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Agenda Item 13.2 Appendix 1

Suzanne Barker Leeds Teaching Hospitals NHS Trust Head of HR - Policy and Performance St James’s University Hospital Beckett Street Leeds LS9 7TF Sent by email to: suzanne.barker4@nhs.net

20 May 2015 Dear Suzanne

Leeds Teaching Hospitals NHS Trust advice Line report 1 March 2014 to 28 February 2015 We are pleased to provide Leeds Teaching Hospitals NHS Trust (‘LTHT’) with this advice line report as part of the Enhanced Subscription to the Public Concern at Work advice line. This report is prepared with a view to providing details of the way the advice line is being used as well as the context of recent legal and policy changes in whistleblowing. We also feature a synopsis of the Sir Robert Francis Freedom to Speak Up Review with practical suggestions to assist the Trust in complying with the recommendations in that report. Advice line overview It should be noted that the information provided in these annual reports is presented so as not to breach the duty of confidence that PCaW owes the client – in this instance the individual caller – under legal professional privilege. LTHT should also bear in mind that providing the name of the employer is not a prerequisite to seeking and obtaining independent confidential advice from PCaW. On our advice line we focus on the public risk and how the issue can be raised responsibly. This means that when contacting us, staff may:

Provide their name only Identify themselves as working for LTHT – with or without their name Not provide any information as to their identity or their employer

LTHT staff can contact us in one of the following ways:

Via the details given in the Employer’s policy (Freephone number: 0800 008 6718/ speakoutleeds@pcaw.org.uk)

Independent web search or other source of information – PCaW helpline number 020 7404 6609/ helpline@pcaw.co.uk

Between 1 March 2014 and 28 February 2015 we received between one and three self identified calls to the PCaW advice line. Given the number of self-identified calls received and the duty of confidentiality we

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owe to callers to the advice ine, we are unable to provide more information about the nature of the call(s) and whether they were of a public interest nature or not. During the same time period we received 6 calls to the Freephone number. We are unable to provide details about any of these calls as we do not specifically track the freephone calls made into our advice line, again to protect confidentiality and to allow callers to remain anonymous if this is their wish. When interpreting this information it is important to consider the number of concerns being reported via internal channels as this is the real measure of success in relation to the trust whistleblowing arrangements. Low call numbers to the advice line can indicate the need for promotion and refreshing of the whistleblowing arrangements (inlcuding the access to independent advice) amongst staff, however it can also be indicative of staff following the whistleblowing policy and having the confidence to raise concerns internally. In those circumstances, there will be a reduced need for advice from PCaW as individuals will feel confident raising their concerns through internal processes. It is important to bear in mind that the role of PCaW is that of a safety net to sit behind the internal whistleblowing arrangements in place. Staff may also be raising concerns at line management level without escalating issues to other whistleblowing contacts named wiithin the policy. Therefore reports to middle and senior management, as well as calls to the advice line must be considered jointly to gain a true picture of staff awareness, trust and confidence in the whistleblowing arrangements. The Whistleblowing Commission provide a useful list of key KPIs by way of the Code of Practice that organisations can use to review, assess and benchmark their own arrangements over time (see below). LTH NHS Trust Whistleblowing arrangements In December 2013 PCaW presented the findings of a comprehensive review of LTHT’s arrangements and a number of recommendations were made in relation to revision of the policy, training, communication and follow-up evaluation. Since then LTHT has made strong progress on the issue by demonstrating buy-in from senior management and with a key NED role leading this work. The role of designated officer has also been an important introduction to the Trust whistleblowing arrangements and this is in line with the recommendations of the Francis Freedom to Speak Up Review (more on which below). In March 2014 PCaW revised and re-launched the Trust’s policy, assisting with follow-up communications. LTHT has also taken out a rolling subscription to the PCaW Enhanced Package which includes staff access to a Freephone advice line number. In April 2014 detailed training was given to all designated officers, focusing primarily on how to encourage and respond to staff who raise concerns. We also provided a briefing in December 2014 which made recommendations for follow-up work including:

Review of designated officers at 12 months after training - an opportunity to review who the officers are, gain feedback and decide whether and how to further develop the role.

12-18 month review. We suggested the Whistleblowing Commission Code of Practice as a basis for this review at the time and the recommendations from the Freedom to Speak Up Review will now form the basis for this work. In addition, the review will include information from the designated officer review, NHS staff survey results and data from this annual report.

Roll out of guidance for all managers. This could be in the form of larger staff briefing, guidance documents or an e-learning programme (which we have developed and will be available shortly).

Further promotion of arrangements.

Further work was undertaken in April 2015 including a series of meeting on 28 April to include a second meeting of the whistleblowing review team, chaired by Mark Chamberlain and attended by PCaW,

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Corporate Leads, Staff Side, and the Trust Designated Whistleblowing leads (DWLs), a separate PCaW/union staff-side meeting to flesh out issues, and a meeting with the DWLs to review progress and consider next steps. We have two further training sessions booked in this year on 23 June and 1 July. These sessions will include 1.5 hour update training with the DWL’s, awareness sessions for management groups and a progress report to senior officers. Issues identified for particular attention arising out of the discussions in April and which will feature in future training include:

1. Further consideration of the DWL role, in particular: a. Flexibility (ie staff from any CSU can raise a concern with DWL – this does not have to be a

concern linked to the DWL’s own CSU) b. How to raise the profile and visibility of the DWLs – this is a key element of the promotion

of the Trust’s whistleblowing arrangements c. The value of peer to peer review incorporated in the regular DWL meetings was

emphasized by all those present and an annula meeting is therefore an important feature. d. Consider whether a periodic, PCaW facilitated and structured interview might make sense.

This would include an element of data capture as well as update training for the role.

2. Procedural guidance for DWL. This was highlighted as a useful next step including: a. A quick reference guide b. Manager’s guidance c. Case log documents – for review d. RAG status for types of cases ordinarily going through formal process - a new suggestion

for discussion and to help DWL to consider whether the formal or informal route is appropriate for any particular concern and to roll out in training across all staff

3. Phase 2 communications – renewed focus on visibility and profile of DWLs. Ideas from DWL meeting:

a. Use of regular team brief b. Induction and DWL presentation c. Slides for DWLs to introduce the arrangements and their role

We look forward to working with you on these issues at the upcoming training sessions in June and July.

The Freedom to Speak Up Review, led by Sir Robert Francis The Freedom to Speak Up recommendations extend to employers, regulators and the Secretary of State. They cover culture change, improved handling of cases, measures to support good practice, extending legal protection and external review and accountability. The report calls for a move away from defensive attitudes and a climate of fear within the NHS, towards a culture where raising and addressing concerns and challenging poor practice becomes the norm. The proposals include the creation of both a Speak Up Guardian at local level and a National Whistleblowing Officer sitting above health regulators reviewing the handling of concerns and treatment of whistleblowers.

Attached at Annex A is a summary of the review’s recommendations.

Your whistleblowing arrangements are already designed to help in the creation of a ‘safe learning culture’ which, as part of the ongoing work with us, is measured and monitored (principle 1). The main provisions of your whistleblowing arrangements are compliant with the Francis principles but there is a need to integrate and review such policies on an ongoing basis. It should also be noted that the report tasks NHS England, NHS TDA and Monitor to support the requirement for the production of integrated policies across both

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incident reporting and the raising of concerns, and so any work undertaken on your current policies should take this into account.

Francis suggests that there should be a common procedure for the reporting of incidents and concerns and highlights good practice in a number of areas which I have set out in in detail in Annex B. In summary there is good practice guidance in the report on the following specific issues:

Driving culture change

Making the raising of concerns a normal activity

Promoting a ‘no bullying’ culture

Recording and monitoring of concerns that are formally raised

The investigation process

Suspensions and special leave

Mediation, reconciliation and alternative dispute resolution

Training

Advice and support for staff raising concerns

Transparency

Many of these issues will already be covered in some of your trust policies and procedures (eg. your incident reporting, risk management and clinical governance processes). Your normal HR, disciplinary, grievance and suspension polices will also require review to ensure they are compliant with all of the recommendations (for instance the creation of a ‘no bullying’ culture in which staff training is provided). It would seem appropriate now to consider what work is required in order to update these policies with your designated officers and the ongoing meetings over the summer will be undertaking this work.

Review of policies and procedures One of the challenges of implementing the recommendations of the Francis report lies in the lack of acknowledgement that many NHS organisations will have policies and procedures that already deal with some of the processes that are being recommended in order to drive culture change from board level. The work we have already undertaken with you to date demonstrates this and your policy already attempts to make the raising of concerns a ‘normal’ activity. We would suggest therefore that a strategy is developed to thoroughly review the existing trust processes and policies and enhance them as necessary to ensure they comply with the Francis principles, and of course we can assist with this.

You have of course already drafted a detailed action plan which is in progress on this issue.

Handling concerns On the handling of concerns we would suggest that it makes sense to develop a form for completion at the stage that a member of staff wishes to raise a concern ‘formally’ under the whistleblowing policy. You will need to discuss what is meant by the ‘formal’ and the ‘informal’ process, perhaps with reference to where the individual member of staff wishes to raise the concern (ie. with line management, more senior managers or with your designated officers). It is suggested in the good practice guidance, that where the concern is raised formally, the CEO or designated board member should have a record of the concern. A system for processing, formally logging and reviewing all such concerns is suggested in the report.

There are specific requirements around the investigation process. We would suggest the good practice principles set out in the review report are considered during the review of your incident reporting and investigation processes, including your serious untoward incident processes, so that they may be adapted as appropriate.

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Learning from these incidents is suggested. It is likely that you already undertake action planning similar to what is suggested in the report – what is now required is a look across existing incident management and whistleblowing reporting in order to ensure that matters coming through either process are integrated, streamlined and reviewed as one.

Other considerations There are a number of other processes that will need to be considered by your CEO/ the board, at the point a member of staff raises a concern – for example suspensions and special leave as well as settlement agreements with confidentiality clauses all require CEO/Board approval.

The report makes a number of recommendations that will likely require longer term and more detailed consideration at any NHS trust, as they have resource implications and may not be part and parcel of existing policy and procedure. These include the provisions relating to: the public celebration of those who have raised concerns; the requirements surrounding the need for reflective practice; the provisions relating to access to mediation, reconciliation and ADR; access to counselling for those who have raised concerns; the need for the publication of Quality Accounts and the reporting into the NLRS/ National officer (a role that is yet to be formulated by NHS England, Monitor and the CQC); the creation of local Freedom to Speak up Guardians (subject to a live consultation by the Department of Health); access to training for staff generally and for those involved in handling and investigating concerns as well as the formation of a panel for the investigation of serious concerns.

There is clearly a need for a thorough cross-referencing of the way in which incident investigation, dispute resolution and training is currently managed across the Trust with a view to ensuring all of the processes are integrated and Francis compliant. We will be pleased to assist with this work over time.

PCaW Training In response to the report and to assist Trusts in adopting Francis’ recommendations in a streamlined way, we are designing an NHS specific training course which will be launched in the next couple of months. It is likely that the course will cover the following key areas:

the legal background and context of whistleblowing

embedding and evaluating best practice arrangements

how to improve and measure culture

addressing the concern and handling the whistleblower

accountability, audit and review We are also in the midst of producing an e-learning course designed to help staff understand the basic principles around whistleblowing and will be looking to launch this in the health sector in due course. Summary In this report we have set out the work undertaken in recent months by LTH NHS Trust to improve the culture around whistleblowing across the board. Good progress has been made in relation to the issue and further review is now necessary following Sir Robert Francis’ recent report. This is something that all NHS bodies will be grappling with, and this is particulalrly difficult at a time when resources are tight and demand for all services delivered by the Trust remains high. As has been recognised by the Trust Board aready, speaking up/ whistleblowing is a vital safety net in any organisation, but especially in the NHS where the perception is such that this is an issue that is always dealt with badly or going to go wrong. We would be pleased to continue working with you on this key issue and to help continue to drive through improvements suggested by the Francis report.

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I hope this report is useful and look forward to further discussions with key members of staff over the courseof this year. Yours sincerely Cathy James Chief Executive cj@pcaw.org.uk

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Annex A

Freedom to Speak Up: an independent review into creating an open and honest reporting culture in the NHS, February 2015, Sir Robert Francis QC The issue of whistleblowing in the health and social care sectors has been notably high on the government and media agenda over the last two years. The findings of the Sir Francis inquiry into serious patient safety failures at Mid-Staffordshire NHS Foundation Trust, and media coverage of high profile cases, have confirmed an all-too common and deeply concerning pattern of victimising whistleblowers who have tried to raise concerns. As a result, the Government commissioned Sir Robert Francis QC to undertake the Freedom to Speak Up review and consultations with a wide range of organisations including Public Concern at Work, as well as a number of NHS whistleblowers, took place over summer 2014. In his report Sir Francis outlined his recommendations for employers, regulators and the Secretary of State

under a number of themes, including:

Culture change

Improved handling of cases

Measures to support good practice

Particular measures for vulnerable groups

Extending legal protection

A main thrust of the Francis Report is the importance of visible leadership underpinned by clear and robust policies and procedures. This means that these should designed to ensure that raising concerns and challenging poor practice is normalised and encouraged.

Boards should ensure that progress in creating and maintaining a safe learning culture is measured, monitored and published on a regular basis. (pages 5, 96, 210 of Report)

NHS Trusts – key learning points

NHS employers are responsible for ensuring that raising concerns is a part of normal work practice. All NHS organisations should have structures that facilitate both informal and formal raising and

resolution of concerns. Responsibility for whistleblowing should rest with an executive board member in charge of safety and

quality rather than human resources. The Chief Executive Officer (CEO) or a designated board member should regularly review all concerns

logged formally to ensure they are being dealt with appropriately and swiftly. The Board should ensure procedures identify a range of people who can easily receive concerns

including: a person (“Freedom to Speak Up Guardian”) appointed by the chief executive to act in a genuinely

independent way

a nominated NED to receive reports directly or via “Guardian” and to report regularly on concerns

and the organisation’s culture to the Board

at least one nominated executive to receive and handle concerns

at least one nominated manager in each department

a nominated independent external organisation (such as PCaW or the Whistleblowing Helpline)

providing external advice

NHS employers must focus on information and not on the credibility of the whistleblower in order to

a) to seek the truth and b) impartially assess risk to patients.

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every member of staff should be trained on how to raise concerns and how to handle criticism

there should be a presumption of feedback. The perception that nothing will be done is seen as a

major barrier to establishing a healthy whistleblowing culture

…there is almost always some feedback that can be given, and the

presumption should be that this is provided unless there are overwhelming

reasons for not doing so. (page 15, Report).

Investigating the concern should be the priority

there should be a well-documented audit trail and managers should be able to justify their actions

disciplinary action should not be considered until the facts are established

all employers should devise and implement systems which enable investigations to be undertaken

and where appropriate by external investigators

Protecting staff also means employers should:

ensure staff have access to mentoring, advocacy, advice and counselling, and mediation

support a scheme that helps current and former workers find alternative employment in the NHS.

(The report states there should be a moral as well as legal obligation on staff being reinstated if a

tribunal orders it.)

Regulators – impact for NHS Trusts

System regulators should regard departure from good practice (as identified in the Report) as relevant

to determining whether an organisation is safe and well-led.

a poor record of handling whistleblowing concerns should prompt regulatory action

Health Education England and NHS England should create a national curriculum for training in

consultation with stakeholders

NHS England, Monitor and NHS Trust Development (NHS TDA) should issue joint guidance on support

expected for staff who raise concerns

The report suggests that the three main regulators (CQC, Monitor and NHS England) should work

together more closely - facilitated by the Department of Health

The use of gagging clauses: The report recommends that settlement agreements should be available

for inspection by the CQC as part of their inspection process. Confidentiality clauses, if used, should be

justified as being in the public interest and Monitor and NHS TDA should consider whether their role as

reviewer of settlement agreements should be delegated to the new Independent National Officer.

Secretary of State Secretary of State should review progress made in the implementation of these Principles and Actions

and the performance of the NHS in handling concerns and the treatment of those who raise them on an annual basis minimum, and report to Parliament.

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Annex B Good practice points - making the raising of concerns a ‘normal activity’(section 5.3)

When a staff concern is raised the primary focus is on identifying and resolving any patient safety issues.

There is an integrated policy and a common procedure that does not distinguish between reporting incidents and raising concerns, and focuses on the safety issue not the possible legal status or other employment issues arising from the concern.

The policy and procedure: – o reflects good practice described in this report

o applies to all staff concerns irrespective of whether the staff member classes it as whistleblowing

o includes requirements necessary for compliance with any obligation to report issues to patients and the organisation such as professional and statutory duty of candour

o authorises, and does not prevent or deter staff from raising concerns directly with any prescribed person, as well as any commissioner, but may advise them that the employer welcomes concerns being raised first within the organisation.

The responsibility for overseeing policy, procedure and practice relating to raising concerns is allocated to the executive board member who has responsibility for safety and quality.

Investigation of concerns is separate from employment procedures where possible. Disciplinary action necessary for any party associated with a concern is not considered or

taken until the completion of any investigation and identification of any action required unless there are exceptional circumstances.

Where a concern is reported to an external body, the organisation reflects, without seeking to blame, on the reasons why this happened.

Good practice – Promoting a no bullying culture (section 5.5)

Boards ensure that everyone in senior or managerial positions are aware of the importance they attach to eradicating any form of bullying.

Employers take steps to ensure there is no culture of bullying in the whole of, or individual parts of their organisation. This includes: –

o clearly articulated standards and expectations of staff at all levels o developing strategies to work with staff to address bullying where there is evidence that

there is a problem o regular training for everyone in leadership and managerial positions on how to address and

how to prevent bullying including awareness of personal impact and the potential to be perceived by others as oppressive or bullying (see good practice in 7.1)

o clarity in all relevant policies and procedures that bullying and harassment will not be tolerated, and that conduct of this nature is capable of being regarded as gross misconduct

o a range of resources and support to address unacceptable behaviour, for example counselling and mediation

o monitoring all relevant indicators and formal and informal reports of concerns to understand the culture in the organisation

o fair procedures for dealing promptly with complaints and concerns about bullying.

Leaders and managers: o are clear through their actions as well as their words that bullying and oppressive

behaviour is unacceptable and will not be tolerated o provide constructive and honest feedback when they see inappropriate behaviour.

Staff develop self awareness about their own behaviour and its effect on others

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Good practice – Handling concerns (recording and monitoring) (section 6.2)

The records of formally raised concerns include: o the date on which the concern was made, and when it was acknowledged o a summary of the issue and any supporting evidence provided o any patient safety issues raised by the concern o the gravity and urgency of the issue in the view of both the person raising the concern and

the person recording it o any actions the person raising the concern(s) considers should be taken to address the

issue and by whom o the wishes of the person raising the concern regarding disclosure of their identity to others,

and confirmation that it has been explained to them that it will not always be possible to protect their identity

o who will be responsible for taking action on the report.

Once logged a copy of the record is given: o to the person raising the concern o the CEO or a designated board member, anonymised if requested, unless that would

prejudice the CEO/board member’s ability to act on the report. This copy includes what action is to be taken.

There is a process for onward referral, both internally and externally, and monitoring to avoid cases being ‘lost in the system’.

Feedback is provided, whatever the outcome and whether or not a formal investigation takes place, to all those involved with raising, managing or monitoring the concern, including feedback on progress and the reasons for any change to the agreed timetable.

The CEO or designated board member regularly reviews all concerns that are brought to their attention; and where they consider it appropriate, the regulator relevant to the case (either system or professional) is informed.

Anonymous concerns are classed as formal concerns, recorded and followed up in the same way as other formal concerns (see 6.3).

Appropriate training is mandatory for everyone in an organisation who may receive concerns from staff. It includes the organisation’s procedures for recording and handling concerns

Good practice – Handling concerns (the investigation process) (section 6.4)

The investigation of a staff concern: o is done quickly within an agreed timescale that is set out at the start. The person who

raised the concern is informed of any changes to the timescale o is separate from any disciplinary process involving anyone associated with the concern

where possible o has a degree of independence proportionate to the gravity or complexity of the issue o is conducted by appropriately qualified and trained investigators who are given the time to

conduct and write up their investigation as per the agreed timescale. They are not expected to fit this into their normal work schedule. In cases involving death, serious injury or serious levels of dysfunction of system or relations, the investigators are not employed by the responsible organisation

o seeks to establish the facts by obtaining accounts from all involved and examining relevant records

o takes into account known good practice or guidelines including clinical guidelines o results in feedback of the findings and any recommendations or proposed actions to the

person who raised the concern and all those involved taking into account confidentiality issues where necessary

o confidentiality is not used as an excuse to refrain from providing feedback

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o ensures there is someone who keeps in touch with the person who raised the concern at all times to keep them abreast of progress, and to monitor their well-being.

The outcome of the investigation is considered at a level of seniority appropriate to the gravity of the issues raised alongside, where relevant, a programme of proposed action.

The trust has access to a panel of trained investigators, who can respond quickly and with the necessary level of expertise.

Learning from the investigation is shared across the organisation and beyond where appropriate Good practice – Suspensions and special leave (section 6.5)

Suspension of staff involved when concerns are raised is a last resort, where there is no alternative option to protect patient or staff safety, or to maintain the integrity of any investigation or for another compelling reason.

Alternatives to suspension or special leave are always considered including restricted practice, mediation and support and temporary redeployment to a non-patient facing role or to another site.

A decision to suspend or give special leave to someone who has raised a concern is only taken by a nominated executive director or directors with the authority of the CEO.

Any decision to suspend or grant special leave is accompanied by an explicit and recorded consideration of all reasonable, practicable alternatives that have been considered and the reasons they were not appropriate.

The number of suspensions or special leave resulting from raising concerns and their ongoing justification is regularly reviewed by the board.

The number of suspensions and special leave resulting from raising concerns is shared with regulators and used as an indicator by both the board and the regulators to consider how concerns are handled in the organisation.

Staff who are suspended or on special leave following raising a concern are given full support in line with Principle 11 in 7.2.

Good practice – Mediation, reconciliation and alternate dispute resolution (ADR) (section 6.6)

NHS organisations make full use of mediation, reconciliation and ADR expertise, whether internal or external, at an early stage with the agreement of all parties involved in a dispute or disagreement. It is particularly used:

o where relationships are poor, to support remedial action to resolve issues before they break down irretrievably

o where relations have broken down, to try to repair them o to build or rebuild trust in a team or a relationship where there has been a difficult issue o to support staff involved in a difficult case to prevent or support recovery from stress and

mental illness.

Mediation and similar techniques are undertaken with the agreement of those involved, respecting their confidentiality. Refusal to consent is never considered as a cause in itself for disciplinary action.

Expert support of this type is also considered prior to, or instead of, disciplinary action where there are concerns about an individual’s behaviours or their oppressive management style, in line with the concept of a just culture described in 5.2, although repeated infringements of a type likely to undermine an open and honest culture are not be tolerated.

Good practice – Training staff in raising and handling concerns (section 7.1)

Every member of the organisation participates in training on raising and handling concerns. It is designed to meet their likely needs with some groups, such as directors, managers and HR, having a more detailed focus on handling than others.

Training is done in groups, face to face and preferably multidisciplinary, making use of scenarios and role play.

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Training ensures all staff gain an understanding and expectation about the policy, process and support available and what is appropriate and acceptable behaviour when raising and handling concerns. It includes:

o the process to follow when a concern is raised including the approach to take in terms of investigation and how to prevent a situation escalating

o how to raise concerns with tact to avoid causing offence or provoking defensive behaviour, including raising concerns in challenging situations e.g:

where the person raising the concern has been involved personally and might share some of the responsibility

which might affect colleagues or be unwelcome news for a senior manager where it is likely that others may disagree with the person raising the concern where the person raising the concern does not have the full picture. consideration of human factors, how people react under stress and how to

challenge hierarchies how to respond appropriately to a concern raised about one’s own work or

behaviour or that of one’s team how to support an individual(s) who raised a concern, and any colleagues involved.

Training and guidance is available on managing performance issues including if and how they may relate to whistleblowing.

Good practice – Advice and support for staff raising concerns (section 7.2)

People who can support staff with concerns

A range of people are available to provide advice and support for staff thinking of raising a concern or who have already raised a concern including:

o a Freedom to Speak Up Guardian(s) o a designated non-executive director o a designated executive director o a nominated manager in each department o an independent external organisation, such as a helpline or advisory service.

The Freedom to Speak Up Guardian: o is recognised by all as independent and impartial o has direct access to the CEO and the chair of the board o has authority to speak to anyone within or outside of the trust o is an expert in all aspects of raising and handling concerns o has dedicated time to perform this role, and is not expected to take it on in addition to

existing duties o watches over the process, and ‘oils the wheels’ o offers support and advice to those who want to raise concerns, or to those who handle

concerns o ensures that any safety issue is addressed and feedback is given to the member of staff

who raised it o safeguards the interests of the individual and ensures that there are no repercussions for

them either immediately or in the longer term o takes an objective view where there are other factors that may confuse the issue, such as

pre-existing performance issues, to enable these to be pursued separately o identifies common themes and ensures that learning is shared o raises concerns with outside organisations if appropriate action is not taken by their

employer o works with Human Resources to develop a culture where speaking up is recognised and

valued o helps drive culture change from the top of the organisation.

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The designated non-executive director: o is an independent voice and champion for those who raise concerns o works closely with the Freedom to Speak Up Guardian to act as a conduit through which

information is shared with the board o provides challenge to the executive team on areas specific to raising concerns and the

culture in the organisation.

The designated executive board lead: o oversees and reviews internal raising concerns processes o ensures staff feel empowered to raise concerns o ensures learning from concerns is shared across the organisation o is accountable for the treatment of whistleblowers within the organisation.

Counselling and Support

Staff support and counselling is accessible and available when required to all staff who have raised concerns

counselling is offered to staff who have been suspended or are on sick/special leave following raising a concern

organisations keep track of what is happening to staff who have raised a concern and whether they are doing enough to support them.

Team Support

Open and facilitated team discussions, including reflective practice, are used to create shared ownership of problems and solutions

team building exercises are used to develop and sustain strong teams where people can speak openly to improve patient safety.

Good practice – Supporting staff back into employment (section 7.3)

Employers: o seek to reinstate staff who have spoken up, offering training, mediation and support where

necessary o make clear that they welcome job applications from people who have raised concerns at

work to improve patient safety o consider a history of having raised concerns as a positive characteristic in a potential

employee.

Organisations actively support and participate in the employment support scheme (once set up) for NHS staff and former staff having difficulty finding employment in the NHS as a result of making a protected disclosure and about whom there are no outstanding issues of justifiable and significant concern relating to their performance.

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Annex C Whistleblowing in context Whistleblowing Commission Audit and Review checklist We provide the Commission’s audit and review checklist which forms part of the Code of Practice. It serves as a useful list of KPIs for organisations to use in auditing their whistleblowing arrangements to provide assurance to the Board that they are working effectively. In summary the WBC identifies the following key indicators:

• The number and types of concerns raised and outcomes of investigations • Feedback from individuals who have used the arrangements • Complaints of victimisation • Complaints of failure to maintain confidentiality • Other existing reporting mechanisms • Adverse incidents that could have been identified by staff (eg consumer complaints, publicity or

wrongdoing identified by third parties) • Any relevant litigation • Staff awareness, trust and confidence in arrangements

We would suggest that some of this work could be undertaken periodically by PCaW and would be happy to discuss workplans for this at your convenience.

Developments introduced by Government - In March 2015 the Department of Business, Innovation and Skills (DBIS) published guidance for employers on whistleblowing and a non-statutory Code of Practice which includes: having a written whistleblowing policy, training for staff on raising concerns and for managers on receiving concerns and ensuring clarity around the use of gagging clauses.

Legal developments – a number of professional bodies in the health sector are now prescribed and are considering how they manage this. It has also renewed their focus on this issue and many are looking at how whistleblowing works in their own organisations (internal arrangements), how they receive information from external whistleblowers and how to manage whistleblowing when it arises in the fitness to practise context. Furthermore, a duty on prescribed persons to report annually on whistleblowing concerns received by them was enacted by way of the Small Business, Enterprise and Employment Act in March 2015.

GMC consultation – In a recent report Sir Anthony Hooper (Chair of our Whistleblowing Commission) recommended that the GMC should go further to understand the background of a fitness to practice referral and organisations should be made to declare whether the doctor being referred has themselves raised concerns about patient safety. The GMC are currently discussing the recommendations with key interest groups and will publish an action plan about how it will take them forward.

Duty of Candour – now a statutory duty. Following consultation the GMC and NMC plan to publish guidance on the duty later this year.

The First 100 campaign Following the Whistleblowing Commission’s report, the charity launched ‘The First 100’ campaign which encourages enlightened organisations to become early signatories to the Code of Practice and show they are committed to best practice in this vital and ever-developing area. The campaign is proving to be a great success and we have already signed up 40 organisations from a variety of sectors and industries. For a full list of signatories and testimonials please see our webpage. As a client who has done a good deal of work in this area already, LTHT is perfectly placed to join the campaign as it is already utilising our advice, expertise and materials to ensure its arrangements meet best practice. Becoming a signatory is a free and simple way of gaining the recognition you deserve for your efforts.