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1 TRUST BOARD IN PUBLIC REPORT TITLE: EXECUTIVE SPONSOR: REPORT AUTHOR (s): REPORT DISCUSSED PREVIOUSLY: (name of sub-committee/group & date) Action Required: Date: 26 th February 2015 Agenda Item: 1.6 CHIEF EXECUTIVE S REPORT Michael Wilson Chief Executive Gillian Francis-Musanu Director of Corporate Affairs N/A Approval ( ) Discussion ( ) Assurance ( ) Purpose of Report: To ensure the Board are aware of current and new requirements from a national and local perspective and to discuss any impact on the Trusts strategic direction. Summary of key issues National Issues: Report on Freedom to Speak Up Review House of Commons Health Committee Report - Complaints & Raising Concerns Local Issues: Opening of Earlswood Centre Foundation Trust Membership Macmillan Fundraising Appeal for East Surrey Hospital Cancer Information Centre Recommendation: The Board is asked to note the report and consider any impacts on the trusts strategic direction. Relationship to Trust Strategic Objectives & Assurance Framework: SO5: Well led: Become an employer of choice and deliver financial and clinical sustainability around a clinical leadership model Corporate Impact Assessment: Legal and regulatory impact Ensures the Board are aware of current and new requirements. Financial impact Patient Experience/Engagement Risk & Performance Management NHS Constitution/Equality & Diversity/Communication Attachment: N/A N/A Highlights national requirements in place to improve patient experience. Identifies possible future strategic risks which the Board should consider Includes where relevant an update on the NHS Constitution and compliance with Equality Legislation

2 TRUST BOARD REPORT 26 th February 2015 CHIEF EXECUTIVE S REPORT 1. National Issues 1.1 Report on Freedom to Speak Up Review On 12 th February Sir Robert Francis published his report on the Freedom to Speak Up review. In his report Sir Robert sets out a number of Principles and Actions which aim to create the right conditions for NHS staff to speak up, share what works right across the NHS and get all organisations up to the standard of the best and provide redress when things go wrong in future. The report also details good practice that is taking place and also reveals how some staff have not been treated as we would want and expect. To address the gap and variation, the report identifies ways in which organisations can create the right culture, how concerns should be handled and what is needed to make the system work. Included in the report are two over-arching recommendations, 20 principles and 36 specific actions that cover local and national organisations which are grouped under five key themes. These are the need for culture change, improved handling of cases, measures to support good practice, particular measures for vulnerable groups and extending the legal protection. The focus of the whole package is ensuring issues are dealt with as patient safety issues. With many of the local actions, there is a parallel recommendation to system regulators about how they assess this against whether an organisation is well-led. The two over-arching recommendations are: 1. All organisations should implement the principles and actions in the report in line with the good practice outlined. 2. The Health Secretary reviews progress at least once a year against the actions in the report. Some of the specific actions task boards locally with the need to: assess progress in creating and maintaining a culture of safety and learning, ensuring the culture is free from bullying encourage reflective practice, individually and in teams, as part of everyday practice have a policy and procedure built on good practice talk about and publicly celebrate the raising of concerns ensure staff have formal and informal access to senior leaders. In this area, it also recommends: 2

3 a person is appointed locally by the chief executive to act as a 'Freedom to speak up guardian' an executive director and non-executive director are nominated as individuals within your organisation who can receive concerns a manager in each department to be nominated to receive concerns staff have access to advice and support from an external organisation (e.g., whistleblowing helpline). The report also suggests the creation of an Independent National Officer. It is to be jointly resourced by the regulators and national bodies to be a support to the local guardians, advise organisations where good practice has not been followed and review the handling of cases when required. It also asks Health Education England and NHS England to develop a training package and tasks each organisation with ensuring that every member of staff receives training in how you expect them to both raise and act upon concerns. A letter has been sent to every NHS trust Chair and Chief Executive to re-enforce the importance of staff being able to discuss concerns openly in teams and for action to be taken. This letter has been circulated to all Senior Leaders in the Trust. The government has accepted in principle all of Sir Robert s recommendations, including proposed new legislation to protect whistleblowers who are applying for NHS jobs from discrimination by prospective employers. The government will also shortly consult on other measures including: a new National Whistleblowing Guardian to protect those who speak up practical help through Monitor, the Trust Development Authority and NHS England to help whistleblowers find alternative employment a local whistleblowing guardian in every NHS organisation - reporting directly to the chief executive training for staff on how to raise concerns and protect others who do so The final decision on how the recommendations are implemented will be made following consultation. These are important recommendations for the Trust and our plans to address the recommendations will be reviewed by the Executive Committee and the Finance and Workforce Committee and an action plan developed and implemented. The full report can be accessed here: Freedom to Speak Up Review. 1.2 House of Commons Health Committee Report Complaints & Raising Concerns The report, Complaints and Raising Concerns published by the Health Select Committee on 21 st January 2015, provides a follow-up review of the handling of complaints and concerns in the NHS since the Committee s initial inquiry in 2011 into Complaints and Litigation. The latter examined the working of the NHS complaints system, including the 3

4 treatment of staff that raised concerns about NHS services, and the procedures in place to encourage NHS staff to raise concerns without fear of detriment. This report examines progress in implementing the relevant recommendations made in the Committee s 2011 report and Government response Developments since the Committee s 2011 report The Committee acknowledged that, since their earlier report, patient safety and the treatment of complaints and concerns have become much higher profile issues and improvement has been made but there is significant scope for further improvement across the NHS, even in trusts regarded as high performers. They also recognised that, in the drive towards a more transparent NHS, the number of complaints about a provider, rather than being an indicator of failure, may highlight a service which has developed a positive culture of complaints handling and it will be important for system and professional regulators alike to be able to identify the difference. To enable monitoring in improvement of complaints handling by the successor Committee in the next Parliament, the Committee recommended that: the Government should publish a detailed evaluation of the progress achieved, and work remaining to be undertaken, by the cross-service Complaints Programme; the Department of Health should include an evaluation of the operation of the complaints system across the health sector in the light of the post- Francis changes Complaints handling by providers, commissioners and the professional regulators and Government reviews of progress In contrast to its 2011 recommendation that separate complaints systems and stratified standards may be best to meet patient and service user needs, in its 2015 report the Committee considers it would be desirable over time to bring health and social care complaints together. To achieve progress towards this, the Committee recommended that: The complaints system be simplified and streamlined by establishing a single complaints gateway across the NHS, for both providers and commissioners, including online availability, so that wherever a complaint is raised, it is the system, not the complainant, which is responsible for routing it to the appropriate agency to get it resolved. This streamlined process needs to be adequately resourced. Trusts must remain the leads in handling complaints made against their organisation. However, there is a greater role for commissioners to work constructively with providers on delivering improvements to services and to hold providers to account for delivering a well-functioning complaints system. CQC should remain responsible for examining the culture of complaints handling by providers. To meet the Francis recommendation that Trusts be assessed on how well they are handling complaints, Trusts should be required to publish at least quarterly, in anonymised summary form, details of complaints made against the Trust, how the complaints have been handled and what the Trust has learnt from them. The service-user led vision for complaints, My expectations for raising concerns and complaints, developed by the Parliamentary and Health Services Ombudsman in cooperation with system partners and stakeholders, was praised as best practice for first tier complaints handling. 4

5 There should be clear commissioning and consistent branding of PALS and NHS Advocacy services to make them as visible and effective as possible to any patient seeking assistance through the complaints process. Current complaints advocacy services were found to be hard to identify for members of the public and variable in their arrangements nationally. The Department of Health should also set out in its response to this report the progress has been made in reviewing the commissioning arrangements for advocacy services. The Government should complete a progress report on the functioning, funding and budgets of local Healthwatch organisations, due to concerns regarding the lack of ring-fencing of the funding provided for their use. Reform of the primary care complaints system, currently centralised by NHS England, to address current problems with fragmentation and loss of local knowledge, and to improve timely responses and local learning and improvement. The Committee agreed with the GMC that people wishing to give information about poor practice should be able to do so anonymously, but considered that medical professionals raising concerns about poor practice via a confidential helpline are under a professional duty to provide as much information as possible to enable the matter to be investigated and to put patients first. The GMC s Hooper Review will ensure that its practices and investigations adequately support registrants who genuinely raise patient safety concerns in the public interest, and protect them from retaliatory action. Essential progress towards linking together professional regulation, system regulation and the complaints system should be monitored by the successor Committee in the next Parliament. Establishment of a single health and social care ombudsman, as a first step towards the integration of social care complaints into a single complaints system Second-stage complaints handling: the Parliamentary and Health Services Ombudsman The Committee recognised steps taken to improve complaints handling and investigations by the Parliamentary and Health Service Ombudsman in delivering on the Committee s recommendations in However, serious criticisms of the Ombudsman s handling of complaints prompted the Committee to recommend: an external audit mechanism be established to benchmark and assure the quality of Ombudsman investigations. The Ombudsman was asked to set out how her organisation is seeking to address problems with its processes, and a timetable for improvements Whistleblowers and staff who raise concerns: The Committee found that on-going poor treatment of whistleblowers has undermined trust in the system s ability to treat staff who raise concerns fairly, with consequent implications for patient safety. To address this, there should be a programme to identify whistleblowers who have suffered serious harm and whose actions are proven to have been vindicated, and provide them with an apology and practical redress. The NHS must strive to emulate the complaints and concerns reporting culture that parallels other safety critical sectors such as aviation and nuclear energy. Locally we will consider the recommendations from this report. Our CQC report acknowledged that the Trust was seen as doing well with managing and responding to complaints and we have made further progress in the last 12 months. However we do acknowledge that there is always more to do. We will review our complaints and other processes in light of these recommendations and will report back to the Safety & Quality Committee. 5

6 The full Health Select Committee report is available at: 2. Local Issues 2.1 Opening of Earlswood Centre Our diabetes and endocrine teams have now moved to the heart of our community with the opening of the new Earlswood Centre. This spacious new Centre means our team of consultants and four specialist nurses can provide separate clinics for people with Type 1 and Type 2 diabetes along with clinics for young adults and people using an insulin pump. This brings diabetes and endocrine care for local people into one place. On behalf of the Board I would like to thanks the whole team and also to the support teams who together have worked hard to make our plans a reality for patients. 2.2 Foundation Trust Membership As we continue our journey to become a Foundation Trust that the numbers of patients and local people choosing to become an FT member continues to grow. We have now reached a membership total of 9,888 members (including staff). This is a great milestone for the Trust and our local community. 2.3 Launch of Macmillan Fundraising Appeal for East Surrey Hospital Cancer Information Centre The launch of the appeal for the new Macmillan Cancer Support Centre which will be based at East Surrey Hospital took place on 27 th January at Reigate Grammar School. It was good to see and meet so many people at the event which was hosted by newsreader Nicholas Owen, and their real enthusiasm to support us in building a specialist centre close to home that will provide specialist care and support. Gill Birch, from Redhill, spoke movingly about her experience of cancer treatment and her passion for making sure that that no-one faces cancer alone. 3. Recommendation The Board is asked to note the report and consider any impacts on the trusts strategic direction. Michael Wilson Chief Executive February

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