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Response to independent review findings

Craig Black, interim chief executive for West Suffolk NHS Foundation Trust, said:

“The Trust Board will be considering the findings in full over the coming days and weeks – we take full responsibility for failings and short comings around the handling of events leading up to and surrounding the whistleblowing, and are truly sorry to the staff and families affected.

“All our staff should feel confident to speak up without fear of retribution and we have taken a number of actions over the last two years to improve our HR, culture and leadership practices, including appointing two new Freedom To Speak Up Guardians. We will use this report to make further changes to continue our work to create an open, fair and inclusive organisation that puts our staff and patient safety front and centre.”

 

Background to review:

The independent review into West Suffolk NHS Foundation Trust was commissioned by NHS England and Improvement, at the request of the Department of Health and Social Care, in February 2020.

It was sparked when an anonymous letter raising issues around patient safety was written to the family of a patient who had sadly died whilst in our care. Following receipt of this letter in October 2018, the letter was passed to the Trust.

It is the Trust’s handling of its own investigation around the anonymous letter, specifically the request for hand writing and finger print samples, and the improper pursuit of a group of staff, including pursuing a clinician through a wrongful disciplinary process, which has been called into question and considered in the review.

In addition, the review also investigates the handling of previous patient safety issues and concerns raised by staff.

The published report can be found here.

 

Actions taken on key issues

Whilst the investigation has been taking place, the Trust has been working hard to lead improvements on key areas across the Trust. Actions taken on key areas being investigated in the review include:

 

Supporting staff to raise concerns

  • Two new Freedom to Speak Up (FTSU) Guardians have been appointed, both with a clinical background and dedicated time to carry out their roles.
  • The Board regularly takes advice from and consults the FTSU Guardians around how speak up concerns are handled and both now present a quarterly report to the Board on activity, themes, concerns and actions.
  • The Trust has implemented a number of measures to help support staff to raise concerns, including creating a network of speak up champions across the Trust to encourage and support a speaking up culture; making speaking up training available to all managers and staff; establishing and growing a dedicated staff support psychology team; and refreshing our FIRST Trust values, so staff have a clear set of behaviours to adhere to.
  • The Guardians are embedding speaking up into mandatory learning and clinician training, are attending team meetings across the Trust and holding drop in sessions to promote speaking up. In due course, they will be working on a Speak Up strategy and are currently training a network of approximately 40 speak up champions across the Trust with the ambition of expanding the network.
  • The number of concerns raised with the guardians has remained steady with 15 and 18 cases in the last six months (as of October 2021).

 

Improving how we handle investigations

  • A review of priority HR policies has been undertaken with a change in emphasis and language; the language now used is reflective of a supportive, kind and compassionate approach with the emphasis on informal resolution and learning.
  • Through the Better Working Lives Group, we recently surveyed doctors for their experience in going through processes such as complaints, coroners’ inquests and safety investigations. We then asked doctors to nominate peer supporters and now have six of them who have agreed to take on the role. The Trust’s staff psychology service is shortly going to train them and provide them with supervision, so this peer support should be up and running in early 2022.
  • We have invested in a team of embedded HR business partners who are helping to support teams across the Trust.
  • Decisions on exclusion, as part of the Maintaining High Professional Standards (MHPS) process, now involve clinical directors and all MHPS concerns are now overseen by a non-executive director, with a regular progress report made to the Board.

 

Growing a listening and restorative culture

  • The Board has overseen a refresh of the Trust’s FIRST Trust values to focus on Fairness, Inclusion, Respect, Safety and Teamwork, setting a standard of behaviours for all staff to strive to adhere to, no matter their role. These values will be launched alongside the new Trust Strategy in early 2022.
  • Using results from recent NHS staff surveys, as well as the 2,000 responses we had from our 2020 staff engagement programme ‘What Matters to You’, we have developed the next iteration of our West Suffolk People Plan.

 

Patient safety and quality improvement (QI)

  • Since 2018, the Trust has significantly invested in and grown the QI team from two to four, including a new associate director of QI, with continued planned growth to seven in the new year. Notable actions include:
    • Worked directly with Derek Feeley (as CEO of the Institute of Health Improvement) and held workshops with senior Trust executives and senior leads from wider West Suffolk partners to establish key areas of focus and kick-start QI collaboration across the system
    • Developed QI tools for staff to use to carry out improvements
    • Re-designed and re-launched the Trust’s QI training package
    • Run monthly QI drop in sessions and a series of staff workshops.
  • These actions have resulted in a 70% increase in the number of QI projects taking place across the Trust since September 2020.
  • On patient safety, the Trust is an early adopter of NHS England’s Patient Safety Incident Response Framework (PSIRF). PSIRF brings about a new approach to incident management recognising the needs of those affected, examining what happened to understand all the factors contributing to the incident and responding with action to mitigate risks essential to improving the safety of healthcare. PSIRF has enabled us to review our incident meetings process, timeliness of investigations and the involvement of staff and patients.
  • In response to the NHS Patient Safety Strategy (2019), the Trust has implemented patient safety specialists, including two newly appointed patient safety incident investigators. Their work includes developing an incident response plan, which will help us identify the Trust’s most significant risks, and ensure learning is put in place.
  • There will be an uplift of our critical care outreach team (CCOT). The CCOT provides invaluable expertise to support safe and timely management of deteriorating patients, and this uplift means there will be two CCOT nurses per shift. The impact of this will be:
    • Wider coverage including responding to obstetric referrals
    • Senior clinical support to nursing and medical staff on a 24/7 basis
    • Attendance at doctor handovers and at night safety huddles
    • Better safety netting – especially out of hours.
  • All incidents reported on Datix are reviewed daily by the patient safety team and issues are escalated as appropriate.

 

Board development and strengthening our governance processes

  • A group of staff took part in training provided by Mersey Care. The training focused on building an environment of understanding and support so that when things don’t go as expected, rather than feeling blamed, staff feel empowered to learn. Following the training, the Trust paused ongoing HR cases and they were reviewed with this new approach. Approximately 75% of cases were resolved informally or through alternative means rather than going to a formal hearing.
  • Also influenced by the National Patient Safety Strategy we have three new board committees - insight; involvement and improvement (known as the 3i committees) - have been introduced as ways to provide a flow of assurance and escalation of issues to the Board of directors.
  • We have reviewed and made changes to the Trust’s governance structure, delegating responsibility to board committees and relevant board members.
  • Shortly be launching a new Trust strategy with a clear vision, ambitions and objectives with executive directors responsible for delivery of appropriate areas.

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