Organisation objective

• Governance

Executive summary

This paper provides the annual report on internal Freedom to Speak Up (FTSU). It recognises the vital work of our FTSU guardians who support our staff to speak up and sets out the key themes from the cases raised by our staff this year.

Action required

The Board is asked to discuss the report and note next steps, and to thank NHS England’s FTSU guardians for their hard work.

Background

1. The NHS Executive received a mid-year update in October 2023, which shared information on casework themes and developments to establish a single FTSU service. Actions from the discussion included:

• clarity on what executive directors can reasonably expect from a FTSU guardian in terms of amount of information they can share (this will vary depending on each case and consent in place), and clarity on the different roles and responsibilities of those involved in the FTSU process (the second part is covered on the new FTSU pages on NHS England’s intranet)
• putting in place the ability for the FTSU guardians to get to know the executive directors (this is in-hand)

2. Professor Sir Stephen Powis has recently been appointed as Senior Responsible (SRO) for FTSU, taking over from Richard Barker. Non-executive board oversight remains with Sir Andrew Morris, but thought is being given to who takes over the non-executive portfolio ahead of Sir Andrew’s departure in March 2025. The new internal FTSU Team is hosted by the Delivery Directorate.

Assessment of issues, including themes and trends

Summary of developments in 2023/24

3. The three legacy organisations (NHS England, NHS Digital and Health Education England) had their own FTSU arrangements which were maintained following the legal merger to give continuity to staff while we designed new, unified FTSU arrangements for the new NHS England. These arrangements aimed to take the best parts of the legacy arrangements and use the learning from their experiences. As part of the organisational redesign, a team dedicated to internal FTSU was created, and has been in place since January 2024. The unified service launched in June 2024.

4. In establishing a unified service, we gave existing Guardians from the legacy organisations the option to remain as a Guardian for the unified service, being clear on expectations for the Guardian role, which varied to different extents from the legacy organisations. This resulted in a number of Guardians stepping down from the role either in light of these expectations and/or taking on new roles in the restructure. The cohort of 30 Guardians for the unified service has significant diversity according to our latest ESR data:

• 66% female and 34% male
• 30% white and 57% BME
• 10% disabled and 80% non-disabled

5. NB: this data is extracted from ESR and any gaps in percentages adding up to 100% are made up of ‘other’ or ‘unknown’. Capacity of Guardians (in terms of caseload) is being carefully monitored, and we plan to recruit more Guardians in October 2024.

6. The unified service, and strategy, are based on engagement and feedback from Guardians, staff networks, trade unions and HR, as well as reflections from experiences of staff speaking up to-date.

7. The FTSU Strategy was shared with the People & Remuneration Committee in November 2023, which has a vision that:

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.

It has five pillars:

• improving awareness and understanding of FTSU
• providing support for our Guardians
• 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

8. The new FTSU service, features provision for completely anonymous reporting, better thematic and performance data, more information about how FTSU works on the intranet, including how the role of Guardians is different from the role of Human Resources. The effectiveness of the new service will be reviewed at the end of the financial year.

Themes and trends

Cases received in 2023/24

9. We received a slightly lower number of cases this year compared to the 208 cases in 2022/23. With the organisational change programme taking place, an increase in cases had been anticipated. A lower number does not mean that staff have less concerns than last year.

10. Indeed, NHS England’s latest staff survey results make clear that they experience barriers to speaking up, with only 53% of staff feeling safe to speak up about anything that concerns them (national average across NHS is 62%), and, if they did speak up, only 36% think that the organisation will do something about it (national average across the NHS is 50%).

11. We expect that the unified FTSU service will help to address some of the barriers staff face, and we will use this question in future years to help measure its effectiveness, recognising that factors beyond the control of the FTSU service influence this result too. The highest scoring NHS trusts in the staff survey scored 79% and 74% respectively for this question, and we will look to see what we can learn from them.

12. The strongest themes raised in 2023/24 relate to:

• bullying and harassment, by line managers, senior leaders and within teams
• cultural Leadership, including lack of empowerment and lack of collaboration
• adherence to HR Policies, including recruitment practices
• worker Safety or Wellbeing
• misuse of NHS money

13. Last year we said it was critical to address these (largely recurrent) themes (and the root causes of them) as we build the new NHS England. This is particularly critical because bullying and harassment account for more than 40% of our live caseload. Therefore, the recent opportunity for FTSU to substantively contribute to our forthcoming People Plan and the new leadership development programme for our staff has been welcome. There remains a need to: ensure that FTSU fits into our corporate orientation/induction; and see a clear and overt connection between the learning from the Michelle Cox case and the cultural development of the new NHS England. The way the hybrid working policy was communicated was felt to be particularly damaging to staff confidence in the leadership being interested in listening to staff.

14. Guardians continue to raise concerns about, and make constructive offers of support to help address, poor staff experience of our grievance process. There also remain frustrations in some cases of significant delays in progressing grievances (recognising the complexity of some of these cases). Therefore, it is vital that the new Employee Relations Team is sufficiently resourced to deliver improvements at pace. That includes the development of a suitably independent mediation service and a resolution framework so that there is a greater emphasis on building and repairing relationships, and a reducing need to use formal processes.

15. Guardians have continued to have the opportunity to raise thematic concerns with Chief Executive, Amanda Pritchard, and with our non-executive directors.

Improvements from FTSU cases in 2023/24

16. Regular liaison between FTSU and senior leaders in HR & OD has been ongoing to provide an escalation route for our most complex and/or long-running cases. This has also enabled some qualitative triangulation of FTSU and HR concerns on a case-by-case basis. A forum for periodic engagement between all Guardians and HR BPs has been established. This fully respects the independence of FTSU, and provides an opportunity to establish effective working relationships, clarifying roles and responsibilities and discussing themes.

17. As a result of concerns raised about lack of support for individual members of staff being targeted in the press and on social media, work has been done to bolster support for staff (in terms of health and wellbeing, and personal security), guidance for line managers and improved liaison with our Communications Team.

18. As above, themes from FTSU have begun to feed into the specifics of the leadership development programme.

19. Learning and improvement is the 5th pillar of our FTSU strategy and it will take time to develop a systematic approach to this, and will be a significant focus for the next 18 months.

Next steps

17. The next six months will be focused on:

• establishing a more systematic approach for addressing (and preventing) detriment that is sometimes reported when staff speak up
• regular communications about FTSU following service launch
• working with EDI Team and establishing ways of working with staff networks (once they are settled)
• rolling out training and development programme for Guardians
• recruitment of more Guardians
• starting to build a systematic approach to capturing and sharing learning and improvement that results from speaking up

Publication reference:  Public Board paper (BM/24/32(Pu))