Freedom to Speak Up and the role of leadership

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Today’s publishing of Sir Robert Francis’ Freedom to Speak Up review has once again confirmed the importance of good leadership in creating the right climate, tone and culture where staff can thrive and patients and service users can receive the care and compassion they deserve.

As we have stated in the official response, when Francis’ report into the failings at Mid-Staffs was first published two years ago, the Academy was just about to launch our series of professional development programmes – and though we now have over 31,000 people on their journeys with us, it is clear we still have a long way to go.

Hearing that we have staff in the NHS who feel scared to speak out against failings, tells me that to truly bring about culture change, we need visible leaders in the health service for whom the values of the NHS are central to how they lead. Leaders, at all levels, who create a culture of openness, candour and compassion – with the patient or service user at the centre. And to achieve this, the importance of well evidenced and delivered leadership development cannot be stressed enough.

Supporting people to achieve the self-awareness needed to be strong, open and accountable leaders is a major part of our leadership interventions. Something which is vital if we are to achieve a culture of reflective practice of honest conversations and feedback – as Francis recommends.

As reinforced today, staff who are not supported, “can suffer greatly” – ultimately having a negative impact on our patients. We therefore need leaders, at all levels, to work towards eliminating this culture of fear that has previously allowed failings to happen. We need leaders who are able to engage and empower those around them. Leaders who develop methods of open communication and learning.

There are some fantastic leaders already working throughout the NHS and we need to embrace their passion, commitment and expertise – supporting them to thrive as in return, staff who feel fully engaged are much more likely to go the extra mile, with a greater loyalty and commitment to their purpose; patient care.

In order to create this engaged and positive culture where poor leadership is openly challenged and improved – and the potentially more vulnerable members of our community are included and developed, leaders need to first be empowered themselves – and this is exactly what, through our programmes and interventions, we aim to achieve.

To truly develop a culture where staff can thrive, rules can be followed to achieve the desired outcomes across all of health and care, we need everyone to be involved and supportive of the difference that great leadership can make. It should be central to the ethos of everyone who works within health and care – to truly provide a supportive, positive and inclusive health service for all.

Personally, I know we are committed to driving this change. Are you?

5 thoughts on “Freedom to Speak Up and the role of leadership

  1. Dear Jan,

    I agree wholeheartedly with the principle of your blog.
    The third paragraph I think is of crucial importance. Putting thousands of NHS staff from ‘all levels’ through leadership development is great, but I suspect the effect might be greater if every member of a Trust executive team went through such development. Culture change needs a commitment to living acceptable values openly and honestly and demonstrating them clearly at tHe top of the organisation.

    I would be interested to know how many members of executive teams have had individual development recently, perhaps within the past two years?

  2. I am really pleased to read Jan’s confidence on NHS leadership. In fact NHS does have some good leaders and if not NHS would not have been one of the best healthcare in the Western world.

    But it is also true that each year 20,000 patients die and 55,000 patients suffer more than six months due to medical errors and nearly 85% of these errors are due to systems failures.

    Robert Francis has clearly identified the bullying culture and its impact on patient safety, staff well-being and NHS as a whole. In a kind, caring and compassionate NHS there is absolutely no role for bullying, victimisation and discrimination.

    But Roger Kline’s article clearly suggests that NHS top leadership is not diverse. BME staff are 3 times more likely to be bullied, harassed, victimised and sadly not supported with their career progression and due to club culture and old boys network many poor leaders are appointed in the NHS. Because of these patients, staff and NHS suffers. Many of these tragedies are preventable.

    I sincerely hope NHS will appoint value based leaders who uphold the values of NHS and protect patients and staff. In such a culture diversity reflects leadership. NHS Leadership Academy must lead from the front and lead by example and make sure that there are diverse leadership in the academy and all leaders must be trained in the importance of value based leadership and we must hold NHS leaders to account. If not many patients, staff and NHS will suffer.

  3. Thank you both for your comments. I do believe in the importance of leadership development at every level and though, like you’ve mentioned June, leadership development for executive teams is important, I don’t think that this alone is enough. We have existing, popular offers for executive level leaders, such as our Top Leaders programme and are in the process of developing support programmes and offers for some of the most senior leaders in the system but to really change culture, leaders at all levels should be supported and developed – for themselves, their own team and patients and also for the development of the senior leaders of the future.

    Other national bodies such as the CQC, through their ‘well-led’ domain, supported by Monitor and the Trust Development Authority, focus on the most senior leadership positions within organisations – and while we have only a small core team at the Academy, we aim to support a more professional approach to leadership development – for staff at all levels and from all backgrounds, which as you raise Umesh, is also extremely important in creating culture change – with 23% of our own senior team members being from a black and minority ethnic background themselves.

  4. I was seen in emergency back in Feb 2014 …the hospital consultant at Whipps Cross stated that I need to be under his care (Dr Flood)…since then 17 months… one appointment after another has been cancelled…I have yet to be seen….I suggest leadership looks into the appointment process and if I may I would introduce some logic so that the system flags up an individual you have cancelled/ rescheduled appointments for 17 months….