‘We all have a duty to speak up when we suspect something might be wrong’ | Nursing Times

I am mindful that, yet again we are tragically learning of another, and arguably the worst, scandal to rock the NHS. In which innocent victims have had to fight to expose preventable harm inflicted on them. The inquiry has concluded that this was no accident and the NHS and successive governments have repeatedly failed to listen, act and be open and honest. This refusal to uphold their duty of candour has caused further physical and emotional harm to those infected and affected. The refusal to acknowledge and learn from the failures undoubtedly allowed for ongoing catastrophic outcomes for all the victims and their loved ones.

“The responsibility of leaders to take appropriate action is vital”

But what impact has this had on the wider culture of the NHS and its leadership’s seemingly perennial failure to hold their hands up when something goes wrong? Why do we keep hearing of these horrendous scandals and inquiries, and why is the culture of the NHS and government still not wholeheartedly changing in response to errors and concerns raised? Too often when people raise concerns the focus of attention is applied to dismissing the claims and discrediting the individuals who are bravely speaking up or who have been harmed.

Why is there still a defensive culture of senior leaders whose initial response is one of incredulity and opting to not take responsibility to prevent further harm and distress? The time, effort and public money spent on deflection, denial and dismissal when concerns are raised is a despicable waste and should be put towards learning and improving safety.

What can we do as health professionals to assist in improving the safety culture of our own workplaces? We all have a duty to speak up when we suspect something might be wrong, however, this will only happen if the culture enables this, and people feel psychologically safe and empowered to do so. This is entirely reliant on leaders setting the right tone and leading by example to ensure all workers can raise concerns. The responsibility of leaders to take appropriate action is vital. If your manager responds favourably to you when you speak up, but then either does nothing to address the concern or fails to feed back to you, this will not elicit confidence in the speaking up process. Thus, leading to people perceiving speaking up as futile.

While much of the responsibility for action and improvement sits with leaders, we all have the option of supporting our colleagues in speaking up and ensuring managers know of potential problems. Many feel isolated and vulnerable when raising concerns. If colleagues can encourage and collectively support each other in persevering to shine a light on wrongdoing, errors and poor conduct, the sheer strength in numbers will help turn the tide of culture change. I truly believe that together we can make a measurable difference.

We also all have an absolute responsibility to advocate for our patients and their loved ones. If harm is suspected to have occurred, or experiences less than acceptable, we must raise this on behalf of our patients, and request transparency to ensure wider learning and improvement for the sake of us all.

Yet again, I call for the unimaginable suffering of all those affected by the infected blood scandal to be a genuine and lasting watershed. This must now be a turning point for compassionate, curious and sincere NHS leadership and culture at all levels of this beloved institution.

Helené Donnelly is head of safety culture, Nuffield Health