Raising concerns ‘share and learn’ 3 May 2016 Friends House, London Nyla Cooper, Programme Lead Adele Bunch, Senior Programme Officer Kathleen Kane, Programme Officer

Today Welcome and introductions NHS Employers role Key developments and messages, Nyla Cooper, NHS Employers The National Guardian function, Charles Rendell, Care Quality Commission National integrated whistleblowing policy and employee support scheme, Tom Grimes, NHS Improvement Local achievements and challenges – group work and feedback Lunch & networking Effectively engaging for quality data, Steven Weeks, NHS Employers Draw the line evaluation AOB and next steps Close

Role of NHS Employers help employers understand and contribute to changes in healthcare, enabling them to improve the quality and safety of patient care work closely with employers, key national bodies and regulators to influence policy and regulatory change provide advice, guidance, information and resources to help employers review, develop and implement effective local arrangements deliver a range programmes targeted at influencing cultural change – staff experience, staff engagement, organisational development, health, work and well-being, equality and diversity and people-performance management

Actions and progress – learning not blaming ActionTimeline Employers Take forward actions in an effective, proportionate and affordable manner, in advance of national guidance being issued – including appointment of local FTSU guardians Mandated in the NHS Standard Contract from April 2016 (issued by NHS England) Local guardians to be in place by 1 October 2016 Care Quality Commission INO to set up national guardian’s office Guidance for guardians published March 2016 Transitional team in place by end April 2016 Advert for National Guardian published 29 April 2016 National Office to be fully functional by October Health Education England Work with the Care Quality Commission and National Guardian, to produce guidance on the training needs for the Freedom to Speak Up guardian role and curriculum for NHS organisations Face to face training sessions for guardians (throughout summer 2016 – dates tbc) Launch of the E-learning modules (tbc) Guardian conference (March 2017)

Actions from the Learning not blaming report ActionTimeline NHS Improvement Devise a support scheme for NHS staff and former NHS staff who are experiencing difficulties finding employment as a result of having made protected disclosures To produce a standard integrated policy and procedures for reporting incidents and raising concerns First forum held 23 February 2016 Published 1 April 2016 NHS England To produce guidance on how to implement the principles and actions in primary care Consultation published March 2016 – closes 6 May Department of Health To establish an independent patient safety investigation function for the NHS (under the single leadership of the NHS Trust Development Authority and Monitor) Ongoing

National Guardian Freedom to Speak Up What are Freedom to Speak up Guardians? 6 National Guardian’s Office Charles Rendell May 2016

7 1.National Guardian (functions) 2.Operating principles 3.Latest news 4.Freedom To Speak Up Guardians 5.National consultation 6.Engagement 7.Important developments Outline National Guardian Freedom to Speak Up

8 1. National Guardian (functions) National Guardian Freedom to Speak Up Support guardians, building a strong network Key role in designing the training and consistent framework for Freedom to Speak up Guardians Manage concerns raised by Freedom to Speak up Guardians if they have lost confidence in how their organisation is handling concerns 1. To provide support and advice for the Freedom to speak up Guardians Provide advice to individual members of staff who have raised concerns, in situations where it appears good practice has not been followed locally Advice should focus on achieving local resolution 2. To advise staff raising concerns The National Guardian will advise providers on good practice in responding to staff concerns The National Guardian will be able to refer issues to CQC, NHSI and NHSE when it finds that a provider has not followed good practice 3. To advise providers (NHS trusts and foundation trusts) The National Guardian will have a highly visible role in providing support to the system. This should include sharing good practice, reporting on common themes in concerns raised and action taken The National Guardian will have a national role in recording the types and numbers of concerns raised and actions taken locally so a national perspective can be offered 4. To provide support for the system

9  Will establish a clear process to review current cases  Will use authority of office to ensure recommendations are acted upon and taken seriously – no statutory powers  Will be independent and free of interference from national bodies 2. Operating principles (1 of 2) National Guardian Freedom to Speak Up

10  Will not take responsibility away from trusts in the handling staff concerns)  Will not circumvent existing processes for raising concerns  Will not investigate historic cases 2. Operating principles (2 of 2) National Guardian Freedom to Speak Up

11 Set-up team (National Guardian’s Office) Soft launch (28 April) Letter from Sir Robert Francis QC & David Behan Consultation response (6 May) Job advert (National Guardian) Friday 29 April Guardian, Sunday Times, Russell Reynolds 3. Latest news (1 of 2) National Guardian Freedom to Speak Up

12 Scope (until National Guardian is appointed) Setting up a case referral system Enquiries taken from FTSU Guardians and NHS Providers Signposting to other organisations 3. Latest news (2 of 2) National Guardian Freedom to Speak Up

13 Recruitment of FTSU Guardians Trusts to nominate by 1 October 2016 Information available on FTSU Guardians currently in place 4. Freedom To Speak Up Guardians National Guardian Freedom to Speak Up

Positive General support for proposed National Guardian role and Office of the National Guardian Majority felt proposals would support the development of a culture of openness in the NHS Principles and functions of National Guardian received majority approval National consultation (1 of 4) National Guardian Freedom to Speak Up

Challenge Concerns about the lack of statutory powers Response A clear process for undertaking independent reviews will be created It will include memorandums of understanding with national bodies to leverage their powers National consultation (2 of 4) National Guardian Freedom to Speak Up

Challenge Concerns about systems to ensure the National Guardian is seen as independent Response It will not be managed by the CQC, but it will be accountable to the CQC, NHS England and NHS Improvement It will prepare and issue its publications independently, without any internal scrutiny or censor by CQC National consultation (3 of 4) National Guardian Freedom to Speak Up

Challenge A phased approach to primary care? Need to cover the independent and adult social care sectors Response Establish what resources are required by NHS Trusts and NHS Foundation Trusts Any extension to office functions would be considered and consulted on National consultation (4 of 4) National Guardian Freedom to Speak Up

18 Programme of events across England NHS staff / Non Exec Directors Health Education England / Public Concern at Work workshops National Conference (March 2017) 6. Engagement National Guardian Freedom to Speak Up

19 NHS Improvement (Whistleblowing policy) NHS England (Primary Care consultation) NHS Employers (Guardian of Safe Working) 7. Important developments National Guardian Freedom to Speak Up

20 Questions National Guardian Freedom to Speak Up

Update on implementing FTSU Tom Grimes Head of Enquiries, Complaints & Whistleblowing 3 May 2016

What I will cover National whistleblowing policy Employment support scheme Your thoughts?

National whistleblowing policy 23 “a harrowing and isolating process with reprisals including counter allegations, disciplinary [action] and victimisation” Action 2.2: NHS England, NHS TDA and Monitor should produce a standard integrated policy and procedure for reporting incidents and raising concerns and a single integrated policy. The objective is to normalise the raising of concerns through: Knowing how to raise concerns Feeling fully supported Feeling protected

How will it work? 24 To be adopted by all NHS organisations – key elements and principles Local process - still room for flexibility locally The policy has taken account of feedback from: whistleblowers employers

What does the policy cover? 25 Importance of raising your concernWhat concerns you might raiseConfidentialityWho can raise concernsWho can I raise concerns withWhat will we doInvestigation and feedbackCommunicationBoard oversightExternal bodies

Vision for staff raising concerns – what it should feel like 26

The Employment Support Scheme 27 ‘There needs to be a support scheme for staff who are having difficulty finding employment and can demonstrate that this is related to having made a protected disclosure, and about whom there are no issues of justifiable and significant concern about their performance. This should be run jointly by NHS England, the NHS TDA and Monitor, and should be supported by all NHS organisations’. Freedom to Speak Up

The Employment Support Scheme 28 As a minimum the support scheme should provide: Remedial training or work experience for registered healthcare professionals who have been away from the workplace for long periods of time Advice and assistance in relation to applications for appropriate employment in the NHS The development of a ‘pool’ of employers prepared to offer trial employment Guidance to employers to encourage them to consider a history of having raised concerns as a positive characteristic in a potential employee. Freedom to Speak Up

Accessing the scheme 29 For some, clearly no performance issues. For others, performance is disputed Need to establish whether applicants are whistleblowers and if concerns are ‘significant and justified’ Process important in building credibility of scheme Independent panel to judge each case on merits Panel to decide whether: there are ‘significant and justified’ concerns (eg, criminal investigation, safeguarding concerns)? the applicant has raised concerns?

The support offer 30 Generic Develop a menu of support and include coaching Scheme could work by giving each participant a number of credits to use, with a formal agreement between scheme and applicant Question: what should be on the support menu? Specific There are existing mechanisms to support clinical staff to rebuild/ refresh skills Similar mechanisms exist for some other professions

Placement 31 Range of opportunities to return to work, including interim and fixed-term roles, with coaching support Recognise that other factors restrict employment (ESR) Onsite and external support provided Clear terms of reference, expected behaviours etc Scheme most likely to work if we start small and build credibility and trust Questions: how do you see such placements working and what will motivate employers to participate?

Prevention 32 Important to act earlier to prevent employment problems emerging Triggers that could be used to monitor progress of individuals who have raised concerns Early access to support scheme may be needed in some circumstances Risk factors such as use of suspensions which could be reported to Board and considered by regulators Question: what triggers could be reported and how might they be linked to formal processes, eg. inspection, risk profiling, quality & safety reporting?

Discussion mins discussion on your allocated section of the scheme: 1.Accessing the scheme 2.Retraining and Support 3.Placement 4.Prevention

Local achievements and challenges Reflecting on this morning discuss on your tables: Local progress to date: What have you put in place? What have you learnt? What are the challenges still to be overcome? What further support/resources would you find useful for NHS Employers/or other national bodies to provide to help overcome some of these challenges?

Lunch & networking

Effectively engaging for quality data Steven Weeks Development and Employment Team, NHS Employers

Reporting concerns data Staff Survey data on reporting concerns measuring awareness measuring confidence and security

Trends – small steps in the right direction Overall key finding improved from 3.62 to 3.63 out of 5 Awareness of how to raise concerns up from 84 to 86% Feeling secure to do so (stable 68%) Feeling confident organisation would address concerns (56%) down from 57% Highest level of concern in small number of trusts Big improvements in 15 trusts. Most trusts stable.

Draw the line resources concerns-at-work-and-whistleblowing/draw-the-line Currently running a survey to evaluate the resources and identify areas for improvement. Self-assessment tool Template presentation and ‘how to use’ guide Manager’s guide to raising concerns How can the tools be improved?

Supporting you Template presentation and ‘how to use’ guide Manager’s guide for raising concerns (whistleblowing) Self assessment tool Draw the line campaign logo Posters and flyers Top tips for raising concerns Raising concerns in the NHS – a guide for staff Dedicated guardian hub of the website including top tips for guardians Various shared learning examples of local guardian models Download your free copies from the NHS Employers website at: at-work-whistleblowing at-work-whistleblowing

NHS Confederation workforce conference and NHSE annual summit Bookings are now being taken for the NHS Confederation annual conference and exhibition and the NHS Employers annual summit. Book your place now by visiting:

NHS Employers social media conference Want to understand how using social media effectively within your organisation can improve communication with staff and recruitment. £99 for NHS employees including lunch and social conference Download the programme and book your place now: best-staff-are-the-ones-using-social-media

Keep updated and stay in touch NHS Employers website: work-whistleblowingwww.nhsemployers.org/your-workforce/raising-concerns-at- work-whistleblowing Subscribe to our weekly workforce bulletin: Feature your organisation on the guardian map Follow us on LinkedIn or link up on Get in touch - and

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