Temporary Workers, Permanent Voices: A Speak Up Review

Recommendation 1: System standards for speaking up and detriment protection for temporary workers Decision/action: National bodies should set clear, consistent expectations that speaking up arrangements for temporary workers are visible, accessible, safe and free from detriment. These expectations should be embedded across national frameworks, codes of conduct and national guidance. Key requirements: For NHS England: • Embed Freedom to Speak Up (FTSU) requirements into national temporary staffing frameworks. • At the next review, NHS England to update the national FTSU policy, guidance and planning tools, update them to incorporate learning from this review, particularly ensuring the reflection and planning tool supports senior leaders to take a broader, more inclusive view of their workforce, ensuring temporary workers are actively considered. For Nursing and Midwifery Council (NMC): • Ensure continued appropriate expectations concerning speaking up vis-à-vis their members, and to update learning sessions they deliver employers to stress important of all workers temporary or permanent to be safe and encouraged to speak up. For Recruitment and Employment Confederation (REC): • Strengthen or develop REC’s sector-specific guidance for healthcare to include clear expectations on FTSU for members working in healthcare. Provide or signpost practical materials, advice and tools made available by relevant national bodies and healthcare organisations, to help members support agency workers to understand and exercise their FTSU rights. For all: • Expand targeted learning resources for bank/agency staff. • National guidance by NHS England, NMC and REC must set clear expectations that speaking up must never affect access to shifts or placements, with clear processes for monitoring, documenting and responding to concerns about withdrawn work. This should be informed by existing guidance from the NGO on preventing and addressing detriment, which sets out what organisations must do to ensure workers are not disadvantaged as a result of speaking up, and how they should respond when concerns about potential detriment are raised.1 Timeframe: These recommendations should be achieved by March 2027.

Recommendation 2: Strengthen regulatory assurance for temporary workers’ speaking up experiences Decision/action: CQC should explicitly assess whether host organisations’ FTSU arrangements meet the needs of all workers, including temporary workers. Owner: CQC. Key requirements: • Guidance, training and any other relevant resources are in place to enable inspectors to effectively assess temporary workers’ ability and confidence to speak up, including to the Freedom to Speak Up Guardian. This should include clarity on what good practice looks like to support consistent assessments. • Utilise data and insights on speaking up experience of temporary workers in regulated organisations on inspections, including speaking up case data (see recommendation 3). • Findings from assessments should be used to drive improvement and reduce variation across the sector. Timeframe: These actions should be undertaken by March 2027, with an assessment of how effectively they are working in practice completed by April 2028.

Recommendation 3: Strengthen speaking up arrangements and insight for temporary workers Decision/action: Host organisations and temporary workforce providers should ensure that speaking up arrangements meet the needs of temporary workers including being visible, accessible, impartial and consistent, ensuring temporary workers can speak up safely and are supported and encouraged to share concerns, suggestions and other insights. They should improve the recording, monitoring and analysis of temporary workers’ speaking up experiences to address blind spots, support organisational learning and strengthen improvement work. Owners: Host organisations; temporary workforce providers (lead). Key contributors: Freedom to Speak Up Guardians. Key requirements: For host organisations: • Ensure that all speaking up routes, including access to Freedom to Speak Up Guardians, are fully available to temporary workers on the same basis as permanent staff. These routes should be visible, accessible and include anonymous options, with barriers such as lack of intranet or IT access identified and addressed. • Provide clear onboarding and induction information for temporary workers, including minimum standards for access to IT systems, escalation routes and named contacts. • Where Freedom to Speak Up champion or ambassador networks exist, organisations should ensure these networks appropriately reflect their workforce by seeking to include temporary workers within these roles. • Record and monitor speaking up cases raised by temporary workers. Where appropriate, Freedom to Speak Up Guardians should record when a case is raised by a temporary worker and use this data to build insight, identify barriers and support ongoing improvement. Host organisations should also draw on other relevant sources, such as the NHS Staff Survey for bank only workers (NSSB), to develop a broader understanding of temporary workers’ speaking up experiences. • Use insight from speaking up cases and other local data to consider whether factors such as ethnicity, disability or migration status may shape the speaking up experiences of temporary workers and reflect this in local improvement work (see Recommendation 6). For temporary workforce providers: • Maintain clear speaking up arrangements, including anonymous routes, ensuring temporary workers feel safe, supported and encouraged to speak up. • Provide and monitor the uptake of effective speaking up training for all workers, ensuring this aligns with expectations set out in NHS England guidance. • Seek feedback from temporary workers about their experiences of host organisations and use this insight to inform improvement. • Where a temporary worker raises a concern about a host organisation, providers should ensure the concern is handled appropriately within their role, including supporting the worker, escalating issues to the host organisation where required, and taking any action that falls within the provider’s remit. • Provide clear onboarding and induction information for temporary workers, including minimum standards for access to IT systems, escalation routes and named contacts. • Record speaking up issues raised by temporary workers, including steps taken within the provider’s remit. These records should support worker safety, help identify broad themes and inform any appropriate escalation to host organisations. For all: • Fair process: When concerns are raised about temporary workers, a fair process should be followed by informing them promptly, sharing appropriate information, giving them the opportunity to respond, and documenting decisions and outcomes. Timeframe: These recommendations should be achieved by March 2027.

Recommendation 4: Protect temporary workers from detriment when they speak up Decision/action: Host organisations and temporary workforce providers should take coordinated steps to prevent temporary workers experiencing detriment when they speak up, including in access to shifts or future work. Owners: Host organisations; temporary workforce providers. Key requirements: For host organisations: • Document decisions to pause/withdraw assignments. • Review shift allocation data to identify potential detriment. • Respond to provider queries about possible detriment in a timely, transparent way. For temporary workforce providers: • Provide clear routes for temporary workers to raise concerns about withdrawn or reduced shifts, review these concerns to understand whether detriment may have occurred, and raise them with host organisations as appropriate for clarification or action. For all: • Provide clear messages to reassure temporary workers that speaking up will not affect access to work. • Develop and maintain agreed routes for communication and escalation on potential detriment. Timeframe: These recommendations should be achieved by March 2027.

Recommendation 5: Strengthen partnership working between host organisations and temporary workforce providers Decision/action: Host organisations and temporary workforce providers should work together to provide temporary workers with consistent, safe speaking up arrangements across organisational boundaries, supported by clear expectations, reliable information flow and joint action where concerns arise. Owners: Host organisations, temporary workforce providers. Key requirements: For host organisations: • Put in place a clear mechanism for sharing relevant information with temporary workforce providers about speaking up issues and decisions affecting temporary workers, in line with confidentiality and data protection requirements. • Respond to provider queries about concerns or potential detriment in a timely and transparent way, clarifying context and actions taken. For temporary workforce providers: • Provide clear routes for temporary workers to raise concerns about their experiences in host organisations. • Raise concerns with host organisations for clarification or action within the provider’s remit and keep a basic record of concerns and steps taken. For both host organisations and providers: • Agree shared expectations on how concerns from temporary workers are raised, shared and progressed across organisational boundaries. • Establish joint pathways for responding to potential detriment affecting temporary workers (see Recommendation 4). • Maintain routine, light-touch communication to share themes, learning and practical fixes that improve temporary workers’ experience of speaking up (aligned with Recommendations 3 and 6). Timeframe: These recommendations should be achieved by March 2027.

Recommendation 6: Promote a culture of inclusion and belonging for temporary workers Decision/action: National bodies and host organisations should promote cultures where temporary workers feel valued, respected and included, supporting psychological safety and speaking up. Owners: National bodies (including the Department of Health and Social Care and NHS England); host organisations. Key requirements: For national bodies: • Set clear expectations, through national policy and communications, that inclusion and belonging apply to all workers, including temporary workers, and reinforce the value and contribution that temporary workers make to patient care. For host organisations: • Leaders to use respectful language and model inclusive behaviours towards temporary workers. • Consistent messaging reinforces that temporary workers are integral contributors to patient care. • Temporary workers are included in routine communication, safety briefings, handovers and team activities. • Expectations for inclusive practice are embedded in local induction, guidance and policy. • Apply an intersectional lens to local data and feedback to understand how characteristics such as ethnicity, migration status, disability or other factors may interact with temporary worker status to amplify barriers to inclusion and speaking up and use these insights to inform local improvement activity. Timeframe: These recommendations should be achieved by March 2027.