scheme to measure improvements in psychological capital, and to gain insights and feedback to help inform future scheme design.

Applicants

Survey

All applicants to the scheme who were not offered a place, were sent a short survey to complete on their experience of applying to the scheme.

1:1 semi-structured interviews

All those who applied to the scheme but were not offered a place had the opportunity to give their feedback in a 1:1 semi-structured interview.

Baseline findings

To establish the impact that the scheme has had on participants ability to move forward  with their personal and professional lives, it was important to establish a baseline measure.

Prior to the scheme beginning all ten participants took part in a 1:1 semi-structured 
interview. The purpose of the baseline interview was to gather rich qualitative insights into how participants were feeling and their expectations for the scheme.  

In the first part of this section, we discuss the key findings and themes relating to how the participants were feeling before the scheme began. The second part will look at the participants expectations of the scheme.

Key baseline themes

These 6 key themes were extracted from the qualitative data using thematic analysis. They encapsulate how participants were feeling when entering onto the scheme.

• Psychologically unsafe
• Ostracised
• Despondent
• Principled
• Impacted career
• Personal toll

Psychologically unsafe

In psychologically safe environments, people are free to express themselves without fear of negative consequences. Likewise, in psychologically unsafe environments there is often a culture of blame and finger-pointing, where mistakes are not acknowledged, and people are quick to criticise or blame each other for any problems that arise.

Participants described feelings akin to gaslighting having spoken up, whereby mistakes were not acknowledged and instead they were made to feel that they were the one in the wrong for having spoken up. 

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Ostracised

Participants described feeling ostracised since speaking up. Many described instances 
of being ignored or shunned in an attempt to hurt or punish them for having spoken up. 

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Despondent

Almost all participants felt they had been part of long and drawn-out processes as a result of speaking up. Participants described a sense of despondency and hopelessness that their concerns would not be taken seriously and dealt with in a fair, consistent and timely way. For many, they felt their efforts to do the right thing by speaking up were futile, despite risking so much in doing so.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.   

Principled

Participants described how their personal values relating to both health care and acting with integrity have kept them trapped in what they felt were toxic and for some, traumatic environments. Many described their predicament in wanting to feel psychologically safe, but not wanting to leave the NHS.

Note: Quotes under this theme are from unique participants. No participant has been quoted twice.   

Impacted career

Speaking up has impacted almost all participants’ careers. Some participants were not offered training with limited explanation as to why, others chose to leave their profession in favour of feeling psychologically safe and others had to leave the workplace completely and as a result, fell behind on their continued professional development.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Personal toll

It was clear that it is not just participants’ careers that have been impacted having spoken up, the experience has taken a significant personal toll on participants lives too. Participants entering onto the scheme are in a vulnerable and raw place.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Expectations for the scheme

During the baseline 1:1 discussion, participants were asked to outline their expectations of the scheme.

Key themes

• To feel less alone
  • Participants were looking forward to meeting others who had spoken up. They described how they felt that they had suffered detriment despite doing the right thing and how meeting others who had acted with integrity was a key part of the scheme for them.
• To build resilience
  • Participants saw the scheme as an opportunity to pause and reflect, looking inward and building themselves up from the inside to be more resilient in the future.
• To build confidence
  • Most of the participants have been through experiences that have significantly knocked their confidence. Building self-belief and restoring confidence in their ability to be great at what they do was a big draw of the scheme.
• To move forward
  • The experience of speaking up and the aftermath of doing so has been a long process for many people on the scheme (years for some). Participants described their hope that the scheme would allow them to move on with their lives.

Scheme engagement

Scheme induction

All participants attended the scheme induction session. The induction was attended by scheme managers, representatives from supplier organisations and a keynote speaker, who shared their journey of speaking up.

1:1 Psychological wellbeing support sessions

9 out of 10 participants completed their 6 individual sessions with their therapist, which gives an overall attendance rate of 98% at the time of writing this report. This is a very positive outcome and suggests that the participants engaged well in their therapy sessions.

Overall, around 50% of participants chose to space their individual sessions with their therapist, due to wanting support throughout the whole scheme.

Group sessions

Group sessions covered the following topics:

• sleep problems
• mindfulness
• self-compassion
• 5 ways to wellbeing
• returning to the workplace

Career coaching

The coaching sessions included:

• A diagnostic call to understand each individual’s background, aims, objectives, needs and timescales.
• Allocation of each person to a suitable coach based around the information provided.
• Up to 6 hours of coaching delivered individually tailored to each person’s needs.
• Examples of topics typically including future career direction, reviewing previous achievements to help build confidence, help with applications, interview support and adapting to changes in circumstances as a result of speaking up.
• Access to an online career hub with resources such as online courses, videos and interactive tools to help you make the right career decisions, accelerate job searching and maximise opportunities.

Personal development workshops

The three development workshops were designed to be interactive and focused on personal and practical development. An outline of the workshops can be found below:

• Session 1: Your story – this session enabled participants to reshare their stories with a focus on learning to then begin to regain confidence after speaking up.
• Session 2: Your journey – this session built on the first workshop; participants refocused their lens on their journey ahead.
• Session 3: Your potential – the third and final session continued to build on the first two workshops, helping participants to maximise their potential going forward.

1:1 Check-ins with scheme managers

1:1 check-ins were conducted on a monthly basis, however participants could also book one in at any point during the scheme if they needed to speak to scheme managers more regularly. There was a good uptake of the 1:1 session throughout the scheme.

Scheme engagement conclusion

Overall engagement with the scheme was high, however whole group sessions were less well attended than 1:1 sessions.

This is likely due to two factors:

• Limited flexibility of the timings of the group sessions when compared to 1:1 sessions.
• Differing expectations around what the group sessions were about and how to best engage with them.

Despite lower engagement with whole group sessions, enthusiasm for them is high. Learning outcomes are shared in this report to improve the design, delivery and attendance of whole group sessions.

Scheme impact

To establish the impact that the scheme has had on helping participants to move forward both professionally and personally, we gathered insights from our participants at the end of the scheme, to compare against the baseline data that we gathered before they had started on the scheme.

Psychological capital findings

Psychological capital refers to the positive psychological resources that individuals possess, including hope, self-belief resilience and optimism (1). To gauge participants levels of psychological capital before and after the scheme, we posed four statements:

• I feel hopeful that I can move forward (hope).
• I believe in my ability to overcome challenges (self-efficacy).
• I feel strong even in times of uncertainty (resilience).
• I feel positive about the future (optimism).

Participants were asked to rate how they were currently feeling using the following scale: 1 strongly disagree, 2 disagree, 3 neither agree or disagree, 4 agree, 5 strongly agree.

The findings found an improvement across all areas of psychological capital which included participants feeling more hopeful to move forward, believing in their ability to overcome their challenges, feeling strong in times of uncertainty, and feeling positive about the future.

The findings in figure 1 below show a comparison of the average scores given by the participants before the scheme and at the end of the scheme.

The findings found an improvement across all areas of psychological capital which included participants feeling more hopeful to move forward, believing in their ability to overcome their challenges, feeling strong in times of uncertainty, and feeling positive about the future.

Individuals with higher psychological capital tend to be more proactive in dealing with challenges and setbacks, experience less stress and burnout and have better mental and physical health (2).

Whilst we cannot claim that the scheme alone has been the only contributing factor to the increase in psychological capital, it was clear from speaking to participants that the scheme has contributed to the increase in scores across all areas.

Figure 1: Psychological individual session outcome averages

1:1 Psychological wellbeing support outcome measures

Qualitative outcome measures were gathered across all scheme providers, however due to the psychological nature of HelloSelf sessions, three quantitative outcome measures were used to establish overall wellness. These were:

• Depression tracker:  The patient health questionnaire-9 (PHQ9; Kroenke and Spitzer, 20)
  • A self-administered screening tool used to assess the severity of depression symptoms in adults.

• Anxiety tracker: The generalised anxiety disorder-7 questionnaire (GAD7; Spitzer, Kroenke, Williams, and Löwe, 2006)
  • A self-reported screening tool used to assess the severity of symptoms of generalised anxiety disorder in adults.

• Wellness Tracker: The clinical outcomes in routine evaluation-10 (CORE10; Barkham et al., 2012)
  • A self-report questionnaire designed to measure psychological distress and functioning in adults.

Figure 2 below shows averages of the participants’ initial scores, where available, and the participants’ last recorded scores, where available and the average outcome scores. The psychological measures to track wellness (CORE-10), anxiety (GAD 7) and depression (PHQ-9) on average from the initial score fell by almost half, with a reduction in the score indicating a positive outcome.

Due to the low number of participants and incomplete data sets for some participants, these should only be interpreted as approximate trend data.

Please note: a reduction in score across all three measures indicates an improvement. 9 out of 10 participants showed improvements across all three measures.

Figure 2: HelloSelf individual session outcome averages

Overall scheme rating

When asked “how likely would you be to recommend the scheme to others who have spoken up”? participants gave an overall rating of 4.75 out of 5 (from 8 ratings).

Supporting quotes

NHS organisation findings

Organisational findings were captured across both the baseline and end of scheme 1:1 interviews. While it is clear that the scheme is supporting participants to move forward both professional and personally, it is important to capture any organisational learning to ensure that individuals do not feel negatively impact by speaking up.

Key themes

Perceptions of human resources (HR)

HR play an important role in ensuring the needs of the workforce are addressed and balanced with organisational needs. There is an opportunity for NHS organisational HR and organisational development leads to support leaders and managers in their duty to maintain a psychologically safe environment for employees.

In some instances, participants have felt that the needs of the organisation had been put ahead of employees. The role of HR for many did not feel like a safe space to speak up, but rather that HR would work to protect the interests of the organisation first and foremost, over and above the needs of employees.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Conflict of interest

Whilst not commonplace, it should be noted that where the Freedom to Speak Up guardian is also the HR representative dealing with the issue, a conflict of interest can exacerbate the situation. This conflict of interest is particularly poignant when considered in light of the previous theme around the perceptions of HR.

Note: quotes not shared to protect anonymity

Hierarchical power imbalance

In psychologically safe cultures, power is used in a way that promotes collaboration, trust, and respect among team members. Leaders who cultivate psychologically safe cultures recognise that their role is not just to exercise power over others but to empower their team members to contribute their unique perspectives and ideas.

In some instances, it was felt that the natural power held by those in positions of seniority in some NHS organisations, had been used to control and silence employees creating a psychologically unsafe environment. Evidence suggests that psychologically unsafe cultures can lead to an increase in safety incidents (3).

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Freedom to Speak Up guardian influence

Whilst most participants on the scheme have found the Freedom to Speak Up guardians to be supportive, their level of influence within the organisation has often meant that the impact they are able to have to resolve issues is limited.

In the previous theme we discussed the strong power imbalance driven by a culture reliant on hierarchical power dynamics. This theme is at play here, where many Freedom to Speak Up guardians are in relatively junior roles compared to those who are being accused of poor practice or behaviours.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

End of scheme findings

During the semi-structured interview, participants were asked to share their reflections and experiences at the end of the scheme.

Thematic analysis of the responses has revealed the following key themes:

• Validation
• Camaraderie
• Empowerment

Validation

Participants described how the scheme has helped to validate that what they went through was real, that it mattered and that they did the right thing in speaking up. For many this was the first time that they have been able to feel like this.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Point to consider: scheme providers should be cognisant of participants’ different stages of recovery and consider how this variance has the potential to impact the recovery stage of others on the programme (eg through triggering).

Camaraderie

Camaraderie is a feeling of trust, friendship, and mutual respect that develops among a group of people who have shared experiences. Almost all participants commented on the strength they have drawn from others in the group. The group have independently set up a Whatsapp chat so that they can remain connected after the scheme.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Point to consider: the power of meeting others who have spoken up was an unforeseen benefit of the scheme. Consideration should be given to ways in which the power of network and camaraderie can be continued after the scheme. This could be in the form of an alumni network which could help provide both ongoing support for alumni participants, as well as help to inform organisational recommendations to avoid patterns of organisational issues from continuing.

It is recommended that for any WhatsApp groups that are formed within cohorts, guidance is provided for how participants may or may not wish to engage.

Empowerment

At the end of the scheme most participants described a sense of inner strength, confidence, and control that has arisen from an increased belief in their abilities. They described how elements of the scheme have given them back their confidence to do things they would not have done before.

Note: quotes under this theme are from unique participants. No participant has been quoted twice.

Point to consider: the baseline interview revealed that speaking up has impacted almost all participants’ careers. Some participants were not offered training with limited explanation as to why, others chose to leave their profession in favour of feeling psychologically safe, and others had to leave the workplace completely. As a result, almost all fell behind on the continued professional development required to practice within their profession.

To further enhance the sense of empowerment, consideration should be given to ways in which participants can close the gap in their continued professional development caused through speaking up. This could be in the form of ring-fenced funding at a scheme level, or ideally at an organisational level.

The scheme enhances confidence and empowerment, but without the necessary continued professional development required to practice, their ability to move forward professionally is limited.

Mitigating the impact of speaking up

The scheme appears to have reduced the negative impact on individuals who have spoken up, even in cases where they have experienced personal or professional setbacks.

Baseline feedback identified that participants came onto the scheme feeling psychologically unsafe, despondent, ostracised, principled, having their careers and personal lives impacted upon.

Participants left the scheme with three clear themes, identified as validation, camaraderie and empowerment. These compared more positively than the baseline themes that participants came to the scheme with.

Application process

All those who applied to the scheme but were not offered a place (38 people) were sent an invite to complete a short survey on their experience of the application process. They were also offered the opportunity to attend a 1:1 semi-structured interview to follow up their survey with richer qualitative feedback.

• 18 out of 38 completed the survey.
• 5 out of 38 attended a 1:1 semi-structured interview.
• 9 out of 10 current participants were asked to share their experience of the application process in their end of scheme 1:1 semi-structured interview.

It is noted that scheme participants will likely have a more positive view of the application process as they were offered a place on the scheme.

Key findings/themes

• Clear criteria
• Risk of invalidating experience
• Managing expectations

The key findings and themes cover all aspects of the application process; from initially finding out about the scheme, the application form, the informal discussion (where applicable) and finding out about the outcome of their application.

Clear criteria

The eligibility criteria for the scheme was shared as part of the application process. Despite this, some felt unclear as to why some were chosen over others, particularly if they met the criteria outlined on the form. For some, this added to the feelings of disappointment and hopelessness that they have experienced having spoken up.   

Risk of invalidating experience

For many on the scheme, their experience of speaking up has spanned many years and is deeply complex. Whilst some were glad of the 150-word limit and found that it helped them summarise, most found it challenging and frustrating to reduce their experience into a restricted word count. Most people spent a lot of time carefully considering and summarising their experience to maximise their chance of being accepted onto the scheme, but they were unclear how their explanation of their experience would be judged or used in the decision-making process.

Those who speak up often experience feelings of isolation and loneliness. Participants describe how taking part in the scheme and meeting others in similar circumstances to them has helped to validate their experience and combat some of those negative feelings. On the flip side of this, those who do not get offered a place have their feelings of loneliness and hopelessness exacerbated by the perceived “rejection”, which for many feels like it was based on a 150-word restricted view of their experience.

Managing expectations

Most people were unaware that the number of applicants outstripped the number of places available on the scheme. In fact, several people were misinformed and led to believe that applicant numbers were low, and they were most likely going to gain a place on the scheme. This misinformation did not come from anyone directly involved in the scheme management, but rather from those within the organisation helping to raise awareness of the scheme (Freedom to Speak Up guardians and human resources). People felt that understanding this information could have helped to manage feelings of disappointment associated with not gaining a place.

Resources and signposting

When notified that they have not got a place on the scheme, applicants are directed to supporting our NHS people information on our website and are sent a copy of the health and wellbeing leaflet. Both the website and the leaflet outline free resources and support services that are available.

Speaking Up Support Scheme information on our website

When asked to rate how useful, accessible and easy to understand the Speaking Up Support Scheme information on our website was, applicants responded either in agreement with the statements, or they remained neutral. Some people did not access or use the website so were unable to comment.

Health and wellbeing leaflet

When asked if the health and wellbeing leaflet was useful, 35% of respondents agreed, 47% remained neutral and 12% disagreed. Some applicants did not remember the leaflet and others commented that they felt less positive or open to the information being shared as they were dealing with feelings of disappointment having not been accepted onto the scheme.

Additional support

Applicants who were not accepted onto the scheme had sought the support from the following places since speaking up:

• GP (with referrals to therapy)
• occupational health
• privately funded therapy.

Learning outcomes

The learning outcomes in this evaluation report are based on either direct participant feedback or from analysis of the insights and data gathered throughout the evaluation.

All stakeholders should carefully consider these learning outcomes and take the necessary actions to implement them. Priority should be given to learning for NHS organisations, to improve the experience of speaking up within the NHS.

From the feedback obtained learning outcomes have been grouped into four key areas:

• NHS organisations
• Scheme design
• Scheme onboarding
• Application

NHS organisations

The following organisation-wide learning outcomes are outlined below to help prevent the negative impact of speaking up. They are designed to create a discussion point for human resources and senior leaders. In some instances, further insights and data should be gathered to validate findings and support the right approach in each individual organisation.

1. Improve levels of psychological safety

Interventions to achieve this could include:

• Thorough behavioural assessment of managers and leaders entering into senior positions, with behavioural capability given significant weighting in the process.
• Bespoke leadership training in creating safe psychological spaces and surveys to include questions on psychological safety to capture ongoing feedback.
• Performance management to measure and reward those enabling psychologically safe cultures.
• All managers and leaders undertaking the National Guardian Office Freedom to Speak Up training.
• A greater alignment between human resources and the Freedom to Speak Up agenda, so that workers do not feel negatively impacted by their processes, style and behaviour.
• More early interventions such as mediation and listening circles, to ensure those who speak up feel listened to.

2. Better support from human resources (HR) for speaking up

When workers speak up, it is important that HR reinforce their position in the organisation as a facilitator and advocate of psychological safety.

• HR should ensure that the needs and interests of both employees and organisations are addressed and balanced. They should support leaders and managers in their duty to maintain a psychologically safe environment for employees.
• HR professionals should ensure they too are trained in creating psychological safe environments in the workplace and will benefit from the Freedom to Speak Up training provided by the National Guardian Office.

3. Clarity of the Freedom to Speak Up guardian role    

The role of Freedom to Speak Up guardians is pivotal in creating safer cultures within the NHS.

• Organisations should ensure that there is no conflict of interest between the guardian role and HR functions. In addition, there was a perception from participants that their Freedom to Speak Up guardians’ banding level inhibited influence required to drive change.
• Organisations should also ensure that their Freedom to Speak Up guardians are enabled with the autonomy and independence to fulfil their guardian role.

Scheme design

Participants’ overall feedback of the scheme was positive. Most of the feedback for improvement was relating to logistics, timings and content within the group sessions.

4. More 1:1 psychological wellbeing session

Many participants felt that the number of 1:1 psychological wellbeing support sessions left them wanting more.

This includes the 1:1 psychological wellbeing support sessions and the coaching sessions. Some had secured the funding via their organisation to add additional sessions onto the end of their agreed 6 sessions however, this was not an option for everyone on the scheme.

Those that added additional sessions onto their scheme funded sessions, found that 2 extra sessions were sufficient to reach a natural point of closure for the sessions.

It is recommended that additional budget is secured to ensure that those participants that would benefit from an additional 1 or 2 sessions are able to access this via the scheme, negating the need for them to go via their organisation or to self-fund.

5. Extend the gap between coaching sessions

Some participants questioned why the coaching sessions could not begin earlier in the scheme, as the later start meant that they had to “squeeze” their sessions into only a few months.

Many felt that this left them with limited time to action their learnings between sessions. It was generally agreed upon that increasing the spacing between sessions would be advantageous.

Whilst it is still recommended that the coaching sessions do not start before the 1:1 psychological wellbeing support sessions, there is an opportunity to extend the time of the scheme in future cohorts, to allow for longer gaps between coaching sessions. This will enable participants to make the most of the opportunity by engaging in their development actions between sessions.

6. Improve group session design and delivery

There is an opportunity to review the design and delivery of the group sessions, to ensure clarity of session and more flexibility.

• It is recommended that for future schemes, the group sessions are designed in a way that allows more interaction and participation from the group.
• It is also recommended that the purpose and content of the sessions are communicated up front, so participants know what to expect beforehand.

7. Improve group session and personal development workshop attendance

It is noted that the group elements of the scheme have lower engagement and attendance than the 1:1 element.

This is due to the limited flexibility of the group sessions when compared to the 1:1 sessions, rather than a reflection of participants’ enthusiasm for the sessions.

Some participants are not currently working, whereas other participants are working in extremely demanding jobs. Therefore, finding mutually convenient times for all participants to attend is challenging. It is recommended that all dates for the group sessions are agreed up front.

Whilst this was the case here, some participants found the way in which dates were communicated confusing.

Therefore, it is also recommended that the scheme administrators or individual providers put the diary invites into participants’ diaries to avoid confusion.

It is recommended that participants are given an option to attend an alternative session to avoid missing out. However, there is a trade-off to this, as group cohorts form close relationships with others on the cohort, therefore giving the option to attend sessions with mixed cohorts could compromise the psychological safety that is established within cohorts.

It is recommended that attending alternative sessions is only offered in exceptional circumstances.

Scheme onboarding

Scheme onboarding refers to the initial weeks prior to joining the scheme through to the first few days/weeks on the scheme.

8. Limit the need to re-tell experience

The initial days and weeks of the scheme saw participants re-telling their experience multiple times (during the application process, meeting with scheme providers and meeting with fellow participants). Whilst many participants were happy to talk about their experience of having spoken up, for some this was difficult and triggering.

It was suggested by one of the participants that recording their experience to be shared with providers and fellow team members may be a better way to manage this, however it should be noted that trust is low within the group, which could impact willingness to be recorded.

It is recommended that participants are asked their preferences for sharing their experiences prior to the scheme beginning, giving options for how much and in what way they would be happy and willing to share their experience.

9. Extend scheme induction

Participants felt that the scheme induction session was a great launch of the scheme. The scheme induction session included a session from a previous whistleblower within the NHS and many fed back how inspiring her story was.

This seemed to set the participants up well and give them hope that with time and support they truly can move forward (as the speaker had done).

It is recommended that this session forms a core part of future cohort inductions and is extended to include more speaking up advocates and carried out in person where possible.

Application

A number of relatively simple improvements can be made to the application process to address the key findings of the evaluation.

10. Review application questions

It is recommended that only questions that will aid decision making are asked on the application form.

Any question asked on the application form should have clear and measurable criteria that is communicated to applicants at the time they apply.

• It is recommended to remove the question that asks people to describe their experience of speaking up for a number of reasons:
  • It has no bearing on the outcome of the decision.
  • It is challenging for applicants to describe their experience in a word limited way.
  • It can result in people feeling their experience in somehow “not worthy” of a place on the scheme.

11. Introduce a waiting list

It was unfortunate that most applicants not offered a place on the scheme had actually met the criteria. They were not offered a place as a result of limited availability and not as a result of not meeting the eligibility criteria.

This was not always communicated to applicants and led to feelings of disappointment and hopelessness.

Introducing a waiting list as opposed to “rejecting” people will help to manage the negative feelings associated with not being offered a place on the current cohort. It also speeds up the onboarding of cohorts with participants ready-and-waiting to join.

12. Clear communications to applicants

Be clear in your communications that places on the scheme are limited and ensure that local human resources teams and Freedom to Speak Up guardians are aware of this when recommending the scheme to their staff. This will help to manage expectations and avoid disappointment.

If numbers are manageable, it is recommended that those not offered a place on the scheme are informed by telephone. This is in recognition of the sensitive nature of the scheme and the vulnerability of applicants. It will allow for the scheme management team to better judge the need for signposting and to add context and nuance to the reasons.

Acknowledgements

The completion of this scheme and subsequent evaluation report was made possible by the contributions and hard work of the various individuals and organisations.

Special thanks are given to our ten scheme participants. They have demonstrated the utmost integrity in speaking up in difficult circumstances; bravery in telling their stories and resilience in embracing this scheme.

Contact

Author: Jessica Hornsby, Independent Organisational Psychologist.
Email: Jess@equalital.com

Report commissioned by NHS England’s Advocacy and Learning People directorate.

Publication reference: PRN00542