Raising concerns share and learn 11 November 2015 London Nyla Cooper, Programme Lead Adele Bunch, Senior Programme Officer Today Welcome and brief introductions NHS Employers role Key messages and developments The role of the INO, Charles Rendell, CQC Table discussion local guardian models Lunch & networking New patient safety video, Margit Veveris, HEE Our freedom to speak up service, Sharon Landrum and Carol Skillen, Wirral University Teaching Hospital Developing a standard integrated policy for reporting raising concerns, Tom Grimes, Monitor Evaluation 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 from the Learning not blaming report (DH July 2015) ActionTimeline Employers To take forward actions in an effective, proportionate and affordable manner, in advance of national guidance being issued including appointment of local FTSU guardians As soon as practicable Care Quality Commission To consult on independent national officer (INO) role To appoint INO To develop support team function Consultation Sept-Dec 2015 By Dec 2015 By April 2016 Health Education England To work with the Care Quality Commission and INO once appointed, to produce guidance on the training needs for the Freedom to Speak Up guardian role and curriculum for NHS organisations By April 2016 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 To 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 Engagement with key stakeholders and other interested parties throughout Nov-Dec 2015 Consultation Nov-Dec 2015 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 National Guardian Briefing November 2015 Charles Rendell, Strategy Manager CQC November 2015 7 Contents Introduction The purpose of the National Guardian CQCs role in relation to staff concerns Principles for how the Office of the National Guardian will operate Functions of the National Guardian 8 Introduction In response to concerns about the culture in the NHS, the Secretary of State for Health commissioned Sir Robert Francis to carry out an independent review: Freedom to Speak Up (FTSU). The review was asked to identify measures to foster a culture in the NHS in England where staff can feel safe to speak out about patient safety, as well as learning lessons by listening to those who have experiences to share, both positive and negative. The review was published in February One of the major recommendations was to create an Independent National Officer to support staff raising concerns and the wider system. The Department of Health (DH) consulted on Sir Roberts recommendations between the 13 th March 2015 and 4 th June 2015, including whether the Independent National Officer should be hosted by CQC. Overall, the consultation received 103 responses from individuals and on behalf of organisations. The consultation received 75 responses regarding the National Guardian and the majority of these, 56, were in full support of the role being hosted by CQC. 9 National Guardian to be hosted by CQC Learning not to Blame states that the person undertaking the role will: Advise NHS Organisations to take appropriate action where they have failed to follow good practice, or advise the relevant system regulator to make a direction to that effect Provide support to the Freedom to Speak up Guardians Provide national leadership on issues relating to raising concerns by NHS workers Offer guidance on good practice and handling concerns; and Publish reports on the office of the Independent National Officer. - Source: Learning not to Blame: Government response to the Freedom to Speak Up consultation July 2015 10 Contents Introduction The purpose of the National Guardian CQCs role in relation to staff concerns Principles for how the Office of the National Guardian will operate Functions of the National Guardian 11 Why do we need a National Guardian? The National Guardian is intended to fill a gap in the system, around external review of how NHS trusts handle concerns raised by staff. CQC currently looks at how well trusts handle staff concerns as part of its assessment and notes any issues in relation to the treatment of staff or systems for raising concerns. Monitor/TDA then direct trusts to address these issues. As prescribed persons, CQC, Monitor and TDA can also investigate concerns raised with them if there are outstanding safety issues. However, these mechanisms do not generally involve reviewing how individual cases were handled locally, or how staff were treated. The only way staff can raise an issue about ill-treatment externally is through an Employment Tribunal. The National Guardian is intended to provide external review of how cases are handled locally, where there is a cause for concern. This will involve reviewing the process that ahs been followed, not investigating the concern or forming a judgement on the outcome of any existing investigations. The National Guardian is not intended to take over investigation of cases, because this would take responsibility away from local organisations. The National Guardian will advise staff raising concerns and providers, and will support the local FTSU Guardians, as well as providing national, high-profile leadership on the raising of staff concerns. Detail on the functions to be performed is set out on slide 5. 12 Contents Introduction The purpose of the National Guardian CQCs role in relation to staff concerns Principles for how the Office of the National Guardian will operate Functions of the National Guardian 13 CQCs role in relation to staff raising concerns CQC is an independent regulator, on the side of people who use services and acting to encourage all providers to improve the quality of services they provide. CQCs purpose is to ensure health and social care services provide people with safe, compassionate, high-quality care and to encourage services to improve. CQC provide robust, fair and consistent judgements of quality of care that expose poor care and variation in care, and make quality transparent. CQC has a dual role in relation to staff raising concerns about poor care: CQC look at how well the providers it regulates respond to staff concerns; and CQC want to receive information about poor care from staff directly in order to inform its overall assessment of individual providers Every planned CQC inspection now looks at how well services handle complaints and other concerns about poor care, as this can be an indicator of the quality of leadership and a reflection of how safe and responsive the culture is. The National Guardian will carry out two important functions that are distinct from CQCs role: It will review individual cases (whereas CQC, on the whole, looks at systemic issues) It will consider the treatment of the employee (whereas CQC, on the whole, looks only at quality and safety issues) 14 Contents Introduction The purpose of the National Guardian CQCs role in relation to staff concerns Principles for how the Office of the National Guardian will operate Functions of the National Guardian 15 Principles for how the Office of the National Guardian will operate 1. The National Guardian will be independent of NHS providers, and the National Guardians decisions will be free from interference, including from national bodies. 2. The National Guardian will have wide discretion on whether or not to get involved in specific cases. 3. NHS providers will continue to be responsible for the effective handling of staff concerns. 4. The National Guardian will not circumvent existing authorised processes for raising concerns or replace existing legal remedies. The National Guardian will not second guess or interfere with ongoing processes locally or nationally.. 5. The National Guardian, whilst not having specific statutory powers, will have sufficient authority from four ALBs to ensure recommendations are taken seriously and acted upon. 7. The National Guardian will not review historic events, but may consider cases where the original concern was raised in the past but ill-treatment of the staff member is a current issue 6. The National Guardian will challenge others ( locally and nationally) to look again at cases, and advise on appropriate actions rather than undertaking investigations directly. 16 Independence of the National Guardian The National Guardian will be an appointment by the CEO of CQC on behalf of the Board. The National Guardian will not be a member of the Executive Team, thereby allowing the role to operate independently of the executive function of the CQC. The National Guardian will be able to refer issues to CQC, Monitor, TDA or NHSE. This will be supported by MOUs, a bi-annual committee and annual reports to each of the Boards. The National Guardian will share communication channels with CQC, including website, customer service call centre and press office. The National Guardian will potentially use CQC branding for any reports or communications but these will be independent reports and will not be signed off by the CQC Board. The storage of information by the National Guardian must be covered by an adequate level of protection. Review mechanisms will need to be agreed for the National Guardian to pass information to others outside and within CQC. National advisory Board public and provider organisation representatives ( bi-annual) The National Guardian appointment reviewed periodically (e.g. every 3 years) While the National Guardian is accountable to the CEO of CQC for delivery of their annual work programme, their decisions over which cases to review and their recommendations will be entirely independent. This is the same way that the Chief Inspectors operate within CQC with regards to their quality judgements. 17 Contents Introduction The purpose of the National Guardian CQCs role in relation to staff concerns Principles for how the Office of the National Guardian will operate Functions of the National Guardian 18 Functions of the National Guardian Support Local 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 review how staff concerns have been handled 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 support and advise providers (NHS Trusts) The National Guardian will have a highly visible role in providing support to the system. The National Guardian will have a national role to report on progress towards the creation of a sae and open culture. 4. To provide challenge and support for the system 19 Timelines 13 September National Guardian Advertised 17 September Consultation launched 12 week run November Transition team appointments December National Guardian appointment Jan/Feb National Guardian responds to consultation Team appointed and logistics April National Guardian Office live 20 Any questions? Consultation paper can be found at Guardian progress There are currently guardians in post in 18 NHS organisations across the country Various models ranging from one guardian to several per trust Shared learning of three models available on our website If your organisation isnt on the guardian map, let us know Local guardian models - discussion On your tables, discuss the progress made so far in relation to the local Freedom to Speak Up guardian including: The model you have adopted and reporting structure Learning so far Successes for far Lunch & networking New patient safety video Rosie and Margit Veveris Video A single national whistleblowing policy Tom Grimes Head of Enquiries, Complaints and Whistleblowing GOV.UK/monitor What am I going to cover? 27 FTSU recommendationThe purpose of the policyWhat the policy coversYour thoughts? Freedom to Speak Up 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 28 How will it work? 29 To be adopted by all NHS organisations key elements and principles Local process will sit beneath it - still room for flexibility locally The policy has taken account of feedback from: whistleblowing organisations employers What does the policy cover? 30 Importance of raising your concernWhat concerns you might raiseHow you will be protected by your employerConfidentialityWhat support is availableWho you can raise concerns withHow the concern will be recordedInvestigation and feedbackCommunicationBoard oversightExternal bodies Vision for staff raising concerns what it should feel like 31 Your feedback Each group to feedback on: Your general thoughts on the draft national policy A specific issue (details on each table) 32 Summary 33 Understanding the national policy Opportunity to feedback Thank you Group 1 The intention is that this policy be adopted by all NHS organisations, with local process sitting beneath it. Do you agree with this approach and do you feel the policy is compatible with existing local processes? 34 Group 2 The policy (and example process in Annex A) encourages staff to first raise concerns with their line manager, before escalating to their local whistleblowing guardian and then a board member. What are your views on this system of escalation: is it helpful or should it be open to the individual to decide at what level and with who he/she raises his/her concern with? 35 Group 3 FTSU looked at the experiences of vulnerable staff groups when raising concerns and we believe that the national policy will make it easier for all staff to raise concerns, including those that may be more vulnerable. Do you think it achieves this and, if not, what else could be included? 36 Group 4 The policy lists examples of the type of concerns staff might raise under it. Do you think there examples are helpful? What, if anything else, could be included in the list? 37 Supporting you Template presentation and how to use guide Managers 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 (new) Dedicated guardian section of the website including top tips for guardians (new) Various shared learning examples of local guardian models Download your free copies from the NHS Employers website at:work-whistleblowingwork-whistleblowing Keep updated and stay in touch NHS Employers website:concerns-at-work-whistleblowingwww.nhsemployers.org/your-workforce/raising- concerns-at-work-whistleblowing Subscribe to our workforce bulletin:Feature your organisation on the guardian map Follow us on LinkedIn or link up on Get in touch: Evaluation and close Please spare a few moment to complete our evaluation form your feedback is important to us. THANK YOU