PATIENT SAFETY NOW

I had the privilege of speaking to a large group of people who work in the NHS this week. I was asked to talk on the latest thinking on patient safety and what we have learnt over the last three decades. Within that talk I spoke about the issues of psychological safety.

In the Q&A, the questions, one by one were all in similar ways saying..

Yes, but…

How do we have the courage to speak up?

How do we talk to people who are not listening?

We raise things and never get any feedback

We are frightened to say anything because we are too junior/too worried about repercussions/too inexperienced/ too…….

When we raise anything we are dismissed and ignored

This was just a selection and these questions are not new. Last year, last month, last week, any of my workshops. Same thing.

Psychological safety has become like a ‘just culture’, a bit of a buzz word. All you need is to build a psychologically safe space. Simple as that. No.

It is really hard to do in practice. Really hard to speak up. And let’s face it, in this very pressured world, really hard to hear. It has been so for decades.

We have been trying to address this for so long now and tried all kinds of things. Over the last fifty years we have gone from the 1970s when challenging a superior was often treated as a firing offence to 2026 where we are supposed to have a culture where it is ‘easy’ to speak up and share your concerns.

During my training we were expected to be unquestioning and obedient and the only way in which issues were raised, such as Ely Hospital in 1969 because someone was brave enough to speak up. There was the Bristol Royal Infirmary inquiry, where one whistleblower struggled so much that he left the country.

This raised awareness and led to the then NHS Management to mandate all trusts to have whistleblowing policies. If you need to have a whistleblowing policy you are too late. Over the years there have been a few small initiatives such as anonymous boxes for ideas, but little really in the way of truly helping staff to speak up. The initiatives from the NPSA such as ‘Being Open’ was seen as not effective enough so it was replaced with the Duty of Candour. Different from speaking up, but still all about being able to share what you know and to do so without fear. The Mid staffs inquiry demonstrated that we were not achieving the expected results with Robert Francis finding of a culture of intimidation and staff being bullied into silence. This led to the Freedom to Speak up review, Freedom to Speak up Guardians, and National Guardians Office.

Then in July 2025, The Dash Review of Patient Safety delivered a blow to all this. The National Guardians Office was to go. That for some reason it was seen as duplicated work already carried out by the Freedom to Speak up Guardians. An oversight office was no longer needed. Without this strong voice where do people go if they need to escalate issues from a local level? Where is the support for the local guardians? What does this say about the importance of speaking up in a culture of silence.

What can we do now? We know from the work of Amy Edmondson and Timothy Clark and others how very very important the ability to belong, to ask questions, to challenge, to share ideas, and to admit mistakes is. We know it is really hard and people need help, supportive leaders, people who will listen and want to hear.

But you cant just tell people to speak up. Rather than ‘whistleblowing policies’ or a few brave and courageous people lifting their heads above the parapet we need to embed a completely different way of working that gets into the DNA of the NHS. The way we do things around here. It should become so normal that in the future it would seem shocking that people were not able to speak up.

Don’t just tell people to be braver, build it into everything you do. If you do you might be surprised about the gold dust that people are holding that you wished you knew about before. There are a lot of bright, caring people across the NHS who have ideas, who have questions, who are ready and waiting to share them. There are people who can spot the little ways in which things are failing but don’t know where to tell others without these little things becoming the big things.

If you want a more responsive health service, or an innovative health service, if you want a safer health service, if you want a more productive health service…..

Listen

Value and thank people for what they do and what they say

Learn from the feedback

Explore the ideas people raise

Praise people for raising difficult issues

Above all – be kind

None of those cost money or even that much time. So what’s stopping you?