Temporary NHS staff ‘fearful’ of speaking up about patient safety issues

Temporary NHS workers fear speaking up about patient safety due to discrimination, an investigation has found, with some subjected to racism.

Agency staff told the Health Services Safety Investigations Body (HSSIB) that workplace culture and attitudes in some NHS organisations made them feel “isolated” and “unable to integrate” with their teams.

Health leaders described the findings as “unacceptable” and warned that racism “creates further challenges and barriers to raising safety concerns”.

The probe by the patient safety body is one of several exploring the NHS workforce and patient safety.

It claims bank staff, agency workers and locum doctors are discriminated against due to their working status, and in some cases, their ethnicity.

This can impact their ability to seek support and ask questions, which can impact patient safety, the HSSIB warned, while some staff are fearful of speaking up in case they lose future work opportunities.

Matt Mansbridge, senior safety investigator at the HSSIB, said: “Through the course of our investigation it was troubling to hear of the widespread discrimination against temporary staff and the negative impact this has on their daily lives.

“Sadly, some told us they had experienced racist behaviour during their time in the NHS.

“Trusts and national organisations expressed that they are aware that many temporary staff experience discrimination and that this prevents them from talking freely.

“We heard from staff and agencies that the cultures and attitudes that had developed in organisations left them feeling isolated, unable to integrate with teams they are working with and feeling fearful when patient safety issues arose, or incidents occurred.”

Sir Julian Hartley, chief executive of NHS Providers, added: “All NHS staff must feel empowered to speak up. This includes temporary workers who play an important role in enabling the NHS to deliver patient care, especially in the face of major workforce challenges.

“It is also unacceptable that temporary workers from ethnic minority backgrounds experienced racism from both patients and staff members. This creates further challenges and barriers to raising safety concerns.”

The HSSIB also found temporary staff do not always have necessary access to electronic systems, leaving them unable to request patient information or tests.

As part of the probe, 30 serious incident reports from NHS trusts regarding patient safety and involved temporary staff were analysed.

Among these was a case of an 86-year-old woman who had blood inside her chest cavity following a fall at home.

An investigation found there were delays in a CT scan being completed as access restrictions meant the locum doctor in the same day emergency care unit was not able to use the electronic system to request a scan.

The scan was outstanding when she deteriorated and died two days after being admitted to hospital.

Lynn Woolsey, chief nursing officer at the Royal College of Nurse (RCN), said: “Temporary nursing staff are highly skilled professionals but are often working with colleagues they have not met, in unfamiliar environments, and in settings where there are too few staff.

“They do an incredibly difficult job and without them services would struggle to function. They deserve support, not abuse or isolation.”

Mr Mansbridge also called for change. He said: “An inclusive environment which encourages speaking up can only be achieved when barriers up are reduced or removed entirely.

“It is clear that much change is needed, especially as discriminatory narratives and perceptions around temporary staff are not only seen but also tolerated across the NHS.”

Professor Habib Naqvi, chief executive of the NHS Race and Health Observatory, said: “Black and ethnic minority clinical staff, irrespective of their working status, must feel confident about speaking up and disclosing information that can prevent avoidable incidents, and be assured that their concerns will be listened to and acted upon.

“The healthcare system must take this opportunity to learn important lessons from the investigations highlighted in this report so that optimal care is provided for patients, and staff do not fear the prospect of being discriminated against for voicing concerns through official channels.

“Urgent action is needed now to tackle the unacceptable levels of racism, bias and discrimination at work experienced by temporary employees from black, Asian and minority ethnic backgrounds. We know that an engaged and fully supported workforce leads to compassionate workplaces, organisational efficiencies and, critically, better outcomes for all patients.”

An NHS spokesperson said: “Every NHS trust should be adopting the updated national Freedom to Speak Up policy and NHS England has recently asked all local areas to urgently ensure all staff have easy access to information on how they can raise concerns, including through having a dedicated Freedom to Speak Up Guardian in place.

“If people feel disadvantaged as a result of speaking up, NHS England has ensured there is additional help available with a national scheme in place so staff can receive additional intensive support in these circumstances.”

A Department of Health and Social Care spokesperson said the findings of the investigation raised “significant concerns and improvements must be made”.

They said: “It highlights a culture of discrimination that can undermine the role NHS staff play in speaking up about potential risks to patient safety.

“This Government is determined to drive positive cultural change where whistleblowers are free to speak up, knowing they will be supported and their concerns will be listened to and acted upon.”