Venue: Ground Floor Committee Room - Loxley House, Station Street, Nottingham, NG2 3NG. View directions
Contact: Jane Garrard Senior Governance Officer
Apologies for absence
Councillor Kirsty Jones - personal
Councillor Sam Webster – other council business
Declarations of interest
To confirm the minutes of the meeting held on 12 January 2023
The minutes of the meeting held on 12 January 2023 were confirmed as an accurate record and signed by the Chair.
Anthony May, Chief Executive of NUH presented a report and spoke to the Committee about ongoing work to create a safe and inclusive workplace at Nottingham University Hospitals NHS Trust. The following points were made:
(a) in 2021 the Care Quality Commission (CQC) identified a culture of bullying and discrimination at NUH, with a particular emphasis on racial discrimination against Black, Asian and Minority Ethnic (BAME) colleagues;
(b) the leadership of NUH have offered a public apology and stated clearly that racism and bullying in the organisation will not be tolerated. It is important to recognise that NUH includes a lot of people from diverse backgrounds, and for colleagues to be educated about this diversity, to understand it and celebrate it, to ensure that NUH is a positive place to work and to receive care;
(c) cultural change needs to be led from the top of the organisation. The Chief Executive has made tackling discrimination a personal priority, and recently participated in the Race Equality Week Five-Day Challenge. Certificates were presented on 10 February 2023 to mark the end of a reciprocal mentoring programme, which saw BAME colleagues mentoring senior leaders to help them understand their background, culture, and challenges working in NUH;
(d) the CQC report outlined problems with locating the Trust’s work on inclusion, equality, and diversity with the HR service. HR work effectively but they are stretched, so to respond to that concern the leadership of the inclusion agenda will sit with a new Director of Corporate Governance, Gilbert George, who is a prominent black leader in the NHS with a strong track record of leading on inclusion. That change will be implemented on the 1 April 2023;
(e) in February 2023 NUH published its ‘People First’ report, which outlines a roadmap for the organisation designed around its key priorities, including a commitment to improve its culture and leadership. The report describes plans for a new Inclusion Policy, to be completed by September 2023, overseen by a newly established Equality, Diversity and Inclusion Oversight Committee chaired by non-executive director Serbjit Kaur;
(f) there are a range of programmes ongoing to promote cultural change in NUH. Work has been undertaken to develop staff networks, including the BAME Network, and to give staff time to engage with them. There are a number of BAME Ambassadors across the Trust acting as an accessible point of contact, who are available to help defuse issues that might arise in the workplace, give their experiences and to advise colleagues. There are three Freedom to Speak Up Guardians in the Trust, supported by Freedom to Speak Up Ambassadors across NUH, who provide a means of escalating concerns. They have been asked to pay special attention to hotspot areas where there may be issues with bullying, and to areas subject to special intervention such as maternity. Additionally, the leadership of NUH have been meeting and discussing inclusion issues with the trade unions. NUH have been looking for further opportunities to bring people together, and an inclusion conference has been arranged for 31 March 2023;
(g) in summary, in response to the CQC report there have been interventions with over 3000 members of staff, encouraging them to speak up about any concerns with avenues to report concerns confidentially, backed up by positive programmes of activity under a single point of leadership, with scrutiny from a new non-executive committee;
(h) as a result of the measures taken, NUH are seeing signs of improvement. The National Staff Survey is due to be published on 9 March 2023 but indications are that the results are encouraging. NUH hopes to see stronger progress next year when the programmes of work have had time to mature.
Onyinye Enwezoe, Chair of BAME Shared Governance Council at NUH, and Richard Holder, Chair of the BAME Network at NUH, gave their perspective on the report:
(i) it is important that the organisation has clearly stated that they acknowledge the problem with racism and bullying, and expressed the willingness to do the work need to address it;
(j) when the pandemic started in early 2020, BAME colleagues raised issues with the Trust, and a BAME Strategy Covid-19 Committee was formed, chaired by the Director for People. The Committee looked at sickness records, issues with pay, and how the pandemic affected them at home;
(k) measures are being taken to make NUH a more welcoming place for BAME staff. There is a yearly international staff celebration event, bringing all staff with an international background together to acknowledge their contribution. There have been staff sessions recently on Allyship and other subjects, helping to educate staff about awareness of how their actions can make their colleagues feel, and to foster mutual understanding and acceptance;
(l) staff have been attending community events outside of NUH, most recently an event for the Filipino community in Aspley, speaking to the families of people who work for NUH and listening to concerns from staff and patients from diverse communities;
(m)Onyinye Enwezoe has recently been appointed as Lead Matron for International Recruitment and Pastoral Support. The post has not started yet but issues are already being raised affecting the families of NUH staff members in the community, which shows that racism and bullying is not just a problem in NUH, but exists across the community;
(n) the ‘open door’ policy with regard to the senior leadership team at NUH has been helpful, and is making a real difference. There is work ongoing to embed inclusive practice at other levels of the organisation, such as the middle-management layers where there have been issues in the past;
(o) over the last 25 years there has been a gradual change across the whole of the NHS in terms of the way race and inclusion are treated, and NUH is on the right trajectory.
During the subsequent discussion and in response to questions from the Committee, the following points were made:
(p) concerns about the culture at NUH have been raised for some time, including by the Committee in November 2021. Plans for improvement have been outlined before and announcements have been made about the appointment to relevant job roles, but it seems that it has only recently started to be properly addressed;
(q) it is encouraging to see NUH recognise that change needs to be embedded in corporate governance and service management, and not just enacted through specific initiatives;
(r) the report says that the new Inclusion Policy will be developed by December 2023, which seems like a long time to take. It is hoped that this will be completed earlier than this, by September 2023;
(s) there are questions around the diversity of the senior leadership and the Board. The Workplace Race Equality Standard data shows BAME representation on the Board has declined relative to the BAME workforce. In the clinical ranks, senior staff are representative of the community, but not necessarily in the managerial ranks. There are changes at the senior level that do show a visible commitment to change: the new Diversity and Inclusion Oversight Committee, led by a non-executive director from a BAME background; a recently appointed new Director of Inclusion; and BAME colleagues are being actively targeted for Associate Director posts being recruited to at the moment;
(t) as well as the senior leadership team, it will be an important task to promote diversity in the middle management layers of NUH. There are measures to try to improve representation in this area, such as putting BAME colleagues on interview panels as part of Positive Action. Shared Governance and measures through the BAME network are being used to encourage BAME colleagues to develop leadership skills and apply for higher posts;
(u) data in WRES 2022 shows that white applicants are more likely to be shortlisted for roles at NUH than BAME applicants. The Chief Executive of NUH chairs a group on recruitment and retention, and is working with the Chief People Officer to write a report on recruitment and retention. They are looking at the case to bolster resources in the recruitment team, and to change recruitment processes to be more inclusive;
(v) NUH is looking to fill 2000 vacancies, and is reaching out into diverse communities to promote working at NUH, including going into schools, appearing on local radio stations, and going to community events with materials giving information about apprenticeship routes and other ways into the NHS. NUH have a memorandum of understanding with the University of Nottingham and are meeting with Nottingham Trent University, to work on measures to recruit and retain people attending university in Nottingham;
(w)there is work to be done on basic measures to improve retention. Staff raise issues about hygiene factors, car parking, the Medilink bus service, the retail offer at the hospitals, rest areas, access to cold water, and other workplace issues. If people feel badly treated due to discrimination on top of this, retention can be difficult, so it is important to look at the whole experience. Progress has been made in a number of areas to make NUH a better place to work – on the meal deal, on the transport system, and on car park permit allocations for example;
(x) the Committee requested updated figures on the proportion of NUH staff who are from a BAME background. It was clarified that this is 26%;
(y) NUH has repeatedly scored poorly on staff sickness rates, so it would be useful to look into the link between long-term sickness for stress and mental health impacts and retention, particularly for BAME staff. The staff survey being completed around the 9 March 2023 will give turnover and sickness rates, and other survey data will be analysed over the spring;
(z) it is important to ensure that changes are effective ‘from the Board to the ward’, which is why there are initiative such as the Cultural Ambassadors, BAME Ambassadors, and the Freedom to Speak Up Guardians and Ambassadors to provide a link between the senior leadership and the frontline;
(aa) concerns had been raised previously about the Freedom to Speak Up Guardians having insufficient funding and not having executive responsibility. It was confirmed that they will report to the new Director of Corporate Governance, who has been asked to look into the case for employing more Freedom to Speak Up Guardians, and that the Chief Finance Officer has been asked to work with the team to make sure they are appropriately supported and resourced;
(bb) twelve cultural ambassadors have been recruited, and have received comprehensive training from the Royal College of Nursing over four half-days. The Committee urged the importance of them receiving specific industrial relations training also;
(cc) there has to be clarity on how this improvement process will be monitored. There are a number of means by which NUH will track its progress:
i. the National Staff Survey is carried out yearly and compares staff experiences between different NHS Trusts. It is very extensive, and includes questions on inclusion, perceptions of bullying, and other relevant issues. Significant numbers of people complete the survey in NUH and across the country;
ii. the Workforce and Race Equality Standard (WRES) involves the yearly collection of data to measure the accessibility of career opportunities for staff members with a BAME background, involvement in disciplinary procedures, experiences of bullying, and other data relevant for inclusion;
iii. a key output of the new Inclusion Policy will be the development of a data set to help track progress, which will be in the public domain so that NUH can be held accountable;
iv. these quantitative approaches will be supplemented by more qualitative work. NUH will be running focus groups in March 2023, and the senior leadership visit teams on the frontline to speak to staff regularly;
(dd) Healthwatch is particularly concerned with how internal issues at NUH impact on the patient experience. It would be useful to collect information from patients about their experiences from a cultural perspective as part of the Friends and Family Test feedback;
(ee) it is important to understand the culture, heritage, and particular needs of patients in order to care for them effectively. There is a Patient Partnership Group who go onto wards, do spot checks and audits, and give feedback on the patient experience;
(ff) the BAME Shared Governance Council has led a number of inclusion projects to improve the care of BAME patients. NUH recently launched a wig project in partnership with Sista’s Against Cancer, after receiving feedback that the options for wigs were not appropriate for BAME cancer patients and that wig vouchers were not always available before patients lost their hair. Clinics are being held with a trichologist to give patients advice, and a project has been started to educate nurses on appropriate hair and skin care for diverse hair and skin types;
(gg) it is important to make sure that important information is accessible and that the hospital is navigable for those for whom English is not the first language. The translation service at NUH works with over a hundred languages, and there is a database of staff who can speak certain languages, and staff are trained in how to give information to patients appropriately. NUH are looking for ways to make improve communication with patients in a culturally sensitive way at every stage of their care, and to ensure that patients receive apologies when their experience is not what they would like;
(hh) national issues impact on the patient experience also, and can cause perceived discrimination when NHS workers are expected to engage with rules around immigration and access to care for international residents, which can cause conflict and lead to complaints against the Trust. The Committee Chair agreed to put NUH colleagues in contact with local Nottingham Members of Parliament to raise these issues;
(ii) the Shared Governance Council recently went into the community to have a conversation about culturally appropriate menus, attending mosques and synagogues, and gave feedback to the catering team;
(jj) a pack is being prepared to give guidance on how to deal with the end of life for patients in a culturally sensitive way, including how to manage the remains for patients of different faiths and engage with the families of deceased patients;
(kk) the accessibility of the Emergency Department (ED) has been discussed before at the Committee, particularly with regard to neurodivergent people, and it would be useful to look at ED from the perspective of inclusivity. NUH have been actively looking at how to manage sensory overload in ED and make people more comfortable, for example, by opening a ward that previously been a decamp area to get people out of unsuitable places in corridors. There are programmes focusing on lighting and noise, as this can interrupt sleep and exacerbate mental health problems;
(ll) at the Committee meeting in November 2021, it was reported that NHS England had completed an external review of the BAME Strategy, and NUH were expecting the results. It was also reported that work was being completed on the governance arrangements for a Quality Assurance Group, with a governance sub-group underneath it;
(mm) NUH do not know when the next CQC inspection will be, but are hoping to improve from ‘inadequate’ to ‘requires improvement’ in terms of being well-led. They are undergoing some survey work to help gauge the prospects of this, and are in negotiations with NHS England about how long their support package will be in place.
(1) request that Nottingham University Hospitals NHS Trust provide the following additional information:
a. Key findings from the external review of the Black and Minority Ethnic Strategy that was undertaken with NHS England / Improvement in 2021 and what has happened as a result.
b. Staff sickness and turnover, by BAME staff if possible.
c. A copy of its Inclusion Strategy, when available.
(2) include a review of Nottingham University Hospitals NHS Trust’s progress in creating an inclusive workforce in the Committee’s future work programme.
The Committee noted its Work Programme for the remainder of the municipal year 2022/23.
(1) that Committee members will meet with provider organisations in April to discuss their draft Quality Accounts 2022/23 and, in each case, whether to submit a comment for inclusion and, if so, the content of that comment; and
(2) to delegate authority to the Chair of the Health and Adult Social Care Scrutiny Committee to agree the final wording of comments for submission to provider Quality Accounts 2022/23, subject to consultation with other committee members.