The Guardian Service response to the culture review of ambulance trusts
(Independent review chaired by Siobhan Melia, Chief Executive Sussex Community
Foundation Trust – published 15 February 2024)
Section 1: Foreword
We welcome this review. The points it makes are already well known but it succinctly and accurately describes the environment in which the workforce operates. We endorse the recommendations but would go further. Speaking up culture is fundamental to wider improvement: it is an enabler of change as well as a building block of positive culture in its own right. By getting speaking up right, and enabling everyday dialogue to take place, you will be making across the board cultural improvements.
In this report we make the following points:
- The time for action is now - The focus on waiting times is acute and change to support the wellbeing of the workforce must keep pace with this.
- Speaking up is an enabler - Speaking up is an enabler of change and will help ambulance services respond to all the recommendations made.
- Learning together - All members of the blue-light family face similar challenges and can learn from each other. It has taken many years for speaking up to begin to embed itself in the health sector but this learning will help all blue-light services to accelerate their progress.
- Effectiveness should be judged by the experience of the workforce - The lived experience of the workforce is the ultimate measure of effectiveness of speaking up arrangements. Senior leaders will only be able to judge their speaking up culture by seeing and hearing what the workforce see and hear for themselves.
- Infrastructure is a by-product not a driver of culture - Infrastructure is reflective of the culture it serves. Changing infrastructure will not change culture but insight will be gleaned from understanding why existing infrastructures developed in the way that they did.
- Barriers presented by hierarchy and seniority are everywhere - Command and control structures and visible representations of rank are only one way in which hierarchy and seniority operate. Power differences are played out in numerous overt and subtle ways. Effective speaking up arrangements require routes that can operate outside these parameters as they will always impact on people’s ability to speak up.#
- Bullying and harassment breeds silence - Bullying and harassment breeds silence. This strengthens the need for Guardian support that operates outside and independent of cultures in which bullying and harassment persists.
- Everyday dialogue is preventative and curative - Whilst the response to matters raised by speaking up needs to be swift and effective, solely focusing on improved investigations and other processes will miss the point. Enabling effective everyday dialogue and empowering workers to resolve matters without recourse to further escalation will, in the long run, drive the most powerful change.