Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England: The FTSUG mixed-methods study

Aled Jones; Jill Maben; Mary Adams; Russell Mannion; Carys Banks; Joanne Blake; Kathleen Job; Daniel Kelly

doi:10.3310/GUWS9067

Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England: The FTSUG mixed-methods study

Aled Jones^*, Jill Maben, Mary Adams, Russell Mannion, Carys Banks, Joanne Blake, Kathleen Job, Daniel Kelly

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

9 Citations (Scopus)

Abstract

Background: The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives: The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. Design: The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking up’ by health-care employees; (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts; and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Setting: Acute trusts and mental health NHS trusts in England. Participants: Work package 2: Freedom to Speak Up Guardians (n = 87) were interviewed.Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Results: Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture.

Original language	English
Journal	Health and Social Care Delivery Research
Volume	10
Issue number	23
DOIs	https://doi.org/10.3310/GUWS9067
Publication status	Published - 2022

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10.3310/GUWS9067

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@article{4af5290cc24b4630bda6d13764480d60,

title = "Implementation of {\textquoteleft}Freedom to Speak Up Guardians{\textquoteright} in NHS acute and mental health trusts in England: The FTSUG mixed-methods study",

abstract = "Background: The introduction of {\textquoteleft}Freedom to Speak Up Guardians{\textquoteright} into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives: The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. Design: The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting {\textquoteleft}speaking up{\textquoteright} by health-care employees; (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts; and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Setting: Acute trusts and mental health NHS trusts in England. Participants: Work package 2: Freedom to Speak Up Guardians (n = 87) were interviewed.Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Results: Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. {\textquoteleft}Freedom to Speak Up Guardian{\textquoteright} is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians{\textquoteright} effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture.",

author = "Aled Jones and Jill Maben and Mary Adams and Russell Mannion and Carys Banks and Joanne Blake and Kathleen Job and Daniel Kelly",

note = "Funding Information: The NGO was established in April 2016 as an independent non-statutory body that was tasked with normalising speaking up and leading effective cultural change, but was not concerned with historical cases and the instigation of speak-up investigations. The NGO is jointly sponsored by the Care Quality Commission (CQC), NHS England and NHS Improvement, and its Accountability and Liaison Board includes senior representatives from the sponsoring bodies. Three years after its establishment, additional funding was allocated to the NGO to support its work to integrate FTSU in primary care, including the appointment of regional leads to spearhead this work. Funding Information: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 23. See the NIHR Journals Library website for further project information. Publisher Copyright: {\textcopyright} 2022 Jones et al.",

year = "2022",

doi = "10.3310/GUWS9067",

language = "English",

volume = "10",

journal = "Health and Social Care Delivery Research",

issn = "2755-0060",

publisher = "National Institute for Health Research",

number = "23",

}

TY - JOUR

T1 - Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England

T2 - The FTSUG mixed-methods study

AU - Jones, Aled

AU - Maben, Jill

AU - Adams, Mary

AU - Mannion, Russell

AU - Banks, Carys

AU - Blake, Joanne

AU - Job, Kathleen

AU - Kelly, Daniel

N1 - Funding Information: The NGO was established in April 2016 as an independent non-statutory body that was tasked with normalising speaking up and leading effective cultural change, but was not concerned with historical cases and the instigation of speak-up investigations. The NGO is jointly sponsored by the Care Quality Commission (CQC), NHS England and NHS Improvement, and its Accountability and Liaison Board includes senior representatives from the sponsoring bodies. Three years after its establishment, additional funding was allocated to the NGO to support its work to integrate FTSU in primary care, including the appointment of regional leads to spearhead this work. Funding Information: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 23. See the NIHR Journals Library website for further project information. Publisher Copyright: © 2022 Jones et al.

PY - 2022

Y1 - 2022

N2 - Background: The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives: The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. Design: The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking up’ by health-care employees; (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts; and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Setting: Acute trusts and mental health NHS trusts in England. Participants: Work package 2: Freedom to Speak Up Guardians (n = 87) were interviewed.Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Results: Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture.

AB - Background: The introduction of ‘Freedom to Speak Up Guardians’ into every NHS trust in England was intended to support workers and trusts to better raise, respond to and learn from speaking-up concerns. However, only broad guidance was provided on how to implement the role. As a result, there is the potential for important local differences to emerge as the role is implemented across England. Objectives: The overall aim of this study was to better understand the implementation of Guardians in acute trusts and mental health trusts. Design: The Freedom to Speak Up Guardian role was conceptualised as a complex intervention consisting of several interacting and interlocking components spanning the macro level (national organisations), the meso level (individual trusts) and the micro level (employees, teams and wards/units). A mixed-methods study was designed, which consisted of three work packages: (1) a systematic narrative review of the international literature regarding interventions promoting ‘speaking up’ by health-care employees; (2) semistructured telephone interviews with Guardians working in acute hospital trusts and mental health trusts; and (3) qualitative case studies of Freedom to Speak Up Guardian implementation, consisting of observations and interviews undertaken in four acute trusts and two mental health trusts. Interviews were also undertaken with national stakeholders. Setting: Acute trusts and mental health NHS trusts in England. Participants: Work package 2: Freedom to Speak Up Guardians (n = 87) were interviewed.Work package 3: 116 interviews with key stakeholders involved in pre-implementation and early implementation decision-making, workers who had spoken up to the Guardian, and national stakeholders. Results: Wide variability was identified in how the Guardian role had been implemented, resourced and deployed by NHS trusts. ‘Freedom to Speak Up Guardian’ is best considered an umbrella term, and multiple versions of the role exist simultaneously across England. Any comparisons of Guardians’ effectiveness are likely to be possible or meaningful only when this variability is properly accounted for. Many Freedom to Speak Up Guardians identified how a lack of available resources, especially time scarcity, negatively and significantly affected their ability to effectively respond to concerns; their opportunities to collect, analyse and learn from speaking-up data; and, more generally, the extent to which they developed their role and speak-up culture.

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IS - 23

ER -

Implementation of ‘Freedom to Speak Up Guardians’ in NHS acute and mental health trusts in England: The FTSUG mixed-methods study

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