Freedom to Speak Up: Raising concerns in the workplace

Freedom to Speak Up (FTSU) is one of the mechanisms that can be used to speak up about issues that affect patient safety and workplace culture. Reporting concerns is part of our training from the outset. Compliance with GDC standards mandates reporting significant issues that may jeopardise patient safety. These obligations are reinforced throughout our careers, from Dental Foundation Training to consultant level.

The FTSU campaign has brought more visibility to the avenues available for healthcare professionals who want to raise concerns. Every hospital trust appoints a FTSU guardian, usually with a network of champions/ambassadors, who serves as a local point of contact for whistleblowing concerns. Corporate trust communications are shared on a regular basis to ensure that everyone knows how to share concerns. The policies and framework for reporting are easy to access and the initiative aims to foster a culture in which speaking up is encouraged and protected.

The challenges of speaking up

Speaking up can take many forms, and we are taught early how to handle difficult situations in the workplace and escalate them through your educational supervisor, training programme director, governance lead, or clinical director depending on your career stage. Trusts that have a history of poor management of concerns often struggle to instil confidence in staff regarding the effectiveness of reporting mechanisms. There is also a disparity in the resources and support available to FTSU guardians across different trusts. Some guardians are in the role full-time, and others part-time, so do not have as much time or resources to handle the volume of concerns as others. This can deter staff from reporting issues, and even damage trust in the process.

There are also several challenges to using FTSU effectively. One major hurdle is the fear of repercussions or a lack of anonymity when raising your concerns. Secondly, there is a perception that some concerns may not be addressed in a way that provides the desired outcome, depending on the quality of the governance processes where you work. It is one thing knowing who to speak to but taking the extra step to go forward and raise a concern can cause a lot of worry, especially when you have worked in a trust for a long time prior to FTSU being put in place and borne witness to less than ideal outcomes in the past.

Recommendations for improvement

Raising concerns about wrongdoing or inappropriate behaviour in a hospital setting is crucial for maintaining patient safety and fostering a healthy workplace environment. While there are frameworks in place to support whistleblowers, challenges remain in ensuring these processes are effective and trusted by all healthcare professionals.

Dentistry is usually a small specialty in hospitals compared with other departments which may have dozens of consultants. This can impact on your level on anonymity, and it is often easier to speak to a colleague before escalating a concern, especially if you share the same worries and can report the issue together. FTSU operates under a legal framework meaning that everyone is dealt with equitably and should not be disadvantaged afterwards, however several measures could be taken to enhance the current framework:

• Enhanced education and awareness: Ensuring all staff are aware of the rights and support available through initiatives like FTSU
• Standardised support for guardians: Ensuring consistent resources and support for FTSU guardians across all trusts
• Cultural shift: Promoting a culture where raising concerns is seen as constructive rather than punitive, emphasising learning and improvement.
• Improved support for those raising concerns: Where anonymity is difficult to secure, those raising concerns should be fully supported both during and after the process.

Feeling supported to speak up

As a hospital dentist, your work is often very different to what other staff members do. Addressing the challenges of speaking up will require a concerted effort from healthcare institutions, policymakers, and regulatory bodies to strengthen protections and support for clinicians. By doing so, we can ensure that hospitals are not only safe for patients but also supportive and transparent workplaces for healthcare professionals.

If you are concerned about speaking up, Speak Up provides signposting, advice, and guidance and is delivered by Social Enterprise Direct on behalf of the Department of Health. It offers free, independent, confidential advice on the speaking up process. Protect is a whistleblowing charity that can support you with advice on the process and your rights. It is helpful, and it can ease anxiety about the process to have the right advice, evidence, and support behind you before raising a concern.

While progress has been made in promoting transparency and accountability, there is still work to be done to create a culture in which speaking up is universally valued and protected.