national guardian freedom to speak up · 2019-03-22 · • nhs standard contract revised (january...

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National Freedom to

Speak Up

Conference 2019

@NatGuardianFTSU

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Housekeeping

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Welcome and the

journey so far

Dr Henrietta HughesNational Guardian for the

NHS

Welcome

What feels different

Learning from Gosport

Workplace sexual harassment

Responding to feedback

THANK YOU

Case reviews

▪ 5 reports published

▪ 24 individual cases

▪ 87 recommendations

- Conflict of interest

- Settlement agreements

- Independence of investigations

▪ Support implementation locally and nationally

▪ Gap analysis by trusts

Case reviews: phase 2

Pilot

launched:

June 2017

Pilot ended:

June 2018

Independent

evaluation:

Aug/Sept 2018

Feedback: Oct

2018 – Jan 2019

Evaluation

implemented: Jan

2019 - present

New Case

Review Officer in

post and launch

of phase 2:

Summer 2019

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Speaking Truth to

Power

Professor Megan ReitzHult International Business

School

Speaking Truth to Power

© Ashridge Executive Education 2018

Professor Megan Reitz

Speaking Up and Listening Up……….

Reitz, M. and Higgins, J. (2017)

Wisdom to listen up

(How do we

silence others?)

Courage to speak up

(How do we silence ourselves?)

POWER

H ow-to

R isk

U nderstanding

T rust

T itles

What affects speaking up and listening up?

H ow-to

R isk

U nderstanding

T rust

T itles


What affects speaking up?


Speaking up in your experience

Usually -always

Junior Middle Senior

Malpractice 54% 77% 78%

Challenge ways of working

20% 50% 73%

Offer ideas 31% 64% 82%

You

93%

84%

89%

50% 67% 73%

27% 52% 68%

40% 63% 72%

82%

70%

81%

Speaking up with a problem: 40% likely rewarded, 25% likely ignoredSpeaking up with an idea: 43% likely rewarded, 29% likely ignored

We doubt ourselves


We talk to ourselves

What stops you or helps you to speak up?


Speak-Up Traps

Spot the imposter voice Question assumptions See the others pov

We abdicate

H ow-to

R isk

U nderstanding

T rust

T itles


What affects listening up?


Listening up in your experience

Always – usually Those senior to you

Malpractice 82%

Challenge ways of working

60%

Offer ideas 63%

You

95%

94%

92%

93%

91%

92%

79%

48%

55%


What stops you or helps you to listen up?


Listen-Up Traps

We forget how scary we are

We send

‘shut up’

not ‘speak

up’ signals

Empathise with others Question the ‘list’ Know your face….

When you need to speak up and listen up ….mindfully


Mindfully speaking up and listening up:

• In-the-moment mindfulness vs.

autopilot

• Responsiveness vs. reactivity


Spot the imposter voice

Question assumptions

See the others pov

Empathise with others

Question the ‘list’

Know your face….

Summary

• Speaking up and listening up are personal and organisational imperatives

• Speaking up is relational – listening and inviting others to speak up is a blind spot and we’re probably not as good as we think we are

• Changing habits of conversation personally, let alone organisationally, is no mean feat – we need to disrupt ‘automatic pilot’

• Training the mind to respond rather than react is one intervention that shows promise

[email protected]

@MeganReitz1

© Ashridge Executive Education 2018 Reitz, M. and Higgins, J. (2017)

mailto:[email protected]

http://www.meganreitz.com/

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Break

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Moving into primary

care: three

perspectives

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Moving into primary

care: NGO ambitions

Russ Parkinson

Head of Office

National Guardian’s Office

Our ambition

Speaking up is business as usual

What we have already

The landscape

Our approach

Vanguards

Regional Liaison Leads

Regional Integration Plans

Our vanguards

A number of vanguards are emerging

We will hear from two

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Moving into primary

care: GP

Confederation

John Walsh

Leeds GP Confederation

Leeds Community Healthcare NHS

Trust

The perspective of a GP Confederation

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Moving into primary

care: Freedom to

Speak Up and DMS

Col Phil CarterDefence Medical Services

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Tablework:

Developing an

integrated approach

to speaking up

Integration starts now

Assemble in your regions

Introduce yourself to someone you don’t know

Discuss:

• what is already happening to support integration in your region?

• what is happening to support Freedom to Speak Up in your

region?

• what are the quick wins?

• what are the longer-term wins?

Place a dot on the map

Leave your name and contact details

Integration starts now

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Welcome back!

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Feedback from

tablework

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Civility Saves Lives

Dr Chris TurnerUniversity Hospitals

Coventry & Warwickshire

NHS Trust

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Caroline Dinenage MPMinister of State for Care

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Questions for

speakers

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Speaking up and our

culture change

journey

Jane Butcher and Kevin Moynes

East Lancashire Hospitals NHS

Trust

Kevin Moynes Jane ButcherDirector of HR and OD

Creating a Supportive Staff Culture

East Lancashire Hospitals NHS Trust 2013

Inside a 'failing' UK hospital

Channel 4 News

10 ENABLERS OF EMPLOYEE ENGAGEMENT: WHAT

MATTERS TO ELHT STAFF

East Lancashire Hospitals NHS Trust 2018

2018 Staff Survey result

Performance

Referral to Treatment

Cancer

Waiting Times in A&E

Infection Prevention and Control

Stroke

Harm Free Care

Financial Duties

Patient experience

Thank you

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The views from a

Clinical

Commissioner

Dr Jo Sauvage

Chair

NHS Islington CCG

Freedom to speak up

Views from the world of

commissioning

Dr Jo Sauvage

Chair

Islington CCG

• The commissioning landscape

• The evolution of FTSU

• System outcomes and limitations

• Next phase of the NHS and integrated systems ‘The NHS Long term plan’

• Implications for Freedom to Speak Up in the NHS

• Case study: Applicable learning from uniting clinical leadership in Integrated

systems

Themes covered

• CCGs authorised on 1st April 2013 (Health and Social Care

Act in 2012)

• Clinically-led statutory NHS bodies responsible for local

health services

• Planning

• Commissioning

• Monitoring

• Services include:

• Mental health services

• Urgent and emergency care

• Elective hospital services

• Primary Care & community services

The role of the commissioner

What is commissioning?

• Determining needs of a population

• Defining priorities

• Service specification

• Negotiating and agreeing contracts

• Monitoring service quality and ensuring contract standards are met

Planning, agreeing and monitoring services, including..

Copyright: the King’s FundA fragmented picture………

Clinical commissioning

groups£75.6bn 2018/19• 195 CCGs across England

• Commission most NHS services including urgent

and emergency care, acute care, mental health

and community services

• Responsible for approx. two thirds of total NHS

budget

• Membership bodies

• Led by an elected governing body made up of

GPs, other clinicians and lay members

• Work closely with NHS England, which is

responsible for assuring CCGs, and supporting

them to develop

Copyright: the King’s Fund

• 5 NHS England regional teams, increasing to

7 in April 2019

• NHS England directly commission:

• Specialised services, such treatments for

rare cancers, renal dialysis, neonatal

services

• Primary care, including pharmacists and

dentists and optometrists

• Some public health services, e.g.

screening programmes

• Some other services – e.g. for people in

prisons

NHS England regional teams

£24.2 bn in 2017/18


• 152 local authorities

• Commission many public

health services including

sexual health services,

health visitors, school

nursing and addiction

services

• Commission social care

services for older people

and for those of working age

Local authorities

Public health grant £3.1bn in 2019/20

2017/18 approx. £17.1

bn on adult social care


• The Freedom to Speak Up (FTSU) concept introduced 2015

• Sir Robert Francis review into ‘whistleblowing’ processes in the NHS.

• FTSU:

• improving and protecting patient safety;

• improving and supporting staff experience;

• leading and promoting learning cultures that embrace continual

improvement.

• Themes:

• Developing cultures where safety concerns are identified

• Encourages ability to raise concerns

• Focus on preventative action, before people feel the need to ‘blow

the whistle’

• NHS Standard Contract (September 2016) and since then, there has

been demonstrable impact at trust, regional and national levels.

Freedom to speak up across the landscape

• NHS standard contract revised (January 2018):

• Strengthened organisational requirements around speaking up arrangements

• Obligation to comply with NGO guidance about the guardian role and its implementation

• NHS Improvement, ‘Guidance for NHS trust and NHS foundation trust boards on Freedom

to Speak Up’ (May 2018):

• speaking up is only part of the solution

• responsibility to listen and respond well

• to take the right actions

• feedback appropriately

• crucial to creating an open, supportive and learning environment.

• Describes the role of boards and individual responsibilities in relation to speaking up.

• Supports benchmarking and development of effective speaking up arrangements.

• Indicator of a well-led trust.

• Boards knowledgeable and engaged in integrating speaking up into their strategy.

Freedom to speak up across the landscape

• National Guardian’s Office has captured quantitative data

• Year on year increase in reporting

• Themes:

• patient safety / quality of care

• bullying and harassment

• incidents of detriment.

• Qualitative data at trust level

• analysed and integrated into internal safety processes.

• contribution to trust’s safety culture

• assessed via quality review processes CCG quality review/ safety

barometers/CQC

Outcomes to date

• FTSU guardians and FTSU principles are expanding

• Diversification aligned with transformation in care model

• Private providers of NHS services

• NHS England/NHS Improvement/Care Quality Commission

• Speaking up processes are also being introduced in primary care

• general practice

• community pharmacy

• dentistry

• optometry

Next steps

Leadership and culture

• Culture/behaviour change complex

• Evidence of positive outcomes (not universal)

• Introducing individual guardians within organisations

• Leadership currently intra-organisational

• Enhanced collaboration to improve safety

• Skills and experience

• Role and resource diversity across the provider community

• Cascading of learning into smaller organisations

Limitations

Systemic factors

• Worker wellbeing (NHS Staff Survey) decrease in workplace

wellbeing (trust & culture)

• Leaner management/financial constraints

• Operational priorities

• Reduced time for quality improvement or mentoring

• Multi-provider landscape

• Systems and process alignment-requiring systemic

approaches to integration

• Complexity at organisational interfaces

Limitations

How is commissioning changing?


Transformation in the model of delivery with a focus on:

• Integrated Care Systems working across organisational interfaces

• Physical health/mental health and care needs of residents

• Strategic commissioning function to drive population health outcomes,

prevention interventions and focus on wider determinants

• Alignment of provision within a place-provider partnership

• Alignment of leadership for the benefit of the local system

• Alignment with new GP contract: Primary Care Networks/social

prescribing

• Optimisation of enablers- workforce/digital/estates

• Changes to the regulatory architecture to enable integrated working:

• ‘Workforce Implementation Plan’

• ‘Long Term Plan proposals for possible changes to legislation’

NHS Long Term Plan: from organisation to system

Opportunity:

Workforce

Systems/Interfaces

Training & Learning

Collaboration

Complexity:

Accountability

Relationships

Leadership

Trust

NHS Long Term Plan & FTSU implementation

Membership

• Medical Directors Trusts/FTs

• CCG GP Chairs

• DAS/DCS

• Nurse members/AHPs

Purpose

• Strengthen relationships

• Working together for benefit of patients

• Reduced variation, create consistency

• Application of systematic pathways of care

• Clinical Practice Groups to evaluate data/QI methodology

• Opportunities for transformation (workforce/estates)

Case study: Driving change through clinical leadership

Opportunities for Strategic Commissioning

(North Central London STP Health and Care Cabinet)

Outcomes: bring people and organisations together

• Clinical leadership owning and driving the ‘Case for Change’: shared vision of

transformation

• Strengthened system leadership voice by collaboration across organisations

• Recognition of need for distributed model of leadership

• Collaboration with other professional groups to optimise delivery

• Build relationships and trust across organisational interfaces

• Culture change of engagement and commitment

• Remember the need for organisational development

• Accountability to work with and through colleagues

• Systematically cascade communication, systems and processes

invite/inform/involve/inspire

• Create an aligned way of working across organisational interfaces

• The platform for future opportunity to improve patient care

Learning- Create ’The only show in town’

• Think about workforce portability

• Work as a system to drive quality & safety for patients/ Staff wellbeing

• Linking multi-agency working/multiple interfaces

• Separate employment contract and accountability to places of work

• Use of data /information to drive improvement & share learning

• Importance of knowing & trusting each other to the way we work , esp. for FtSU

• How to support FTSU Guardians required to work/influence across organisational interfaces

including

• Private sector

• Voluntary sector

• Local Authority

• Regulation and quality control across integrated pathways - integrated safety barometer

• Benefits to complexity at organisational interfaces

• Alignment with workforce development and quality improvement methodology

• Clinical and Executive behaviour

How does this apply to FTSU?

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Speaking up:

A CEO’s perspective

Dr Navina Evans

Chief Executive Officer

East London NHS Foundation

Trust

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Reflections from the

day

Dr Henrietta Hughes National Guardian for the NHS

Integration

North East and Yorkshire

North West

Midland

s

East of EnglandLondon

South

West South East

Speaking up campaigns and case studies

100 Voices campaign

Speaking up index

Speak Up Month Twitter activity impacted

on the upsurge of speaking up.

• 3,600 cases brought to guardians during

Q3 of 2018/19

• Almost 1,000 more speaking up cases

recorded this quarter compared to last

• There were 5,013 #SpeakUpToMe

hashtag mentions

Bullying

behavioursConflicts of interest Inequality

Workarounds

Focus on targets

Competition Entrenched

views

Rivalry

Where are we now?

Where are we heading?

Next steps

Integration

Next steps

Integration

Implementation

Next steps

Integration

Implementation

Innovation

Next steps

Integration

Implementation

Innovation

Inspiration

THANK YOU

please complete your

evaluation forms

national guardian freedom to speak up · 2019-03-22 · • nhs standard contract revised (january...

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