Vision and Strategy

RDaSH leading the way with care

Within our FTSU approach we are all committed to everyone speaking up, we also have designated enhanced FTSU roles including the FTSU Guardian and Deputy Guardian, Board members and Advocatesfrom across the organisation have essential roles in:

• Ensuring all methods of raising concerns are promoted

• Raising the profile and visual leadership of FTSU

• Providing advice and support in exploring any concerns raised

• To ensure FTSU training is available for all staff

• Ensuring that learning from patient and staff safety concerns is always at the heart of all we do

• Engaging with the National Guardian’s Office and regional FTSU network to share learning and best practice

• Ensuring timely, clear and concise feedback is delivered to all who raise concerns.

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Vision

Our vision is that we approach Freedom to Speak Up (FTSU) with

From front line care to Board level, all staff at RDASH are committed to supporting a transparent and open culture, where all staff including: agency workers, temporary workers, students, volunteers, governors and other stakeholders are encouraged and feel safe to ‘Speak Up’.

Promoting Rights Inclusion Diversity EqualityPRIDE

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• Ensure that all staff are aware of their obligations as advocates of Freedom to Speak Up

• Provide regular and diverse communication to ensure that everyone is aware of how they can Speak Up

• To promote FTSU e-learning and develop enhanced levels of FTSU leadership training

• To ensure managers are clear about their roles and responsibilities when handling concerns and are supported to do so effectively

• Ensure monitoring and evaluation of the number and nature of concerns is timely and supported by appropriate governance

• To incorporate FTSU concern evaluation with other business intelligence to inform actions to promote staff and patient safety and quality of clinical services

• Ensure that key learning related to concerns are articulated to all in an open and transparent manner, while respecting confidentiality

• Ensure that assurance processes are in place to provide oversight of the rigour of concern exploration or investigation, and consistency of approach

• Ensure feedback is obtained concerning FTSU experience to enable continuous improvement

• Provide regular monitoring and review of policies relating to FTSU.

We will prioritise the following actions to deliver our FTSU vision:

Strategy

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Questions and answers What is Freedom to Speak Up? Significant evidence following incident enquiries and analysis conducted by agencies such as NHS Improvement, demonstrates that having effective speaking up arrangements help to protect patients and improve the experience of NHS workers. There are a number of enabling factors that support ‘speaking up’ throughout organisations including:

• Visible leadership culture that supports and encourages the raising concerns at all levels in all parts of the organisation

• Employment of a FTSU Guardian, a senior Guardian Team and a network of FTSU advocates to champion ‘speaking up’ and support a culture of safety

• Listening and ensuring those who raise concerns feel valued and that their concerns receive the appropriate level of review and responses

• Fostering a culture free from bullying and coercive behaviour

• Providing managerial and guardian processes that enable rapid, proportionate and transparent reviews of concerns raised including timely feedback.

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What is the strategic context of FTSU in the NHS and at RDaSH?

Following the Mid-Staffordshire Inquiry, Sir Robert Francis published a report in 2015 that highlighted the importance of cultures that embrace transparency and support raising concerns to enable patient safety. This report provided recommendations for NHS Trusts, supported by the National Guardian’s Office and is now encompassed in the NHS Contract, which is monitored by the Care Quality Commission (CQC). The CQC assesses a Trust’s speaking up culture during inspections under key line of enquiry (KLOE) 3 as part of the well-led question.

How does FTSU link with our RDASH approach to patient safety, staff engagement and continuous improvement?

FTSU principles are threaded through all safety, improvement and engagement processes within RDASH. Our RDASH patient safety and assurance processes support proactive and preventative approaches whilst also enabling rapid reflection if an incident has occurred.

The key elements of our Workforce and Engagement Strategies concern effective staff support, leadership and management development, that centres upon equality and diversity within an ethos of transparency and improvement, which is key to a FTSU culture supporting the delivery of safe, high quality and efficient services.

Staff who are enabled to work in a culture that supports ‘speaking up’ will demonstrate our Trust values through aligned behaviours. Our values are:

Passionate Reliable

Open,transparent and valued

Progressive

Caringand safe

Empoweringand supportive

of staff

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Why do we think FTSU is important at RDASH?

At RDASH we strive to deliver excellent levels of patient care in an environment which is safe for patients and staff alike. There is significant evidence within NHS research about the positive effects of having a strong FTSU culture and staff engagement can be found at the core of reports from NHS Improvement, NHS England and the Care Quality Commission. This evidence indicates the following benefits:

• Improved patient safety

• Improved service quality

• Improved staff health and well-being

• Lower levels of turnover and sickness absence

• Greater financial efficiencies

• Improved service productivity

• Improved engagement

• Increased staff retention

• Increased levels of health and safety within the organisation.

What are the specific FTSU roles at RDASH?

It is the responsibility of the RDASH Board of Directors to engender an open culture which invites and encourages both positive and negative feedback from all who use and work within the services. This feedback is used to inform future strategies to support an ethos of continual learning and continual improvement including the promotion of FTSU as a central tenant of this culture.

Although every member of staff within RDASH has a role to support a FTSU culture, there are staff who have specific roles and responsibilities.

These include:

Chief Executive and Trust Chairman

The Chief Executive is responsible for appointing the FTSU Guardian and regularly meeting with them. They are also ultimately accountable for ensuring that FTSU arrangements meet the needs of the workers in their Trust. The Chief Executive and Chair are responsible for ensuring the Trust’s Annual Report contains information about FTSU and confirms that the Trust is engaged with both the regional Guardian network and the National Guardian’s Office.

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Executive Director responsible for FTSU

The Executive lead for FTSU is the Workforce and Organisational Development Director, who is responsible for:

• Ensuring they are aware of latest guidance from the National Guardian’s Office

• Overseeing the creation of the FTSU vision and strategy

• Ensuring the FTSU Guardian role has been implemented, supported and has adequate cover for planned and unplanned absence

• Ensuring that a sample of speaking up cases have been quality assured

• Conducting an annual review of the strategy, policy and process

• Ensuring the learning derived from speaking up issues is embedded in the Trust’s services

• Ensuring allegations of detriment are promptly and fairly investigated and acted on

• Providing the Board with a variety of assurance about the effectiveness of the Trust’s strategy, policy and process.

Non-Executive Director responsible for FTSU

The Non-Executive lead is responsible for:

• Ensuring they are aware of latest guidance from National Guardian’s Office

• Holding the Chief Executive, Executive FTSU lead and the Board to account for implementing the speaking up strategy. Where necessary, they should robustly challenge the Board to reflect on whether it could do more to create a culture responsive to feedback and focused on learning and continuous improvement

• Role-modelling high standards of conduct around FTSU

• Acting as an alternative source of advice and support for the FTSU Guardian

• Overseeing speaking up concerns regarding Board members.

Medical Director and Director of Nursing

The Medical Director and Director of Nursing are responsible for:

• Ensuring that the FTSU Guardian has appropriate support and advice on patient safety and safeguarding issues

• Ensuring that effective and, as appropriate, immediate action is taken when potential patient safety issues are highlighted by speaking up

• Ensuring learning is put into practice within the Teams and Departments they oversee.

It’s the bestjob in the trust as it makes staff feel listened to and keeps patients safe

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FTSU Guardian and Deputy Guardian

There are 10 principles of the FTSU Guardian role defined by the National Guardian’s Office:

Fairness FTSU Guardian teams appointed or selected in a fair and transparent way Conflict FTSU Guardians should guard against potential conflicts caused by holding additional roles

Reach The FTSU message should reach everyone – development of a local network of advocates or ambassadors can help with this

Diversity All staff groups, especially the most vulnerable, need routes to enable them to speak up, staff networks can support this Communication FTSU messages should be included in training and feedback on how it generates change should be disseminated regularly

Partnerships FTSU Guardians need to develop strong partnerships with teams and individuals throughout their organisation

Leadership All Leaders in the organisation should demonstrate their commitment to FTSU and CEOs and NEDs will meet regularly with the FTSU Guardian

Openness FTSU Guardians should present regular reports to their Board of Directors in person

Feedback FTSU Guardians should gather feedback on their performance

Time FTSU Guardians should have sufficient time and resource to meet the needs of workers in their organisation.

Executive and Non-Executive leads and the FTSU Guardian, review all FTSU concerns in the Trust, local data, regional FTSU information and guidance and case review reports from the National Guardian to identify improvement possibilities.

Within RDASH a number of services work closely together to support and process concerns,these services can include:

• The Human Resources Team

• The Patient Complaints, PALS and Patient Safety team

• The Health and Well Being Team

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• The Equality and Diversity Leads

• The Trust Communications Team

• Care Group Managers and Clinical Leads

• Staff Governors

• Unions/staff side representatives

• Occupational Health

• Counter-fraud teams

• Guardian of Safe Working Hours.

As a Trust we also work with a number of external organisationsto support concern exploration where appropriate. These include:

• Regional and National FTSU networks

• National Guardian’s Office

• FTSUGs in other Trusts

• CQC

• NHS Improvement

• NHS Leadership Academy

• Partner Universities for Student Nurses, Doctors and AHPs.

FTSU Advocates

National guidance also recommends NHS Trusts establish an FTSU Advocate role to provide immediate support and signposting to staff on how to raise their concerns. Advocates also support the Guardians and share learning across the Trust. Within RDASH we have a range of advocates who represent all Directorates and Care Groups and are diverse in professional background and seniority.

What are all staff leaders responsibilities for championing a FTSU culture at RDASH?

All leaders within the Trust can readily articulate the Trust’s FTSU vision and key learning from issues that staff have spoken up about and regularly communicate the value of speaking up. Basic training about FTSU is available through Trust induction and also an e-learning package. An aim for the coming year is to develop more enhanced specific leadership and development training that integrates and emphasises the importance of learning from issues raised by people who speak up.

All leaders at RDASH take an interest in the Trust’s speaking up culture and are proactive in developing ideas and initiatives to support speaking up. The way that they can evidence, analyse and robustly challenge themselves to improve patient safety, and develop a culture of continuous improvement, openness and honesty, is a priority for the coming months, and aligned with the development of an enhanced patient safety and assurance process.

Questions and answers

I felt supported throughout the process and was immediately put at ease. I was made to feel that someone cared about me and valued my opinionand role

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Visible leadership and use a variety of methods to seek and act on feedback from workers, is significantly important for all leaders at RDASH. Leaders prioritise speaking up and work in partnership with their FTSU Guardian meeting with the Trust Guardian in the Operational Management Meeting, Senior Leadership Meetings, Leadership Development Forum and also team specific meetings where FTSU concerns have been raised. All leaders, including Board leaders, are encouraged to model speaking up by acknowledging mistakes and making improvements.

Senior leaders regularly reflect on how they respond to feedback, learn and continually improve and encourage the same throughout the organisation. Regular contact is also maintained with the National FTSU Guardian’s office to enable support and learning. The National Guardian is also available as an avenue for serious concerns which staff feel either have not been addressed within the Trust or relate to senior members of the Trust including Trust Board.

How do we measure FTSU at RDASH?

Examples of measures which are considered when exploring the impact of safe and transparent cultures that embrace ‘speaking up’ include:

• Staff survey results • Bullying and harassment reports

• Grievances • Serious incidents

• Never events • Issues raised to CQC

• Exit interviews • Incident reporting • Retention figures • Suspensions

• Litigation • Number of issues raised to FTSU Guardian Teams

• Feedback on those issues raised • National benchmarking data from the National FTSU Guardians Guardians Office.

The NHS Staff Survey is a key measure of staff engagement at RDASH. Within the staff survey there are specific questions that relate to FTSU:

RDASH RDASH Trusts 2016 Results 2017 Results Comparator NHS Staff Survey Questions Results

Q13a Do staff know how to report concerns? 97% 96% 97%

Q13b Do staff feel secure in reporting concerns? 72% 70% 73%

Q11c Did staff actually report concerns? 96% 97% 96%

Q12b Are staff encouraged to report concerns? 87% 87% 68%

Q12a Do staff feel that they are treated fairly after 52% 51% 53% reporting concerns?

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What does our staff survey tell us?

The overall results from the 2017 Staff Survey showed that our results are very similar to comparator Trusts, however, our staff rate us better in terms of encouraging staff to raise issues, which is positive in terms of transparency. We need to improve our performance on how people feel after raising a concern and to ensure people know the Trust is a safe place to raise concerns in. This strategy targets these factors.

What are the governance and reporting processes concerning FTSU?

RDASH supports an open and transparent culture concerning speaking up internally and externally. Issues raised via speaking up are part of the performance data discussed openly with Commissioners, CQC and NHS Improvement. Discussion of FTSU matters take place at a minimum bi-annually in the public section of Board meetings (while respecting the confidentiality of individuals). The Trust’s Annual Report contains anonymised data relating to speaking up and actions the Trust is taking to support a positive speaking up culture.

FTSU reports, containing suitably anonymised information are provided at the following committees and meetings in order to analyse FTSU concerns, map concern connections, and also understand reasons that people may speak up outside of typical organisational management processes:

• Executive Management Meeting

• Operational Management Meeting

• Directorate Specific Meetings

• Quality Committee

• Audit Committee

• Team meetings

• Locality Meetings

• Governor engagement meetings

• ‘Listen to Learn’ events

• Staff side meetings

All managerial and clinical leaders within RDASH work openly and positively with the FTSU Guardian Team to continually improve the Trust’s speaking up culture. Additionally the RDASH FTSU Guardian Team work to develop bilateral relationships with organisational regulators, inspectors and other regional and national Guardians.

As encouraged in NHS Improvement’s 2018 report, within RDASH leaders use speaking up as an opportunity for learning that can be embedded in future practice to deliver better quality care and improve staff experience. This includes reviews of internal concerns and case review reports from the National Guardian to identify improvement possibilities.

Your actionwas swift and made sure that the issues were escalated and addressed. You also kept everyoneup to date with your actions, which was very reassuring

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• Quantitative and qualitative information and other information that enable the Board to fully engage with FTSU to understand the issues being identified, areas for improvement, and receive assurance about the actions being taken

• Data and other intelligence are presented in a way that maintains the confidentiality of individuals who speak up

• Information on learning and improvements have been made as a result of staff speaking up

• Information on the number and types of cases being dealt with by the FTSU Guardian and their local network

• An analysis of trends, including whether the number of cases is increasing or decreasing

• Themes in the issues being raised (such as types of concern, particular groups of workers who speak up, areas in the organisation where issues are being raised more or less frequently than might be expected)

• Information on the characteristics of people speaking up (professional background, protected characteristics)

• Patient safety or workers experience issues

• Information pertaining to the FTSU culture including, barriers to speaking up and opportunities to learn and improve can be built

• Action taken to improve FTSU culture

• Details of actions taken to increase the visibility of the FTSU Guardian and promote the speaking up processes

• Details of action taken to identify and support any workers who are unaware of the speaking up process or who find it difficult to speak up

• Information on any instances where people who have spoken up may have suffered detriment and recommendations for improvement

• Information on actions taken to improve the skills, knowledge and capability of workers to speak up and to support others to speak up and respond to the issues they raise effectively Learning and improvement

• Feedback received by FTSU Guardians from people speaking up and action that will be taken in response

• Updates on any broader developments in FTSU, learning from case reviews, guidance and best practice.

Monitoring and ReviewingA Freedom To Speak Up Biannual Report is presented to the Board by the Freedom To Speak Up Guardian and the Executive Lead for Raising Concerns which includes:

The indicators of staff engagement success will be:

• Improvement in staff survey response in targeted FTSU questions

• FTSU Concern satisfactory outcomes

• Positive feedback from staff who ‘speak up’

• Patient complaints and concerns reduce due to proactive intervention prompted by staff ‘speaking up’ early

• Exit Interview information improving

• Staff feedback in ‘Big Conversation’ events and team & locality meetings demonstrating good levels of speaking up.

As outlined by the CQC the benefits of a culture that embraces FTSU are: improved patient safety, improved service quality, improved staff health and well-being, lower levels of turnover and sickness absence and increased levels of health and safety within the organisation. Additional to the specific indicated listed, all of these factors are measured continually through our RDASH audit and Quality Assurance monitoring systems.

Indicators of success

Strategy Authors:

Chief Executive, Executive Director Responsible for FTSU | Non-Executive Director, Responsible for FTSU | FTSU Guardian.

www.rdash.nhs.uk

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