Temporary NHS workers fear speaking up about patient safety due to discrimination, with some subject to racism according to an investigative report by the Health Services Safety Investigations Body (HSSIB).

Agency staff told the HSSIB that workplace culture and attitudes in some NHS organisations made them feel ‘isolated’ and ‘unable to integrate’ with their teams.

Health leaders described the findings as ‘unacceptable’ and warned that racism ‘creates further challenges and barriers to raising safety concerns.’

The inquiry claims bank staff, agency workers and locum doctors are discriminated against due to their working status, and in some cases, their ethnicity. The HSSIB warned that this can impact their ability to seek support and ask questions, which can impact patient safety; meanwhile some staff are fearful of speaking up in case they lose future work opportunities.

The investigation was told by some temporary staff that they had experienced discrimination on the grounds of race from both patients and other staff members. The investigation observed that some temporary staff accepted such discriminatory behaviours as the norm, saying ‘that is just the way it is’.

Trusts, national stakeholders and organisations who supply temporary staff to the NHS told the investigation that they were aware that this group may experience discrimination on the grounds of race when working in the NHS.

The NHS Race and Health Observatory told the investigation that temporary staff were seen as ‘other’ due to not being part of the core team. This, coupled with experiencing racist behaviour, may mean they do not feel psychologically safe (feeling able to take risks without fear of negative consequences) to ask questions or raise concerns, which in turn impacts on patient safety may impact their psychological safety to ask questions or raise concerns, impacting on patient safety.

Matt Mansbridge, senior safety investigator at the HSSIB, said in a press release, “Through the course of our investigation it was troubling to hear of the widespread discrimination against temporary staff and the negative impact this has on their daily lives. Sadly, some told us they had experienced racist behaviour during their time in the NHS.”

“Trusts and national organisations expressed that they are aware that many temporary staff experience discrimination and that this prevents them from talking freely,” Mansbridge added. “We heard from staff and agencies that the cultures and attitudes that had developed in organisations left them feeling isolated, unable to integrate with teams they are working with and feeling fearful when patient safety issues arose, or incidents occurred.”

Julian Hartley, chief executive of NHS Providers, added, “All NHS staff must feel empowered to speak up. This includes temporary workers who play an important role in enabling the NHS to deliver patient care, especially in the face of major workforce challenges.”

Hartley continued, “It is also unacceptable that temporary workers from ethnic minority backgrounds experienced racism from both patients and staff members. This creates further challenges and barriers to raising safety concerns.”

Habib Naqvi, chief executive of the NHS Race and Health Observatory, said, “Black and ethnic minority clinical staff, irrespective of their working status, must feel confident about speaking up and disclosing information that can prevent avoidable incidents, and be assured that their concerns will be listened to and acted upon.”

“The healthcare system must take this opportunity to learn important lessons from the investigations highlighted in this report so that optimal care is provided for patients, and staff do not fear the prospect of being discriminated against for voicing concerns through official channels.

Mansbridge called for change. He said, “An inclusive environment which encourages speaking up can only be achieved when barriers up are reduced or removed entirely. It is clear that much change is needed, especially as discriminatory narratives and perceptions around temporary staff are not only seen but also tolerated across the NHS.”

“Urgent action is needed now to tackle the unacceptable levels of racism, bias and discrimination at work experienced by temporary employees from black, Asian and minority ethnic backgrounds,” Mansbridge said. “We know that an engaged and fully supported workforce leads to compassionate workplaces, organisational efficiencies and, critically, better outcomes for all patients.”

An NHS spokesperson said, “Every NHS trust should be adopting the updated National Freedom to Speak Up policy and NHS England has recently asked all local areas to urgently ensure all staff have easy access to information on how they can raise concerns, including through having a dedicated Freedom to Speak Up Guardian in place.

“If people feel disadvantaged as a result of speaking up, NHS England has ensured there is additional help available with a national scheme in place so staff can receive additional intensive support in these circumstances,” the spokesperson added.

The HSSIB also found temporary staff do not always have necessary access to electronic systems, leaving them unable to request patient information or tests.

As part of the probe, 30 serious incident reports from NHS trusts regarding patient safety that involved temporary staff were analysed.