The behaviour of senior leaders and unfair recruitment practices were the most common concerns expressed by NHS England and Improvement staff who raised issues with the organisation’s freedom to speak up guardians.
An NHSE/I board meeting last week heard the number of issues raised with FTSU guardians had increased but remained “low”.
There were 56 reports made in 2020-21 and 17 in quarter one of this year, according to the report giving an update on the guardians’ work.
NHSE/I, which has around 5,000 staff, started work to improve its FTSU process early last year, and in the past 18 months has increased the number of FTSU guardians from 17 to 42.
The board paper said: “The two strongest themes of the concerns raised in [2020-21] related to: recruitment practices (particularly fairness of process and inclusiveness) and conduct of senior leaders.”
The report said there were important lessons to be gained from its findings, and revealed some action had already been taken.
On recruitment practices, the report said: “significant changes have been made in response to feedback from FTSU and other channels”, including the creation of a new system for internal recruitment, and improving online job adverts. The process for early termination of fixed term appointments has also been tightened.
The report stated that improving “leadership and management behaviours” was “vital in developing the culture within the organisation and sustaining openness”.
It also revealed that NHSE was “improving awareness and management of conflicts of interest and use of consultants: [and that] additional training is being introduced in some areas, along with internal audit activity, to identify any further improvements”.
NHSE/I have both faced claims of poor staff culture and engagement over several years, although Thursday’s meeting was told that the latest staff survey — which has not been published — had shown improvement.
Nicholas Hodgetts, one of NHSE’ FTSU guardians, told the board it had “been a thrilling year in terms of the progress of the freedom to speak up movement” in the organisation.
He said: “The fact more people are speaking up is a good thing…but it would be great in an ideal world if people feel safe enough to speak up and know that they can do that whilst identifying themselves and knowing that we can take those things towards a successful conclusion without that kind of the fear of negative repercussions.”
He said there had been support from senior directors over the past 12-18 months, and said: “Even though some of the conversations we have are difficult and even though some of the cases we end up getting involved in which might involve senior levels might meet with difficult conversations, and on occasions resistance, the fact that the conversations are happening in the first place is seen as a major step forward and is seen as a positive that culture change is starting.”
Mr Hodgetts and board members including regional director Ann Radmore, non-executive Sir Andrew Morris, and chief people officer Prerana Issar, all indicated they thought there been progress in improving staff culture over the past year, but that problems remained.
Ms Radmore said there was “a lot more to do” and that the ultimate aim should be to move to an “adult to adult relationship” with staff, in which “people can have those difficult conversations”.
Sir Andrew said: “When I compare it with where we were three years ago, boy have we moved on… [But] I think there is more work to be done. Hopefully we will see [improvements] cascade down through the structure.”