Leeds Community Healthcare Trust, Freedom to Speak Up Organisation of the Year at the 2020 HSJ Awards, have demonstrated an approach that promotes how integration can allow Freedom to Speak Up to flourish.

“A strong speaking up culture is where all voices are heard, understood and valued,” says John Walsh, Freedom to Speak Up Guardian at LCH. “Speaking up is everyone’s business within an organisation and beyond.”

Using the knowledge gained from his own experience in this role, John has been able to share the learning across organisational boundaries to support an integrated approach to speaking up in the local area. Alongside the BAME Speaking Up Champions, a Speaking Up Champion for staff undergoing domestic abuse and violence and the 15 Freedom to Speak Up Guardians in the vanguard site in Leeds General Practice, there is new work with the local authority to learn together and grow good speaking up practice.

The Freedom to Speak Up team at LCH has developed an approach called ‘Speaking Up is a Practice Not a Position’. “For Freedom to Speak Up to work, you need buy-in from all workers at all levels within the organisation. Workers need to feel able to speak up, managers at all levels need to be ready to listen up, and senior leaders need to follow up where appropriate,” says John.

There are many widely advertised routes for speaking up, including the Freedom to Speak Up Guardian, anti-bullying officers, easy access to directors, managers, Staffside, HR and an anonymous ‘Ask the CEO’ function on the intranet. This means there are many portals to speak up through and workers can access any of them.

There is a special emphasis on an offer of ongoing emotional and practical support to all staff who speak up.

Most Freedom to Speak Up concerns raised at LCH are by workers who have been recommended this route by others who have used this service.

The trust has worked on making speaking up available for all. This includes work with BAME colleagues to support speaking up (co-developed and delivered by our BAME Staff Network and its chair at the time Kulvant Sandhu) and a closed online support group for workers who are shielding.

To support managers at all levels to listen up, John delivers the final day of the trust leadership programme with a focus on speaking up, listening up, psychological safety, caring cultures and inclusive leadership.

This approach is backed up by a willingness from senior leaders to improve the organisational culture at LCH. All directors have been involved with speaking up concerns, including meeting directly with workers who have spoken up where workers have requested this.

John presents two papers per year to the board and reports to Thea Stein, the CEO, who has given her full support for Freedom to Speak Up. The CEO role is crucial and has shared the message and practice across the organisation.

Another way the LCH Freedom to Speak Up Team works collaboratively with other organisations in the local area is through supporting peer reviews. A local health trust Locala and John’s trust carried out a peer review of each other’s Freedom to Speak Up Guardian service. The Freedom to Speak Up Guardian from Locala offered a clear and open appraisal of LCH’s speaking up arrangements after independently interviewing workers, managers, those who have spoken up and the CEO. The results of the peer review indicated a good speaking up service at LCH and added that the Freedom to Speak Up message was positively embedded across the organisation. Since this, another NHS Trust has requested and received a peer review from LCH.

Having created this culture at LCH, John has worked hard to spread the learning regionally and nationally, through speaking at NGO events and sharing learning with others, such as Leeds Beckett University, Leeds City Council and the Yorkshire Royal College of GPs.

LCH has shown a real commitment to not only getting the culture right internally, but also embedding a speaking up culture across organisations in the local area. Using the model which is giving workers a voice in LCH, John has been able to facilitate Freedom to Speak Up being integrated across the local area and to a wider group of workers – working towards speaking up becoming business as usual.