Royal Cornwall Hospitals NHS Trust: A review by the National Guardian of speaking up in an NHS trust

Within 12 months the trust takes appropriate measures to identify the causes of poor working relationships across the whole organisation and implements effective actions to remedy those causes, including steps to measure the effectiveness of those actions.

Within 12 months the trust takes steps to implement national guidance from NHS England relating to the managing of conflicts of interest.

Within 12 months trust leaders develop and begin the implementation of a strategy to improve the speaking up culture across its workforce. 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 6 months the trust should review incident reporting rates and identify any areas which appear to be under-reporting and take action to address this.

Within 3 months the trust should take appropriate steps to ensure that 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 trained investigators.

Within 3 months the trust should take appropriate steps to ensure that the confidentiality of workers who speak up is appropriately supported, in accordance with trust policy and procedure and good practice.

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.

Within 3 months the National Guardian’s Office and its partners involved in reviewing settlement agreements in the NHS, including the Department of Health and Social Care, NHS Employers and NHS Improvement, should complete this review and take all appropriate steps to implement its findings.

Within 3 months the trust should revise its new speaking up policy, to ensure it is in line with the NHS Improvement national speaking up policy.

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

Within 6 months the trust should put effective systems in place to monitor the development of a positive speaking up culture.

Within 6 months the National Guardian’s Office should draw up national guidelines for the NHS relating to the content of speaking up training for workers.

Within 12 months the trust should ensure that the content of any speaking up training it provides for its workers is consistent with guidance issued by the National Guardian’s Office and NHS Improvement, including findings and recommendations from NGO case reviews and the Freedom to Speak Up Survey 2018 and board guidance from NHSI

Within 3 months the trust should take appropriate steps to identify the necessary resources required to ensure the Guardian role meets the needs of workers and then provide those resources.

Within 3 months the trust should ensure that reports for board members regarding the trust’s speaking up arrangements continue to contain appropriate levels of detail, in accordance with the joint guidance from NHS Improvement and the National Guardian’s Office.