Guardians looking out for Northumberland's hospital staff

Kirsty Dickson, the freedom to speak up guardian for Northumbria Healthcare.Kirsty Dickson, the freedom to speak up guardian for Northumbria Healthcare.
Kirsty Dickson, the freedom to speak up guardian for Northumbria Healthcare.
More than 400 staff at Northumbria Healthcare have raised potentially serious concerns that they may not otherwise have done in the past two-and-a-half-years.

Every NHS trust in England has a freedom to speak up guardian and Kirsty Dickson has been the guardian at Northumbria Healthcare NHS Foundation Trust, which runs hospitals in Northumberland and North Tyneside, since October 2016.

A key recommendation from Sir Robert Francis’ review into the culture of raising concerns in the NHS, freedom to speak up guardians across the health service are there to support staff in raising genuine concerns about their work.

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The guardians, who are completely independent and governed by the Care Quality Commission, do not get involved in investigations or complaints, but help to facilitate the raising concerns process where needed, ensuring policies are followed correctly.

A report to last Thursday’s (March 28) meeting of the Northumbria Healthcare board revealed that Kirsty has received received in excess of 400 speak-ups from staff since she started, including 134 in the middle two quarters of this financial year (July to December 2018).

She told board members that she had been at a regional meeting the day before and it was clear that Northumbria has high volumes of speak-ups. “I see that as a good thing and it reflects the culture in the organisation,” she said.

“Thanks for the support because the staff are truly getting value from this.”

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The meeting also received an update from Dr Mike Vincent, who is the trust’s guardian of safe working.

This new role was created in 2016 to monitor and ensure the safe implementation of the new contract for junior doctors (TCS), which was introduced in August of that year.

The 2016 TCS provided the first contractual link between education and training for junior doctors.

The activity in each job is set out in a work schedule that includes the expectations and training opportunities for the junior doctors in that post, in addition to the duty pattern and out-of-hours work.

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Junior doctors can report deviations from the work schedule using the process known as exception reporting via an online system.

The main changes are that the total number of hours worked per week (on average over a rota cycle) is 48 with an absolute maximum number of 72 hours in any rolling seven-day period.

Shifts can now be a maximum of 13 hours in length and trainees can only work five long shifts (classified as a shift of more than 10 hours) or four late or night shifts before a break.

Dr Vincent reported that there have been 246 exception reports since December 2016, 227 of which were for hours and rest and the other 19 for education. There have been 96 reports since August last year.

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The vast majority were resolved with time off in lieu, while a small number were dealt with by payment.

Dr Vincent said there was some concern about junior doctors being discouraged or perceiving that they are being discouraged from filing exception reports.

A survey in December 2018 received just 34 responses (16 per cent), but eight of those reported discouragement. Even if they were the only eight, that still represents one in 25 of the trust’s junior doctors.

Ben O'Connell, Local Democracy Reporting Service