Evidence of a bullying culture and a failure to respond to serious concerns, especially among black and minority ethnic staff, have been uncovered at an NHS trust in the North West of England, following the first review by the national office responsible for improving the ability of health workers to speak out.
The National Guardian’s Office, which was set up after a national review of whistleblowing by Sir Robert Francis in 2015, conducted a review of the speaking up processes, policies and culture at Southport and Ormskirk NHS Trust over this summer.
“It described in detail the experiences of bullying alleged by workers, the fear that some staff had described about speaking up”
National Guardian’s Office
It followed the receipt of information that suggested that the trust was not responding to concerns in accordance with good practice.
To carry out the review, a team from the national office met with nurses, doctors and ancillary staff, as well as ward managers responsible for handling problems at the trust.
It also looked at staff survey results, policies and a cultural review commissioned by the trust in 2016 in response to concerns relating to the treatment of black staff or those from another ethnic minority background.
In a report on the organisation that was published today, the office said there was a “longstanding culture where the trust did not respond appropriately to specific and serious concerns raised by its workers”.
The office said it had received evidence of concerns about bullying and discrimination against BME staff that had been ignored. The bullying culture also meant BME and other staff were often too scared to speak out in the first place, said the report.
“I have published a set of 22 recommendations for the trust, which are designed to improve workers’ ability to speak up”
When staff did speak out, there was a “persistent failure” by the trust to let employees know what action it had taken, said the report, which created a “widespread belief among staff that the trust did not take their concerns seriously”.
Meanwhile, there was no specific training for frontline workers and managers about how to raise and deal with issues, and many workers felt most of the trust’s senior leaders were “invisible and inaccessible”.
The trust was also not fully supporting its new Freedom to Speak Up Guardian since the post was set up in August 2016. The role has been introduced in all NHS trusts to ensure concerns are dealt with properly by employers, and to pass on cases that have not been dealt with correctly to the national office.
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In today’s report, the national office also highlighted that the trust had still yet to publish the findings from its internal cultural review, despite it having been completed in June 2017.
“The report described in detail the experiences of bullying alleged by workers, the fear that some staff had described about speaking up, governance failures in responding to that fear, bullying, and an overall culture in the trust that, to many of those interviewed for the review found to be ‘elitist’, ‘insular’ and which was characterised by ‘nepotism’,” said the national office.
While some senior leaders at the trust had seen the findings, the Freedom to Speak Up Guardian at the trust had not.
The office said it was told by the trust that, following legal advice, it had decided to delay publication.
“Although the trust clearly needed to be sensitive about some of the review’s contents, including the identity of individuals referred to in it, while it resolved certain issues, there was nevertheless significant learning relating to speaking up that the trust could potentially share, without compromising its resolution of those specific issues,” said today’s report.
Dr henrietta hughes 3x2
The National Guardian’s Office has set out 22 recommendations for the trust, including one calling for the organisation to share the learning from its cultural review within three months.
It has also issued a recommendation for the Care Quality Commission after it questioned whether the CQC fully checked the way the trust had assessed if one of its directors was “fit and proper”.
Staff had raised concerns about the alleged discriminatory behaviour of one of the trust’s directors, prompting the organisation to commission an external “fit and proper person” review. But evidence suggested none of the staff who spoke out were interviewed as part of the investigation.
The National Guardian’s Office said the CQC must revise its approach to ensuring that fit and proper person reviews were carried out properly, and must check that they included information from people who spoke out.
Dr Henrietta Hughes, the who leads the guardian’s office, 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.
“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,” she said.
“I can, however, only act on cases that I am aware of,” she said. “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.”
“The learning from the review is a welcome and helpful addition to the robust action plan we have in place”
Karen Jackson, interim chief executive at Southport and Ormskirk, 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,” she said. “Most of these concerns went back a good number of years.”
She added: “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.”