A member of the Health Visiting team contacted Graham Rodber, the Freedom to Speak Up Guardian at Hounslow and Richmond Community Healthcare Trust, about their team structure. They were concerned about operational decision making and management of risk and that a high volume of agency and bank staff were working within the team.

Permanent part-time staff were not able to take on additional hours to cover shifts that were vacant and the concerns centred around longer-term agency and bank staff not having appropriate induction, supervision or training. Further concerns regarding the flat structure and lack of senior leaders within the team were also raised.

Graham contacted the Director of Nursing and Non-Medical Professionals who is the responsible director for Freedom to Speak Up within the organisation. An external investigation was commissioned. The worker who raised concerns was supported throughout the process and Graham kept them informed on the investigation’s progress.

As a result of the external investigation, a series of recommendations were made including an urgent review of all existing agency staff and their compliance with training, performance issues, supervision and knowledge of the clinical computer system – SystmOne. Further recommendations were to ensure that references are requested from agencies for all future agency recruitment and to prepare an audit of supervision themes for the safeguarding committee.

In addition, it was recommended that the learning from the outcomes of the investigation should be shared with Health Visitor Teams via a learning event using an Appreciative Inquiry approach.

Appreciative Inquiry is a way of looking at organisational change which focuses on identifying and doing more of what is already working, to identify and spread good practice.

Following the conclusion of the investigation, Graham said,

“The worker was absolutely right to raise their concerns with me, and I am glad we were able to support them throughout the process. Other workers within the Health Visiting teams will have seen that concerns and feedback are taken seriously, and the organisation acts upon matters raised. I hope that all workers will now feel confident and safe to raise further matters should they arise in the future.”

This case study was featured in our 2020 Annual Report.