Raising concerns

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Raising concerns share and learn 11
November 2015London Nyla Cooper, Programme
LeadAdele Bunch, Senior Programme Officer
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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

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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

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Actions from the Learning notblaming report (DH
July 2015)
Action Timeline
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
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Actions from the Learning not blaming report
(DH July 2015)
Action Timeline
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

• 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

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National GuardianBriefing November 2015Charles
Rendell, Strategy Manager CQC November 2015

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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

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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 2015. 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 13th March
  2015 and 4th 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.

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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

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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

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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.

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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

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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)

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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

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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.
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.
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
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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.
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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

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Functions of the National Guardian
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Timelines
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Any questions?

• Consultation paper can be found at
• http//www.cqc.org.uk/nationalguardian

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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

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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

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Lunch networking

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New patient safety video Rosie and Margit Veveris
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Video

• http//goo.gl/BmQhGj

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A single national whistleblowing policy
Tom Grimes Head of Enquiries, Complaints and
Whistleblowing
GOV.UK/monitor
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What am I going to cover?
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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

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How will it work?
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What does the policy cover?
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Vision for staff raising concerns what it
should feel like
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Your feedback

• Each group to feedback on
• Your general thoughts on the draft national
  policy
• A specific issue (details on each table)

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Summary
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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?

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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?

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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?

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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?

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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 http//www.nhsemployers.org/your-workf
  orce/retain-and-improve/raising-concerns-at-work-w
  histleblowing

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Keep updated and stay in touch

• NHS Employers website www.nhsemployers.org/your-w
  orkforce/raising-concerns-at-work-whistleblowing
• Subscribe to our workforce bulletin
  www.nhsemployers.org/workforcebulletin
• Feature your organisation on the guardian map
• Follow us on LinkedIn or link up on Twitter
  _at_nhse_nyla
• Get in touch nyla.cooper_at_nhsemployers.org
  adele.bunch_at_nhsemployers.org

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Evaluation and close

• Please spare a few moment to complete our
  evaluation form your feedback is
• important to us.
• THANK YOU