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Case reviews

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In June 2017, the National Guardian’s Office launched a 12 month trial of its case review process. The trial will review the handling of concerns and the treatment of people who have spoken up, where there is evidence that good practice has not been followed.

Case reviews will identify areas where the handling of NHS workers’ concerns did not meet the standards of accepted good practice in supporting speaking up and recommendations will be made to NHS organisations to take appropriate action where they have failed to follow good practice. Case reviews will also commend areas of good practice.

The National Guardian’s Office will initially conduct a 12 month pilot of the case review process, after which they will assess and refine the process, taking into account the feedback received from case referrers and others.

Case review referrals can be sent to the National Guardian’s Office by email to: casereviews@nationalguardianoffice.org.uk

When referring by email we recommend that you use the downloadable referral form below. Using this form will assist us in promptly processing your referral.

Official documents

Published reports

Case review news

Friday 27 April 2018

Case review announced to take place at Nottinghamshire Healthcare NHS Foundation Trust

In response to a referral regarding the handling of speaking up, the National Guardian’s Office (NGO) has announced it will be carrying out a case review of speaking up at Nottinghamshire Healthcare NHS Foundation Trust.

The purpose of the review is to look at how the trust has responded to its workers speaking up and to publish its findings. Where the NGO receives evidence that good practice has not been followed the review will make recommendations on how this can be improved.

“Importantly, the report will also commend areas of good practice and will be used by other NHS organisations as a means of identifying learning and assessing their own speaking up practices and processes,” said, Dr Henrietta Hughes, the National Guardian for the NHS.

Ruth Hawkins, Chief Executive for the Trust, added: “We welcome the scrutiny offered by this case review of speaking up. Whilst we are proud of what we have achieved so far with our Freedom to Speak up Guardian and other staff voice initiatives, we know we can do more. The Trust is keen to learn and improve and we hope this will be another tool to aid us with that.”

Friday 20 April 2018

Royal Cornwall Hospitals NHS Trust next in line for NGO case review

The National Guardian’s Office (NGO) will be carrying out its next case review at Royal Cornwall Hospitals NHS Trust (RCHT). This is in response to information that the trust needs to improve the support it provides to workers who speak up.

The NGO provides leadership, support and guidance on speaking up in the NHS. As part of its work, and reviews how NHS and foundation trusts have supported their workers to speak up.

RCHT is the main provider of acute and specialist care services in Cornwall and the Isles of Scilly. Its approximately 5,000 workers serve a population of around 430,000 people. In October 2017, the trust was rated as 'inadequate' overall by the Care Quality Commission. Following this inspection, the trust was put into 'special measures'.

RCHT will work with the NGO to review how it handles speaking up and issues raised by its workers.

The National Guardian for the NHS, Dr Henrietta Hughes, said: “I am pleased that Royal Cornwall Hospitals NHS Trust will be working with my office to identify areas for improvement in speaking up.

“The objective of this review will be identifying as much learning as possible about how speaking up arrangements and cultures can be improved. The review will also highlight examples of good practice, including any innovative steps that the trust has taken to support its workers to speak up.

“By working together we hope to continue to promote an open and transparent culture where speaking up is business as usual.”

RCHT Chief Executive, Kathy Byrne said: “It is vital every member of staff feels able and confident to challenge and to speak up if they have any concern about the safety of patients or staff. The case review is a positive opportunity for us to learn where we can improve and to make speaking up at RCHT an open and supportive process.”

In June 2017, the trust announced the appointment of Louise Dickinson as their new Freedom to Speak Up Guardian.

1 February 2018

National Guardian’s second case review identifies opportunities for trust to learn and improve speaking up processes

The second case review report to be published by the National Guardian’s Office has revealed significant opportunities for the culture of speaking up at Northern Lincolnshire and Goole NHS Foundation Trust to be improved.

Dr Henrietta Hughes, National Guardian for the NHS, said, “We received information that the trust’s support for its workers to speak up was not always in keeping with good practice, including instances where workers had spoken up anonymously to the Care Quality Commission (CQC).

“Our review found that the trust had failed to respond appropriately, including where staff had raised serious safety issues. We also found evidence of the existence of bullying in the trust and a bullying culture within specific teams that made workers fear the consequences of speaking up.”

The findings detailed in the report include reference to the fact there was no specific training for staff on how to speak up, or for managers to support people speaking up, or how to handle matters raised.

Some of the trust’s policies and processes were also highlighted in the report, with their speaking up policy not meeting national minimum standards as set out by NHS Improvement, and their bullying and harassment policy needing improvement to ensure it met the standards set out in guidance by NHS Employers.

The review found examples of good practice that was supportive of trust workers speaking up. This included a robust recruitment process to select staff to undertake guardian roles and the improvement of HR processes to ensure they are more supportive of workers who speak up.

“It’s good to see some activities are already being pursued by the trust and we hope the our report will help them to improve and draw together an action plan to address each of the 23 recommendations over the coming 12 month period,” said Dr Hughes.

“I encourage other trusts to reflect on the recommendations and to look at how they might improve and apply the learning to their own cultures and processes.”

Last week also saw the publication of new guidelines by the CQC in relation to the fit and proper person’s requirement (FPPR) for directors. The National Guardian’s first case review in relation to Southport and Ormskirk Hospitals NHS Trust made a recommendation for the CQC around FPPR for directors.

As well as making specific reference to speaking up, significantly the updated guidance also highlights bullying as an example of mismanagement, which can often be a serious and continuous obstacle to speaking.

Next week, the action plan to address the recommendations for Southport and Ormskirk Hospitals NHS Trust goes to their board, having been agreed by NHS Improvement (NHSI).

“Seeing our case review reports acted upon and driving real change is a key measure as we continue to roll out our case review pilot,” said Dr Hughes. “The reaction from the CQC shows a tangible development in relation to the issue our report highlighted, and it is excellent to have NHSI and the Southport and Ormskirk Hospitals NHS Trust board engaged in the process of implementing our recommendations.”

16 January 2018

Case review announced for Derbyshire Community Health Services NHS Foundation Trust

The National Guardian’s Office will be carrying out its third case review at Derbyshire Community Health Services NHS Foundation Trust. This is in response to a referral it has received regarding the handling of a case of speaking up in the trust.

This review will be taken forward as part of the 12 month pilot of the National Guardian’s Office case review process. This was launched in June 2017 to review the handling of concerns and the treatment of people who have spoken up, where there is evidence that good practice has not been followed.

As part of a case review the National Guardian’s Office makes recommendations to NHS organisations to take appropriate action, whilst also commending areas of good practice.

The National Guardian’s Office has already published one report for a case review carried out at Southport and Ormskirk Hospital NHS Trust and is due to publish a second relating to Northern Lincolnshire and Goole Hospitals NHS Foundation Trust shortly.

15 November 2017

National Guardian for the NHS calls for action on speaking up

The National Guardian for the NHS has published a set of recommendations following concerns raised by staff about the speaking up culture at Southport and Ormskirk Hospital NHS Trust.

The case was referred to the National Guardian’s Office as many people had spoken up at the trust but their concerns were not properly acted on. The report identified failures to act appropriately on multiple and serious allegations and a number of wide ranging issues that represented significant barriers to speaking up. These included a culture of bullying and alleged discriminatory behaviour.

As a result of the report, the National Guardian has made 22 recommendations for the trust and one for the Care Quality Commission, encouraging all organisations to reflect on these and apply the learning to their own cultures and processes.

Dr Hughes said:

“I would like to thank Southport and Ormskirk NHS Trust and all those who were involved in the review for their cooperation, willingness to work together, and appetite for learning. Many individuals at the trust said their views or concerns had not previously been taken seriously. The trust also failed to consider the needs of its black and minority ethnic staff.

“I have published a set of 22 recommendations for the trust, which are designed to improve workers’ ability to speak up and to tackle the barriers to speaking up that were present in the organisation. My review also highlights areas for improvement in the Fit and Proper Persons Test which I have recommended that the Care Quality Commission addresses in its revised guidance.

“I can, however, only act on cases that I am aware of. If any individual or organisation within the NHS feels that they have a speaking up case that has not been dealt with in accordance with best practice, I would encourage them to refer the matter to my office for consideration.”

Karen Jackson, interim Chief Executive, Southport & Ormskirk Hospital NHS Trust said:

“We were pleased to be able to work with the National Guardian’s Office to review how speaking up is, and has been, handled by the trust. We encouraged staff from across the trust to take part and they raised a range of concerns. Most of these concerns went back a good number of years.

“The trust now has a new senior management team in place. The learning from the review is a welcome and helpful addition to the robust action plan we have in place to ensure that speaking up is seen as a way to make improvements for our staff and for our patients.

Chris Hopson, Chief Executive of NHS Providers said:

“This is a constructive and valuable report. It provides welcome insight for all trusts into what makes speaking up work well and sets out the process and policies that support it.

“It highlights how openness and transparency from senior leaders are vital in ensuring staff are treated fairly at work. The focus on improving the culture for black and ethnic minority staff is particularly welcome given the concerns that exist right across the NHS.”

23 August 2017

Special measures trust to work with National Guardian's Office to pilot new review process

The National Guardian’s Office (NGO) was established in 2016 to support Freedom to Speak Up in NHS trusts. It also reviews instances where there is evidence a trust may need to improve its support for speaking up.

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust is in ‘double special measures’ (for quality of care and finance).  There is evidence that the culture and processes for staff at the trust to ‘speak up’ or raise concerns do not always work well.

The NGO launched a pilot of its process for reviewing culture and processes for ‘speaking up’. Northern Lincolnshire and Goole NHS Foundation Trust has now volunteered to work with the NGO to use this pilot to review how it handles speaking up and concerns raised by its staff. It will do this with reference to the recommendations of Sir Robert Francis’ Freedom to Speak Up Review (February 2016).

The National Guardian, Dr Henrietta Hughes, said: “I am delighted that North Lincolnshire and Goole NHS Foundation Trust has volunteered to work with my team to identify areas for improvement in speaking up.  The purpose of this review will be to identify learning for the trust, as well as all NHS organisations and their staff. Working together is a positive step in embedding the open and transparent culture we all wish to see where speaking up is business as usual.”

North Lincolnshire and Goole NHS Foundation Trust Chief Executive, Dr Peter Reading said: “Our staff have recently raised a number of concerns about the trust. I am therefore pleased to have the opportunity to work with the National Guardian’s Office to review whether our processes and cultures have fully supported our staff to speak up and whether there are lessons to be learned about how we can do this more effectively. I intend to use learning from this review to make improvements for our staff and our patients”.

The Trust appointed Mr Makani Hemadri, consultant in general surgery, as its Freedom to Speak Up Guardian earlier this year to act in an independent and impartial capacity, working alongside the board and executive team to help support the organisation to become a more open, transparent place to work.

Last updated:
2 May 2018