1. Raising concerns ‘share and learn’ 23 February 2016 Horizon, Leeds Nyla Cooper, Programme Lead Adele Bunch, Senior Programme Officer

2. Today Welcome and introductions NHS Employers role Key messages and developments, Nyla Cooper, NHS Employers The National Guardian for the NHS, Charles Rendell, Care Quality Commission Enhancing the legal protection for whistleblowers, Sarah McKenzie and Giles Crompton- Howe, Department of Health Local achievements and challenges – group work and feedback Lunch & networking Making data work, Caroline Waterfield, NHS Employers Showing we care by speaking up; ten months on, Mark Hudson, Guys and St Thomas NHSFT Evaluation and next steps Close

3. 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

4. Actions and progress from the Learning not blaming report (DH July 2015) 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 Within this financial year – plans in place by September 2016 Care Quality Commission INO to set up national guardian officeTo be fully functional by October 2016 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 April 2016

5. Actions from the Learning not blaming report (DH July 2015) NHS England to produce a standard integrated policy and procedure for reporting incidents and raising concerns Department of Health to establish an independent patient safety investigation function for the NHS ActionTimeline NHS England, NHS Trust Development Authority and Monitor (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 23 February 2016 April 2016 NHS England To produce guidance on how to implement the principles and actions in primary care Engagement with key stakeholders (By end 2015) 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) By April 2016

6. National Guardian Freedom to Speak Up What are Freedom to Speak up Guardians? 6 The Office of the National Guardian Our progress including the role of the local freedom to speak Up guardian Charles Rendell 23 February 2016

7. 7 To provide you with an update on the progress in establishing the Office of the National Guardian To feedback to you the outcome of the national consultation To share with you the plans we have to support organisations to establish the role of the local freedom to speak up guardian and to listen to your views Aims of the session National Guardian Freedom to Speak Up

8. 8 National Guardian took up post on the 4 th January Initial priorities set for year one Provide national support for the establishment of the local guardians Effective engagement with a range of stakeholders Be a resource to NHS staff through the development of an effective website and the giving of advice Progress National Guardian Freedom to Speak Up

9. Established a clear framework for accepting cases for review ( in collaboration with a range of organisations) and aim to begin taking on cases from October Set up a network of local guardians Produce an annual report Demonstrate progress on how the office is perceived in terms of its independence and trust in its decision making 9 Aim in first year National Guardian Freedom to Speak Up

10. The establishment of the office is taking place in 3 phases – Phase one – start up team – January – March – Phase two – transition team – April – October – Phase 3 – fully operational with a substantive team from October onwards We are not rushing this we need to get it right Office will be live from April 4 th for queries and with a temporary website. We aim for case referrals to be accepted from October and onwards. 10 Process National Guardian Freedom to Speak Up

11. Consultation ran from 12 September to 9 December 78 responses Whistleblower forum Online Community 11 Response to the national consultation National Guardian Freedom to Speak Up

12. Respondents: – Generally supportive of the proposals for the role of the National Guardian and the Office of the National Guardian – Majority of respondents felt that proposals would support the development of a culture of openness in the NHS – The principles and functions of the National Guardian as set out in the consultation also received majority approval. 12 Response to the national consultation National Guardian Freedom to Speak Up

13. Respondents: – Concerns about the lack of statutory powers – Concerns about the systems to ensure that the National Guardian is seen as independent – A phased approach to primary care was raised. Furthermore people emphasised the need for a role in the independent and adults social care sectors. 13 Response to the national consultation National Guardian Freedom to Speak Up

14. The office of the national guardian will comprise of the following key roles » National Guardian » Deputy national guardian » 3 x national guardian lead roles – each will support and connect with a designated group of local guardians across the country, supporting & developing them in addition each will have a designated responsibility covering the following Communication & engagement Supporting and engaging with BME staff Responsible for the case work » 3 support case review workers » I communication officer 14 Proposed structure of the office National Guardian Freedom to Speak Up

15. The office of the national guardian will report to three Boards – Accountability Board - Consisting of the ALBs ( CQC, NHSE, NHSI) – Regulators Board – Consisting of representatives from the professional regulators – Expert by Experience Board – Consisting of those who have experience of speaking up and representative groups (including individuals who work with the those who speak up). 15 Proposed Governance structure of the office National Guardian Freedom to Speak Up

16. Expectation is that all NHS & Foundation Trusts will have appointed a local freedom to speak up guardian by September 2016 Some Trusts have already done this and a number of differing models are evolving The National Guardian has drawn up guidance to all NHS & Foundation Trusts which sets out role, purpose and the skills required to enable them to design a service that best fits their organisation Aim is for all guardians to be trained during June – September with a national conference in October 16 Role of the local freedom to speak up guardian National Guardian Freedom to Speak Up

17. Every NHS trust and NHS foundation trust will be required to have appointed a local Freedom to Speak up Guardian during the coming financial year (2016/17). This is, however, not an appointment to be rushed. Trusts are expected to have plans in place by September 2016, based on local needs and how confident staff already are about raising concerns and speaking up. The title of these roles is to be the same across the NHS to ensure clarity and provide support for staff who move between organisations. Depending on size and complexity, organisations may wish to consider a structure underneath the local guardian, such as local ambassadors/advocates. There should not be more than one local Freedom to Speak up Guardian. The local guardian may be a standalone post or as an addition to an existing role or an external adviser. 17 Role of the local freedom to speak up guardian National Guardian Freedom to Speak Up

18. The individual appointed as local guardian needs to have authority, respect and credibility. Local guardians need to have a track record of supporting staff, an understanding as to how difficult it is for someone to raise a concern and an understanding of the local policies to support a member of staff and their managers to use them appropriately. Local guardians should be accountable to the chief executive and have open and frequent access to the Board. They must also feel confident and have the necessary authority should they need to raise concerns externally. 18 Role of the local freedom to speak up guardian National Guardian Freedom to Speak Up

19. We have 3 questions – What do you see as the priorities for the website – What key points would you include in a job specification and training requirements for Local Guardians – What success measures should be used in year 1 19 Your role now is to help us identify what is needed to help these roles be successful National Guardian Freedom to Speak Up

20. 20 Thank you Any Questions? Close National Guardian Freedom to Speak Up

21. 21 Enhancing legal protection for whistleblowers

22. 22 Background The protections created by Public Interest Disclosure Act, inserted into the Employment Rights Act in 1998, have played an important role in raising issues and holding organisations to account. However, the 2013 report into the Mid Staffordshire NHS Foundation Trust exposed unacceptable patient care and a culture that deterred staff from raising concerns. In response to concerns about the reporting culture in the NHS, the Secretary of State for Health commissioned Sir Robert Francis QC to carry out an independent policy review, “Freedom to Speak Up”.

23. 23 Freedom to Speak Up Report The report contained two recommendations to enhance legal protection for whistleblowers: 1.Sir Robert Francis concluded the the existing legislation under the Employment Rights Act 1996 and the Equalities Act 2010 did not give adequate redress to whistleblowers when they are applying for new jobs and recommended legislation be developed to address this. 2.He also recommended extending statutory protection to all students studying for a career in healthcare rather than just student nurses and midwives.

24. 24 Protection for NHS job applicants Primary legislation - The Small Business, Enterprise and Employment Act 2015 introduced legislation to protect whistleblowers from discrimination by future NHS employers. Secondary legislation – Regulations (still in draft) will implement the protections in the Act, prescribe additional bodies to whom the law applies and set out the remedies for those discriminated against Timeline to introduce secondary legislation: –Public consultation in March/April –Coming into force in the Autumn

25. 25 What will the regulations do ? 1.Lists the NHS bodies to be treated as NHS employers 2.Imposes a duty on NHS employing bodies not to discriminate against an applicant because it appears to the NHS employing body that the applicant has made a protected disclosure. 3.Allows the applicant to complain to the employment tribunal in respect of an alleged discrimination within a 3 month time limit. 4.Allows the employment tribunal to order the employer to pay compensation that is : –Just and equitable –Minimum £5,000 & no limit –Having regard for conduct complained of and loss sustained

26. 26 What do the draft regulations do ? 5.Clarifies that a claim may also be made for breach of statutory duty. 6.Allows for awards to be made against third parties in certain cases.

27. 27 Any thoughts on the proposed content of the draft regulations ?

28. 28 Protection for students Sir Robert Francis recommended that the Government should ensure that its proposal to widen the scope of the protection under the Employment Rights Act 1996 includes all students working towards a career in healthcare. Section 43k of the Employment Rights Act 1996 deals with extending the definition of a worker beyond those who have a contract of employment and therefore those who have protections under the Public Interest Disclosure Act (PIDA) 1998. Student nurses and midwives are already included and are now classified as a worker for the purpose of PIDA.

29. 29 Extending the definition of a worker The proposal is to use secondary legislation to amend the Employment Rights Act 1996. We are in the early stages of scoping out the legislative changes. We are currently developing a list of students who spend time in a healthcare setting as part of their course. We are working with the Healthcare Professions Regulators to identify those students in training that lead to professional regulation. Are there any other students who do not have a career path that leads to professional regulation ?

30. 30 My contact details Sarah McKenzie 0113 254 6120 Sarah.mckenzie@dh.gsi.gov.uk

31. Achievements and challenges Reflecting on this morning discuss on your tables: Local progress to date How might national changes challenge or enhance local progress? What support do you require from the National Office to meet priorities in year one? What resources and support would you like to see on the National Guardian website?

32. Lunch & networking

33. Making data work Caroline Waterfield Assistant Director, Development and Employment Team

34. Showing we care by speaking up ten months on Mark Hudson, Associate Director of Workforce 23 February 2016

35. Context 35 GSTT has around 13,650 staff 15 clinical directorates plus corporate directorates £1.3 billion annual turnover History of policy provision – Raising a Matter of Concern (whistleblowing) Staff felt confident raising concerns, less confidence in concerns being dealt with

36. Why is this important to us? There is clear evidence that if staff feel confident to speak up then the environment staff work in will be safer and more effective Our Francis listening exercises have told us that staff who have a supportive line manager and work within an effective team feel more confident in speaking up All organisations are asked to ensure that they have a range of mechanisms and develop a culture where staff can speak up safely

37. The main Francis recommendations 37 Twenty principles which are collated into six categories; from category three ‘measures to support good practice’. These are: Principle 10 – training – every member of staff should receive training in their organisation’s approach to raising concerns and acting on them Principle 11 – support – all NHS organisations should ensure that there is a range of person’s to whom concerns can be reported easily and without formality. This has a sub-set of actions: –a person (a ‘Freedom to Speak Up Guardian’) appointed by the person’s chief executive to act in a genuinely independent capacity –a nominated non-executive director to receive reports of concerns directly from employees (or the Freedom to Speak Up Guardian) and to make regular reports on concerns raised by staff and the organisation’s culture to the Board –at least one nominated executive director to receive and handle concerns –at least one nominated manager in each department to receive reports of concerns –a nominated independent external organisation (such as the Whistleblowing Helpline) whom staff can approach for advice and support

38. Our approach Launch of ‘Showing we care by speaking up’ in June 2015 Giving staff a range of mechanisms to speak up safely if they don’t feel they can talk to their line manager or use the formal processes in the Trust. Providing: – a dedicated email address, – designated advocates in each directorate and –an external phone number 38

39. Guardian, Advocates or Champions? We considered the Trust too large for one single guardian We wanted to create another opportunity for a listening ear within the Trust A term that would represent the voice of staff Training 39

40. The role of the Advocate 40 Will provide immediate support and signposting for staff members raising concerns, determining the best course of action and advising the staff member of their options. Will act as the interface between employees and the Trust in cases where employees wish to remain anonymous Will link into staff side colleagues in order to gain support and improve resolution results Will keep a record of concerns raised and link with Freedom to Speak up Guardian

41. Post-launch 41 Strategic approach to improving the climate in the org – ongoing work –An additional question added to performance appraisal and the training adapted –Values based recruitment to determine the culture of leadership we wish to engender –Showing We Care by ….. Will expand to include innovation, flexible working, having good conversations, giving staff time in their appraisals etc all of the elements that require courage –Advocate ‘decompression’ sessions

42. Where we are today Staff Survey results 2015 show – 95% of staff say that they would know how to report a concern (6% higher than last year), –74% would feel secure in doing this (2% higher than last year) –68% felt confident that their concern would be addressed (6% higher than last year) Share the learning with the Trust Waiting to see recommendations from National Guardian

43. Where we are today Staff continue to raise concerns through a variety of channels Development of the advocate role to be proactive Supporting staff to raise concerns requires a blended approach

44. 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: http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at- work-whistleblowing http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at- work-whistleblowing

45. Keep updated and stay in touch NHS Employers website: www.nhsemployers.org/your-workforce/raising-concerns- at-work-whistleblowingwww.nhsemployers.org/your-workforce/raising-concerns- at-work-whistleblowing Subscribe to our workforce bulletin: www.nhsemployers.org/workforcebulletinwww.nhsemployers.org/workforcebulletin Feature your organisation on the guardian map Follow us on LinkedIn or link up on Twitter @nhse_nylaLinkedIn Get in touch: nyla.cooper@nhsemployers.org adele.bunch@nhsemployers.org nyla.cooper@nhsemployers.org adele.bunch@nhsemployers.org

46. Evaluation and close Please spare a few moments to complete our evaluation. Your feedback is very important to us. THANK YOU