Freedom to Speak Up reports hit record high with nurses submitting most

Dr Jayne Chidgey-Clark, National Guardian for the NHS in England, made the comments as the scheme released its figures for workplace reporting for 2022-23.

"No one should be punished for doing the right thing"

Jayne Chidgey-Clark

A total of 25,382 reports were raised with local Freedom to Speak Up Guardians between 1 April 2022 and 31 March 2023 – a 25% increase from 2021-22 and the highest ever.

Of these cases, the most common report was of inappropriate behaviours and attitudes (30%), followed by worker safety and wellbeing (27%), and bullying and harassment (22%).

Nurses and midwives submitted the highest proportion of reports to guardians, making up 29% of them.

Of those who provided feedback on the handling of their case, 83% told the National Guardian Office they would speak up again if they had a future complaint, having gone through the process.

Dr Chidgey-Clark, a registered nurse, said an increase in reports, and the high percentage of people feeling like the process worked, was reassuring.

“Freedom to Speak Up guardians supported over 25,000 cases – that is 25,000 opportunities for learning and improvement which otherwise may not have been heard,” Dr Chidgey-Clark said, in a foreword to the report.

“I am proud of the work which guardians do, and that they provide a trusted channel for healthcare workers to speak up to.

“But I am also thoughtful regarding this increase, which while showing trust in the Freedom to Speak Up Guardian role, can be seen as an indication that workers do not always have confidence in other routes to speaking up.”

She explained it is difficult to judge whether a high, or low, number of cases is a good thing: a high number could mean either a culture of speaking up, or that there are a lot of problems, whereas a low number could suggest that workers are happy with what they see, or that there is a culture of suppression.

A higher number, Dr Chidgey-Clark said, could also mean staff do not trust other escalation procedures in their workplace.

Of the reports submitted to Freedom to Speak Up Guardians in 2022-23, 3.9% of complainants reported experiencing detriment as a result.

This was a decrease from 2021-22, when it was 4.3%, but an increase from 2019-20 and 2020-21 levels.

Dr Chidgey-Clark said she was “disappointed” that detriment still continued, even if it had declined once more.

“I am encouraged that Freedom to Speak Up Guardians are available to support those people, and are felt to be an increasingly trusted route,” she added.

“But I am disappointed that detriment continues. No one should be punished for doing the right thing.

“When people speak up it is because they want things to improve – whether that is for the safety and quality of care for patients and their families or the working environment for colleagues.”

Dr Chidgey-Clark said, however, that a continuing decrease in the number of people submitting reports anonymously was encouraging: “Levels of anonymity are to me an indicator of confidence in the Guardian route for speaking up.

“The proportion of cases raised anonymously continues to fall – down to 9.3% from 17.7% when we first started collecting data in 2017.

“People do not reveal their identity – even to a Guardian - when they are too fearful of the potential consequences of speaking up.

“The continued high-profile cases reported in the media continue this chilling effect that speaking up is not safe.

"Add that to feelings that speaking up is futile, and this will silence workers who may feel that speaking up is not worth the risk if nothing will be done if they do.”