Axing NHS agencies could undermine ‘speaking up’ culture

Ministers announced over the weekend that 201 organisations will be scrapped, including the National Guardian’s Office and the Health Services Safety Investigations Body (HSSIB).

It comes as part of the 10-Year Health Plan for the NHS, which is due to be published in full later this week.

The National Guardian’s Office was created in 2015 and leads a network of Freedom to Speak Up (FTSU) guardians, who work across NHS trusts in England where they support nurses to raise concerns.

Meanwhile, the HSSIB was the first organisation in the world to be set up as an independent investigator of patient safety incidents. It recently led a series of investigations into mental health inpatient services across England.

According to the BBC, ministers had raised concerns that there were more than 150 bodies responsible for regulating or assessing healthcare services in England.

Health and social care secretary Wes Streeting said: “Over the past decade and a half, an overly complex system of healthcare regulation and oversight has been left to spiral out of control.

“So many of the problems in the NHS come down to a failure to listen to patients. The changes we are making will hold a megaphone up to patients’ lips and force the service to listen to their feedback.”

Responding to the plans, Helené Donnelly, nurse and head of safety culture at Nuffield Health, told Nursing Times that scrapping organisations like the National Guardian’s Office was “concerning although not wholly unexpected”.

She said: “The concerning element is the possible perception that the ethos of ‘Freedom to Speak Up’ is no longer seen as an important priority for the NHS going forwards.

“The role of the FTSU guardian has been very successful and has assisted in promoting psychologically safe environments for people to speak up and ultimately protect and improve patient safety.

“However, I do agree that reform and wider improvements are needed with regard to how the guardian roles continue to evolve and, crucially, have impact,” she added.

Ms Donnelly previously worked at the former Mid Staffordshire NHS Foundation Trust, where she repeatedly raised concerns about standards of care in A&E.

Helené Donnelly

She went on to be a key witness to the subsequent public inquiry into the trust held by Sir Robert Francis KC.

Ms Donnelly pioneered the role of ambassador for cultural change and the concept of a FTSU guardian – a role created in 2016 in response to a report on speaking out by Sir Robert.

There are now more than 1,200 FTSU guardians working in the NHS and beyond, to ensure workers can speak openly about issues impacting their ability to do their job.

Ms Donelly noted that, while many individual guardians and organisations had “excelled and gone above and beyond to embed the role” in promoting safe cultures, this had not been the case everywhere.

“Some guardians have been appointed to the role for entirely the wrong reasons and some organisations have simply paid lip service to it,” she said.

“It is my belief that we now have an opportunity to refresh and reset the guardian roles, strengthening their ability, responsibility and influence.

“This will still require oversight, steer and accountability from either the [Department of Health and Social Care] or [Care Quality Commission], but this needs to be far more effective and efficient.

“This is essential in order to give people confidence that ‘speaking up’ to improve patient safety and experiences is always the right thing to do,” she told Nursing Times.

Nicola Ranger

Meanwhile, Royal College of Nursing general secretary and chief executive, Professor Nicola Ranger described the move as “high-stakes”.

She said: “Today, in hospitals across the NHS, we know one nurse can be left caring for 10, 15 or more patients at a time. It’s not safe. It’s not effective. And it’s not acceptable.”

“For these proposed changes to be effective government must take ownership of the real issue, the staffing crisis on our wards, and not just shuffle people into new roles.

“Protecting patients has to be the priority and not just a drive for efficiency,” she added.

Also responding to the announcement, Matthew Taylor, chief executive of the NHS Confederation, said he welcomed “any opportunity to reduce duplication” across the health service.

However, he added: “NHS leaders would encourage the government to not forget the failings in care that led to these bodies being set up in the first place and tread carefully so as to ensure their vital missions continue in future.

“Staff and patients will still need safe spaces where they can speak up,” said Mr Taylor.

The decision to abolish hundreds of agencies follows the announcement earlier this year that NHS England would also be scrapped, with responsibility for the health service brought back into central government.