The commitment of senior leaders to listen to workers earned Northern Lincolnshire and Goole NHS Foundation Trust (NLG) a place in the final of the 2021 HSJ Awards.

At the start of the pandemic, little was known about the impact that COVID-19 would have on ethnic minorities.

As the crisis unfolded, workers from NLG’s Black and Minority Ethnic (BAME) network started to highlight a number of concerns that certain groups of workers were suffering more significant consequences of contracting the virus than others.

The Trust’s Chief Executive advocates an ‘open door’ policy for workers to speak up to him. His encouragement of a speaking up culture at NLG meant that some members of the BAME network felt able to directly speak up to him about the impact of the COVID-19 on ethnic minority colleagues.

As a result of this, two workers from this network were asked to form part of a working group to consider the information and options available at the time. These options included working from home, redeployment to lower risk areas, and the use of enhanced personal protective equipment (PPE) where appropriate. Generally, the options were aimed at trying to reduce the risks to the individual concerned especially if they were in one or more vulnerable groups and maintain the levels of care needed. The working group involved the lead for Equality and Diversity and the Health and Safety Lead.

Information through various forums (such as via national professional bodies and mortality data available through regional and local information sources) was discussed, reviewed and verified in a short period of time to make sure that action was taken quickly. The working group identified some vulnerable groups where mortality rates were much higher than in other groups of workers – even though they may not have known this at the time. The scope of the work was extended to include these groups.

This led to the development of the ‘options pathway’ – a tool designed for managers to determine the level of risk to each worker and options available to reduce the risk. After a review by the working group and the Trust Executive Team, the pathway was developed further so it could be inclusive of all staff groups with the aim of identifying those at a significantly higher risk.

The widening of the pathway was also done with the aim of overcoming barriers from potentially vulnerable groups, such as those concerned at being taken out of work or those who did not want to be individually identified and potentially being retired. To overcome another barrier, workers were not asked to specify medical conditions; just to flag whether they had knowledge of any underlying conditions that might affect them.

The pathway was tested and successfully rolled out throughout the trust. It was also communicated to other trusts, via national groups, to share the learning at a time where there was no national guidance on identifying the risks COVID-19 poses to specific groups.

The options pathway has been a vital tool for NLG workers in identifying those at risk and it continues to be developed as the pandemic evolves. This includes supporting some workers return to the trust after a period of working from home.

This example shows the value in having a supportive culture from the top down. A number of groups were involved in the production of the options pathway – from the ethnic minority workers who first spoke up within their networks right up to the Trust Executive Team and the Chief Executive, who made sure that the workers were listened to and that actions were taken as a result. The success of this has given confidence to other workers who might want to speak up in the future. 

Liz Houchin, Freedom to Speak Up Guardian for NLG said: ‘’The trust is committed to making speaking up business as usual and there are lots of different routes available for workers to be able to do that, as this case demonstrates. It also highlights the importance of speaking up and the positive outcomes that can happen when workers feel able to speak up – it does not matter which route they chose, we want workers to know that silence isn’t safe.’’ 

Peter Reading, NLG’s Chief Executive, said: “One of the things I have tried really hard to do is enable workers to speak up and get their questions answered. The Freedom to Speak Up Guardian is just one route we have. It is crucial workers feel they are listened to – it builds engagement, motivation and puts rumours to bed quickly. Even when we can’t do what they ask, for whatever reason, it’s important we reflect on that and explain why that’s the case. All the evidence shows an open and transparent culture helps to retain workers and build better patient care so why wouldn’t we do everything we can? Of course, there’s always more we can do but this project shows we do listen and that can make such a difference.”