As former chair of Welsh council, and now Welsh consultants, I’ve been privy to some extraordinary tales of doctors attempting to highlight concerns, wrong-doing or discrimination.

The advice given 15 years ago to a doctor needing psychological support from bullying and undermining was that they would win at tribunal, but never work in Wales again. That wasn’t right then, and it certainly isn’t right now.

But surely the NHS has moved on? We have a solid set of NHS Wales Core Principles that link to each health board’s own core values of putting people first, valuing staff and listening are fundamentals. These are signed up to by employers, NHS Wales and Welsh Government, along with a commitment to compassionate leadership. Yet it still seems that excellent staff end up leaving the NHS and that many of them have complained or raised concerns prior to doing so.

While we all hear the laudable rhetoric of us moving towards a no-blame learning culture, this isn’t how it’s perceived in many frontline services. 

The NHS Wales Staff Survey 2018 stated: 'There are large numbers of respondents [staff] who say they do not think their organisation will take effective action if incidents are reported.'

Staff often still fear that speaking out or raising concerns may either compromise their career prospects or expose them to aggressive behaviours from more senior staff. This simply cannot continue.

Seven years ago, Keith Evans published his review of concerns and complaints handling in NHS Wales. This ex-CEO of Panasonic UK observed that the Welsh NHS was the most overly complex matrix organisation he had ever come across. To those of us on the front line it seems to have become more complex since then, not less.

The Welsh NHS should welcome a critical look in the mirror and face up to its deficiencies by listening and acknowledging what is wrong, and, if implemented in partnership with healthcare unions, Freedom to Speak Up Guardians could be the answer.

Initially proposed after the inquiry into Mid-Staffordshire NHS Foundation Trust, every NHS trust in England now has a guardian who is part of a national network led by the National Guardian for England, Henrietta Hughes.

With Scotland having recently introduced the Independent Whistleblowing Officer, that leaves Wales as the only UK nation without an equivalent provision for healthcare staff.

A comparable role in Wales would see a National Freedom to Speak up Guardian for Wales supported by guardians in each local health board.

In the early stages of the pandemic, as staff raised concerns about personal protective equipment, facilities, and nosocomial infection, we heard from doctors across Wales who were being threatened with disciplinary action because they wanted to follow enhanced protection procedures to ensure they were safe.

While the BMA was able to take these concerns directly to the top of the Welsh NHS, it was nonetheless disappointing that we had to do so. Had Guardians been in place, staff would have had additional outlets to raise concerns with.

Whilst unions are best placed to advise on individual and collective concerns, the National Guardian for Wales could compliment this work by reporting publicly each year to the Welsh Parliament on the overall numbers and types of issues raised by staff, as well as how health boards and Welsh Government have responded. This would provide a national picture and significantly increase the accountability of Welsh Government. Furthermore this would improve patient safety and support staff who would otherwise leave Wales at a time when we need them most.

Repeated failings tell us this system of accountability must be independent, empowered and able to speak truth to power. For if we are to navigate an effective path out of COVID over the next few years, listening to the concerns of staff and acting upon them must be at the centre of those actions.

We are hopeful that by working in partnership with other healthcare unions, Welsh Government and NHS Employers Wales to address the process for raising concerns in Wales, this could soon become a reality.

Freedom to speak up? The future of our NHS in Wales depends on it.

Phil Banfield is chair of the BMA Welsh consultants committee

BMA Cymru Wales’ full list of priorities for the next Welsh Government can be found here