NHS Wales' "Speaking Up" policy - is a culture change possible?

Welcome news came out of the Welsh Government yesterday (20th September 2023) with the publication of its “Speaking Up Safely for NHS Wales Policy”.

The document was developed in social partnership with trade unions and NHS Wales employees to enhance existing procedures to ensure a consistent approach across Wales. Particularly so in relation to assurances given to staff that concerns would be taken seriously, heard fairly and not result in personal repercussions.

It would appear that the publication was brought forward in light of the concerns raised following the conviction of Lucy Letby recently. The document itself seeks to set about to create a significant culture change in which speaking up is supported within a safe environment with everyone knowing how to raise a concern and the process which will follow.

Speaking in the Senedd, the Minister for Health & Social Services Eluned Morgan said:

“Recent events have been a stark reminder of how vital it is that everyone working in the NHS feels safe and confident to speak up about anything that gets in the way of delivering safe, high quality care. Speaking up and bringing issues and concerns into the open is a brave and vulnerable thing to do and NHS Managers must be willing to listen, deal with concerns appropriately and be open to constructive challenge. I am committed to creating the culture where Speaking Up is welcomed and seen as an opportunity to listen, learn and improve”.

She continued to tell the Senedd that all Welsh Health Boards had been written to and were being reminded of their duty of candour. Whilst commendable, this Policy, in my opinion is a massive undertaking. The patient safety charity AVMA (Action against Medical Accidents) have campaigned for years and years for a statutory legal duty of candour to be open and honest when things go wrong in healthcare. This has been successful in certain areas of health care but not universally.

This is going to require significant effort on behalf of those involved in NHS care delivery both clinicians and managers to create a safe environment of trust for people to speak out in relation to concerns over treatment. If it can be achieved, it will not be an overnight success and is likely to take a long period of time to bed in, and be implemented. Changing mindsets and changing cultures is a significant undertaking in any organisation, but more so in the NHS given its size and previous/current culture of not being forthcoming when things go wrong. There will be many, myself included, who have doubts as to whether this can be achieved.

The last number of years have seen a number of independent enquiries in relation to healthcare (Shrewsbury and Telford, Cwm Taf). The latest of these (underway presently) is a review of maternity services at Nottingham University Hospitals NHS Trust (NUH) by Donna Ockenden. The Chairman of NUH accepted in July that a brick wall approach must change and a “new relationship built on transparency and trust is needed”.

It remains to be seen whether the mindset and culture change proposed by the Welsh Government can be delivered. For public confidence to be restored, truth, candour and honesty must be at its core. It is a formidable challenge on any interpretation.

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