Raising concerns and Freedom to Speak Up

The Freedom to Speak Up (FTSU) function within the Trust has strengthened over the past year which is evidenced by the consistent level of new concerns raised each month and the increasing integration of speaking up within the wider strategic work on culture and behaviours within the Trust.

Due to the consistently high number of contacts through FTSU, the complexities of casework and the need to support concern resolution and better embed speaking up as business as usual into the Trust, the capacity of the team will increase to three full time Guardians in the spring of 2023. The team has also successfully recruited 21 ambassadors, with an additional seven being supported through specific roles within partner areas of the Trust.

The greatest assurance received this year with regards to how speaking up and raising concerns is gently becoming standard practice within the Trust, was an increase in the National Staff Survey results for the main associated question. I feel safe to speak up about anything that concerns me in this organisation. Whilst an increase of 3% is still below the average for all trusts, it provides us with the assurance that the challenging work we continue to undertake is making a difference to the culture of speaking up within EEAST.

The CQC inspection report (July 2022) also saw a positive move to Requires Improvement under Well Led with specific reference to the FTSU function and the Speak out campaign of which FTSU played a fundamental role.

This year has seen the team actively support staff to raise their concerns whilst working in close partnership with leaders, managers and various teams across the trust to facilitate resolutions to those concerns.

Empowering staff to speak up in a safe and confidential environment is the primary aspiration of the FTSU programme and publication of data is presented in an unidentifiable way to protect individual staff members and teams within the Trust.

It is important to note that whilst the most common theme is recorded from the staffs perspective and this is the information which makes up the key data on themes, the team record the secondary and tertiary themes which the concerns may also cover. The top three concerns reported remain the same as previous years, with staff reporting a lack of consistency in the application of some of the Trusts systems and processes. This is true in some cases, however not for all, and the team works with staff to better understand the relevant policies.

The number of staff reporting bullying and harassment whilst remaining in the top three themes, has reduced significantly to 59 this year from 115 the previous year. The National Guardians Office (NGO) introduced a new theme this year for reporting - Inappropriate attitude and behaviours of which there were 20 cases this year. Whilst it is a separate theme, the behaviours may still be classed as bullying and harassment, however the overall figure has still reduced. The continued communication on inappropriate attitudes and behaviours, the review of HR polices and the increased capacity within the People Services teams has meant that the informal routes for escalation are being explored earlier and rapidly supported and the formal routes have a stringent underlying process and a separate investigations team, which results in time frames being significantly reduced.

The third highest reported theme is regarding senior and middle managers. They typically refer to staff feeling victimised by managers through their communication and actions, showing favouritism to others within a team, a lack of support and a mis abuse of power. There has also been a steady and slight increase in the number of concerns raised about managers over the past three years. The information on level of manager has been anonymised within reports, however it is noted that a higher proportion of lower-level managers are now raising concerns about their managers, which evidences the ongoing messaging regarding all levels of staff having the right to raise a concern, is filtering through.

Several actions were completed with regards to the wider culture of speaking up and raising concerns with the leadership team:

• Monthly meetings between the Lead Guardian and the Chief Executive Officer and quarterly meetings between the Lead Guardian, lead executive and non-executive directors with this responsibility
• Regular meetings with each executive director.
• Quarterly oversight at the Trust board meetings.
• Support to directorates and departments regarding the reporting and resolution of concerns.
• Freedom to Speak Up representative at every corporate induction session.
• Bi-monthly meetings of the Raising Concerns Forum

This year saw the NGO undertake a review on the culture of speaking up across all ambulance trusts which involved a desk top review and compact survey of FTSU Guardians in ambulance trusts focussing on the implementation of the Guardian role and the barriers to speaking up. EEAST were fortunate to be one of the five ambulance trusts selected for a second phase of the review which included structured interviews with the Guardian, Executive and Non-Executive Leads and other key senior leaders. Four focus groups were also held for staff to share their experiences, with two groups held for staff who are identified as less likely to engage in such reviews. The report was published in February 2023 and identified 5 key themes:

• The culture of ambulance trusts.
• Leadership and management.
• The experience of people who speak up.
• Implementation of the Freedom to Speak Up Guardian role.
• The role of system partners and regulators

Four recommendations were made which include the call for an independent cultural review with Ministerial oversight to improve the culture of NHS ambulance trusts and for CQC and NHS England to effectively regulate, inspect and support the improvement of the speaking up culture in ambulance trusts. All ambulance trusts have two recommendations which is to make speaking up business as usual and to implement the Guardian role in accordance with the updated national guidance to ensure we can meet the needs of our staff. EEAST is in a strong position with these two recommendations, however work is ongoing to develop an action plan for the next two years which will ensure we exceed the actions that will support the recommendations. The action plan will include:

• Introducing the NGO and Health Englands FTSU training - Speak Up, Listen Up and Follow Up as a mandatory course with monitoring to ensure compliance.
• Facilitating a full NGO led board development session.
• Completion of the NGOs annual self-evaluation tool to better identify any weaknesses and areas for improvement on speaking up within the Trust.
• Developing a clearly defined reporting and accountability tool for the management of concerns as the team increases.
• Completing the training and embedding of FTSU ambassadors collaboratively with champions and ambassador leads across the Trust to be a more local and immediate point of contact for staff to raise concerns.
• Evidence learning and progression using case studies and lived experience feedback from staff.
• Increase the number of opportunities for staff to engage with FTSU via planned engagement visits and ambassador led engagement and involvement.
• Continue to ensure the themes, patterns and gaps identified via FTSU cases is addressed through the Raising Concerns Forum and subsequent forums which address the culture within the organisation.

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