NHS “Speak up Month” October 2018

30 October 2018

Within the NHS October is “speak up month”.  This is an initiative of  the National Guardian’s Office which is an independent non-statutory body charged with the task of leading culture change in the NHS so that speaking up becomes “business as usual”.  Importantly the National Guardian’s Office is not a regulator but it has close links with the Care Quality Commission, NHS England and NHS Improvement.  In the National Guardian’s “Guidance to boards on freedom to speak up in the NHS Trust and NHS Foundation Trusts” published in May 2018 the introduction states “Effective speaking up arrangements help to protect patients and improve the experience of NHS workers.  Having a healthy speaking up culture is an indicator of a well led trust”.


As one who has long campaigned around issues such as a duty of candour and protection of whistle-blowers and commented on the negative impact of dysfunctional relationships within the NHS  I think that the National Guardian’s Office campaign can be a highly effective driver of cultural change and improvements in patient safety.

Each Trust appoints a Freedom to Speak Up “Guardian” who will support staff in speaking up.  From my perspective (as a lawyer who represents patients who have suffered harm as a result of substandard treatment) the most important role of the Guardian is prevention of situations developing where patient safety is compromised.

I was lucky to be invited to attend a pan sector day run by the National Guardian and hosted at Sandhurst.  The participants learned about unethical behaviour and what can drive people to obey orders against their better judgment.  We were taken through an ethical leadership exercise with no apparent “right” answer and we learned about both bystander apathy and bystander intervention. I went away thinking that there was much that all sectors could learn from encouraging the freedom to speak up in their organisations. The Guardians really can be champions of change if they are afforded by the organisations leaders the voice, dignity and respect that the role deserves. 

I also attended a Guardians’ training day and learned first-hand the issues and complex dynamics faced every day by Guardians in Trusts up and down the country. I saw that they have a unique opportunity to create an environment of Trust and are working hard to achieve that.

I do wonder whether one piece of the jigsaw that is missing is the direct route to the patient voice - I appreciate that the PALS (Patient Advice and Liaison Service) may have access to the Guardians but I question whether this is known by the public and used by the PALS? Patients often hold information which could be crucial to understanding a situation. Attention paid to a cluster of early warnings from patients could prevent a catastrophe developing.

So, food for thought for the next phase: whether patients should also have a formal mechanism for speaking to Trust Guardians if they have concerns?

In the meantime congratulations to the Guardians for the work done so far.

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