Engagement across the country revealed that there might be issues among BME staff to use the existing system, such as the Freedom to Speak Up Guardian service. The People Plan highlighted that BME staff must have confidence in the system for this to be effective.
The Francis report indicates that this is not new to the NHS and that this is an institutional problem that affects every staff member. The inquiry also highlighted the additional barriers for vulnerable groups, including BME staff, when raising bullying, harassment, or discrimination. The reality is that the NHS actively discourages people from speaking up and tries to ignore those that do. In the worst cases, this has led to job losses, mental health problems or suicide. Ironically, the perpetrators have often been protected or even promoted. There has been a lack of awareness by an organisation’s leadership about the scale or existence of this problem, which is well known amongst frontline staff.
It was also clear from the evidence that there are some groups who, for different reasons, are particularly vulnerable, including locums and agency staff, students and trainees, BME groups and staff working in primary care.
These issues have a significant impact on patients care and outcomes, as evidenced in the report.
By March 2021, NHS England and NHS Improvement will launch a joint training programme for Freedom to Speak Up Guardians and WRES Experts. We are also recruiting more BME staff to Freedom to Speak Up Guardian roles, in line with the composition of our workforce. But if the reasons for the lack of confidence in the current system by staff, including BME staff, are not explored, it will have a limited impact.
Recommendations to removing barriers to help staff speak up
These recommendations are for short term goals for 3-6 months (S), medium term goals for 6-12 months (M) and long term goals for 12 months (L).
- All organisations need to assess the current level of trust that staff have in speaking up, which should include how much confidence staff have that concerns they raise will be addressed appropriately. (M)
- Organisations need to ensure those dealing with concerns raised have adequate training to respond sensitively to those that speak out. (M)
- Each STP/ICS should explore options that will allow staff to report concerns anonymously when they feel their organisation has not addressed their concerns appropriately. (M)
- For example, the system could set up independent external Freedom to Speak Up Guardians. (M)
- All organisations need to ensure that ‘Freedom to Speak Up guardians’ (FTSU) report directly to the board (to maintain independence). The CEO must be accountable for any action/inaction in response. (S)
- All FTSU need to work closely with ED&I Leads and staff network leads (whilst maintaining confidentiality) to identify patterns of bullying, harassment and discrimination concerning specific protected characteristics. (S)
- Each STP/ICS needs to identify patterns of bullying and harassment, discrimination and or exclusion in organisations and investigate them. (S)
- Organisations to demonstrate a high level of transparency in dealing with incidents and how they have dealt with perpetrators and hold them to account (i.e. how many people have been on training, re-educated, disciplined, promoted). (M)
- Organisations need to consider historical evidence of bullying, harassment and discrimination when applying for any senior post, including director level in an NHS organisation. (S)
- Employers need to demonstrate that staff have open access to senior leaders to discuss concerns when they feel this has not been dealt with appropriately. (S)