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ED blood testing - easy read

Description: Testing for HIV, Hepatitis B and Hepatitis C These are illnesses that affect the blood and cells in your body. If you are aged 16 or older you can have your blood tested for these illnesses in a London accident and emergency department (A&E). It is important to nd these illnesses early. If you get treatment for these illnesses early enough can save your life. Treatment for these illnesses is free with the NHS. Your blood test results are kept private. If you do not want to be tested for these illnesses please let a member of staff know. For more information visit: www.fasttrackcities.london/testinginae if
Url: /Media/UHS-website-2019/Docs/Services/Emergency-medicine/ED-blood-testing-easy-read.pdf

People who refuse medical or surgical treatment for self inflicted injury

Description: Auto Generated Title On these pages I discuss the clinical law on which our nursing and medical staff rely when caring for our patients. Mr Robert Wheeler, director, department of clinical law Patients present to our hospital with a variety of deliberately self inflicted injuries. These include cuts, overdoses, swallowing the indigestible; or failing to eat and drink. There are also less common injuries, such as conjunctival insertions, and burns. Providing the patient consents to treatment, the effects of the injuries can usually be neutralised. If the patient is a young person (16 to 17 years old), then it may be possible to rely on their parents to provide consent, although as can be seen below, persistent refusal of the young person may lead to a court declaration, even in the middle of the night. However, generally, consent is available and therapy can proceed. Nevertheless, it is vital to control the patient’s environment; in every case where a patient presents with self harm, they must be denied any opportunity of harming themselves further. If patients of any age refuse treatment, your clinical management much depends on whether they have capacity. Although tempting to conclude that a patient who harms himself could only have done so because he lacks capacity in the first place…such a deduction is not tenable. In England, young people and all adults (18 years and over) are presumed to have capacity. It is only by overcoming this presumption by proving that (i) the patient has an impairment of, a disturbance in the functioning of the mind or brain; and (ii) is unable to understand the relevant information, retain it, weigh it and communicate their resultant decision….that the diagnosis of incapacity can be made. If the patient lacks capacity, then in the absence of an advanced decision, they must be treated in their best interests. On the basis of the common law, and now the Mental Capacity Act 2005 (MCA), all efforts must be made to save their lives, or to prevent permanent irremediable harm. When considering the list set out in the first paragraph: All of these injuries may be treated to their logical conclusion, and these legal authorities includes the necessary, proportionate and least restrictive restraint that may be required to achieve the treatment. Hopefully, the patient will regain their capacity, and provide consent for the latter stages of the treatment. However, (self-evidently) this authority does not extend to imposing non-consensual interventions that go beyond saving life or preventing permanent irremediable harm. You are obliged to stem the haemorrhage, repair the brachial artery, close the forearm wounds ….but plainly, you are not permitted to fix the Dupytren’s contracture or excise the ganglion, just because it seemed to be convenient under the same anaesthetic. If the adult has capacity to refuse treatment that will save their lives, then their autonomy should be respected. The practicalities of our acquiescence to their wishes do, nevertheless, depend on the clinical situation. When Kerrie Wooltorton presented to hospital with poisoning, and whilst competent, steadfastly refused treatment that could have saved her life, days passed; during this period for reflection, her clinicians were able to conclude that they could follow her wishes, making her comfortable, but allowing her to die. At the other end of this time spectrum, if an emergency is so dire that the doctor has inadequate time to assess capacity, then he should act to save life; the rugby tackle of the ‘competent’ patient running towards the open third-floor window illustrates this point. If the competent young person refuses her consent in these circumstances, despite her mother’s provision of consent, then Trusts have resorted to Court. Six weeks ago, in P, a High Court judge was called in the middle of the night by emergency department staff faced with a 17 year old girl who had taken an overdose of paracetamol. She was refusing liver-protective treatment, although her mother had readily agreed to it. At the time of the call to court, nine hours had passed since ingestion. A psychiatrist did not consider that she lacked capacity. The judge acknowledged the competent young person’s right to make her own decisions, and her undoubted wishes and feelings that led to her overdose, and continued to operate in her refusal of treatment. Nonetheless the judge found that the young person’s views were not decisive, when balanced against the risks of liver necrosis. For this reason, the Court authorised treatment for the overdose, and for any restraint or sedation that might be necessary to accomplish this. One circumstance causing difficulty is when a competent patient is admitted with a self-inflicted injury that is sectioned under the Mental Health Act 1983 (MHA). The MHA authorises, under some circumstances, non consensual treatment and detention for the medical treatment of mental illness, but not for the treatment of physical illness. In a recent case, it was held that a man with schizophrenia could be detained and treated for his mental illness without his consent under the terms of the MHA. But that retaining him in hospital, and giving him non-consensual therapy with a view to controlling his diabetes could not be authorised in the same way. To achieve diabetic control the MCA, together with it’s associated protections, must be employed. This is not merely bureaucratic. Those guarding our civil liberties are rightly determined that patients with mental illness should lose no more of their liberty than is absolutely necessary to achieve treatment for their index illness. Otherwise, they must share all other liberties that their fellow citizens enjoy. With this in mind, it is important to contemplate s63 of the MHA. This does permit us to provide medical treatment to competent patients for physical injuries that are related to the mental illness for which they have been sectioned (in some circumstances) under the MHA. In B a 24-year-old woman was detained under s3 of the MHA due to her psychopathic illness; for which psychotherapy was the only known treatment. One of the symptoms of her illness was a compulsion to harm herself; this she variously accomplished by cutting, burning and starving herself. The application to court flowed from her weight reduction to 30 kg, when it was feared that without feeding, she would die. The court found that her compulsion to starve was a symptom of her mental illness, and that feeding could be regarded (in this context) as ‘medical treatment’. In this way, B could be compulsorily fed under the authority of s63. Unsurprisingly, providing non-consensual treatment for physical conditions under s63 has at times caused consternation; for instance when a competent schizophrenic woman has had to endure non consensual caesarean section, since the birth of the live baby ‘would allow effective treatment of her mental illness’ . In some forms of mental illness, the refusal of food is considered as a symptom of mental illness, and falls well within the remit of s63 if the patient has already been compulsorily detained, whether or not he is competent. For those without capacity, feeding may be given under the MCA. For those with capacity but not admitted under the MHA, an application to the High Court under its inherent jurisdiction is likely to make non-consensual feeding lawful. Again, any court declaration will make lawful the necessary, proportionate and least restrictive restraint that may be required to achieve the treatment. Please seek advice if you have lingering uncertainties when faced with these difficult cases. Daily Telegraph, 1 October 2009 NHSFT v P [2014]EWHC 1650 (Fam) B v Croydon HA [1995] Fam 133 Tameside & Glossop v CH [1996] 1 FCR 753
Url: /HealthProfessionals/Clinical-law-updates/People-who-refuse-medical-or-surgical-treatment-for-self-inflicted-injury.aspx

WDES annual report 2022

Description: Workforce Disability Equality Standard - Annual Report 2022 2 Executive Summary The Workforce Disability Equality Standard (WDES) is a set of ten metrics that will help NHS organisations to compare the experiences of disabled and non-disabled staff. These metrics are necessary because evidence and research shows that the level of reported discrimination and inequality for disabled people working in the NHs remains high. The WDES was commissioned by the Equality and Diversity Council (EDC), and developed through extensive engagement with Trusts and key stakeholders. It is mandated through the NHS Standard Contract. Implementation of the WDES became an obligatory requirement for national healthcare organisations in 2019, so this is the fourth reporting year for the WDES metric. It is important to note that the data sources for the WDES metrics are a combination of the 2021 National Staff Survey, and workforce data reported at the national data collection cut-off date of 31 March 2022. An infographic offering a visual comparator of WDES 2021 to 2022 has been produced, alongside a guide to the metrics (appendix 1). All NHS organisations are required to produce an action plan to articulate the response to the WDES results, this can be found within the appendices (appendix 2). As UHS continues to develop our Equality, Diversity and Inclusion Strategy 2023-2026, we have incorporated the WDES actions contained in this report into the work programme that will deliver the strategy. The key findings from the 2022 submission show: 1. Out of a total of 13,389 staff (31 March 2022), disabled staff represent 12.16% of the workforce. Overall, this is a 1.24% decrease from 2021 data, this is not representative of wider society which 1 in 5 (22%). Further analysis shows there has been a minimal increase in representation of disabled staff within cluster 2 (AfC Bands 5-7) and 4 (AfC Band 8C-9 and VSM) of our non-clinical workforce and an increase in cluster 4 of our clinical workforce. 2. Data suggests that disabled shortlisted applicants are 0.90 times likely than non-disabled applicants to be appointed to a vacant post. This is an improvement in comparison to last year and suggests that people with disabilities are more likely to be appointed than those without disabilities or long term illness. A score of 1 indicates equal opportunity and anything under 1 indicates more likely, over 1 is less likely. 3. Data indicates disabled staff are less likely than non-disabled staff to be entered into a formal capability process. 4. Disabled staff are more likely than non-disabled staff to experience bullying, harassment and abuse from patients, service users, relatives, members of the public, managers and colleagues than non-disabled counterparts. 5. Disabled staff are less inclined to believe the Trust provides equal opportunities for career development as compared to those staff without disabilities. 6. Disabled staff feel more pressure than non-disabled staff to come to work when unwell. 7. Disabled staff are less satisfied than non-disabled staff that the Trust values their work. 8. There has been a decrease in Disabled staff saying that UHS have made adequate adjustments for them to carry out their work. 9. The staff engagement score for disabled and non-disabled staff is on par with each other and with that of overall staff engagement at UHS. 10. There continues to be no declared representation of disabled staff on the Trust Board. Other than one indicator (an improvement in the likelihood of disabled applicants being appointed from shortlisting in comparison to non-Disabled applicants), there has been minimal change. However, the disparity gap has widened in some areas as the experiences of non-disabled staff has improved. With this in mind, we are committed in continuing to have meaningful engagement with our disabled staff to co-create short and long-term actions with the support of the Long-term Illness and Disability Network to help move the Trust towards disability equality. The WDES data 2022 confirms that the priorities in our draft EDI Strategy are the right ones, to improve or eliminate disparity between experiences of people with long term illness, and disability and those without. We must maintain our focus on: 1. Inclusive recruitment practices and equal opportunities: Large scale review of current recruitment practices to eliminate bias from the systems and promote inclusivity. The Inclusive Recruitment Programme will ensure that recruiting managers are trained in inclusive recruitment techniques and criterion based methods will ensure bias is removed. We will align with the national programme for overhauling recruitment and promotion and contribute to this work wherever possible. The implementation and embedding of processes that ensure inclusive recruitment and equal opportunities for all. Our talent management programme will provide further opportunities for people with disabilities and long term illness to access development. 2. Workforce reflecting our wider communities: In line with the Inclusive Recruitment programme, we will be increasing efforts to make recruitment processes inclusive and therefore not post any barriers to the community in terms of applying for roles at UHS. We will be working with specialist partners to help us to self-assess our environments for people with disabilities or long term illness. Our recruitment outreach will also work more with local communities to attract people from the city from diverse backgrounds. We will provide career toolkits for all people who are unsuccessful at interviews to help them to succeed next time. We will be continuing to promote declarations to ensure we can measure our representation across our workforce and consider a target for % of people with disabilities and long term illness in our workforce which is in line with the reported demographic of our communities. 3. Safe and healthy working environments: Our Equality, Diversity and Inclusion strategy states a clear intent for UHS to become an anti-racist and anti-discriminatory organisation. We aim to decrease disparity of experience by 5% across all indicators in the WDES which will either reduce by half or eliminate disparity altogether. We will be working closer with colleague who lead on hate crime, violence and aggression to ensure robust mechanisms for reporting of incidence and the data is used to steer accountability and meaningful action. We will identify mechanisms and root causes of the disproportionality of staff with disabilities or long term illness experiencing discrimination, harassment, bullying and/or abuse and in turn whether there are trends within the trust that need targeted action. The link to the leadership and management work programme is a critical enabler of creating safe and healthy work environments. Improve the day-to-day experience of working at the Trust for disabled staff, ensuring their experience is free from discrimination, bullying, harassment and/or abuse and individuals feel they are valued. 4. Inclusive leadership and management: Ensure leaders and managers are clear on their accountabilities with regards supporting people with disability and long term illness and the responsibilities they hold to deliver the actions within the EDI strategy. To have development opportunities in supporting disabled staff and those who may identify with a protected characteristic. That all leaders and managers understand their own bias and can access learning in terms of how they behave, lead and make decisions. To support leaders and managers to understand their role as allies and role models, and how to challenge behaviours or actions that are not in line with Trust policy or values. To support leader and managers to develop greater awareness of the legal aspects of their roles in relation to equality, and how diversity and difference can enhance their team delivery and performance. Ensure leaders and managers have learning development opportunities to support individuals with Disabilities and know their responsibilities in relation to the inclusion agenda and specifically actions required to ensure people with disabilities feel valued in the wider workforce. 2 WDES Data Return 2022 Metric 1: Percentage of staff in AfC pay bands or medical and dental subgroups and very senior managers (including Executive Board members) compared with the percentage of staff in the overall workforce. Owing largely to a successful risk assessment campaign throughout the Covid-19 pandemic, disclosure rates in 2020 (15%) and 2021 )13.4%) accurately reflected the local population. However, recent data shows a steady yet continual decrease in declaration rates in terms of the overall representation of disabled staff within the UHS workforce. There is a slight exception of minimal increases in cluster 2 and cluster 4 of 1.3% and 0.09% respectively. Data in Fig 1 and Fig 2 below show the total non-clinical and clinical workforce declaring a disability vs total non-disabled staff in each pay cluster as of 31 March 2022. 2 Fig. 1 Non-Clinical workforce presentation 2021 2022 Pay clusters: Non-clinical Total staff in pay cluster Total disabled staff Total non- disabled staff Total unknown staff Total staff in pay cluster Total disabled staff Total non- disabled staff Total unknown staff Cluster 1 Bands 1-4 2008 14% (283) 69% (1391) 17% (334) 1916 13.25% (254) 71.13% (1363) 15.6% (299) Cluster 2 Bands 5-7 646 10% (66) 77% (495) 13% (85) 743 11.30% (84) 78.06% (580) 10.63% (79) Cluster 3 Bands 8a-8b 183 13% (23) 68% (126) 19% (34) 203 12.80% (26) 71.92% (146) 15.27% (31) Cluster 4 Bands 8c-9 & VSM 93 3% (3) 75% (70) 22% (20) 97 3.09% (3) 81.44% (79) 15.46% (15) Fig 2. Clinical workforce representation Pay clusters: Clinical 2021 2022 Total staff in pay cluster Total disabled staff Total non- disabled staff Total unknown staff Total staff in pay cluster Total disabled staff Total non- disabled staff Total unknown staff Cluster 1 Bands 1-4 2434 16% (384) 73% (1797) 11% (259) 2409 15.19% (366) 74.63% (1798) 10.17% (245) Cluster 2 Bands 5 – 7 5015 16% (799) 70% (3490) 14% (726) 5246 13.62% (715) 73.38% (3850) 12.98% (681) Cluster 3 Bands 8a –b 347 15% (52) 58% (201) 27% (94) 386 15.02% (58) 61.91% (239) 23.05% (89) Cluster 4 Bands 8C-9 & VSM 38 18% (7) 40% (15) 42% (16) 39 20.51% (8) 51.28% (20) 28.20% (11) Cluster 5 Medical & Dental staff, consultants 787 7% (58) 69% (538) 24% (191) 863 6.8% (59) 72.1% (622) 21.1% (182) Cluster 6 Medical & Dental staff, non-consultants career grades 421 6% (25) 82% (345) 12% (51) 428 4.9% (21) 83.2% (356) 11.9% (51) Cluster 7 Medical & Dental staff, medical & dental trainee grades 1027 4% (43) 93% (955) 3% (29) 1059 3.4% (36) 93.9% (994) 2.7% (29) In contrast to the 2021 data submission there is a decrease in representation of Disabled staff across clusters within the clinical workforce with the exception of cluster 4 which has seen an increase in representation from 18% to 20.51%. Metric 2: Relative likelihood of Disabled staff compared to Non-Disabled staff being appointed from shortlisting across all posts. This refers to both external and internal posts. The indicator below indicates that non-disabled staff are 0.90 times less likely to be appointed from shortlisting than disabled staff. This compares favourably to 2021, where the score was 1.02, a score below 1 indicates positive equal opportunity. Relative likelihood of staff being appointed from shortlisting across all posts 2022 Disabled Non-Disabled Number of shortlisted applicants 608 6897 Number appointed from shortlisting 234 2377 Relative likelihood of non-disabled staff being appointed from shortlisting compared to disabled staff 0.90 Metric 3: Relative likelihood of Disabled staff compared to Non-Disabled staff entering the formal capability process, as measured by entry into the formal capability procedure.. In line with WDES guidance, there is no requirement to analyse the relative likelihood where there are fewer than 10 cases reported involving disabled staff. Relative likelihood of staff entering the formal capability process, as measured by entry into a formal capability process 2022 Disabled Non-Disabled Number of staff entering the formal capability process 0 16 Relative likelihood of Disabled staff entering the formal capability process compared to non-disabled staff 0 Metric 4: (Part A) Percentage of Disabled staff compared to Non-Disabled staff experiencing harassment, bullying or abuse from patients/service users, their relatives or other members of the public, managers and other colleagues; (%s of total participants in staff survey related question, not % of total workforce) Harassment, bullying or abuse from patients/service users, their relatives, or other members of the public: 2021: Disabled – 30%; Non-Disabled – 25.2% 2022: Disabled – 26.7%; Non-Disabled – 21.4% There has been an improvement in numbers of disabled staff reporting they have experienced harassment, bullying or abuse from patients/service users, their relatives or other members of the public. This has decreased by 3.3 from 30% to 26.7%. However, the disparity between the experience of bullying, harassment and abuse between disabled to non-disabled has increased from 4.8% to 5.3% due to the favourable improvement for non-disabled staff. Harassment, bullying or abuse from managers: 2021: Disabled – 13.7%; Non-Disabled – 9.1% 2022: Disabled – 11.9%; Non-Disabled – 7% The data indicates a 1.8% decrease from 13.7% to 11.9% for those with disabilities experiencing harassment, bullying or abuse by managers. However, the disparity between disabled and non-disabled staff experiencing harassment, bullying or abuse by a manager has increased to 4.9%. This is concerning and highlights the need for interventions to eradicate such experience. Harassment, bullying or abuse from other colleagues: 2021: Disabled – 26.7%; Non-Disabled – 16.2% 2022: Disabled – 21.6%; Non-Disabled – 13.6% There is a 5.1% decrease from 26.7% to 21.6% in disabled staff experiencing harassment, bullying or abuse from other colleagues and a decrease of 2.6% from 16.2% to 13.6% in non-disabled staff. it remains a concern that 8% more disabled staff overall are experiencing such behaviours. It is not acceptable that any staff member experiences harassment, bullying and abuse from colleagues. The action for improvement within the draft EDI strategy in terms of achieving an anti-discriminatory organisation and workstreams to reduce bullying, harassment, abuse, hate crime, violence and aggression. Metric 4: (Part B) Percentage of Disabled staff compared to Non-Disabled staff saying that the last time they experienced harassment, bullying or abuse at work, they or a colleague reported it. 2021: Disabled – 49.6%; Non-Disabled – 46.9% 2022: Disabled – 47%; Non-Disabled – 48.7% The 2022 data indicates a worsening of the likelihood of this indicator from 2021 of 2.6%. Whereas the indicator for non-disabled has improved by 2.6%. Continued engagement with individuals and members of the UHS long-term illness and disability network is crucial to gain greater understanding of why individuals aren’t or don’t feel able to report such incidence, and collectively take action to improve. It is also important to note that the participation in this question in the staff survey was lower than other questions, which therefore raises concerns in terms of perception of psychological safety in relation to reporting. . Metric 5: Percentage of Disabled staff compared to Non-Disabled staff believing that the Trust provides equal opportunities for career development. 2021: Disabled – 58%; Non-Disabled – 64.5% 2022: Disabled – 60%; Non-Disabled – 63% This indicator shows that disabled staff are now 2% more likely to think that the trust offers equal opportunities for career progression in comparison to the 2021 data collection. However, it should be noted that Disabled staff are 3% less inclined to believe the Trust provides equal opportunities for career development as compared to those staff without disabilities. Metric 6: Percentage of Disabled staff compared to Non-Disabled staff saying that they have felt pressure from their manager to come to work, despite not feeling well enough to perform their duties. 2021: Disabled – 33.1%; Non-Disabled – 23.6% 2022: Disabled – 26.9%; Non-Disabled – 19.9% 2021 data submission shows 26.9% of Disabled staff felt pressure to come to work despite feeling unwell, in comparison to 19.9% of non-Disabled staff. This shows a decrease for both comparators but does still evident a disparity of experience between Disabled and non-Disabled staff of 7%. Metric 7: Percentage of Disabled staff compared to Non-Disabled staff saying that they are satisfied with the extent to which their organisation values their work. 2021: Disabled – 42.7%; Non-Disabled – 54.9% 2022: Disabled – 39.6%; Non-Disabled – 49.6% Unfortunately, 2022 data submission shows a decrease in Disabled and non-Disabled perceptions on feeling valued by the organisation, with Disabled staff reporting 39.6% and non-Disabled staff reporting 49.6% satisfaction. Whilst disparity has decreased this is due to both disabled and non-disabled rating lower dissatisfaction levels, the level of disparity of experience remains high. Metric 8: Percentage of Disabled staff saying that their employer has made adequate adjustment(s) to enable them to carry out their work. 2021: 79.8% 2022: 78.9% There has been a 0.9% decrease in staff saying that UHS have made adequate adjustments for them to carry out their work. With this decrease in experience, over the next year and for the long-term the trust will make demonstrative efforts in addressing this and will be a priority within the action plan as we look to launch a review of the reasonable adjustments process and introduce a policy and guidelines in supporting all staff through the process. Metric 9: (Part A) The staff engagement % score for Disabled staff, compared to Non-Disabled staff and the overall engagement % score for the organisation. 2021: Disabled – 6.9%; Non-Disabled – 7.4%; UHS overall 7.3% 2022: Disabled – 6.9%; Non-Disabled – 7.3%; UHS overall 7.2% It is reassuring to note that the staff engagement score for disabled and non-disabled staff is on par with each other and with that of overall staff engagement at UHS. Metric 10: Board Voting by % disability 12.16% of the UHS population have declared a disability. There are no Trust Board members (voting or non-voting) who have declared a disability or long term illness. The Trust will continue to encourage staff of all levels the importance of declaration and representation, but with particular focus within senior roles. Conclusion and Next Steps Given that we now have a significant dataset available to us and we continue to encourage higher rates in completion of the annual staff survey, we are now in a position to have meaningful engagement with our disabled staff and the wider workforce to co-create short and long-term actions with continued support of the Long-term Illness and Disability Network to help move the Trust towards disability equality. Furthermore, at this point it is important to highlight this data and the areas for improvement that are needed have also been crucial in the current production of the UHS Equality, Diversity and Inclusion Strategy and the outcomes we are committed in achieving over the forthcoming years. As previously summarised the data indicates that we must maintain our focus on: 1. Workforce reflecting our wider communities: Ensure that Disabled staff are able to access appropriate support in order to progress and remains inclusive of all roles at all levels. 2. Inclusive recruitment practices and equal opportunities: large scale review of current recruitment practices and where necessary The implementation and embedding of processes that ensure inclusive recruitment and equal opportunities for all. 3. Safe and healthy working environments: Improve the day-to-day experience of working at the Trust for disabled staff, ensuring their experience is free from discrimination, bullying, harassment and/or abuse and that individuals feel they are valued. 4. Inclusive leadership and management: Ensure leaders and managers have development opportunities in supporting individuals with Disabilities. Ensuring that when additional support such as reasonable adjustments are required the request/or need is met sufficiently. Our action plan which can be found in the appendices will continue to be reviewed in partnership with the Long-Term Illness and Disability network. The proposed actions will continue to be discussed in terms of progress at Equality, Diversity and Inclusion Council, Equality, Diversity and Inclusion Committee and People and Organisational development Committee. This analysis report along with the relevant action plan will be published on our public website by 31st October to meet the requirements set by the Workforce Disability Equality Standard (WDES). Appendices Appendix 1: Infographic to visualise WDES data 2 Appendix 2: WDES Action Plan 2022 WDES Themes / Areas Proposed actions Responsible for Actions Deadline / review date 1: Workforce reflecting our communities, at all roles, at all levels; ensuring those who are underrepresented groups can access support to thrive, excel and belong within their roles. a) To develop and initiate positive Action Programmes both UHS and HIOW system wide; for those who have disabilities and/or long-term conditions as well as other protected characteristics. Acknowledging individuals experience of barriers to promotion, development and career progression. Workforce Inclusion & Belonging Consultant / Head of EDI / Head of OD July 2023 b) UHS partnership with maaha people in developing and running a positive action leadership programme which will enrol 24 individuals who identify with a protected characteristic and will be designed to support individuals looking to move into, or those who are moving through senior leadership roles within the organisation, building on individuals personal identity, power and influence within the organisation. Workforce Inclusion & Belonging Consultant January 2023 c) Partnership with the Florence Nightingale Foundation; Nurse leadership programme aimed at aspiring nurses from backgrounds that are under-represented in our nursing workforce and ensuring that opportunity for individuals who identify as disabled is equal and representative of wider society. Deputy Director of Nursing & Head of OD April 2023 d) Talent development programme for individuals with a disability and/or long-term condition. Supporting the career development, pathways, training and development of individual’s, ensuring talent workstreams and pipelines that encourage opportunity at earlier stages than current and may include long-term career planning. Develop a talent pipeline/talent management plan to include stretch activities, secondments, shadowing, specialist training, qualifications, coaching and mentoring where it is anticipated a career change will be necessary. This will look at strengthening as well as unearthing our current talent within UHS and ensuring that individuals continue to thrive, excel and belong and we support them to do this. Head of Talent Management / Head of EDI / Workforce Inclusion & Belonging Consultant July 2023 e) Continue to build on newly found working relationship with Southampton job centre. Continue to liaise, attend and promote UHS as an employer of choice to disabled individuals within the wider community, the support that is offered and the career opportunities that available including that of our volunteering roles. Workforce Inclusion & Belonging Consultant / HR Recruitment team April 2023 f) Propose and agree a declaration target throughout the organisation for those who identify as having a disability and/or long-term condition. Representation within wider society is currently 22% and therefore a declaration and representation rate of 20% will be proposed and what we know from engagement within the staff survey (2021) is representative at UHS. To achieve this workstreams will include more in depth narrative about declaration of disability and its importance within the onboarding and induction process within UHS and will include literature on the processes of how to declare. Continue with lived experiences pieces and continue to socialise within internal and external communications methods. Continue to at every opportunity irradicate stigma surrounding what happens if an individual declares a disability and continue to showcase the support we offer to individuals within the organisation as a disability confident employer. Director of OD & Inclusion / Chief People Officer April 2023 2: Safe and healthy working environments, free from aggression, hate and discrimination a) Creation of a behaviour framework to bring to live our Trust Values and more clearly describe the expected behaviours relating to equality, diversity and inclusion that impact individuals with a disability and/or long-term condition. Director of OD & Inclusion / Head of EDI / Workforce Inclusion & Belonging Consultant August 2023 b) Fully establish divisional EDI Steering Groups to drive actions and improvements derived from Disability specific metrics throughout all teams, care groups and divisions. Director of OD & Inclusion / Head of EDI April 2023 c) Creation of EDI data and information dashboard to evidence improvements and scrutinise themes that impact individuals with a disability and determine actions required. Director of OD & Inclusion / Head of EDI April 2023 d) Developing a culture of Allyship: All staff to participate in Actionable Allyship training by 2024. The actionable allyship – stop.Start.continue programme will continue on the statutory and mandatory matrix for all staff to complete. This will provide individuals with the insight, knowledge and skill and to be active allies within a moment of challenging non inclusive behaviours and supporting out statement in being a anti-discriminatory organisation and in turn decrease the disparity of experience between those who have disabilities and those who don’t. Workforce Inclusion & Belonging Consultant August 2023 e) Develop a process where conversation of long-term conditions and disabilities are standard processes within 1.2.1’s, wellbeing conversations and appraisal conversations. Highlighting all individuals responsibility to show allyship and continue to support individuals throughout their work at UHS. Head of EDI / Workforce Inclusion & Belonging Consultant August 2023 3: Recruitment processes which free from bias and are inclusive a) Implement a work programme to review and improve the equity of recruitment processes and practices that impact individuals with a disability and/or long-term condition. Working group to include partnership with our Staff Network leads and representation from our diverse workforce. The working group will look at each stage and deliver on recommendations from engagement within the process. Aligning to the NHS People Plan England/Improvement High Impact Actions and Inclusive Recruitment Programme. Workforce Inclusion & Belonging Consultant December 2022 b) Inclusive training, learning and development for all people involved in recruitment and attraction. Head of Talent attraction / HR Recruitment Team September 2023 c) Deliver a truly Disability friendly process with disability inclusive practices as standard. This will include processes from pre-employment to recruitment, through to employment and the onboarding process. Head of HR / Head of EDI / Workforce Inclusion & Belonging Consultant September 2023 d) Develop an inclusive employer recruitment campaign in embedding our Disability confident status and our intentions to move towards disability confident leader within the next 3years. Head of HR / Head of EDI / Workforce Inclusion & Belonging Consultant / LID Network September 2023 4: Inclusive leadership and management a) Inclusive Leadership content in all UHS leadership & management programmes to include personal learning, person action and accountability. This will move us to a place where equality, diversity and inclusion is the golden thread that runs through all our processes at UHS. Head of OD / Head of Leadership & Development / Head of EDI / Workforce Inclusion & Belonging Consultant April 2023 b) Board and Senior leadership programmes to include the element for all leaders plus strategic and cultural responsibilities for equality, diversity and inclusion. Head of OD / Head of EDI July 2023 c) Inclusive leadership and management as part of the UHS Managers Induction Programme. Head of Leadership & Development / Head of EDI / Workforce Inclusion & Belonging Consultant April 2023 d) Implementation of ongoing learning and development opportunities to enable leaders and managers to role model inclusive behaviours every day. For example: * Inclusive meetings * Agile working * Equality impact assessment * Adjustments required to enable people to thrive and be at their best at work. * Creating environments for people to succeed * Inclusive leadership behaviours aligned to our values Head of EDI / Workforce Inclusion & Belonging Consultant September 2023 5: Networks and partnerships that thrive and support creation of an inclusive and safe place to work. a) Development programmes for Networks and Network Chairs clearly identifying roles to enable leadership of highly active networks, clarity of purpose and future plans. Development opportunities will include coaching, mentoring, influential leadership skills, recognising their contributions as career development. Head of EDI / Workforce Inclusion & Belonging Consultant May 2023 b) Implement and establish the Equality, Diversity and Inclusion Council; A place for network leads and members alongside the equality, diversity and inclusion team to dialogue with one another, bring forward ideas or concerns from the networks and a place for the voices of all individuals within the organisation to be recognised. This will also offer a place for future projects and funding to be discussed and where a decision on what escalations/risks need to be raised within committee meetings. Director of OD & Inclusion / Head of EDI / Workforce Inclusion & Belonging Consultant November 2022 c) Establish and support new staff networks, as per requested: * Long COVID support group * Women’s Network * Carers Network * Veterans Network Head of EDI / Workforce Inclusion & Belonging Consultant April 2023 2
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Equality-reports/Workforce-Disability-Equality-Standard-Annual-Report-2022.docx

Papers Trust Board - 29 November 2022

Description: Date Time Location Chair Agenda Trust Board – Open Session 29/11/2022 9:00 - 13:20 Conference Room, Heartbeat/Microsoft Teams Jenni Douglas-Todd 1 Chair’s Welcome, Apologies and Declarations of Interest 9:00 Note apologies for absence, and to hear any declarations of interest relating to any item on the Agenda. 2 Staff Story The staff story provides an opportunity for the Board to reflect on the experiences of patients and staff within the Trust and understand what the Trust could do better. 3 Minutes of Previous Meeting held on 29 September 2022 9:20 Approve the minutes of the previous meeting held on 29 September 2022 4 Matters Arising and Summary of Agreed Actions To discuss any matters arising from the minutes, and to agree on the status of any actions assigned at the previous meeting. 5 QUALITY, PERFORMANCE and FINANCE Quality includes: clinical effectiveness, patient safety, and patient experience 5.1 Briefing from the Chair of the Charitable Funds Committee (Oral) 9:30 Dave Bennett, Chair 5.2 Briefing from the Chair of the Finance and Investment Committee (Oral) 9:35 Jane Bailey, Chair 5.3 Briefing from the Chair of the Quality Committee (Oral) 9:40 Tim Peachey, Chair 5.4 Chief Executive Officer's Report 9:45 Receive and note the report Sponsor: David French, Chief Executive Officer 5.5 Integrated Performance Report for Month 7 10:05 Review and discuss the Trust's performance as reported in the Integrated Performance Report. Sponsor: David French, Chief Executive Officer 5.6 Finance Report for Month 7 10:35 Review and discuss the finance report Sponsor: Ian Howard, Chief Financial Officer 5.7 People Report for Month 7 10:45 Review and discuss the people report Sponsor: Steve Harris, Chief People Officer 6 Break 10:55 7 Infection Prevention and Control 2022-23 Q2 Report 11:05 Review and discuss the report Sponsor: Gail Byrne, Chief Nursing Officer Attendees: Julian Sutton, Interim Lead Infection Control Director/Julie Brooks, Head of Infection Prevention Unit 8 Medicines Management Annual Report 2021-22 11:15 Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: James Allen, Chief Pharmacist 9 Equality, Diversity and Inclusivity (EDI) Update including Workforce Race 11:25 Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) Results 2022 Receive and discuss the reports Sponsor: Steve Harris, Chief People Officer Attendee: Ceri Connor, Director of OD and Inclusion 10 Annual Ward Staffing Nursing Establishment Review 11:35 Discuss and approve the review Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Rosemary Chable, Head of Nursing for Education, Practice and Staffing 11 Guardian of Safe Working Hours Quarterly Report 11:45 Receive and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Diana Hulbert, Guardian of Safe Working Hours and Emergency Department Consultant 12 Learning from Deaths 2022/23 Quarter 2 Report 11:55 Review and discuss the report Sponsor: Paul Grundy, Chief Medical Officer Attendee: Ellis Banfield, Associate Director of Patient Experience 13 Freedom to Speak Up Report 12:05 Review and discuss the report Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Christine Mbabazi, Equality & Inclusion Adviser/Freedom to Speak Up Guardian Page 2 14 Annual Assurance Process and Self-assessment against the NHS 12:15 England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) Review and discuss the report Sponsor: Joe Teape, Chief Operating Officer Attendee: John Mcgonigle, Emergency Planning & Resilience Manager 15 STRATEGY and BUSINESS PLANNING 15.1 Board Assurance Framework (BAF) Update 12:25 Review and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 16 CORPORATE GOVERNANCE, RISK and INTERNAL CONTROL 16.1 Register of Seals and Chair's Actions Report 12:35 Receive and ratify In compliance with the Trust Standing Orders, Financial Instructions, and the Scheme of Reservation and Delegation. Sponsor: Jenni Douglas-Todd, Trust Chair 16.2 Review of Standing Financial Instructions 2022-23 12:40 Review and approve the SFIs Sponsor: Ian Howard, Chief Financial Officer Attendee: Phil Bunting, Director of Operational Finance 16.3 Corporate Governance Update 12:50 Receive and discuss the update Sponsor: Gail Byrne, Chief Nursing Officer Attendee: Craig Machell, Associate Director of Corporate Affairs and Company Secretary 17 Any other business 13:00 Raise any relevant or urgent matters that are not on the agenda 18 Note the date of the next meeting: 31 January 2023 19 Items circulated to the Board for reading 19.1 CRN: Wessex 2022-23 Q2 Performance Report Note the report Sponsor: Paul Grundy, Chief Medical Officer Page 3 20 Resolution regarding the Press, Public and Others Sponsor: Jenni Douglas-Todd, Trust Chair To agree, as permitted by the National Health Service Act 2006 (as amended), the Trust's Constitution and the Standing Orders of the Board of Directors, that representatives of the press, members of the public and others not invited to attend to the next part of the meeting be excluded due to the confidential nature of the business to be transacted. 21 Follow-up discussion with governors 13:05 Page 4 3 Minutes of Previous Meeting held on 29 September 2022 1 Draft Minutes TB 29 Sept 22 OS v2 Minutes Trust Board – Open Session Date Time Location Chair Present 29/09/2022 9:00 – 13:00 Microsoft Teams Jenni Douglas-Todd (JD-T) Jane Bailey (JB), Non-Executive Director (NED) Gail Byrne (GB), Chief Nursing Officer Cyrus Cooper (CC), NED (from item 5.4 part two) Jenni Douglas-Todd (JD-T), Chair Keith Evans (KE), NED David French (DAF), Chief Executive Officer Paul Grundy (PG), Chief Medical Officer Steve Harris (SH), Chief People Officer Jane Harwood (JH), NED Ian Howard (IH), Chief Financial Officer Tim Peachey (TP), NED Joe Teape (JT), Chief Operating Officer In attendance Jane Fisher, Head of Health and Safety Services (JF) (for item 7.3) Sarah Herbert, Deputy Chief Nursing Officer (SHe) (for item 5.7) Femi Macaulay (FM), Associate NED Corinne Miller, Named Nurse for Safeguarding Adults (CM) (for item 5.8) Karen McGarthy, Named Nurse for Safeguarding Children (KMcG) (for item 5.8) Christine McGrath (CMcG), Director of Strategy and Partnerships Helen Potton, Associate Director of Corporate Affairs and Company Secretary (Interim) (HP) Helen Ralph, Manager, Transformation Team (HR) (for item 6.1) Annabel Shawcroft, Clinical Programme Officer, Transformation Team (AS) (for item 6.1) Jason Teoh, Director of Data and Analytics (JTe) (for item 5.11) Diana Ward, Clinical Outcomes Manager (DW) (for item 5.10) One member of the public (observing) 3 governors (observing) 5 members of staff (observing) 1 members of the public (observing) Apologies Dave Bennett (DB), NED 1. Chair’s Welcome, Apologies and Declarations of Interest JD-T welcomed all those attending the meeting which was being held by Microsoft Teams. Apologies were received from DB. CC would be joining the meeting later. 2. Patient Story HP introduced the Patient Story which focused on the experience of a mother and daughter who had used the Trust’s services. Mum advised that during the pandemic, her daughter had been diagnosed with cancer in her abdomen at the age of nine years old. Page 1 Her daughter had surgery followed by nine rounds of chemotherapy at the Trust followed by radiotherapy in London. Whilst on maintenance chemotherapy her daughter had relapsed and sadly a decision was made that further treatment would not be beneficial. Her daughter’s response was to write a “bucket list”. Some of the items were for herself but some related to changes that she wanted for other people including wanting parents to be fed. Her daughter could not understand why, when she was asked what she wanted to eat, that this did not extend to her mum, when her mum was in the hospital supporting her. Her daughter had not wanted mum to leave to go and eat, and no one else could come to sit with her because of the COVID restrictions. Her daughter was scared and going through gruelling treatment and that made it very difficult for mum to leave her. In addition, her treatment had affected her smell, making her feel unwell which resulted in her mum eating in the ensuite toilet as there was nowhere else to sit and eat. After her daughter died, mum had been working on items from her daughter’s bucket list, with senior representatives of the NHS. Work focused on putting in place a national programme to feed parents, improve food for children and also the provision of play specialists. In terms of food, mum had been working with UHS’ Patient Support Hub since January. Initially snack and toiletry boxes were put into every parent room but now, every children’s ward across Portsmouth and Southampton, a total of 17 wards, received food and drink every week. A charity, Sophie’s Legacy, had been set up and a trial had started that provided parents with a £4 food voucher for the restaurant, which was in addition to the support provided by the Patient Support Hub. The initiative had been well received by parents. The hope is to roll this out across the Country as looking after parents was important to enable them to support the care of their children. JD-T thanked mum for sharing noting how devastating it must have been to lose her daughter and how amazing it was that she and her daughter had wanted to support others in this difficult time. GB also thanked mum for sharing the experience and the work that was being done in her daughter’s name, which was important to continue. DAF noted how extraordinary that at the age of nine her daughter was considering the future of others. DAF asked whether mum had good links with the hospital charity and SH confirmed that he would make contact to ensure that this happened. Action: SH JT noted the importance of good facilities being available including good quality, affordable food. It was important for the Board to look at this and also to look at the estate to ensure that there was appropriate spaces provided for parents. 3. Minutes of the Previous Meeting held on 28 July 2022 The minutes of the meeting held on 28 July 2022 were approved as an accurate record of the meeting save for the following amendments: Page 2 • Page 3 – Correct spelling of Beachcroft • Page 3 – 5.3 third bullet – should read compliant not complaint. 4. Maters Arising and Summary of Agreed Actions Actions that were due had been completed. Action 763 – The complaint data was being compiled and would be sent out shortly. The remaining actions were not yet due but were being taken forward. 5. QUALITY, PERFORMANCE and FINANCE 5.1 Briefing from the Chair of the Audit and Risk Committee KE provided a briefing following the meeting on 12 September. The External Auditors had signed off their opinion on the financial statements with a clean opinion being given. From the Internal Auditors three reviews had been completed. The incident management review had focused on smaller incidents, noting that major incidents would normally be highlighted quickly. A large number had been tested and the conclusion was that the Trust needed to work on turning the reports around within the ten-day period. The Cyber Security review was one of significant assurance. However, the report highlighted that the Trust did not have formal documentation in terms of a Cyber Security Strategy and that not much training was provided for staff. Finally, in terms of General Data Protection Regulation (GDPR) and personal information, the Trust was required to have a “record of processing activities” (ROPA). The Trust undertook hundreds of activities but did not have a ROPA for every activity and the recommendation was to review and put in place an appropriate policy to enable a more general approach for wider coverage. The final review was stage 2 of how the Trust managed and governed IT projects. The report had focused on three areas: • The initial assessment of the benefits of the IT project which had been found to be thorough and well thought out and documented. • More guidance was recommended on how to evaluate benefits particularly in terms of non financial benefits including safety benefits. • There were very few post benefit assessments being completed which would help with learning. Plans were in place to put additional controls in place by March 2023 and a review would take place as part of their follow up procedures. JT reminded members that he had arranged for Cyber training for the Board and had agreed to provide further assurance around some of the arrangements and the Internal Audit was aligned to this. JT noted that staffing arrangements would need to be reviewed as currently there was only one colleague within the digital team that worked on cyber security issues. HP informed the Board that work was already underway in terms of the work around ROPAs. Action: JT Page 3 5.2 Briefing from the Chair of the Finance and Investment Committee JB provided an update from the last meeting noting that discussions had taken place around the current financial position and the operational plan, both of which were due to be discussed in the closed board meeting. There was significant challenge particularly around the deficit position but overall there was a really good grip on exactly where the Trust currently was, with appropriate decisions being made to reflect the balance between managing the financial position, whilst continuing to support our people and activity. A number of ongoing actions around productivity were being addressed together with a clearer view of the future cash position of the Trust. Finally, JB noted that Model Hospital data had been reviewed to enable the Trust to drive efficiencies compared to other hospitals and to facilitate learning. 5.3 Chief Executive Officer’s Report DAF noted that this was the first time that the Board had met since the death of Her Majesty Queen Elisabeth II and wanted to formally recognise the fantastic public service that she had given. The state funeral, which gave an additional bank holiday, provided the Trust with some challenging operational issues, with little guidance being provided in terms of what the best approach should be. Where staff were not involved in urgent or emergency care, such as within outpatients, electives and day case procedures, they were given the choice that if they wanted to work that would be gratefully received, but similarly if they wanted to take the day off to pay their respects, they were able to. Some staff wanted to work and others wanted to take the day. More than two thirds of the scheduled activity had been undertaken. DAF thanked all staff for all of their hard work and dedication. He also noted that: • The pilot of the care village had been very successful and would be discussed further in the next item. • Junior doctor pay rates had been quite challenging and was symptomatic of where the Trust was with many members of the workforce. The Royal College of Nursing (RCN) had notified the Trust of an intended ballot for strike action. Also, the British Medical Association (BMA) had published a rate card that they wanted trusts to pay, which was in many cases, significantly above current ratees. DAF noted that there were groups of staff who had indicated that they would not work for the Trust unless paid the new rates. It was a period of instability and people were understandably wanting to protect their income which was manifesting in the behaviours that we were seeing. • The HR team had been recognised by the Chartered Institute of Professional Management (CIPD), for a National awards which was a testament to the good work that SH and his team did. • The number of COVID positive cases was increasing with around 70 currently in the hospital. Mask wearing had been re-introduced in clinical areas in an attempt to limit the number of nosocomial transmissions. Care homes were not willing to accept patients with COVID which would impact potential discharges. In terms of staff Page 4 absence from COVID this was also increasing and staff were being encouraged to have both COVID and influenza vaccinations. • UHS was in the process of finalising an IT contract which, at first glance looked like it could be a replacement for our Emergency Department (ED) IT system. The initial contract was small but included from a strategic perspective, as the Trust had recognised the potential for having a longer-term development partner. UHS remained committed to its “Best of Breed” strategy but had been struggling to recruit and retain the people needed to develop the systems and this could be a step to delivering this by working together in partnership. Ultimately this could result in UHS not only being able to bring to develop our systems but also had the potential to bring to the market a number of our IT products that we had developed. • At the previous month’s board, the Trust had been aware of its segmentation under the Single Oversight Framework (SOF) review, but had omitted to formally advise the board. The Trust remained in segment 2, with 1 being good and 4 being bad. Trusts in segments 3 and 4 received more dedicated support and oversight. This was a vote of confidence from the regulators in the Trust despite the challenges it was facing. TP noted that the BMA pay card had received much criticism and should be resisted unless there was a proper negotiation about the rates. In terms of the IT partnership this was excellent news. PG noted that the Trust had been very clear through the Local Medical Councils (LMC), and individual conversations with teams, that the Trust would not be entering into negotiations about the BMA rates. It was growing as an issue but was an untenable position to hold in front of the rest of the workforce. Meetings were taking place with teams noting that it was not just about money. PG had been clear with his medical consultant colleagues that he was not able to recommend that consultants were paid as much in one day for an overtime operating list, which was greater than the amount some staff received in a month. In a cost-of-living crisis this was wrong. Many colleagues had understood this approach but there was still many who were very unhappy. JH congratulated SH for the award noting that this was a very difficult award to achieve, with tough competition, and that to achieve it during the pandemic was outstanding. Decision: The Board noted the report. 5.4 Integrated Performance Report for Month 5 (part one) JT noted the challenges that the Trust was currently under and in particular highlighted: • The previous day had been particularly tough with every space in the hospital full and lots of patients in the ED waiting for beds. This was replicated nationally with many organisations had declared critical incidents due to the pressures being faced. It was caused by increased numbers of COVID positive patients and a big spike in the number of delayed patients in the hospital which had hit 245 patients at the start of the week, with almost a quarter of the bed base who could be treated elsewhere. Page 5 • There was a record number of cancer referrals with the waiting list being the highest it had ever been. The Trust continued to deliver more diagnostic capacity than it had ever delivered but continued to struggle with capacity in view of the increased demand. This was a very difficult position alongside a time where staff morale was low and staff were tired due to the pressures over the last couple of years. • One of the two spotlights related to cancer and the Board had a study session the following week with a deep dive. Referrals had grown by about 25% per month from around 1600 two-week referrals to consistently above 2000 per month. The backlog of patients who had breached 62 days had gone up three-fold in the last two years from around 100 to 370 patients. The overall number of patients on the cancer pathway had also doubled in this period. This was challenging for a group of patients that the Trust wanted to prioritise in terms of access to services and care. • Across the Wessex Alliance footprint the backlog remained better than the rest of the Country but it was not where we would want to be in terms of cancer services. It was likely that our performance would dip as we started to treat those patients which would impact the 62 day target, despite the levels of activity and delivering relatively well in terms of our peer groups. • There were some excellent new pathways being developed including the dermatology dream pathway which would make a significant impact on the skin pathway once implemented. Work was also being done with the cancer allowance to map what we had, against what we needed to understand better the gaps. DAF noted that the cancer performance metrics were a measure of the patients that had been treated. Once you had a number of patients above the 62 days, if you did not treat them and let them remain on the waiting list. your measure would remain strong. However, this was not the right thing to do but once you had treated them this would impact that metric which was likely to be poor over the coming months. TP noted that the waiting had continued to get bigger which would suggest that either the Trust was not coping with the numbers coming through and people were therefore waiting longer and longer or that there was a higher rate of cancer in the population. Was this as a result of COVID reducing the body’s ability to fight small cancers that would normally disappear. JD-T also noted the highest number of referrals happening in August and wondered whether there was any national modelling being done around this. JT informed members that Professor Peter Johnson would be one of the presenters at the board study session and this would be a good opportunity to explore this. Anecdotally we appeared to be seeing more sicker patients who had a number of co-morbidities presenting as more complex patients and work was underway to investigate this further particularly from an inequality lens in terms of the demographics that were being referred on the two week wait referrals. PG noted that during COVID people tended to not present which was part of the reason for a backlog of presentations but that diagnosis appeared to also be increasing. Understanding why was not yet known and a discussion in the study session would be helpful to understand that particularly better. In terms of the appraisals spotlight SH noted: Page 6 • That a key element from the People Strategy was the Trust’s ability to provide meaningful progression for our staff. From the feedback given in the staff survey many staff believed that during the pandemic they had not received the development, training or the appraisal focus that they would have wanted. • Work to address that included a multi disciplinary team who had focused on refreshing the appraisal paperwork which had been well received. The team had a wide breadth of staff including clinical, operational and trade union representatives. Previously the number of appraisals carried out had been good but the quality had been low so training for appraisals had been reviewed to improve the quality of the appraisal discussion. Whilst the Trust was better than its peers, this simply highlighted that the NHS was not particularly good at appraisals. • A pilot had been implemented to better align appraisals with objective setting to enable them to cascade down to staff better which would conclude shortly and would feed into the process. JD-T noted that Division D consistently outperformed the other Divisions in terms of completed appraisals. In addition the staff survey showed that they were the only division that achieved a green in terms of an appraisal helping staff to undertake their job. This showed a correlation between the two and wondered what was the learning was. SH noted that Division D had historically had good rates of completion and had been involved in the refresh and had highlighted the need to focus at every level of the team. JH asked whether those within Division D had better promotion and development opportunities which could link back into the value of conducting a good appraisal. SH advised that there was nothing obvious but Division D had some good engagement scores overall but this could be looked at further. GB noted that the new appraisal paperwork had removed the need to consider how an individual contributed to the values of the organisation, and although the values were still referenced, questioned how through appraisal the behaviours and values continued to sit within the process. SH noted that the review of the values work was important and it would be good to look at how that could be brought back into the appraisal process to add value. Decision: The Board noted the report. 5.5 Finance Report for Month 5 IH presented the report and highlighted: • The Trust continued to focus on the underlying deficit, which for months 1 – 4 had been around £3m which had slightly worsened to £3,5m as energy costs started to grow. A deep dive had taken place at the Finance & Investment (F&I) Committee looking at some of the actions being undertaken and some of the future forecasts before the energy cap would come in and whether this would help or otherwise. There would still be a small increase in run rate into the latter half of the year which would deteriorate the Trust’s underlying position as we entered the winter months. • The key drivers were consistent. As well as energy prices, there were some drug costs pressures as we were on a block contract, cost associated with COVID including backfill of staff together with all of the operational pressures that had already been discussed. Page 7 • Cost Improvement Programme (CIP) performance had improved following the introduction of the Cost Savings Group. The Trust was currently achieving more than 80% identified which should increase going forward. In month delivery had also been strong. Everything was being done to try and improve the financial position but there were a number of pressures that were outside our control that would impact this. • Elective recovery framework performance had dipped in line with the operational pressures discussed, but UHS continued to achieve 106%, above the required 104%. UHS was in the top Trusts both in the region and nationally in terms of activity levels compared to 2019/20 levels. However, this was not resolving the waiting list issue that continued to grow. UHS continued to do well in terms of 2019/20 levels compared to other Trusts but this did create a financial pressure. • The Trust had reported a £12m deficit. The Hampshire and Isle of Wight deficit was £53m. This was an outlier within the region, and the region was an outlier nationally. This had resulted in the system becoming an outlier in terms of financial performance which might have adverse consequences going forward including upon the SOF rating. • The underlying deficit reduced the Trust’s cash balance and that may put pressure on our future capital investment programme. KE referred to the financial risks table and asked what the difference was between the original worst case of £57m and the forecast assessments which showed, best, intermediate and worst case? IH noted that the original worstcase scenario had been presented to the Board as part of the planning submissions, to show the range of possible financial outcomes with everything that was known at the time. The current best, intermediate and worst case were the current assessments. KE noted that UHS could not control COVID costs, energy costs and inflationary measures and that this would need Treasury to provide support. IH reminded members that nationally there was a drive to find efficiencies. It was likely that many Trusts would go into deficit this year but it was not clear what the response would be to that. KE commended the work on the CIP which was a fantastic achievement. He questioned whether the position could improve further with more CIP savings. IH advised that a target date of Month 6 had been agreed in terms of everything being identified 100% and the position might improve next month. IH noted that UHS was at 106% activity levels with the national average being around 94%. The 12% from the Elective Recovery Fund (ERF) would be worth about £20m to the Trust. If the Trust had undertaken less activity the Trust’s financial position would be a lot less stark but UHS continued to put patients first and try and balance performance, money and quality. In response to a question from JD-T IH confirmed that as of today and what was currently known, UHS could still achieve the best-case scenario. DAF suggested that in view of what had happened in markets over the recent days it was unlikely that the NHS would want to approach the Treasury. UHS should proceed on the basis that there would be no financial support being provided. In those circumstances the Board would need to consider at what point more significant interventions would need to be made. Page 8 5.6 People Report for Month 5 JD-T noted that this was a new report for the board. Previously the report had been presented to the Trust Executive Committee (TEC) and following discussion in that forum a decision was made that it should be presented to the open board for discussion. SH presented the report and noted that the version before the Board was the detailed report presented to TEC. Going forward a more streamlined report, with key highlights, would be developed for the Board discussion. SH highlighted: • Some of the key actions that had been taken in relation to recruitment and retention and also the cost-of-living crisis. There had been discussions at a previous closed board meeting around concerns in relation to the recruitment and retention of certain staff groups and some actions had been put in place to mitigate those concerns. • SH highlighted the challenges around Advanced Clinical Practitioners (ACPs) and pay rates. A few local organisations including GP practices were providing a differential rate of pay with a higher pay band. In the short term this was being addressed by a recruitment and retention premium to bridge the gap, together with conducting a workforce review that would seek to understand the banding and whether there was a need for a permanent band change. However, it would be important to consider the possible impact on the change to other bands across the Trust and manage that appropriately. • UHS continued to undertake Health Care Assistant (HCA) recruitment well, but the challenge was retention. There were good pathways in place but work was needed to strengthen landing boards and increase the support available in the hubs and implement some band 2 to band 3 progression roles for those who did not want to utilise the nursing apprenticeship route. • Demand on the recruitment team had significantly increased with a 25% increase of requested support. Some additional resource had been agreed to support them both within the organisation but also to increase engagement outside of the organisation. • In terms of cost of living, SH had been undertaking a lot of work with partners across the Trust including trade unions and listening to staff voices. There were a number of elements that were not under the Trust’s control including the national pay award and the rising energy crisis so the approach being taking was to take a balanced and fair approach. A number of things would be implemented which would be highlighted to all staff. A substantial discount was being negotiated in the restaurant to help people to eat a broad range of foods at competitive prices. The cycle to work scheme was being expanded, and there was some targeted support for those with high mileage within the organisation. For the 200 or so families who used the nursery the price was being rolled back to April this year. • The Trust already has a range of general support which would be expanded to make sure that we were targeting the right people. Through a partnership with the ICS we were linking up with the Citizens Advice Bureau to provide really high quality financial advice to our staff. We were focusing on crisis, and working with the Charity, had set up a hardship fund of £20,000 which would be distributed to the most challenging cases where staff had been identified as a particular Page 9 hardship case they would be able to eat free at the restaurant. Arrangements had also been made with a local charity to provide vouchers and food parcels. Discussion had taken place as to whether a food bank should be set up on site which logistically would have been difficult, so the decision to work with the charity was agreed to be the best approach to deliver that service for us. • Discussions had taken place at the Trust Executive Committee (TEC) who had fully supported the measures noting the impact on the nonrecurrent spend. KE suggested that this was a very sensible, targeted group of things to support our people. However, asked if the cost of £2.3m was currently included in the financial reports. IH advised that it was not included although some of the nonrecurrent elements had a funding source so would not hit the underlying position. In terms of annual leave buy out there were accruals from previous years. However, there were some recurrent costs. The measures were targeted, proportionate and in line with the Trust’s values for the current pressures being faced and if the Trust did not do anything it would likely increase costs or consequences elsewhere. DAF noted that the report was the same as presented to the TEC at which there had been a more detailed conversation. It would be helpful to understand which areas of the report were more relevant and appropriate for the Board conversation which could be discussed at the next People and OD POD) Committee meeting. Action: SH. JH supported the proposals within the paper and noted that they had also been presented to the People and OD Committee (POD). POD would be tracking the progress of each of the initiatives to ensure that they were delivering as anticipated. JH asked if the Trust had looked at what others were doing to ensure that we were doing everything possible for our staff. SH confirmed that discussions had taken place locally and that the Trust was one of the first to implement the range of measures which were similar to those of others. Nationally, there had been a push to have a collective response, noting that the NHS employed 1.5m people and that there would be national support that would be available shortly. TP noted the importance of having a people report at the Board and whilst the contents were good suggested that they could be presented in a more accessible way. FM also noted the importance of the report and discussion but wondered what staff morale was. If the finance, performance and people report were considered as a whole it was clear that staff were facing a lot of pressure and there was insufficient staff due to high turnover. The volume of patients was increasing which meant that the staff that the Trust did have, had to work harder and longer with pay that was not great and a cost-of-living crisis to deal with. This must have an impact on staff morale and was there also an impact on patient care? SH noted that morale was challenged which was recognised in the executive updates. The Trust undertook a quarterly staff survey alongside the current national annual staff survey and those results have been included within the report. The recent results discussed motivation, engagement and advocacy in Page 10 the organisation and UHS scores were still consistently in the top 10 of the NHS. However, the entirety of that engagement score was deteriorating. Morale was challenged and how that impacted on care was discussed in other forums. GB chaired the Quality Governance Steering Group (QGSG) which fed into the Quality Committee and focused on quality whether that be from the engagement of our staff or other challenges. GB suggested that it was a mixed picture. People enjoyed working as a team and we can see them pull together and work as a team through the challenges. There were a number of different pockets in the organisation who believed that they were in a worst situation following the pandemic and it was important to move out of that space and recognise this as a whole. In terms of quality, it was important to retain a close focus on quality and in some other Trusts they were starting to experience a significant challenge with regards to their quality indicators. At UHS there were some potential early indications that were being closely monitored. Without a doubt staffing levels, and the way in which we looked at the wards, impacted on patient experience and outcome. JD-T noted that one of the proposals was for staff to be able to sell back annual leave and being able to easily access the bank but if this was considered in the wider context, we had staff who were tired and not able to take leave as they had sold it, and were looking to work extra hours on the bank. How did the Trust manage and balance this? How should we look at the overarching risks for the workforce, and consequently patient care and performance, and what were the things that we needed to do to balance that. It would be helpful if the report could address some of those challenges to help the Board’s understanding. In addition JD-T asked NEDs to feedback what they would want to see within the report to enable an effective discussion. Action: SH and All NEDs JH asked about exit surveys and wondered if there was any information from them that could support our approach. SH advised that approximately 30% of staff completed exit surveys which needed to be increased. Pay for the lower paid staff had become an issue. SH reminded members that he chaired the ICS people officers group and that group had been looking at how collectively they could support retention and were looking to purchase better exit surveys for the system pulling together their collective buying power. Decision: The Board noted the report. 5.4 Integrated Performance Report for Month 5 (part two) Having noted the previous discussions under items 5.5 and 5.6 JD-T suggested that a discussion on the remaining of the IPR would be helpful and the following questions and comments were made: • JB noted that on pages 31 and 35, F1 – F5 this suggested that in terms of digital we believed that this was going to transform our efficiencies but it was not clear what the metrics indicated nor were some of them very high. PG suggested that there was an amazing resource in my medical record which we were not really making the most of. Work was needed to raise awareness with both patients and clinicians. Having used it as a patient it had been really helpful and enabled him to go paperless. JT noted that there was a business case that was overdue Page 11 for my medical record around how we industrialised it across the Trust which should provide some huge benefits and would bring a timeline back as to when this would happen. Action: JT JT noted that there was some big digital change happening with the rolling out of speech recognition and some E tools. In addition it would be helpful to look at the indicators to understand whether they were the right ones and review them as part of the digital updates which could be discussed at F&I. Action: JT The Board discussed the importance of giving people an overwhelming reason to access my medical record noting that the NHS App had initially been used for COVID vaccinations but could now enable people to order prescriptions and book appointments. JD-T noted the Serious Incident reports and the number of harm falls which looked higher than previously and wondered in terms of the pressures we were seeing and the issues around workforce should the Board be concerned about this? GB advised that it had recently been falls awareness week. There had been a number of successful programmes in the Trust including bay watch, but with reduced staffing numbers that had became a challenge and some more deliberate high impact actions were needed to reduce those falls. A deep dive into this would be brought to a future meeting. Action: GB GB confirmed that COVID numbers were rising. There were 66 patients with COVID some of whom were both asymptomatic and symptomatic. 5.7 Break The break took place prior to the Safeguarding Annual Report. 5.8 Safeguarding Annual Report 2021-22 and Strategy 2022-25 JDT suggested that the strategy should be discussed first noting that both had been discussed at the Quality Committee. KMcG presented the strategy which had previously been presented to the Trust Board two years ago before Covid. The strategy had been reviewed and updated in line with new legislation and aligned to UHS values and now included maternity services. Some of the strategy linked to children and adult reviews and making safeguarding personal together with our partners and developing stronger links within maternity, the emergency department and the wider hospital. Joining this up with the domestic abuse strategy and ensuring that we were always improving particularly around training and education including level 3 requirements. In terms of the Annual Report from a children’s perspective there were three main highlights: Page 12 • A significant increase, from 3700 to 6004, in the number of information sharing forms (ICF) which come through the ED where a child may possibly be at risk. In particular numbers had increased in the number of children presenting with mental health problems, particularly the 0 – 4 age group. This had been discussed at the Health Safeguarding Looked After Children Partnership who were looking at the 0 – 19 service provision which had changed significantly with COVID and a possible pattern of children of parents accessing through ED rather than going via their GP. • In terms of mental health, for any child who presented in the ED with a mental health condition an ICF would be completed. The number of presentations remained high. Alongside this the number of deliberate harm incidents had risen from 676 to 898, drugs and alcohol referrals had risen as had assaults over the preceding year. • Level 3 safeguarding training was at about 61%. There were two main reasons for this which was capacity and demand for the service and also a change of reporting requirements impacting just over 2000 staff. Training was on the Integrated Care Board (ICB) Risk Register as it was a wider system issue. In terms of the Annual Report for adults CM highlighted the following: • A 31% increase in safeguarding activity from the previous year with a 162% increase in Section 42 inquiries. This was due to a number of reasons including the impact of COVID including the removal of social distancing rules. • A 35% increase in the number of allegations made against people in a position of trust which was something that was being seen across other local provider organisations. These were highly sensitive cases and required significant safeguarding oversight and management alongside collaboration with HR colleagues and the relevant clinical areas, which had a significant impact on the team. • The creation of a new Mental Capacity Act (MCA), Deprivation of Liberty (DoL) and Liberty Protection Safeguards (LPS) team who supported people over the age of 16. Both locally and nationally this was one of the first teams that had been established. The team had worked to embed MCA as every day business which was key to the preparation for when LPS become law later next year or early the following year. • In terms of Learning Disability and Autism there was a lack of local provision which had been acknowledged by the ICS and work was underway in relation to service review and what this needed to look like going forward. GB thanked the team noting how hard they worked to safeguard vulnerable adults and children. GB referenced the Panorama programme that had aired the previous night in terms of a number of safeguarding issues against a Mental Health Trust. Whilst often allegations against staff were not grounded they were taken very seriously and investigated thoroughly. JB noted the 35% increase against staff and wanted to understand what the outcomes of the investigations were and whether they were justified and whether allegations were being made against different groups. CM advised that one of the key areas of allegations focused on restraint and that the level Page 13 of restraint applied was disproportionate. These would always be reviewed. Security staff worked in pairs and wore body cameras which would always be reviewed. There had not been any cases recently where that had proved to be an issue. Although there had been a big increase the total number of cases was 38 so not large numbers. The previous year there had been 23 cases. CC questioned what element of this sat within the Trust and what sat with the ICS? SH noted the importance of remembering the broader picture. Nationally there had been a rise of safeguarding incidents, but it was important to remember that our workforce formed part of that population and had struggled with lockdown and were experiencing hardship. JD-T noted the need for a system approach to manage the increased mental health demand. However, safeguarding was a key focus for the Care Quality Commission (CQC) inspections post COVID, and a local provider had recently been deemed to be inadequate due to safeguarding issues and was an issue for UHS to pay particular attention to. KMcG noted that through legislation children had the Local Area Designated Officer (LADO) which was lacking in adults, which provided a really strong link with that external partner. TP noted that there had been a detailed presentation on this in the Quality Committee. This was a national trend in increased safeguarding problems. Whatever pressure we are put under it was important not to let our safeguarding procedures slip and it needed to be protected to ensure that it worked well. Decision: The Board received the report. 5.9 Medical Appraisal and Revalidation Annual Report including Board Statement of Compliance PG presented the report which was a statement of compliance with the medical regulations and had a robust and strong process in place. PG noted that a new appraisal system had been introduced which had been well received and enabled the ability for medical staff to collect all of their appraisal information within one system instead of the previous three systems. This was beneficial for not only staff but also for those managing the process as it provided real time feedback and information both from a quality assurance perspective but also would enable better management of the process and improve appraisal rates in the future. JD-T asked whether the doctor appraisal information was included within the IPR information that the Board received and SH confirmed that it was reported separately but included in the report and currently stood at 76.7%. CC suggested that the system was good but asked whether everyone was using it. PG confirmed that the system was a mandatory one and would be the only system going forward in the future. In terms of how many staff had undertaken the process this was a little ahead of the rest of the staff. However, the system enabled us to keep better track as people would need to have completed four appraisals within the previous five years to go forward with revalidation which provided a good incentive to keep on top of this. Page 14 JD-T asked for Board members to confirm that they approved the statement of compliance. Decision: The Board noted the report and approved the statement of compliance. 5.10 Clinical Outcomes Summary PG introduced the comprehensive summary noting that the clinical lead who had ran the service for a number of years, had now left UHS and a process of recruitment was currently underway which would provide an opportunity to refresh and review. DW presented the paper and focused on the outcome programme which was unique to UHS, with 64 services out of 86 reporting their outcomes. A total of 484 outcomes had been reported all of which had been reviewed by TP via the Quality Committee. There was a thriving clinical audit programme in place. The outcomes reported per care group covered a large proportion of patients and dealt with both national and international work. In particular DW highlighted: • The Research and Development (R&D) team and the work that they had undertaken internationally on the COVID booster trial. • The Bone Marrow Transparent unit. • Maternity and the nest support teams who focused on women who may need additional support because of serious mental illness, or they were from socially challenging situations, or were non-English speaking, addiction, were homeless or were suffering from domestic abuse and other difficult situations. 12% of patients that were being seen in maternity required nest care. KE asked why 18 services were not reported and DW advised that it was because they did not have the mechanisms in place to know what their outcomes were and work was underway to support them to develop those processes. KE asked whether any of the reds within the report were really poor and JD-T noted that the data used was for 2020 and did not understand why it was so out of date. TP advised that data was provided from national audits was often two years behind, because there was a year of collection, a year of analysis and then it would be published. Within his experience he had never come across a hospital that had measured nearly 500 clinical outcomes let alone p
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Trust-governance-and-corporate-docs/2022-Trust-documents/Papers-Trust-Board-29-November-2022.pdf

Your steroid medication and emergency card - patient information

Description: This factsheet explains what adrenal insufficiency and adrenal crisis are, the symptoms to look out for and what to do if you feel unwell.
Url: /Media/UHS-website-2019/Patientinformation/Medicinestherapiesandanaesthetics/Your-steroid-medication-and-emergency-card-3997-PIL.pdf

WDES report and action plan 2024

Description: Workforce Disability Equality Standard Annual Report 2024 1 Executive Summary The Workforce Disability Equality Standard (WDES) is a set of ten metrics that helps NHS organisations to compare the experiences of disabled and non-disabled staff. These metrics are necessary because evidence and research shows that the level of reported discrimination and inequality for disabled people working in the NHS is higher than any other protected characteristic. The WDES was commissioned by the Equality and Diversity Council (EDC) and developed through extensive engagement with Trusts and key stakeholders. It is mandated through the NHS Standard Contract. Implementation of the WDES became an obligatory requirement for national healthcare organisations in 2019, so this is the sixth reporting year for the WDES metrics. It is important to note that the data sources for the WDES metrics are a combination of the 2023 National Staff Survey, and workforce data reported at the national data collection cut-off date of 31 March 2024. All NHS organisations are required to produce an action plan to articulate the response to the WDES results, this can be found within the appendices (appendix 1). Through the implementation of the UHS Inclusion and Belonging Strategy 2023-2026, we have incorporated the WDES actions contained in this report into the work programme that will deliver the strategy. The key findings from the 2024 submission show: 1. Disabled staff represent 10.97% of the workforce. Overall, this is a 0.19% decrease from 2023 data, this is not representative of wider society which currently shows around 25% of the working age population has a disability. Further analysis shows there has been a minimal increase in representation of disabled staff within the nonclinical workforce and a decrease across the clinical workforce with an exception to cluster 4 (band 8c to 9 and VSM). 2. Data suggests that disabled shortlisted applicants are 0.96times likely than nondisabled applicants to be appointed to a vacant post. This is a minimal CHANGE in comparison to last year and suggests that people with disabilities are equally likely to be appointed than those without disabilities or long term illness. A score of 1 indicates equal opportunity and anything under 1 indicates more likely, over 1 is less likely. 3. In line with technical guidance, this data does not need to be analysed due to less than 10 capability processes. However there has been an DECREASE of disabled individuals entering into the capability process in comparison to 2023. 4. Disabled staff are more likely than non-disabled staff to experience bullying, harassment and abuse from patients, service users, relatives, members of the public, managers and colleagues than non-disabled counterparts, WITH THE DISPARITY GAP WIDENING THIS YEAR. 5. Disabled staff are less inclined to believe the Trust provides equal opportunities for career development as compared to those staff without disabilities. 6. Disabled staff feel more pressure than non-disabled staff to come to work when unwell. 7. Disabled staff are less satisfied than non-disabled staff that the Trust values their work. 8. There has been A MINIMAL increase in Disabled staff saying that UHS have made adequate adjustments for them to carry out their work. 9. The staff engagement score for disabled and non-disabled staff is on par with each other and with that of overall staff engagement at UHS. 10. There continues to be no declared representation of disabled staff on the Trust Board. 2 In relation to the 10 metrics, improvements can be seen in metric 3, 4a, 4b and 7. However these could be argued to be insignificant in their minimal nature. Unfortunately there has either been a worsening or data has remained static in all other metrics. With this in mind, we are committed in continuing to have meaningful engagement with our disabled staff to co-create short and long-term actions with the support of the Long-term Illness and Disability Network to help move the Trust towards disability equality. Conclusion and recommendations The WDES data 2024 confirms that the priorities in our Inclusion and Belonging Strategy are the right ones, to improve or eliminate disparity between experiences of people with long term illness, and disability and those without. We must maintain our focus on: 1. Inclusive recruitment practices and equal opportunities: Large scale review of current recruitment practices to eliminate bias from the systems and promote inclusivity. The Inclusive Recruitment Programme will ensure that recruiting managers are trained in inclusive recruitment techniques and criteria based methods will ensure bias is removed. We will align with the national programme for overhauling recruitment and promotion and contribute to this work wherever possible. The implementation and embedding of processes that ensure inclusive recruitment and equal opportunities for all. Our talent management programme will provide further opportunities for people with disabilities and long term illness to access development. 2. Workforce reflecting our wider communities: In line with the Inclusive Recruitment programme, we will be increasing efforts to make recruitment processes inclusive and therefore not post any barriers to the community in terms of applying for roles at UHS. We will be working with specialist partners to help us to self-assess our environments for people with disabilities or long term illness. Our recruitment outreach will also work more with local communities to attract people from the city from diverse backgrounds. We will provide career toolkits for all people who are unsuccessful at interviews to help them to succeed next time. We will be continuing to promote declarations to ensure we can measure our representation across our workforce and consider a target for % of people with disabilities and long term illness in our workforce which is in line with the reported demographic of our communities. 3. Safe and healthy working environments: Our Inclusion and Belonging strategy states a clear intent for UHS to become an anti-racist and anti-discriminatory organisation. We aim to decrease disparity of experience by 5% across all indicators in the WDES which will either reduce by half or eliminate disparity altogether. We will be working closer with colleagues who lead on hate crime, violence and aggression to ensure robust mechanisms for reporting of incidence and the data is used to steer accountability and meaningful action. We will identify mechanisms and root causes of the disproportionality of staff with disabilities or long term illness experiencing discrimination, harassment, bullying and/or abuse and in turn whether there are trends within the Trust that need targeted action. The link to the leadership and management work programme is a critical enabler of creating safe and healthy work environments. Improve the day-to-day experience of working at the Trust for disabled staff, ensuring their experience is free from discrimination, bullying, harassment and/or abuse and individuals feel they are valued. 3 4. Inclusive leadership and management: Ensure leaders and managers are clear on their accountabilities with regards to supporting people with disability and long term illness and the responsibilities they hold to deliver the actions within the Inclusion and Belonging strategy. To have development opportunities in supporting disabled staff and those who may identify with a protected characteristic. That all leaders and managers understand their own bias and can access learning in terms of how they behave, lead and make decisions. To support leaders and managers to understand their role as allies and role models, and how to challenge behaviours or actions that are not in line with Trust policy or values. To support leader and managers to develop greater awareness of the legal aspects of their roles in relation to equality, and how diversity and difference can enhance their team delivery and performance. Ensure leaders and managers have learning development opportunities to support individuals with disabilities and know their responsibilities in relation to the inclusion agenda and specifically actions required to ensure people with disabilities feel valued in the wider workforce. Our action plan which can be found in the appendices will continue to be reviewed. The proposed actions will continue to be discussed in terms of progress at Equality, Diversity and Inclusion Council, Equality, Diversity and Inclusion Committee and People and Organisational development Committee. This analysis report along with the relevant action plan will be published on our public website by 31st October to meet the requirements set by the Workforce Disability Equality Standard (WDES). 4 Appendices Appendix 1: WDES Action Plan 2024 WDES Themes / Areas Proposed actions 1: Workforce reflecting our communities, at all roles, at all levels; ensuring those who are underrepresented groups can access support to thrive, excel and belong within their roles. a) To continue to develop and support an annual programme of Positive Action Programmes both UHS and HIOW system wide; for those who have disabilities and/or long-term conditions as well as other protected characteristics. Acknowledging individuals experience of barriers to promotion, development and career progression. Continued sponsorship will be offered to delegates post completion of a programme including career coaching, career development workshops, reciprocal mentoring and an offer of attending a mock development centres. b) Talent development programme for individuals with a disability and/or longterm condition. Supporting the career development, pathways, training and development of individual’s, ensuring talent workstreams and pipelines that encourage opportunity at earlier stages than current and may include longterm career planning. Develop a talent pipeline/talent management plan to include stretch activities, secondments, shadowing, specialist training, qualifications, coaching and mentoring where it is anticipated a career change will be necessary. This will look at strengthening as well as unearthing our current talent within UHS and ensuring that individuals continue to thrive, excel and belong and we support them to do this. c) Continue to build on newly found working relationship with Southampton job centre. Continue to liaise, attend and promote UHS as an employer of choice to disabled individuals within the wider community, the support that is offered and the career opportunities that available including that of our volunteering roles. Responsible for Actions Organisational development team and Partner/ Head of OD Organisational development team and Partner/ Head of OD Organisational development team and Partner/ HR Recruitment team and Inclusive recruitment working group Deadline / review date August 2025 September 2025 April 2025 5 Appendix 1: WDES Action Plan 2024 2: Safe and healthy working environments, free from aggression, hate and discrimination d) Propose and agree a declaration target throughout the organisation for those who identify as having a disability and/or long-term condition. Representation within wider society is currently 22%. To achieve this workstreams will include more in-depth narrative about declaration of disability and its importance within the onboarding and induction process within UHS and will include literature on the processes of how to declare. Continue with lived experiences pieces and continue to socialise within internal and external communications methods. Continue to at every opportunity irradicate stigma surrounding what happens if an individual declares a disability and continue to showcase the support we offer to individuals within the organisation as a disability confident employer. a) Fully continue to support established divisional EDI Steering Groups to drive actions and improvements derived from disability specific metrics throughout all teams, care groups and divisions. Organisational development team and Partner/ Head of OD/ Chief People Officer Organisational development team and Partner/ Head of OD b) Develop a culture of Allyship: All staff to participate in Actionable Allyship training by 2024. The Actionable Allyship – Stop.Start.Continue programme will continue on the statutory and mandatory matrix for all staff to complete. This will provide individuals with the insight, knowledge and skill and to be active allies within a moment of challenging non inclusive behaviours and supporting our statement in being an anti-discriminatory organisation and in turn decrease the disparity of experience between those who have disabilities and those who don’t. Completion of the training will be possible by virtual, face to face or E-learning package. Organisational development team and Partner July 2025 September 2025 April 2025 c) Develop a process where conversation of long-term conditions and disabilities are standard processes within 1.2.1’s, wellbeing conversations and appraisal conversations. Highlighting all individual’s responsibility to show allyship and continue to support individuals throughout their work at UHS. Organisational development team and Partner August 2025 3: Recruitment processes which free a) Implement a work programme to review and improve the equity of recruitment Organisational processes and practices that impact individuals with a disability and/or long- development team and term condition. Working group to include partnership with our Staff Network Partner/ HR Recruitment April 2025 6 from bias and are inclusive 4: Inclusive leadership and management 5: Networks and partnerships that thrive and support creation of leads and representation from our diverse workforce. The working group will look at each stage and deliver on recommendations from engagement within the process. Align to the NHS People Plan England/Improvement High Impact Actions and Inclusive Recruitment Programme. b) Inclusive training, learning and development for all people involved in recruitment and attraction. team and Inclusive recruitment working group Head of Talent attraction April 2025 / HR Recruitment Team c) Deliver a truly Disability friendly process with disability inclusive practices as standard. This will include processes from pre-employment to recruitment, through to employment and the onboarding process. d) Develop an inclusive employer recruitment campaign in embedding our Disability confident status and our intentions to move towards disability confident leader within the next 3 years. a) Board and Senior leadership programmes to include the element for all leaders plus strategic and cultural responsibilities for equality, diversity and inclusion. b) Inclusive leadership and management as part of the UHS Managers Induction Programme. c) Implementation of ongoing learning and development opportunities to enable leaders and managers to role model inclusive behaviours every day. For example: - Inclusive meetings - Agile working - Equality impact assessment - Adjustments required to enable people to thrive and be at their best at work. - Creating environments for people to succeed - Inclusive leadership behaviours aligned to our values a) Development programmes for Networks and Network Chairs clearly identifying roles to enable leadership of highly active networks, clarity of Head of HR / Organisational development team and Partner Head of HR / Organisational development team and Partner/ LID Network Head of OD Organisational development team and Partner Organisational development team and Partner/ Head of OD Head of OD April 2025 April 2025 July 2025 July 2025 September 2025 September 2025 7 an inclusive and safe place to work. purpose and future plans. Development opportunities will include coaching, mentoring, influential leadership skills, recognising their contributions as career development. b) Establish a workplace adjustments working group to develop and implement appropriate guidance throughout the organisation. With the additional rollout of a workplace adjustments passport. Organisational development team and Partner/ Head of OD/ Occupational health July 2025 Appendix 2 Metric 1: Percentage of staff in AFC pay bands or medical and dental sub-groups and very senior managers (including executive board members) compared with the percentage of staff in the overall workforce. Fig. 1 Non-Clinical workforce presentation 2023 2024 Pay clusters: Nonclinical Total staff in pay cluster Total disabled Total non- Total unknown Total staff in staff disabled staff staff pay cluster Total disabled Total non- Total unknown staff disabled staff staff Cluster 1 Bands 1-4 2023 13.1% 73.2% 13.7% 2056 13.9% 75% 11.2% (265) (1481) (277) (285) (1541) (230) Cluster 2 8 Bands 5-7 Cluster 3 Bands 8a8b Cluster 4 Bands 8c-9 & VSM 781 11.7% (91) 223 12.1% (27) 93 3.2% (3) 79.3% (619) 75.8% (169) 84.9% (79) 9.1% (71) 12.1% (27) 11.8% (11) 802 13.2% (106) 237 12.2% (29) 98 5.1% (5) 79.2% (635) 76.4% (181) 87.8% (86) 7.6% (61) 11.2% (230) 7.1% (7) 9 Fig 2. Clinical workforce representation 2022 2024 Pay clusters: Clinical Cluster 1 Bands 1-4 Cluster 2 Bands 5 – 7 Cluster 3 Bands 8a –b Cluster 4 Total staff in pay cluster Total disabled staff Total non- Total unknown Total staff in disabled staff staff pay cluster Total disabled Total non- Total unknown staff disabled staff staff 2478 13.4% (333) 78.7% (1949) 7.9% (196) 2459 12.7% (312) 80.0% (1989) 6.4% (158) 5593 12.3% (688) 76.5% (4280) 11.2% (625) 5875 11.3% (666) 79.4% (4662) 9.3% (547) 427 14.3% 66.0% 19.7% 471 (61) (282) (84) 13.2% (62) 71.3% (336) 15.5% (73) 10 Bands 8C-9 & VSM 46 Cluster 5 Medical & Dental 948 staff, consultants Cluster 6 Medical & Dental 580 staff, non- consultants career grades Cluster 7 Medical & Dental 1103 staff, medical & dental trainee grades 19.6% (9) 6.12% (58) 5.34% (31) 2.81% (31) 52.2% 28.3% 43 (24) (13) 76.27% 17.62% 940 (723) (167) 86.38% 8.28% 125 (501) (48) 94.74% (1045) 2.45% (27) 1164 20.9% (9) 6.06% (57) 4.80% (6) 55.8% (24) 78.62% (739) 69.60% (87) 23.3% (10) 15.32% (144) 25.60% (32) 2.49% (29) 92.44% (1076) 5.07% (59) Owing largely to a successful risk assessment campaign throughout the Covid-19 pandemic, disclosure rates in 2020 and 2021 were close to accurately reflecting the local population. However, the 2023 and the current 2024 data shows either a static or steady yet continual decrease in declaration rates in terms of the overall representation of disabled staff within the UHS workforce. In the non-clinical workforce there is a slight exception of minimal increases throughout each cluster. Yet, there is a decrease in representation of disabled staff across all clusters within the clinical workforce. 11 Metric 2: Relative likelihood of disabled staff compared to non-disabled staff being appointed from shortlisting across all posts. Relative likelihood of staff being appointed from shortlisting across all posts Disabled 2024 Non-Disabled Number of shortlisted applicants 630 7736 Number appointed from shortlisting 140 1653 Relative likelihood of non-disabled staff being 0.96 appointed from shortlisting compared to disabled staff This metric indicates that non-disabled staff are 0.96less likely to be appointed from shortlisting than disabled staff. This compares relatively equal and remains static since the 2023 submission which showed a relative likelihood of 0.89. a score below 1 indicates positive equal opportunity. Metric 3: Relative likelihood of disabled staff compared to non-disabled staff entering the formal capability process, as measured by entry into the formal capability procedure. Relative likelihood of staff entering the formal capability process, as measured by entry into a formal capability process Number of staff entering the formal capability process Disabled 1 2024 Non-Disabled 11 12 Relative likelihood of Disabled staff entering the 0 formal capability process compared to non- disabled staff In line with WDES technical guidance, there is no requirement to analyse the relative likelihood where there are fewer than 10 cases reported involving disabled staff. However it should be noted that there has been a slight decrease of cases since the 2023 data submission. Metric 4: (Part A) Percentage of Disabled staff compared to Non-Disabled staff experiencing harassment, bullying or abuse from patients/service users, their relatives or other members of the public, managers and other colleagues; (%s of total participants in staff survey related question, not % of total workforce) Harassment, bullying or abuse from patients/service users, their relatives, or other members of the public: 2023: Disabled – 30.5%, Non-Disabled – 23.5% 2024: Disabled – 29.02%, Non-Disabled – 23.59% There has been a slight decrease in numbers of disabled staff reporting they have experienced harassment, bullying or abuse from patients/service users, their relatives or other members of the public. This has decreased by 1.5% from 30.5% (2023) to 29% (2024). Harassment, bullying or abuse from managers: 2023: Disabled – 11.6%; Non-Disabled – 6.8% 2024: Disabled –13.32%, Non-Disabled – 8.26% The data indicates a 1.7% worsening from 11.6% to 13.3% for those with disabilities experiencing harassment, bullying or abuse by managers. The disparity between disabled and non-disabled staff experiencing harassment, bullying or abuse by a manager has widened to 5.1%. 13 Harassment, bullying or abuse from other colleagues: 2023: Disabled – 21.3%; Non-Disabled – 15.3% 2024: Disabled – 25.84%, Non-Disabled – 16.19% There is a significant 4.5% increase from 21.3% to 25.8%in disabled staff experiencing harassment, bullying or abuse from other colleagues. it remains a concern that 9.6% more disabled staff overall are experiencing such behaviours compared to non disabled staff, with the disparity gap widening by 3.6%. Metric 4: (Part B) Percentage of Disabled staff compared to Non-Disabled staff saying that the last time they experienced harassment, bullying or abuse at work, they or a colleague reported it. 2023: Disabled – 47.1%; Non-Disabled – 45.8% 2024: Disabled – 50%, Non-Disabled – 48.75% The 2024 data indicates a markable improvement of the likelihood of this indicator from 2023 of 2.9%. interestingly, the indicator for nondisabled has also improved. Metric 5: Percentage of Disabled staff compared to Non-Disabled staff believing that the Trust provides equal opportunities for career development. 2023: Disabled – 60.6%; Non-Disabled – 63.0% 2024: Disabled –57.91%, Non-Disabled – 62.33% This indicator shows that disabled staff are now 2.7% less likely to think that the trust offers equal opportunities for career progression in comparison to the 2023 data collectionwhich did show a slight improvement. It should also be noted that Disabled staff are 4.4% less inclined to believe the Trust provides equal opportunities for career development as compared to those staff without disabilities, with the disparity gap widening by a further 2%. 14 Metric 6: Percentage of Disabled staff compared to Non-Disabled staff saying that they have felt pressure from their manager to come to work, despite not feeling well enough to perform their duties. 2023: Disabled – 26.9%; Non-Disabled – 19.0% 2024: Disabled – 26.93, Non-Disabled – 16.36% Data submission shows 26.93% of Disabled staff felt pressure to come to work despite feeling unwell, in comparison to 16.36% of non-Disabled staff. This shows no improvement for disabled staff and a improvement of 2.6% for non-disabled staff. It remains evident that a disparity of experience between Disabled and non-Disabled staff of 10.6%, widening by a further 2.7%. Metric 7: Percentage of Disabled staff compared to Non-Disabled staff saying that they are satisfied with the extent to which their organisation values their work. 2023: Disabled – 39.8%; Non-Disabled – 48.7% 2024: Disabled – 39.74%, Non-Disabled – 49.53% The 2024 data submission shows an unremarkable decrease in Disabled staff perceptions on feeling valued by the organisation, with Disabled staff reporting 39.74% Metric 8: Percentage of Disabled staff saying that their employer has made adequate adjustment(s) to enable them to carry out their work. 2023: 81.0% 2024: 81.3% There has been a 0.3% increase in staff saying that UHS have made adequate adjustments for them to carry out their work. Metric 9: (Part A) The staff engagement % score for Disabled staff, compared to Non-Disabled staff and the overall engagement % score for the organisation. 2023: Disabled – 6.8%; Non-Disabled – 7.2%; UHS overall 7.1% 15 2024: Disabled – 6.70%, Non-Disabled – 7.15% UHS overall 7.04% It is reassuring to note that the staff engagement score for disabled and non-disabled staff is on par with each other and with that of overall staff engagement at UHS, despite overall engagement for this year having decreased. Metric 10: Board Voting by % disability 10.97% of the UHS population have declared a disability. There are no Trust Board members (voting or non-voting) who have declared a disability or long term illness. 16
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Equality-reports/UHS-WDES-report-and-action-plan-2024.pdf

Changing direction in severe anorexia

Description: Changing direction in severe anorexia
Url: /HealthProfessionals/Clinical-law-updates/Changing-direction-in-severe-anorexia.aspx

Symptom and consequence: not interchangeable

Description: A court considers whether a patient with fluctuating capacity should be compelled to have haemodialysis at times when he refuses it.
Url: /HealthProfessionals/Clinical-law-updates/Symptom-and-consequence-not-interchangeable.aspx

Can the Mental Health Act enforce blood transfusion?

Description: A court considers whether a blood transfusion can be administered compulsorily under the Mental Health Act.
Url: /HealthProfessionals/Clinical-law-updates/Can-the-Mental-Health-Act-enforce-blood-transfusion.aspx

UHS Inclusion and Belonging Strategy

Description: Our strategy sets out clear actions we will take to make UHS a place where every person feels they belong and feels safe to carry out their work free from violence, bullying, harassment and abuse, and it sets the direction for us to ensure our workforce is representative of the communities we serve.
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Equality-reports/uhs-inclusion-and-belonging-strategy.pdf

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