In 2018, the National Guardian’s Office conducted a review of the speaking up processes, policies and culture at Royal Cornwall Hospitals NHS Trust, in response to information the office received that the trust’s response to the concerns raised by its workers was not in accordance with good practice.

The purpose of the review was to look at the trust’s speaking up policies and procedures, as well as how it had handled individual speaking up cases raised by its workers, to identify any learning to improve the trust’s speaking up culture.

We also wanted to highlight any good examples of speaking up practice in the trust so that these may be followed by other trusts in England.

The trust supported the review through arranging interviews and meetings with many of its workers and leaders.

The review found evidence that the trust did not always respond to instances of its workers speaking up in accordance with its policies and procedures, or with good practice. Such responses contributed to a belief among some of the workers who spoke to our review that there was not a positive speaking up culture in the trust and that the issues that they raised were either poorly handled, or ignored by management.

Our review also identified areas where the trust could do more to support the speaking up culture.
While the trust commissioned speaking up training for its workers, the training did not refer to national guidance on good speaking up practice issued by either the National Guardian’s Office, or NHS Improvement.

In addition, there was evidence that settlement agreements between the trust and workers were difficult to understand and gave workers the impression that they were not free to speak up.

More positively, it was clear that the leadership of the trust understood well the need to improve the speaking up culture, and were beginning to take steps to do this. These included providing workers with a variety of means of raising issues through a network of speaking up champions across the trust, who supported the work of the trust Freedom to Speak Up Guardian.

The trust leadership also expressed a commitment to make the settlement agreements it reached with its workers more supportive of speaking up.

Read the report and recommendations