The National Guardian’s Office received information indicating that a speaking up case may not have been handled following good practice. The information received  also suggested black and minority ethnic workers had comparatively worse experiences when speaking up.

Reviews seek to identify learning, recognise innovation and support improvement, and, ultimately, improve the experience of workers, patients, and the public.

Based on focus groups and interviews with Trust workers, and analysis of internal processes and data, the report reviews information about the trust’s speaking up culture and arrangements and the trust’s support for its workers to speak up.

The review was undertaken during the COVID-19 pandemic when there was significant pressure on the trust and its workforce.

The review was carried out virtually to minimise additional pressure and allow the participation of those involved. Focus groups and interviews were held with trust workers and senior leaders through October to December 2020.

We reviewed specific experiences of speaking up in the trust. We heard from over 70 workers through these focus groups and interviews. We reviewed documents relating to the trust’s speaking up culture and arrangements,  including policies and procedures, reports and action plans. We also reviewed relevant data from the NHS Staff Survey and other metrics.

The review found that there were long-standing issues with the trust’s speaking up culture. There was a perception among some workers that speaking up was futile. Black and minority ethnic workers – and other groups – also reported facing barriers to speaking up.

Concerns about the trust’s speaking up culture were affecting confidence in the Freedom to Speak Up Guardian service. But workers were speaking up to the Freedom to Speak Up Guardian, although there had been a drop in cases, and most that provided feedback said they would speak up again.

The review found that work was underway to improve the organisation’s speaking up culture, and there was information that this was beginning to make a difference. Changes at a leadership level in the trust were also facilitating that improvement.

The review also found that some workers who had spoken up to national bodies had variable experiences.

The report makes recommendations for actions which national bodies and the healthcare system as whole can take to support organisations, including bringing national guidance into line with good practice and make that guidance universally applicable.

Following the CQC’s lead, the National Guardian’s Office is developing the Speaking Up Partnership Group to improve the consistency and quality of responses given to workers who speak up to national organisations.

Read the report and recommendations