A review carried out by the National Guardian's Office found that the biggest barrier to speaking up for temporary workers was the fear of losing shifts.

The review heard deeply moving stories from temporary workers, with many recounting experiences of unfair treatment at work, not being supported and feeling like an outsider. In addition, temporary workers reported issues such as a lack of proper staff induction, a lack of advocacy and representation, mistrust in speaking up processes and a lack of support after raising concerns.

The review also found:

• 64.6% of participants surveyed said they knew about speaking up arrangements in their organisation
• 5% of workers from NHS Professionals were not aware of Freedom to Speak Up guardians, whereas only 18.8% of workers from Trust Bank were not aware of Freedom to Speak Up guardians
• Seniority had an impact on whether workers knew the arrangements for speaking up, 71% of staff pay bands five-to-eight knew what the speaking up arrangements were, whereas only 59% of bands one-to-four did.

The review's recommendations include calls for the strengthening of support, allowing temporary workers to speak up and the promotion of a culture of inclusion and belonging for temporary workers.

In response, the Recruitment and Employment Confederation's director of campaigns, Shazia Ejaz, said: ‘The NHS must better understand its large, skilled and committed temporary workforce – the very people it is relying on to keep wards open, keep appointments running and keep patients safe. A sensible next step is to include agency workers in the annual NHS Staff Survey.

She added: ‘The report shows that many temporary NHS workers feel undervalued, unsupported and uncertain about their job security, issues made worse by poor integration and team inclusion. This is a major criticism of the NHS given the increasing demand from healthcare workers to work flexibility. It is vital that national bodies and the NHS work together to give temporary workers a stronger voice. Government anti agency rhetoric has only undermined efforts to build an inclusive culture: this report is a clear reminder that such rhetoric must end.

‘We want to collaborate directly with the NHS, National Guardian's Office and national representative bodies. The REC supports the recommendations in the review and will help member recruitment businesses to support measures, statutory or non-statutory, offered by trusts to ensure temporary workers have the right to speak up.'

The full review can be viewed here.