Cases of detriment after speaking up, by NHS trust, since 1 April 2020

By Dr Minh Alexander 5 December 2022

As part of the current discussions arising from the concerns about University Hospitals Birmingham, I have taken a quick and dirty look at the National Guardian’s most recent Speaking Up data, with a focus on reported detriment.

This is data supplied by NHS trust Freedom to Speak Up Guardians, who work for NHS trusts (whether substantively or sub contracted), which is sent to the National Guardian who publishes it.

The data is controlled and potentially filtered by employers, and potentially filtered again when it is processed by the National Guardian, so interpretation should circumspect.

I have looked at years:



2022/23 Quarter 1

(The National Guardian’s Office seems to have removed data from before 2020 from its website. I have some of the old datasets but not all, if anyone needs these.)

In my view, the data has become more incomplete and now resembles the levels of non-compliance seen when the NHS Trust Freedom To Speak Up Guardian posts were still new.

This means that unsavoury secrets can be hidden.

Unexplained failures to submit defeat the purpose of publication.

21 NHS trusts failed to return any speaking up data for Q1 2022/23, including UHB:

Birmingham Community Healthcare NHS Foundation Trust

Cambridgeshire and Peterborough NHS Foundation Trust

Dartford and Gravesham NHS Trust

East Kent Hospitals University NHS Foundation Trust

Great Western Hospitals NHS Foundation Trust

Imperial College Healthcare NHS Trust

Kingston Hospital NHS Foundation Trust

Leeds Teaching Hospitals NHS Trust

Maidstone and Tunbridge Wells NHS Trust

Northern Care Alliance NHS Foundation Trust

Royal National Orthopaedic Hospital NHS Trust

Sandwell and West Birmingham Hospitals NHS Trust

Shropshire Community Health NHS Trust

South Central Ambulance Service NHS Foundation Trust

South East Coast Ambulance Service NHS Foundation Trust

St Helens and Knowsley Teaching Hospitals NHS Trust

Sussex Partnership NHS Foundation Trust

Tavistock and Portman NHS Foundation Trust

The Clatterbridge Cancer Centre NHS Foundation Trust

University Hospitals Birmingham NHS Foundation Trust

University Hospitals Sussex NHS Foundation Trust

The data on detriment for UHB since 1 April 2020 is as follows:

YEARNumber of reported cases of detriment after speaking up at University Hospitals Birmingham NHSFT
  2020/21  7 cases (but there is also missing data from quarter 3, which was not submitted)  
  2021/22  18 cases (but there is also missing data from quarter 2, which was not submitted)  
  2022/23 Quarter 1  UHB submitted no Speaking Up data at all in Q1, including data on detriment  

This data is insufficient to support meaningful discussion of UHB’s whistleblowing governance. An explanation is needed for the patchy data. The full dataset should be disclosed, or at least an explanation should be given on why data is missing.

In general, the levels of detriment vary hugely between trusts:

2020/21Zero to 51
2021/22Zero to 139
2022/ 23 Quarter 1Zero to 24

The overall numbers of cases featuring detriment are as follows:

2022/ 23 Quarter 1182   (If scaled up to a full year, assuming the current trajectory continues, the 2022/23 total would be 728)

The total number of cases of detriment for 2021/22 is especially high partly because East of England Ambulance service recorded a massive spike in detriment – 139 cases.

As we know now, the National Guardian’s Office did not commence work on a planned ambulance review, first planned in 2020, until this year after being asked to account for progress.

This seems all the more troubling seen in the context of the above exploding cases of detriment at East of England Ambulance in 2021/22.

It is also relevant to note that the former, second National Guardian Henrietta Hughes joined the board of South Central Ambulance service, which was recently downgraded to “Inadequate” because of quality issues. The inspection included a finding of “extreme positivity” by trust leaders, which was insensitive to the pressures faced by staff.

The NHS trusts reporting Speaking Up data are different in size and function, and it is not possible to interpret the data on numbers of cases of detriment as a league table.

That caveat apart, these are the trusts which reported the highest numbers of cases of detriment in 2020/21, 2021/22 and 2022/23 YTD:

Importantly, low reported numbers of cases with detriment are not necessarily a good sign. It may reflect staff fearfulness to the point of not engaging at all, or it may reflect on the integrity of the data.

As an example, these are detriment statistics for ambulance trusts from 2020/21, which look implausibly low to me:

I scrubbed the National Guardian’s spreadsheets of non-NHS trust organisations in order to make the handling and analysis of Speak Up statistics on NHS trusts easier.

Here are uploaded spreadsheets, with Speaking Up data on just NHS trusts, for anyone who might have a use for them

Speaking Up data for NHS trusts 2020/21

Speaking Up data for NHS trusts 2021/22

Speaking Up data for NHS trusts Quarter 1 2022/23

Here are the spreadsheets of detriment by NHS trust for years 2020/21, 2021/22 and 2022/3.

Detriment by NHS trust 2020/21

Detriment by NHS trust 2021/22

Detriment by NHS trust Quarter 1 2022/23

For completeness, this is an FOI response from UHB in 2018, which revealed that the feedback from staff who had used the Freedom To Speak Up service was not collected in a structured format.

UHB  FOI response 3 May 2018 collation of feedback from staff who use the Freedom To Speak Up Guardian service


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