Moving from a blame culture to a learning culture is an integral part of Freedom to Speak Up. Dr Henrietta Hughes explains how the National Guardian’s Office is helping organisations embed learning through its case review process

In June 2017, we launched a 12-month trial of our case review process, a key recommendation from the Francis Freedom to Speak Up review. Case reviews listen hard to the experience of workers and look at the speaking up culture in NHS trusts, including how individuals’ cases have been handled.

In association withNGO logo JPEG (002)

Case reviews call out areas for improvement and also commend good practice. We publish reports and, working collaboratively with trusts and regulators, ensure the recommendations are implemented.

Scope for improvement

We have highlighted recurring areas for improvement, finding that the way the guardian role has been implemented does not always meet the needs of workers. Additionally, trusts are not routinely following national policy and guidance. Conflicts of interest are widespread.

For example, in one organisation a worker alleged a sexual assault, then discovered that the investigating officer was the partner of the alleged assailant. In the same trust, a manager was asked to investigate their own conduct. Elsewhere only one of 9,000 members of staff had signed the declaration of interests register.

We have also made recommendations about the excessive use of grievances and counter grievances, the use of settlement agreements, bullying cultures and the Fit and Proper Person Review.

Since we began the case reviews pilot we have completed 24 case reviews at five NHS trusts. The reports have included 87 recommendations made to trusts, Department of Health and Social Care, Care Quality Commission, and a law firm. By carrying out a “gap analysis”, guardians in trusts throughout England have been able to review their own practices, processes and policies and use the learning to make improvements.

Following the pilot, we commissioned an independent evaluation and sought feedback from our advisory groups and other stakeholders. We’re currently exploring options to refine our case review process to reflect that feedback. We will continue to carry out case reviews in the meantime – as we have since the pilot ended in June – and expect to be working to our new model in the summer.

Angela Hillery, chief executive of Northamptonshire Healthcare Foundation Trust, said: “Case review recommendations have helped us to address anything that is getting in the way of allowing people to speak up and affect change.

“They have helped us shape our organisation so that it is more willing to listen and more open to learning. It is vital to the culture of the trust that all workers are actively encouraged and empowered to speak up.

“I believe there are lessons that all organisations across the health sector can garner from the case review reports published by the National Guardian, and I would encourage them to use them to help identify how they can improve.”

To read more about our case reviews, go to