Northern Lincolnshire and Goole NHS Foundation Trust: A case review of speaking up processes, policies and culture

Within 3 months the trust should revise its policies and procedures relating to the reporting and handling of incidents to ensure they refer to the support available for staff to do this from the trust Freedom to Speak Up Guardian and Associate Guardians.

Within 3 months the trust should revise its policy for dealing with serious incidents to ensure it provides that feedback and any learning should be shared with staff who had spoken up regarding an incident.

Within 3 months the trust should revise its current speak up policy to ensure that it is in accordance with good practice and reflects the minimum standards set out in the NHS Improvement speaking up policy for the NHS.

Within 6 months the trust should take steps to ensure all existing and new workers are aware of the contents of its new speak up policy.

Within 12 months the trust should begin work to ensure that, upon the scheduled review of any trust policy and/or procedure, the policy or procedure in question is in alignment with good practice in relation to the freedom to speak up.

Within 6 months the trust board should articulate a vision of how it intends to support its workers to speak up, which encompasses a strategy containing deliverable objectives within fixed timescales and under appropriate executive oversight, and to effectively communicate this to trust workers.

Within 6 months trust leaders should identify and employ a range of appropriate measures to monitor speaking up processes and culture within the trust, to ensure they are responsive to the needs of all workers and are developed in accordance with good practice.

Within 6 months the trust should ensure that its bullying and harassment policy and procedure is consistent with the standards set out in the bullying and harassment guidance issued by NHS Employers, including how the trust will implement and monitor the revised policy and ensure its contents are shared with all staff.

Within 12 months the trust should take steps to address bullying behaviour, including training for all staff relating to the awareness and handling of such behaviour.

Within 6 months the trust should continue to ensure that all investigations into the alleged conduct of workers who have previously spoken up also seek to identify whether any such allegations are motivated by a desire to cause detriment because that worker spoke up and, where such evidence is found, take appropriate action. This should include amending the trust disciplinary policy to require such action.

Within 3 months the trust should ensure that, in accordance with its own policies and procedures and in accordance with good practice, all managers and leaders responsible for handling speaking up provide feedback to every individual who raises an issue, including any actions they intend to take in response.

Within 3 months the trust should ensure that it responds to the issues raised by its workers strictly in accordance with its policies and procedures and in accordance with good practice, including, where appropriate, investigating matters that are raised.

Because of the particular needs of the trust to improve its speaking up process and culture it is recommended that, within 12 months, the trust should provide all workers with mandatory, regular and updated training on speaking up, including for those with responsibility for handling concerns. This training should be in accordance with NGO guidance and the trust should monitor that it is effective.

Within 3 months the trust should allocate sufficient ring-fenced time for the Freedom to Speak Up Guardian and any Associates to ensure they can appropriately support the needs of workers to speak up.

Within 3 months the trust should take appropriate steps to ensure that the role and names and contact details of the Freedom to Speak Up Guardian and Associate Guardians are promoted to all workers across all three trust hospital sites.

Within 6 months a communications and engagement strategy should be developed to promote the Freedom to Speak Up Guardian and Associate Guardian’s role, and to evaluate the impact it is having, in the longer term. This should include strategies to provide feedback on actions taken in response to speaking up and actions to tackle barriers to speaking up.

Within 3 months the Freedom to Speak Up Guardian should ensure that their regular reports to the trust board are sufficiently detailed and comprehensive to support the development of a positive speaking up culture.

Within 3 months the Freedom to Speak Up Guardian and any Associate Guardians should begin regular attendance at regional meetings of their peers to ensure that they have access to guidance and support to undertake their work, including to assist with the writing of board reports and in order to share learning and good practice with them.

Within 3 months the trust should ensure that all HR policies and procedures meet the needs of workers who speak up, including letters to suspended workers that accurately state their ability to access their Guardian or Associate Guardian.

Within 3 months the trust should continue its work to ensure that, where a worker is going through a disciplinary process that also encompasses potential patient safety issues or similar matters they have raised, the trust continues to provide that worker with all appropriate support to speak up about those matters and also takes all appropriate steps to maintain the worker’s confidentiality.

Within 12 months the trust should take steps to actively promote the use of mediation, where appropriate, to resolve issues arising from speaking up.

Within 3 months the trust should consider requesting support from the NHS England WRES Implementation Team to help meet the needs of its BAME workers.

Within 12 months the trust should take all appropriate steps to identify which staffing groups in the trust feel particularly vulnerable when speaking up, why this is the case and how those groups can be supported to speak up freely and protected from any detriment for having done so.