What is speaking up?

5. The National Guardian’s Office for England defines ‘speaking up’ as being about anything that gets in the way of providing patient care or that affects your working life. It could be “something which doesn’t feel right, for example a way of working or a process which isn’t being followed, or behaviours of others which you feel is having an impact on the well-being of you, the people you work with, or patients”[1]. Case studies are available on their website.

6. The term speaking up was originally used in 2015 in the Freedom to speak up report by the chair of The Mid Staffordshire NHS Foundation Trust Public Inquiry[2] (also known as the Francis inquiry), Sir Robert Francis QC. The report set out recommendations for creating an environment in which NHS workers were free to speak up. It was a follow on to the Francis inquiry, which set out a duty of candour for healthcare professionals: the requirement to be open and honest when things go wrong. This guidance is drafted in the spirit of those recommendations.

7. We note that other terms such as ‘whistleblowing’ and ‘raising concerns’, which have slightly different meanings to speaking up, are also widely used and that speaking up is not normally used in Northern Ireland, Scotland and Wales. We have decided to use the term ‘speaking up’ as an umbrella term, and for the avoidance of doubt, in this guidance it covers all concerns about patient/public safety or propriety, such as where something is observed that appears seriously wrong or not in accordance with accepted standards, including what may be termed ‘whistleblowing’ and/or ‘raising concerns’.

8. The duty to speak up is linked to the duty of candour which is incumbent on all healthcare professionals and sets out the need to be open and honest when things go wrong. Speaking up is wider than the duty of candour as it includes speaking up about anything that gets in the way of providing patient care, not just being open and honest when things have already gone wrong (or where there has been a near miss). There may be situations where it is necessary to both a) exercise the duty of candour by being honest when things have gone wrong (or there was a near miss), and b) speak up about the issue to ensure that nothing gets in the way of providing patient care in the future. As such, there are a number of similarities between this guidance and our Supplementary guidance on the professional duty of candour.

Why is speaking up important?

9. Developing a culture that promotes speaking up encourages everyone in the optical sector to look out for and raise issues that may affect patient or public safety. It can prevent harm and help to instil confidence in the profession by them being seen to ‘do the right thing’. It also supports reflective practice in the workforce.

10. There are also good business reasons to listen and take seriously those who speak up – it allows poor practice to be identified early and remedied before it has an impact. Independent inquiries, including the recent Paterson inquiry, have concluded that significant instances of harm in healthcare provision could have been avoided if concerns raised had been taken seriously, or if workers had felt more confident in their ability to speak up[3].

11. The principle of speaking up is a central part of professional responsibilities for all healthcare professionals and is currently underpinned in:

12. We recognise that speaking up is a wider concept than raising concerns as outlined in our standards. When we come to review our standards we will consider how to update them to reflect this guidance.

13. You should use your judgement to apply the guidance that follows to your own practice and the variety of settings in which you might work or operate your business. If you have any questions about how to apply this guidance in specific situations, you may wish to consider seeking further advice (including legal advice) from appropriate professional colleagues, your employer, your professional indemnity insurance provider, your professional or representative body, trade union or speaking up guardian (such as in your local optical committee or employer). Student optometrists and student dispensing opticians can additionally seek advice from their tutor, supervisor or training provider.

[1] https://nationalguardian.org.uk/speaking-up/what-is-speaking-up/

[2] https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry (last accessed 7 October 2021)

[3] James G. (2019). Report of the Independent Inquiry into the issues raised by Paterson, p133-144. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/863211/issues-raised-by-paterson-independent-inquiry-report-web-accessible.pdf (last accessed 7 October 2021)