Freedom to Speak Up Quarterly Progress

Meeting: Trust Public Board

Date: 08.11.2023

Report Title: Freedom to Speak Up Quarterly Progress

Agenda Item: 3.1

Author: Janice Scott, Lead Freedom to Speak Up Guardian

Lead Director: Tom Abell, CEO and Executive Director for FTSU

Link to strategic risk(s):

• SR1a: If we do not ensure our people are safe and their wellbeing prioritised, there is a risk that we will be unable to attract, retain and keep all our people safe and well
• SR1b: If we do not ensure our leaders are developed and equipped, there is a risk that we will not be able to change our culture, and value, support, develop and grow our people

Equality impact assessment: No negative impact identified

Recommendation None required.

Previously considered by: N/A

Purpose: To provide an update and assurance on the FTSU work within the last quarter.

Executive summary

• New FTSU cases increased by 65% from Q1 to Q2 and by 19% in comparison to the same period last year.
• There has been a marked rise in cases related to bullying and harassment. Nearly half of these cases are situated in our support service teams. Further support and engagement is a priority for Q3.
• A noticeable increase in concerns raised regarding the senior leadership team 7. 4 of the reporters cited a fear of suffering detriment if raised openly.
• A pleasing reduction in the number of completely anonymous concerns, yet an increase in confidential concerns indicates there is still a strong fear of detriment by staff and managers.
• The team has seen a significant increase in new concerns due to the commencement of staff engagement visits and the heightened senior leader communication encouraging staff to speak up.

Introduction/ Background

Speaking up and raising concerns have been at the forefront of the leadership engagement over the last year. The support and guidance offered by People Service, Strategy Culture and Education and FTSU teams to staff involved in the trust change programmes has been increased.

FTSU has been an additional and key conduit for the voice of staff within many strategic forums and will continue to facilitate and escalate staff concerns where appropriate.

The continued focus of working in collaboration across the trust to seek new ways of supporting staff to speak up without the fear of detriment remains a priority.

Key issues/risks

The commencement of staff engagement visits and entering into winter pressure is likely to increase the number of new concerns raised and the negative behaviours associated with this.

Expectations around the methods and ways of working under current workloads within corporate and administrative support services may increase FTSU concerns and ER casework.

Options

Summary

The number of speaking up concerns raised is increasing across the trust, however there is still a strong feel that speaking up does not work and staff will be negatively impacted if they do. The fear of speaking up remains however work across the trust continues to build staff confidence.

Appendix A - Freedom to Speak Up (FTSU) Q2 2023-24 report

This report provides information on speaking up activity undertaken during quarter 2 2023/2024.

Executive summary

Key findings:

1. New FTSU cases increased by approx. 65% from Q1 to Q2 this year and by 19% in comparison to the same period last year. The increase can be attributed to the commencement of FTSU engagement visits and the impact of the change programmes which includes a tightening and increased accountability of processes and perceived negative behaviours attributed to change.

2. Of the 89 concerns raised in Q2, the highest 3 categories have shifted:

• Application of systems and process: 28 - 87% increase this quarter
• Inappropriate attitude or behaviours: 18 - 29% increase this quarter
• Bullying and harassment: 15 - 275% increase this quarter

3. The application of Trust systems and processes in the main are process related to service changes, clarity in recruitment and feedback around investigation outcomes to the reporter. The cumulative number of inappropriate behaviour or attitudes and bullying harassment has increased. There aren’t common themes, rather changes in people’s behaviour and manager responses to situations have been identified. Of these concerns:

• 46% are within our support services
• 21% within frontline operations
• 18% within EOC
• 12% within operations support
• 3% within PTS

4. The anticipated rise cited in previous board reports for concerns raised from within the more administrative and corporate area of our support services has continued. Support to managers and staff within this area has been identified as a priority and will be included in the action plan of the National Guardians Office (NGO) reflection and planning tool.

5. Concerns raised within administrative and corporate support services centre around normalised and expected professional behaviours which are cognisant with working within these environments. Breakdowns in communications have been regularly cited linked with the volume of work and associated pressures. The level of staff sickness and ER casework is anticipated to rise in line with this.

6. 7 concerns have been raised regarding individuals within the wider trust leadership team. 6 were escalated to the appropriate level and addressed via CEO involvement. 1 has been logged with no further action at this point. 4 of the concerns cited a fear of suffering detriment which feels very real to them.

7. The number of patient safety/quality concerns is higher than the total number of the previous year. It should be noted that these concerns were related to the behaviours of staff and the impact on patients and one was regarding the safety of patients on vehicles.

8. There has been a reduction in the number of anonymous concerns raised to FTSU which is positive and suggests more confidence in the team. However, there has been an increase in the number of confidential concerns which means staff are still reluctant to have their concerns escalated more openly, which coincides with the percentage of staff stating they still fear suffering detriment if they raise a concern.

9. The percentage of concerns resolved through FTSU facilitated interventions has positively increased due to the increased capacity within the team, the embedding of revised trust processes and the increase in understanding and support provided to staff by managers within the trust.

10. FTSU concerns raised as a percentage of the number of staff for each area will be provided in the next board update and to the next Raising Concerns Forum.

FTSU priorities Q3 2023-24:

1. Re-establishing quarterly engagement visits with a focus on students and support services.

2. Trust completion of the NGO speaking up reflection and planning tool.

3. Preparation for the NGO led board development session on the fear of speaking up and suffering detriment.

4. Establishment of revised FTSU case management process.

Report and analysis of FTSU case work undertaken this year

1. Number and themes of concerns raised

1.2 Quarterly breakdown of concerns raised to FTSU Guardian.

1.2 Theme of concerns*

• Categories are suggested by the National Guardian’s Office; discussion with staff and judgement of the Guardian determines which category a concern is recorded against.

1.3 NGO Professional Groups* 2023-24

Please note as of April 2022 all professional groups were updated by the NGO as follows. Additional clinical services - Staff directly supporting those in clinical roles. In addition, support to nursing, allied health professionals and other scientific staff are included. Have significant patient contact as part of their role. Administrative and clerical - non-clinical staff, including non-clinical managers, administration officers, executive board members who do not have significant patient contact as part of their role. Allied Health Professionals - Registered clinical staff providing diagnostic, technical and therapeutic patient care, including dieticians, radiographers and physiotherapists. Includes qualified ambulance staff such as paramedics. Estates and ancillary - non-clinical support and maintenance staff, including gardeners, plumbers, cooks and housekeepers who do not have significant patient contact as part of their role. Students - Directly employed staff undertaking formal education, including student nurses and midwives Other - Used to encompass anonymous, third-party contacts along with other areas of the Trust that do not fit the NGO reporting categories.

2. Quarterly service area breakdown of concerns

3. Progression towards FTSU KPIs

CQC exit criteria

Aim: Strengthening FTSU and making speaking up business as usual

Cultural oversight group

Aim 1: Key objective 1 - To ensure that EEAST has a culture of belonging and inclusivity

Aim 2: Key objective 1 - To ensure that EEAST has a learning culture embedded

Next section: People Committee Assurance Report