Since the appointment of Jenny Michael as Freedom to Speak Up Guardian in 2018, Portsmouth Hospitals NHS Trust has seen a significant increase in speaking up. An extensive media campaign, which was launched after Jenny’s appointment, has promoted the Freedom to Speak Up message and encouraged workers to raise concerns.
PHT first appointed a Freedom to Speak Up Guardian in October 2016 but decided to raise more awareness when Jenny assumed the role. With the help of the Communications team, PHT launched its own web page, information board and made sure Freedom to Speak Up featured during induction for new starters and refresher training for existing workers. 20 Freedom to Speak Up champions joined the team, including some representing BAME and LGBT groups.
Speaking up is encouraged in many forms at PHT. Jenny has a dedicated email for her Freedom to Speak Up responsibilities and a confidential reporting portal has been created on DATIX. This allows workers to anonymously report a concern if they feel unable to do so in-person.
This added media effort has yielded visible results at PHT. In the previous 15 months before Jenny’s appointment, there were only 23 cases of speaking up. But in the year following her appointment as a guardian, Jenny handled 101 cases. The increase reflects the fact that more PHT workers have become aware of Freedom to Speak Up since Jenny’s appointment.
Recently, the Freedom to Speak Up Guardian was contacted by a nurse, who was facing challenges in trying to raise concerns about a clinical process. The individual encountered several problems, including feeling subjected to undermining and detrimental behaviour from both peers and seniors within the department. This culture left the nurse feeling alone, isolated and not listened to.
The nurse had given up until PHT’s relaunch of Freedom to Speak Up, offering them a chance to revisit these concerns. The individual made contact with the Freedom to Speak Up Guardian who was able to escalate these concerns.
After initially meeting to capture the concerns, Jenny offered ongoing emotional support for the nurse through regular meetings. She signposted the problems to internal well-being support and the nature of the concerns led to an internal clinical audit and a review of current practice.
The results of the audit were shared amongst a multidisciplinary team and measures were put in place to ensure processes and team working were improved. The trust board were actively involved to ensure that the audit took place in a timely fashion and improved working relationships have since been reported. The nurse was invited to a subsequent board meeting to share the speaking up journey, which was well-received.
After this situation was resolved, the nurse said: “Before now, I had little confidence that my concerns would be listened to. The guardian gave me the courage to speak up and supported me through the journey. I have seen some really positive changes in culture and working practices since raising my concerns.”
PHT has seen an increase in the number of workers willing to use the Freedom to Speak Up route with the Care Quality Commission commending their “no blame” culture in a report following an inspection. CQC also commented that workers generally felt confident to raise a concern and that action would be taken.
Jenny continues to offer support and guidance in her guardian role and has found that employment issues are a common theme. She has worked hard to campaign for flexible working, as well as working with the retention workforce group and catching workers early before they leave.
Jenny said: “I really enjoy being a part of ongoing culture change across the organisation and I have seen a significant improvement since I have been in post. Working alongside me are 20 Freedom to Speak Up Advocates who hold a variety of roles and grades. They have been a pivotal part in encouraging staff to raise concerns within their working environments.
“Since being in post around 200 members of staff have sought advice through the Freedom to Speak Up team. All our staff across the trust receive guidance on raising concerns at induction and as part of their essential update training. By providing encouragement to staff and support for managers we are finding that staff are feeling more able to raise concerns at a line manager level and that these concerns are being managed effectively.”
Jenny’s work with the Communications team at PHT is a shining example of how promoting Freedom to Speak Up can help a trust on their journey to make speaking up business as usual.