The National Guardian’s Office undertook a review of the handling of two speaking up cases referred to it by two workers from Whittington Health NHS Trust in 2019.

The cases related to issues raised over a period from 2015 to the time of the review. The office undertook a review because the workers’ referral information indicated the trust’s response to their speaking up had not been in accordance with its policies and procedures, or good practice. The office decided a review could provide potentially important learning for both the organisation and other NHS trusts.

As part of its review, the office also looked at various aspects of the trust’s speaking up function to identify any learning and potential improvement, as well as any good practice or innovation. By ‘function’ we mean the trust’s speaking up arrangements, including its relevant policies, procedures and its support for those with specific, trust-wide responsibilities for supporting workers to speak up.

We visited the trust in November 2019 to gather information for its review. We returned in January 2020 to discuss our findings with trust leaders and agree on what actions they would take in response.

The trust supported the review process by assisting in its planning, providing all requested information and by participating in the engagement process to discuss the review’s findings.

As part of the review, NGO staff interviewed the workers who had referred their speaking up cases to the office and those in the trust who had knowledge of how the organisation had responded to those cases. In addition, we met with senior leaders responsible for the trust’s speaking up function.

The review looked at a range of relevant documentation, including the trust’s speaking up policies and procedures and an independent cultural review report it had commissioned, published in 2018.

At the time of the review, the trust employed a full-time Freedom to Speak Up Guardian. In accordance with national guidance for NHS trust boards, the speaking up function of the organisation was also supported by an executive and non-executive lead.

The review identified areas of improvement regarding how the trust responded to speaking up cases raised by its workers. These included workers not being thanked for speaking up, delays in responding to matters raised and the need to provide better support and information about processes and procedure to those speaking up and handling their cases.

The review identified areas of good speaking up practice. Firstly, the trust provided resource for the Freedom to Speak Up Guardian role to be undertaken full-time. Secondly, the guardian received regular supervision to support them with their management of complex cases and with their wellbeing. At the time of our review, the Freedom to Speak Up Guardian was also having regular meetings with human resources business partners in the organisation to promote understanding and trust between them regarding their respective roles in supporting speaking up.

The trust had decided in 2018 to appoint a full time Freedom to Speak Up Guardian to help ensure its workers received sufficient support to speak up. In doing so, the trust determined the post should be appointed at Band 7, to provide appropriate authority for the post-holder to raise matters with the organisation’s leadership, while not being too senior to be regarded as ‘remote’ to the trust’s workforce. In acknowledging the trust’s reason for their banding decision, we would observe that the authority of the guardian role in supporting the speaking up culture of an organisation derives from its pivotal role in that culture, rather than any banding given to it.

Read the report and recommendations