In 2019, the National Guardian’s Office conducted a review of the speaking up processes, policies and culture at Brighton and Sussex University Hospitals NHS Trust (BSUH). The office undertook this review in response to information it had received from some current and former trust workers that suggested there was not a positive speaking up culture in the trust, particularly in relation to issues raised by black, Asian and minority ethnic (BME) members of staff.

As well as looking at the issues raised in their referral, the review also looked for evidence of improvements to the trust’s speaking up culture that the trust leadership said it had made.

As with all our case reviews, our purpose was to identify learning and improvement and to highlight good practice and innovation. The trust fully supported the review and provided all necessary information for its completion.

The review found evidence that the trust was in the process of making improvements to its speaking up culture and that its leaders were focussed on the importance of positive working cultures in the delivery of high-quality patient care.

Examples of actions to improve the organisation’s culture included the use of weekly ‘improvement huddles’, where all staff in a service were encouraged to speak up about issues where they worked and actions to address them were then agreed by the team members.

Many of the workers we spoke to commented that there had been an improvement in the working culture of the trust since a new leadership team, which also runs a neighbouring NHS trust, started work in April 2017. The staff survey for 2018, published during our review, reflected significant improvements from the previous year’s survey in how trust workers viewed the organisation’s working culture.
Care Quality Commission (CQC) inspectors also found considerable improvements in the working culture of the organisation when they inspected the trust in 2018.

Our review has commended good speaking up practice, where this was identified and has made 6 recommendations on how the trust can build on the improvements it has begun. The review also makes one recommendation for the National Guardian’s Office.

The optimism expressed by many trust workers to our review about cultural improvements was often cautious. The changes were described as ‘fragile’ and ‘green shoots’ and there was clear concern that the new trust leaders might leave before the changes they have instigated are complete.

Some workers and former workers told our review that historic issues relating to discrimination in
the organisation still remained.

Read the report and recommendations