Speaking Up in Care: Creating Trust, Safety, and Shared Responsibility Across Health and Social Care

Background: Health and social care systems increasingly recognise the value of incorporating patient and caregiver perspectives into care planning, improvement, and system redesign. Yet learning in real-time from the people organisations serve remains challenging.

Research shows that encouraging patients and caregivers to voice, or "speak up" about quality or safety concerns when receiving care is insufficient on its own. Voicing is a relational act, shaped by past experiences, communication and relationships during care, and broader contextual factors.

People who experience structural marginalisation or discrimination across systems face additional barriers, and negative experiences in one setting can reduce willingness to speak up in another. One-off safe spaces are not enough, nor is it fair to place responsibility solely on frontline staff to create these conditions. Integrated care networks – collaborative systems connecting health, social, and community care organisations – have an opportunity to foster cultures where voicing is consistently safe, encouraged, and acted upon.

In this workshop, we will explore:

1. How can integrated care networks create safe and supportive systems that enable the people they serve to speak up across care episodes and settings?
2. How can these networks close the feedback loop, ensuring voicing lead to organisational learning and system change?

Audience This workshop will bring together patient partners, practitioners, researchers, and leaders to explore how integrated care networks can create cultures where speaking up is safe and leads to change.

Approach: This workshop combines conceptual grounding, real-world reflections, and participatory discussion.

1. Welcome and framing (8 mins) – Emily & Caroline

• Emily will share how speaking up is a relational act shaped by thoughts, emotions, relationships, and context, and why cultural change across systems is needed.
• Caroline will share how integrated care networks can act as learning systems, creating safe, consistent opportunities for voice.

2. Real-world reflections on speaking up (8 mins) – Charles & Margaret

• Charles will draw on his experiences as both a patient and a specialist Chaplain in the NHS, exploring what compassionate, trust-based communication looks like in moments of vulnerability, and the need for integrated approaches.
• Margaret will share insights from working with patients whose conditions were dismissed, highlighting the harm of not being believed and the role of integrated care in rebuilding trust.

3. Small-group discussions (44 mins)

Participants will explore three themes in discussions facilitated by presenters:

• Being listened to across systems: What helps people feel heard as they move between care settings?
• Closing the loop: How can integrated care networks ensure that what people share leads to learning and change?
• Shared responsibility: How can responsibility for listening and responding to voice be distributed across organisations and roles?

4. Collective synthesis and strategies for change (30 mins)

Facilitated by all presenters, groups will share insights, discuss common themes, and prioritise key strategies identified in small groups.

Outcomes: Participants will co-create an action map of strategies to strengthen patient and caregiver voice within integrated care networks and contribute to a policy note summarising practical recommendations.