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Leap in staff scared to report safety concerns

Published on: 9 Mar 2023

NHS staff are significantly less comfortable raising concerns and are less confident in their organisation to address them, the service’s annual staff survey has revealed.

The 2022 results, published today with a response rate of 46 per cent, showed a decline on all measures relating to raising concerns about clinical safety and speaking up more generally, with the greatest deterioration seen in the percentage of staff who would feel secure raising concerns about unsafe clinical practice.

The percentage of staff feeling secure in raising concerns about clinical safety dropped from 75 per cent in last year’s survey to 71.9 per cent this year – a level not seen since before the pandemic in 2019. Up until this year, agreement with this statement had been steadily rising.

This decline was apparent across all trust types (see chart left), but the biggest drop was reported by ambulance trust staff, falling from 70.3 per cent last year to 65.2 per cent in the latest survey. Staff working at community trusts are the most likely to feel secure raising concerns about clinical practice, with almost 81 per cent agreeing with the question.

This year’s survey also saw a small decline in staff agreeing they felt safe speaking up about anything that concerns them (62.1 per cent agreed with this last year, dropping to 61.5 per cent this year). Only 48.7 per cent of respondents agreed they were confident their organisation would address their concerns.

Nurses and midwives are the staff group most likely to feel secure raising concerns about unsafe clinical practice, at 78.2 per cent, but this has also dropped from 80 per cent last year.

Helen Hughes, chief executive of charity Patient Safety Learning, warned an “alarmingly high” number of staff could not say they felt safe raising concerns.

Ms Hughes continued: “If we are to effectively learn from and prevent future incidents of avoidable harm, staff need to feel safe to raise and discuss patient safety incidents.

“This year’s staff survey results are a clear indication that too often this is still not the case. This is reinforced by the experiences and testimonies of many whistleblowers and the findings of numerous inquiries into major patient safety scandals.”

She added there were a lack of “tangible measures” in place to create a safety culture where staff feel safe to speak up and called for “more resources to support improvement and evaluate their impact”.

New patient safety questions 

For the first time since 2020, this year’s staff survey included questions specifically relating to patient safety.

The results revealed, on average, 35.5 per cent of staff had seen errors, near misses or incidents over the last month that could have hurt staff or patients. Of all trust types, ambulance trusts were the most likely to report they had seen incidents, with more than 40 per cent of respondents agreeing to the question. For community trusts, around a quarter of staff reported they had seen errors, near misses and incidents over the last month.

Staff broadly agreed their organisation encouraged them to report incidents, with eight in 10 staff members across all trusts agreeing with this.

However, just 58.1 per cent of staff agreed their organisation treated staff who were involved in an incident fairly, with fewer than half of all ambulance trust staff agreeing with this (see chart left).

Although the Picker Institute – the organisation which runs the staff survey for the NHS – said this year’s patient safety questions could not be compared to 2020, because of “changes to the questions”, in 2020 over 60 per cent staff agreed staff were treated fairly.

There was also variation according to trust type in the percentage of staff agreeing their organisations “takes action” when errors and incidents are reported, with around half of ambulance trust staff and over three-quarters of community trust staff agreeing with this.