Chamber and committees

The Public Interest Disclosure Act 1998 already offers legal protection to NHSScotland staff members who suffer detriment for raising a genuine concern about patient safety or malpractice.

In addition, and in response to the recommendations from the ‘Freedom to Speak Up’ review, the Scottish Government is continuing to work closely with the Department of Health to ensure that UK legislation to protect whistleblowers applying for NHS jobs extends to the relevant NHS employers in Scotland.

In order to ensure high quality, continuously improving health and social care, the Scottish Government recognises that it is important to strike the right balance between improvement, performance management and scrutiny. Through the Local Delivery Planning (LDP) process, the Scottish Government engaged with a range of stakeholders in considering the performance standards for the NHS in Scotland. In recent years there has been significant reduction in the number of standards and targets that are monitored through the NHS performance frameworks. Reflecting this changing approach boards were asked to develop LDPs for 2015-16 which focused on new actions planned in a small number of priority areas for improvement including prevention and health inequalities, antenatal and early years, person centredness, safety, primary care and integration.

We will continue to review the performance standards and the LDP process for the NHS in Scotland.

In addition Healthcare Improvement Scotland is currently consulting on new enhanced proposals for scrutiny of the quality of care, structured around a more comprehensive set of measures that cover all of the factors knowing to contribute to the quality of health and care. The consultation can be found at:

http://www.healthcareimprovementscotland.org/our_work/governance_and_assurance/quality_of_care_reviews/qoc_reviews_consultation.aspx

We are fully committed to achieving the best possible healthcare outcomes for Scotland’s people through safe, high quality care. Scotland is a world leader, internationally recognised for the improvements in care and safety the Scottish Patient Safety Programme has brought about. The care delivered by our NHS workforce is of the highest quality and we have record staffing levels with staff better equipped to deliver services than ever before.

We have backed this up by our statutory requirements on NHS boards to ensure they have workforce plans in place, and by our mandatory application of an important series of evidence-based workload and workforce tools. These enable NHS boards to assess and deploy the required numbers of appropriate staff accurately and effectively, according to the clinical needs of patients rather than by fixed staffing ratios.

Our staff are at the heart of our NHS. The welfare of NHS staff is critically important with every health board required to have policies in place and to comply with national policies on managing health at work.

The Staff Governance Standard for NHSScotland commits all boards to providing a continuously improving and safe working environment promoting the health and wellbeing of staff, patients and the wider community. Through our monitoring arrangements, we are ensuring that boards have policies and actions in place to support staff.

We are currently in the process of updating the Partnership Information Network (PIN) policy for Managing Health at Work. This is in consultation with boards.

We are currently in the process of updating the Managing Health at Work PIN policy that will be researched and prepared on a partnership basis involving NHSScotland employers, trade unions, professional organizations and the Scottish Government.

The NHSScotland Staff Governance Standard already places a specific obligation on NHS boards, as employers, to ensure that all staff have access to communication channels which offer the opportunity to give and receive feedback, either directly or via their trade union/professional organisation, on organisational and service delivery issues at all levels.

The NHSScotland Partnership Information Network (PIN) policies, which underpin the Staff Governance Standard, provide a minimum standard of practice in employment, helping to ensure fair and consistent management of staff which meets both current legislative requirements and best employment practice. These policies, which are promoted locally, and accessible via a range of mediums, cover, amongst other things, whistleblowing and bullying and harassment.

The National Standards for Clinical Governance and Risk Management, published in 2005, set out the requirement for NHS boards to self-assess their arrangements for clinical governance and risk management to support the delivery of safe, effective and person-centred care and services.

The Scottish Government published the Governance for Quality Healthcare Agreement in 2013. This sets out the respective roles and responsibilities of the Scottish Government, NHS board chief executives, NHS board chairs and non-executives and all staff and includes recommended actions in respect of risk management to support the oversight, planning, and delivery of healthcare services.

In addition, the Learning from adverse events through reporting and review – A national framework for Scotland (2^nd edition), published by Healthcare Improvement Scotland in April 2015, includes risk assessment and prevention actions for boards to minimise risks in order to provide high quality care.

The Scottish Government recognises the importance of ensuring a high quality future supply of senior managers within the NHS and that is why future planning for ‘Effective Leadership and Management’ is one of the five priority areas for action in Everyone Matters, our 2020 vision for the NHS workforce. Within that priority area, we are supporting delivery of specific leadership and management focus areas, and a leadership advisory board has been established to provide strategic leadership and advice.

Led by NHS Education Scotland’s (NES) National Leadership Unit, there are several initiatives that enable NHS staff to undertake appropriate training to progress into senior management positions. For example, the, ‘Delivering the Future’ development programme aims to identify senior strategic clinical leaders and prepare them for future roles at board, regional and national level. The programme was developed to address a perceived gap in recruiting to the most senior strategic clinical leadership roles.

NES has also developed a flexible range of resources including the Leadership and Management Programme which offers leadership and management development to all Scottish medical trainees in higher training, as part of a conceptual framework which also includes the Management Trainees Scheme, the Clinical Leadership Fellowship Scheme, and Launchpad for Leadership. This ensures that all doctors in training in Scotland have a grounding and introduction to leadership and management concepts before they move into their career posts, giving them an understanding of the importance of clinical staff involvement in management within the NHS.

The Scottish Public Services Ombudsman’s Complaints Standards Authority is already leading work for the Scottish Government on the development of a revised NHS complaints procedure, in line with one of the recommendations of the Scottish Health Council’s Listening and Learning report on how feedback, comments, concerns and complaints can be used to drive improvement across NHS services in Scotland. A working group, with membership drawn from across health boards, was recently convened to progress this and will meet for the first time in September 2015.

Much has already been done to develop an open and honest reporting culture in NHSScotland where staff are encouraged and supported to raise any genuine concerns they may have, particularly about quality of care and patient safety. This includes:

The introduction of the NHSScotland Staff Governance Standard which requires employers to ensure that it is safe and acceptable for staff to speak up about wrongdoing or malpractice within their organisation, particularly in relation to patient safety.

Development and publication of a national whistleblowing policy Implementing and Reviewing Whistleblowing Arrangements in NHSScotland Partnership Information Network policy.

Launch of the NHSScotland Confidential Alert Line (NCAL), a dedicated service for NHS staff in Scotland, which provides a confidential service to staff should they have any doubt about whether or how to raise a concern, or worry about doing so. NCAL provides an additional safe space for staff to discuss their concerns with legally trained staff and, if appropriate, have these concerns passed to the appropriate regulatory body on their behalf.

Removal of the standard inclusion of confidentiality clauses and derogatory statement clauses from settlement agreements across NHSScotland, ensuring that staff entering into such an agreement are clear that this does not compromise their right to whistleblow.

Development of guidance for NHSScotland employees and employers on the appropriate use of confidentiality clauses and derogatory statement clauses in settlement agreements. This guidance has been developed in partnership and is due to be published later in 2015.

To further support the above, and in response to the recommendations from Sir Robert Francis’ ‘Freedom to Speak Up’ review, published earlier in 2015, the Scottish Government has also committed to:

Introducing non-executive whistleblowing champions in each NHSScotland board. The role, which has been developed in partnership, will act predominantly as an oversight and assurance mechanism, as well as a conduit to ensure that internal mechanisms within boards are working effectively to support whistleblowing arrangements and staff in raising concerns.

Developing and establishing an independent national officer to provide an independent and external level of review on the handling of whistleblowing cases. Detailed proposals on this role will be subject to a full public consultation later in 2015.

The Scottish Government fully recognises the importance of providing development opportunities for NHS medical staff in order to encourage those who are keen to move into senior management positions. As such, we are developing and promoting a number of initiatives to encourage leadership and management development through high quality programmes, management training schemes, toolkits and resources.

This includes work with the Scottish Academy of Medical Royal Colleges which has established a ‘Working Group on Professionalism and Excellence’ with the aim of promoting the values of leadership at all levels of the profession. The Scottish Trainer Framework also supports the development of clinical leaders and future senior educators in NHS roles, providing the competences and training required for clinicians to become recognised trainers to support the development of students and doctors in training programmes.

NHS Education Scotland (NES) is also involved in a number of initiatives that directly encourage NHS staff to consider management career paths, including the Leadership and Management Programme which provides online and face to face training that is available for all doctors undertaking speciality training; whilst NES and the Scottish Government offer several Scottish Clinical Leadership Fellowships each year, where doctors in training work with senior medical colleagues in NES, Scottish Government and other partner host organisations including the General Medical Council and Health Improvement Scotland.