Workplace culture issues such as favouritism, bullying and harassment are hindering the ability of ambulance workers to speak out over wrongdoing, according to a report.

The National Guardian’s Office conducted a Speak Up Review of ambulance trusts in England after “consistent findings” showed that speaking up culture “appeared to be more challenged” compared with other parts of the NHS.

The report claims “culture in ambulance trusts was having a negative impact on workers’ ability to speak up”.

Some staff expressed feelings that the process was futile, telling the review that a “manager can have 40 complaints raised about them, then be given an award for leadership and subsequently promoted”.

Fear was also “more acute” among certain groups, including ambulance technicians and paramedics, the report found.

There are “broader cultural issues”, the report said, including “favouritism and cliques, ‘command-and-control’ decision making, and bullying and harassment” that are impacting workers’ confidence to speak out.

The review also found a “lack of regard for confidentiality” in cases when workers did speak up, as well as issues not being handled according to policies.

Siobhan Melia, Ambulance Culture Review chairwoman, said: “Ambulance staff work in some of the most pressured environments to provide care to patients, and having worked in an ambulance trust myself I have seen this vital work being carried out first hand by dedicated, compassionate staff.

“But I have also seen the cultural issues, so this review is an opportunity to consider how the local, regional, and national NHS can work differently with ambulance trusts and in a way that is more enabling of cultural improvement.”

NHS England published the national speak up policy in June 2022 to encourage workers to “speak up about anything that gets in the way of patient care or affects your working life”.

In the 2021 NHS Staff Survey just 51.6% of ambulance workers said they were confident about speaking up about concerns. The national average was 62.0%.

The National Guardian’s Office recognised that some trusts are working to improve the situation, but called for an independent cultural review with ministerial oversight.

It also said the Care Quality Commission (CQC) and NHS England should regulate improvements in speaking up culture, as well as recommending mandate training on speaking up and calling on trusts to “meaningfully invest in the Freedom to Speak Up Guardian role”.

Tracy Nicholls, chief executive of the College of Paramedics, which was interviewed as part of the stakeholder process, said: “The college welcomes the publication of the independent review and is pleased to see that a number of cultural issues have been addressed within it, acknowledging that work is being undertaken already to improve the culture within the sector.

“Our members have raised all of these points with us and I am sure that it will give some reassurance that significant issues have been appropriately highlighted.”

Ms Nicholls said the “implementations and sustained focus” of the findings “are of critical importance moving forward and meaningful action must be seen by all stakeholders and staff”.

She added: “Those who are affected by issues raised in this report may well feel disappointed by the inevitable time it will take to address the recommendations and the college will continue to listen to its members and work with the action-holders to ensure focus remains and that the ongoing work continues to foster a respectful and safe workplace culture.”

Dr Navina Evans, chief workforce, training and education officer at NHS England, welcomed the report, which she described as “incredibly important”.

“We are committed to supporting ambulance trusts and all NHS organisations to continuously improve staff experience and services for patients – everyone working in the NHS must feel safe from any form of bullying, harassment, discrimination or abuse, and feel confident that they can raise concerns and that they will be taken seriously and acted on,” she said.

“Our NHS Long Term Workforce Plan sets out how we will do more to ensure staff and volunteers have equal opportunity within a compassionate and inclusive culture, and we look forward to working with ambulance trusts, local integrated care boards and key stakeholders to implement the recommendations in this report.”

Sir Julian Hartley, chief executive of NHS Providers, said: “It is essential that staff feel confident to speak up and this review sets out welcome practical actions to address serious cultural problems within ambulance services.

“Trust leaders agree there’s no room for bullying and harassment in the NHS and no room for complacency. Staff and patients must be and feel safe.”

He added that NHS trusts are “working hard” to safeguard staff wellbeing and improve leadership and inclusion “while striving to hit operational targets in services under huge pressure, but more can and will be done”.

“Trust leaders are committed to implementing the review’s recommendations, working closely with partners throughout the health and care system,” Sir Julian said.

A Department of Health and Social Care spokesperson said “we must ensure ambulance trusts promote a culture that supports everyone”.

“Sexual harassment or misconduct of any kind is unacceptable and NHS organisations have a responsibility to protect both staff and patients,” they added.

“The department has a zero-tolerance policy and is clear the NHS should work to stop any such incidents from happening.

“We thank Siobhan Melia for her important review, and we will work closely with NHS England to ensure the recommendations are implemented in full.”