Title of report Freedom to Speak Up Guardian (FSUG) Trust Board in public Date: Thursday 26 th July 2018 Agenda item: 6.2 Executive sponsor Report author(s) Report discussed previously: (name of subcommittee/group and date) Michael Wilson, Chief Executive Catherine Sharpe, Freedom to Speak Up Guardian Executive Committee 4 th July 2018 Action required: Approval () Discussion ( ) Assurance ( ) Purpose of report: This report from the FSUG provides Trust board with oversight of key information and concerns raised through the FSUG Summary of key issues Introduction to Freedom to Speak Up and FSUG role FSUG Data 2017/2018 FSU Themes and Data Q1 2018/19 National Guardian Office Update Reflections of Guardian FSUG feedback Recommendation: Future priorities for the FSUG are: Further promotion of FSUG role and purpose Developing e-learning modules for existing staff and managers on raising and responding to concerns Building relationships and addressing barriers to speaking up
Demonstrate confidence in independence and quality of investigations into speaking up matters through audit Improving feedback opportunities for FSUG to ensure continual improvement Relationship to Trust strategic objectives and assurance framework: SO1: Safe Deliver safe, high quality care and improving services which pursue perfection and be in the top 25% of our peers SO2: Effective As a teaching hospital, deliver effective and improving sustainable clinical services within the local health economy SO3: Caring Work with compassion in partnership with patients, staff, families, carers and community partners SO4: Responsive To continue to be the secondary care provider of choice for the people of our community SO5: Well led To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model Corporate impact assessment Legal and regulatory impact Financial impact Patient experience/engagement Risk and performance management NHS Constitution/equality and diversity/communication Attachments Trusts are required to have a FSUG as part of NHS standard contract terms and conditions Continued appointment of Freedom to speak up guardian Positive impact on patient safety and experience by supporting speaking up about concerns at the earliest opportunity Assist in identification of risk at an early opportunity. Effective utilisation of processes concerning negative behaviours and performance issues The FSUG is a resource for all staff members regardless of position, background. Inclusive recruitment of ambassadors ongoing. Appendix 1 FSUG Job Description Appendix 2 Comparative National Guardian Office Data for Acute Trusts (up to 5000 staff) Appendix 3 Freedom to Speak Up case studies Appendix 4 Feedback on FSUG 2
1. Introduction The Freedom to Speak Up (FSU) review led by Sir Robert Francis into whistleblowing in the NHS provided independent advice and recommendations on creating a more open and honest reporting culture in the NHS. Key elements included: The appointment of local FSUGs in every NHS organisation, now a requirement of the NHS Standard Contract; The establishment of the Care Quality Commission s National Guardian, with Dr Henrietta Hughes being appointed in October 2016 An integrated policy and a common procedure for employees to raise concerns The review followed on from the Public Inquiry, also chaired by Sir Robert Francis, into the Mid Staffordshire NHS Foundation Trust which exposed unacceptable levels of patient care and a staff culture that deterred staff from raising concerns The National Guardian Office (NGO) published data on Speaking up in the NHS in England in its Annual Report 2017. Until the end of June 2017, nearly 4000 staff had spoken to their FSUG, and more than 1000 patient safety issues have been raised through this new channel. SASH appointed its FSUG through an internal application process appointing Catherine Sharpe on a part time basis from November 2016. SASH are part of the South East Coast regional network of guardians, of which Catherine is the regional chair. Freedom to Speak Up Guardian (FSUG) Role The guardian role involves supporting workers who wish to speak up by providing an additional and effective channel for reporting and escalating concerns, by thanking people for speaking up and by ensuring they receive feedback on the actions taken and learning as a result of the concerns they have raised. (Appendix 1 - FSUG Job Description) The guardian role also works proactively alongside the Trust s leadership teams to tackle barriers to speaking up and promote openness and transparency, specifically; 3
A culture of speaking up is instilled throughout the organisation All staff members have the capability to speak up effectively and managers have the ability to support those who are speaking up All staff members are supported appropriately when they speak up or support other people who are speaking up Speaking up processes are effective and continuously improved The Board is fully sighted on, and engaged in, all Freedom to Speak Up matters and issues that are raised by people raising concerns Safety and quality are assured
Quality & Safety Committee Workforce Committee Joint Negotiating and Consultative Committee Local Negotiating Committee Executive Committee Public Trust Board FSUG links, reporting and triangulation of information 1:1 s Executive Team Members Non Executive Team PAL s Housekeeping/Domestic meeting Departmental /Divisional meetings Volunteers/Agency staff South East Coast Regional Chair of FSUG s Shadow shifts National Guardian Office Chaplaincy Trade Unions
2. Data for 2017-2018 Concerns raised through FSUG 1.4.2017-31.3.2018 = 27 Date Method Staff group Details concern Themes Open/Closed 4/04/2017 Email CS Health & Safety Bullying behaviours A&B C 12/04/2017 Email CS Secretarial Bullying behaviours A&B C 25/04/2017 Email CS Corporate Bullying behaviours A&B C Email CS AHP Independence of HR PPP C 04/05/2017 Anonymous letter Unknown Various A&B; Q&S; PPP C 12/06/2017 Email CS Nursing Lack of training Q&S C 27/07/2017 Email CS Nursing & Medical Ongoing review Q&S; PE; A&B O 04/10/2017 Email CS Admin Lack of induction A&B; PPP C 05/10/2017 Telephone Nursing Male staff/ female pts O; Q&S C 01/11/2017 Email RC Nursing Bullying behaviours A&B O 01/11/2017 Email RC Secretary Bullying behaviours A&B O 8/11/2017 Telephone 1279 Portering Staff levels & morale SL; A&B C 23/11/2017 Face to Face Nursing Personal relationships A&B; Q&S C 23/11/2017 Face to face Corporate Patient safety Q&S; PPP O 28/11/2017 Email RC Nursing Recruitment process PPP C 13/12/2017 Email CS Secretary Bullying behaviours A&B C 13/12/2017 Email CS Secretary Bullying behaviours A&B C 27/12/2017 Email CS Medical Ongoing review Q&S; SL; PC; A&B O 12/01/2018 Face to face Nursing Concerns re ward Q&S; PE 17/01/2018 Email CS Nursing HR processes A&B; PPP C 01/03/2018 Email RC Nursing Contract issues O C 07/03/2018 Email CS Secretary Resource issues PE; Q&S O 08/03/2018 Phone call Nursing Patient management Q&S; PC; PE C 09/03/2018 Email CS Nursing Patient management Q&S; A&B; PE; SL C 20/03/2018 Face to face Admin Attitudes & Behaviours A&B C 20/03/2018 Email to CS Nursing Patient management SL; Q&S C 21/03/2018 Face to face AHP Quality of basic care Q&S; PE O 6
Key to Themes: Q&S Quality & Safety PPP Policies, Procedures & Processes PE Patient Experience A&B Attitudes & Behaviours SL Staffing Levels PC Performance Capability SC Service Changes O Other (Please see Appendix 2 - Table of comparative data for 2017/2018 from Acute Trusts with up to 5000 staff) Concerns raised through FSUG Q1 2018/2019 1.4.2018-30.6.2018 Date Method Staff group 17/4/2018 Email to AHP RC Themes Action taken Learning for FSUG/ Organisational Learning Q&S Thanked, supported and feedback given FSUG-escalation processes and A&B raise knowledge and profile of PE FSUG escalated to Deputy Chief Nurse FSUG role with senior nurses in the organisation FSUG met with Head of Therapies FSUG Met with Divisional Lead Nurse & Matron Divisional Lead Nurse & Matron reviewed safety thermometer data Matron works clinically on ward, no concerns Divisional Lead Nurse & Matron to work with ward leadership re concerns FSUG discussed with CEO & Chief Nurse at Building relationships-overcoming barriers -FSUG efforts to engage staff Review of Data DATIX NSS Patient opinion PAL s Friends & Family Open closed 7
regular 1:1 Observations of ward by Head of Therapies Divisional Lead Nurse Matron Chief Nurse FSUG ongoing feedback and support through email, face to face 17/4/2018 Phone 1279 RN Q&S PPP A&B Thanked, supported and feedback given FSUG escalated to Deputy Chief Nurse FSUG, Nurse who raised concerns and Divisional Lead Nurse meeting FSUG, Nurse who raised concerns, Divisional Lead Nurse, Matron & Ward Manager meeting Investigatory process Feedback meeting to discuss findings to be scheduled FSUG ongoing feedback and support through email, telephone, text, face to face FSUG-escalation processes and raise knowledge and profile of FSUG role with senior nurses in the organisation Building relationships-overcoming barriers -FSUG efforts to engage staff FSUG learning- audit independence and quality of investigation processes Formal investigation outcomes awaited C 8/5/2018 Email to CS Corp A&B Thanked, supported and feedback given Advised about ways to professionally address these behaviours FSUG-respect individuals choice not to escalate concerns if they do not impact on patient safety C 8
9/5/2018 Face to face FSUG office Encouraged local resolution where appropriate Signposted to relevant policies Staff member chose not to pursue informally or formally HCA A&B Thanked and supported Advised about ways to professionally address these behaviours Previous member of team sought local resolution with their line manager and gave positive feedback about how this empowered them and how it enabled them to address unsatisfactory behaviours as they occurred FSUG- as this concern related only to the staff member, it was not assessed as a FSU matter but a grievance. C Encouraged local resolution where appropriate Signposted to relevant policies Signposting and support given -HR process. Staff member pursuing case through Trade unions 15/5/2018 Email to CS HCA A&B PPP Thanked, supported and feedback given Signposted to relevant policies Signposted to Occupational Health, GP Advised about ways to professionally address these behaviours Advised about trade union support in reviewing extension of probationary procedures FSUG met with Divisional Lead Nurse (as FSUG- impartiality supported staff member Although it was not their intention, I felt that they lacked insight and learning from social media incident. This had been discussed with the individual as part of the internal investigatory process, they still held a defensive position on the matter and therefore there was a lack of personal learning. C 9
concerns involved Ward Manager & Matron) Divisional Lead Nurse demonstrated behaviours associated with being open and transparent. She remembered the case regarding the social media incident well and the HR advice that if substantive would ve resulted in disciplinary proceedings hence HR advised extension of probationary period. Details of investigation statements shared with FSUG Staff member seems to lack insight into how their social media post could have caused distress to patients, families and could have damaged the Trust s reputation Staff member appointed in new position 5/6/2018 Phone mobile RN A&B PPP Comprehensive telephone call in which the nurse states they have had extended periods of absence due to sickness and bereavement. Nurse already taking out a grievance against line manager. Nurse does not have union representation and suggested FSUG support by attending hearing, supporting in evidence. FSUG consulted NGO for guidance-advice was to support individual since their perception of a bullying culture preventing them carrying out their FSUG-although a considerable amount of this concern was regarding their personal treatment and ongoing HR processes I wanted to ensure that there wasn t a speaking up issue as the nurse had reported a bullying culture within the clinical team. The NGO advice was to continue to provide support to the individual for this reason. Recent contact from the FSUG to C 10
role and unrealistic expectations of income generation associated with their role. the nurse has not received a response. NGO advice- not to be involved in grievance process. Contacted nurse via text to offer support following grievance hearing- no response Freedom to Speak Up case studies are included in Appendix 3 11
3. National Guardian Office: Latest news Dr Henrietta Hughes published her latest case review report about the speaking up culture at Derbyshire Community Health Services NHS Foundation Trust. The learning identified in this report is not only to support the trust and to improve its speaking up culture, but for all NHS organisations to review their speaking up processes in light of these recommendations. Case review findings: Improvements were needed to be made in relation to timeliness and independence of speak up investigations The way HR policies and processes were conducted could act as a barrier to speaking up Delays in responding to speaking up issues and the unacceptable burden and levels of stress this causes the worker Delays can result in significant costs to the Trust as well as delay learning and improvement. In the report, Henrietta calls for the Department of Health and Social Care to commission guidance from NHS Employers to help support trusts to properly investigate speaking up in a way that is suitably independent and within reasonable timescales. Henrietta Hughes, National Guardian for the NHS said, My office will continue to make recommendations to bodies both inside and outside the health service that impact on the ability of workers to speak up. She said, There is learning from this case review for Derbyshire Community Health Services NHS Foundation Trust and our case review reports are an opportunity for all NHS organisations to learn and improve. In so doing, we can effect change across the whole sector and remove barriers that prevent workers from speaking up. Minister of State for Care, Caroline Dinenage, said, NHS staff deserve to be supported and empowered to provide the best possible care to their patients, and on occasions where staff speak out for safety reasons, it is important the investigations are carried out by suitably independent persons. These are welcome recommendations from the National Guardian s Office and through these guidelines we aim to foster an open culture where all workers feel confident to speak up. : Guidance for Board; FSU self-review tool NHS Improvement and the NGO have jointly published a guide to setting out expectations in relation to FSU to help boards create a culture that is responsive to feedback and focussed on continual improvement. The self-review tool that accompanies the guide will enable boards to carry out in-depth reviews of leadership and governance arrangements in relation to FSU and identify areas to develop and improve. The Care Quality Commission (CQC) assesses a trust s speaking up culture during inspections under KLOE 3 as part of the well-led domain. Catherine Sharpe, Mark Preston & Gillian Francis-Musanu have met to review the guide and assess where SASH currently sit and develop an action plan in collaboration with Pauline Lambert, Senior Independent Director (SID) and Non-Executive Director (NED). Catherine is in the process of seeking input from other Directors with an interest in speaking up, patient safety and strategy development. Page 12 of 15
Reflections of FSUG Much of my reflections as guardian over the first year in post are concerned with promotion and communication of the guardian role and my development and personal adjustment to a non-clinical, standalone role that s focus is change and promoting a positive culture that aids speaking up, enabling identifying concerns and risks at the earliest opportunity. This has required my building relationships with senior leaders and other stakeholders, developing knowledge of the organisational structure and key personnel and roles relevant to promoting awareness of the speak up initiative. It has been necessary to understand the role of various committees, reporting channels, inclusivity networks and opportunities for triangulation of information relevant to speaking up. More recently I have been delighted to have a FSUG slot on trust core induction programme and to have made 2 FSUG videos that will be used in Junior Doctor training and other training. FSUG Feedback Continue to do the fantastic work you do, thank you Don t know - perhaps if there was something in place to protect the whistleblower as this has left me feeling vulnerable despite the wonderful support from FSUG. Freedom to Speak Up Guardian Feedback The impartial help and advice you gave me really empowered me to take control of my situation. I have never used the speaking up guardian before, I was extremely anxious under the circumstances but I found Catherine to be very kind and supportive. I was given the opportunity to express my thoughts without been felt belittled or unworthy. Catherine arranged various dates for me to return to discuss my concerns, relay feedback. Found the service very helpful, and Catherine very easy to speak to. She listened and highlighted the concerns to the appropriate people. I would encourage anyone to use this service, should the need arise. Friends and Family Test 82% knew of and would approach FSUG Further detailed FSUG feedback can be seen in Appendix 4 Page 13 of 15
I am incredibly proud to recruit 11 Freedom to Speak Up Ambassadors, staff within the organisation who share my passion for promoting patient safety and experience by supporting a positive culture for speaking up. Our first quarterly meeting was on the 10 th July, which was attended by Michael who was able to meet 6 of our new ambassadors. Ambassadors have received training and a practical guide on how to respond in cases of speaking up and will work collaboratively with the FSUG as cases are brought to their attention. Their role is focussed on role modelling and spreading the message that we as an organisation are committed to enabling and encouraging staff to speak up and we see this as positive in safeguarding patients, improving their experience and outcomes and supports our continual improvement as an organisation. Page 14 of 15
4. Recommendation The Board is asked to note, future priorities for the FSUG are: Further promotion of FSUG role and purpose Developing e-learning modules for existing staff and managers on raising and responding to concerns Building relationships and addressing barriers to speaking up Demonstrate confidence in independence and quality of investigations into speaking up matters through audit Improving feedback opportunities for FSUG to ensure continual improvement Catherine Sharpe Freedom to Speak Up Guardian July 2018 Page 15 of 15