In September 2017 the National Guardian’s Office conducted a review of the speaking up policies, processes and culture at Northern Lincolnshire and Goole NHS Foundation Trust. We carried out this review because we had received information that the trust’s support for its workers to speak up did not always meet with good practice.
We also received information that many workers had spoken up anonymously to the Care Quality Commission over a two year period, raising a variety of issues, including the existence of a bullying culture and a failure to respond to patient safety issues.
Our review’s purpose was to identify where speaking up policies, processes and culture did not meet with good practice and to make recommendations to the trust on how they should remedy this. We also looked to commend examples of good practice where we found them.
The trust provided all necessary support for our review’s completion, from providing all the information we asked for to working with us to promote the review among its staff and the wider
public.
Our review found evidence of a speaking up culture that needed improvement, where the issues raised by staff were not always handled in accordance with good practice, including where staff had spoken up about serious patient safety matters. We also found that policies and procedures related to speaking up needed improvement as they did not provide sufficient support to trust workers to speak up about issues.
In addition, while the trust had appointed a Freedom to Speak Up Guardian and Associate Guardians to provide independent support for staff to speak up, this service required more ringfenced time to effectively meet all workers’ needs.
Several workers also approached us to tell us about their experiences of speaking up and gave examples of where they felt the trust had not responded appropriately to their concerns. In doing
so they described a bullying culture that existed in certain parts of the trust that meant that workers were often afraid to speak up.
However, it was also clear when discussing the speaking up culture in the trust with its senior leaders that several of them, including the new chief executive officer, recognised that it needed urgent improvement and they were planning a variety of steps to address this. These steps included undertaking listening events with staff groups to learn about their issues, a plan to develop a compassionate leadership programme for senior managers and the development of an equality and diversity strategy to address matters raised by workers in the 2016 NHS staff survey.
In response to the evidence we have found we have made 23 recommendations to the trust on how they can improve their support for their workers to speak up.
With each recommendation we have indicated the time frame in which the trust should aim to implement the necessary actions and we will work with the trust to support this implementation.
In addition to our recommendations we have also commended the trust in a number of areas where we have identified that its speaking up arrangements meet good practice.