In 2018, the National Guardian’s Office has conducted a review of the handling of speaking up cases at Nottinghamshire Healthcare NHS Foundation Trust after receiving information that the trust may not have responded to one of its workers speaking up in accordance with good practice. Once announcing the review of this case other trust workers contacted us to describe their experiences of speaking up.

Where we have identified learning in these cases in relation to improving the handling of speaking up we have made recommendations to this effect.

We have also commended examples of good speaking up practice that we found during our review. Our review took place from May to July 2018 and reviewed the handling of speaking up in two different services of the trust.

In those services, we found that some of those responsible for responding to issues raised by workers did not follow the trust’s speaking up policy, or understand when it should be used. As a result, workers who spoke up did not always receive appropriate support.

In one case, the trust’s response to a worker who spoke up about patient safety was not in accordance with its stated values to treat individuals with care and respect.

We also found the working culture in one of the services was poor, with significant evidence that many staff in that service did not feel free to speak up about their work, or matters relating to patient safety.

More positively, senior leaders demonstrated insight into the need to improve the trust’s support for its workers. In respect of one of the services we visited they agreed to consider reviewing the bullying culture. In another, they were putting plans in place at the time of our review to improve the speaking up culture.

The trust also demonstrated a clear commitment to support the work of the Freedom to Speak Guardian, providing resources for them to work on a full-time basis, as well as regular managerial and clinical oversight to help them manage the challenges of the role. This oversight reflected the trust’s appreciation, as a leading provider of mental health services, of the needs of their Guardian.

At the time of our review, the Freedom to Speak up Guardian had received requests from workers for support to speak up in over 200 separate cases.

Our review makes 13 recommendations for the trust on how it can improve its support for its workers to speak up. With each recommendation, we have indicated the time frame within which we expect the organisation in question to implement the necessary actions.

Read the report and recommendations