Blackpool Teaching Hospitals NHS Foundation Trust: A case review of speaking up culture and arrangements by the National Guardian’s Office

Within three months, the trust should: • Continue to demonstrate that it values the views of its workers, including consulting staff about changes to their services as appropriate, in line with its policies and procedures and good practice.

Within three months, the trust should: • Continue to take appropriate steps to promote a culture of visible and accessible leadership.

Within three months, the trust should: • Take appropriate steps so that issues about which workers speak up are responded to in accordance with trust policies and procedures and good practice.

Within three months, the trust should: • Take appropriate steps to ensure workers who speak up are meaningfully thanked for doing so, in accordance with trust policies and procedures and good practice.

Within three months, the trust should: • Take appropriate steps to ensure its policies and procedures are fair and supportive of all workers in the speaking up process, including those who are the subject of matters that are raised.

Within three months, the trust should: • Take appropriate steps to promote effective communication with those speaking up in order to effectively manage expectations.

Within three months, the trust should: • Take appropriate steps to assure themselves that speaking up practices ensure that the confidentiality of workers who speak up is appropriately supported – including looking into cases where a breach of confidentiality is reported.

Within three months, the trust should: • Take appropriate steps to ensure that workers who speak up can have input into the terms of reference for any subsequent investigations, in accordance with trust policies and procedures and good practice.

Within three months, the trust should: • Take appropriate steps to ensure its response to workers speaking up, including the investigations of those issues and the implementation of learning resulting from them, is undertaken by suitably independent and trained investigators.

Within three months, the trust should: • Take appropriate steps to ensure matters arising from cases of speaking up are investigated within reasonable timescales and without undue delay.

Within three months, the trust should: • Take appropriate steps to ensure that workers who speak up receive meaningful and timely feedback in accordance with trust policies and procedures and good practice.

Within three months, the trust should: • Communicate that detriment for speaking up will not be tolerated, act to prevent detriment occurring, and put in place procedures that would enable cases of detriment to be looked into effectively when they are reported.

Within three months, the trust should: • Take appropriate steps so that those who speak up have access to appropriate support and are made aware of and appropriately supported to access this support in a timely way.

Within three months, the trust should: • Work with their Freedom to Speak Up Guardian to identify potential groups that face particular barriers to speaking up, and work towards addressing those barriers. Within six months, the trust should: • Update and implement the trust's equality, diversity and inclusion strategy considering the findings of this review.

Within three months, the trust should: • Provide assurance that all three FTSU guardians that support workers at the trust are able to meet the requirements of the universal job description. • Revert to using the term ‘Freedom to Speak Up Guardian for all three guardians. It may, locally, consider how it communicates the primary functions of the individuals in each of the roles though, at all times, the individuals should be able to fulfil the requirements of the universal job description.

Within three months, the trust should: • Ensure that that changes to the Freedom to Speak Up arrangements are communicated to workers in a timely way.

Within three months, the trust should: • Take appropriate steps to assure themselves that their Freedom to Speak Up Guardian arrangements have the confidence of the workforce.

Within three months, the trust should: • Provide the Freedom to Speak Up Guardian(s) with ring-fenced time for the role, taking account of the time needed to carry out the role and meet the needs of workers in their organisation. Leaders should be able to demonstrate the rationale for their decisions about how much time is allocated to the role.

Within three months, the trust should: • Take appropriate action to ensure the Freedom to Speak Up Guardian(s) are appropriately supported to carry out their role, in line with guidance from the National Guardian’s Office and NHS England & Improvement.

Within three months, the trust should: • Take appropriate steps to ensure cases brought to the Freedom to Speak Up Guardian are recorded and reported in accordance with guidelines from the National Guardian’s Office.

Within six months, the trust should: • Continue with and review the effectiveness of its programme of work to challenge unwanted and/or unprofessional behaviours. • Continue to promote and facilitate the use of mediation where appropriate.

Within six months, the trust should: • Continue to improve effectiveness of its governance arrangements, including the communication of information from and to ‘board to ward’.

Within six months, the trust should: • Continue to take appropriate steps to ensure human resources policies and processes have the confidence of its workforce, including effective training for workers in human resources.

Within six months, the trust should: • Provide and monitor the uptake of effective speaking up training for all workers, ensuring this meets the expectations set out in guidelines from the National Guardian’s Office.

Within six months, the trust should: • Complete the Freedom to Speak Up review toolkit and share this with NHS England and Improvement, in line with NHS England and Improvement guidelines.

Within six months, the trust should: • Continue to improve the board reports presented by the Freedom to Speak Up Guardian, ensuring this is in line with guidelines from NHS England and Improvement.

Within six months, the trust should: • Develop and begin the implementation of a strategy to improve the speaking up culture across its workforce, in line with guidelines from NHS England and Improvement. The plan should contain measures to identify the main issues the trust should address, clear actions to address those issues and steps to measure the effectiveness of those actions.

Within six months, the trust should: • Develop and evaluate its Freedom to Speak Up communication plan in line with guidelines from NHS England and Improvement, ensuring this takes account of workers in the trust’s community sites and other groups that may face barriers to speaking up.

Within six months, the trust should: • Should develop a plan to ensure that workers can speak up effectively about the impact of integration as its local integrated care system continues to develop and mature.

Within nine months, the trust should: • Review the use of the Freedom to Speak Up Champion role, ensuring this is in line with guidelines from the National Guardian’s Office.

Within 12 months, the trust should: • Discuss and agree a continuity plan to support incoming Freedom to Speak Up Guardians and minimise any disruptions to the Freedom to Speak Up arrangements, ensuring this is in line with guidelines from the National Guardian’s Office.

Within 12 months, the trust should: • Take appropriate steps to identify and review measures to assure themselves that those with senior responsibility for Freedom to Speak Up have the confidence of the workforce, making improvements as needed.

Within 12 months, the trust should: • Revise the trust’s speaking up policy to take account of the observations made in this report. • Take steps to ensure all existing and new workers are aware of the contents and meaning of its revised speaking up policy.