Summary Report on Consultation

Integrated Business Plan – Report on Consultation

SUMMARY REPORT ON CONSULTATION

BACKGROUND

1. Name of the applicant Trust

United Bristol Healthcare NHS Trust

2. Areas served by the Trust

Bristol, South Gloucestershire, North Somerset and the wider catchment area for tertiary services.

3. Contact details of the person responsible for consultation

Lindsey Scott Chief Nurse and Director of Governance United Bristol Healthcare NHS Trust Trust Headquarters Bristol BS1 3NU

01179283601 [email protected]

ABOUT THE CONSULTATION

4. Date of consultation

From: 2nd April 2007 To: 25th June 2007

5. Which media were used for the consultation?

Full consultation document in hardcopy √ Summary consultation document in hardcopy √ Web-based consultation documents √ Other languages versions On request Large print versions On request Children’s version √ Audiotape On request

A full schedule of all of the consultation activity chronologically listed is at appendix one. This also highlights by colour coding whether the activity was targeted at everyone, the public, staff, patients and carers, stakeholders or seldom heard groups.

9th July 2007 1 Integrated Business Plan – Report on Consultation

In order to ensure wide coverage we also provided the following:

 Posters distributed within the Trust and externally [health centres, libraries etc].  Banners at the main entrances of the hospitals in the Trust [5 in total].  Feedback forms for people to give us their views and thoughts.  Membership forms.  Information on an external website and an internal intranet site.  PowerPoint presentations for use in meetings and for presentations.  Displays in the main entrances of the hospital sites [12 in total].  Letters to all staff with payslips and intranet notice.  Information for patients on bedhead services screens.

During consultation there were 2,953 hits on the foundation trust website.

The table below summarises the activity in terms of the number of events of a certain type and the coverage, such as numbers attending or circulation audience.

Audience Activity Numbers Staff Internal Newsletter articles and adverts. 8 Staff Staff meetings, presentations, briefings 52 in total Total attendance 736 Stakeholders Personal letters from Chief Executive 76 in total Patients and Targeted letter / information to GPs surgeries, 137 GP Surgeries Public libraries and schools 33 Libraries Patients and Targeted letter / information to community groups 67 Groups Public 200 Expert Patient Panel members 321 Schools Public Articles in external newsletters 10 separate external newsletters 2,100 groups covered Public Information on external / other websites 2 external websites Patients and Presentations to patient / community meetings / 16 meetings Public groups Total attendance 137 in 13 meetings / 3 not known Stakeholders Stakeholder Meetings 17 meetings Total attendance 140 Public Public Meetings 5 Total attendance 5 Public Roadshows Tesco’s Eastville [5], Bus Station and 7 Temple Meads

6. Number of formal responses received

Type of Response Number Hardcopy using the proforma provided 94 By telephone 3 Verbally at meetings 35 Stakeholder Meetings 17

Appendix two gives more detail on the 94 individual responses received and Appendix three gives more detail from the meetings held both internally and externally.

7. Was the pattern of responses to the consultation in line with the demography and geography of the area? Were there any areas or groups that were not adequately represented in the responses received? Please provide explanations where necessary.

Geographically we tried to cover the three local government areas from which the majority [85%] of our patients come from. This was North Somerset, South Gloucestershire and Bristol. The mail outs and posters sent out either generally e.g. to health centres and libraries, or specific letters with information and invites to meetings were across all three areas. There were three public meetings in Bristol [North, Central and South] and one each in South Gloucestershire and North Somerset. For Bristol, the main catchment area for the Trust, there were seven roadshows including five at the Tesco in Eastville and one each at the Bus Station and Temple Meads Railway Station. It was anticipated that the latter two would capture commuters from North Somerset and South Gloucestershire.

We also targeted the minority and seldom heard groups in the following ways:

Internal  Staff briefings for those who do not have access to the internet. 6 - in total  Presentations to the Trust Equality and Diversity Group, and the Black and Minority Ethnic Group Forum External  Personal letter and information to Seldom Heard minority group leaders.  British Sign Language Forum.  Summary document sent out in Black Development Agency newsletter reaching 200 Black and Minority Ethnic groups.  Bristol Older Persons Forum.  Meeting with local faith group leaders.  Trustees for West of England Centre for Integrated Living [Disabled and Elderly].  Barton Hill Settlement Group [Substance Misuse Users / Homeless].  Bristol Deaf Centre.  Shop Mobility Trustees Meeting [Disabled and Elderly].  Royal National Institute for Blind People Social Event.  Newsletter article Royal National Institute for Blind.  Signpost – members of Black and Minority Ethnic groups.  Meeting at Jamia Mosque Totterdown.

Due to the large number of children and young people treated by the Trust, a particular emphasis was placed on consulting with them including the following activities:

 Summary documents to the Work and Enterprise Network Meeting of Bristol Education Heads.  Personal letter and information to all schools in Bristol, North Somerset and South Gloucestershire.  Bristol City Youth Forum.  Article on North Somerset Primary Times.  Children’s membership competition sheet.  South Gloucestershire Young People Network Seminar.  Ashton Park School Council.  Article for Totterdown Children’s Afterschool Club.  Hillcrest Primary School Council.

An equality impact assessment was undertaken at the start of consultation to assess if the process would disadvantage any of our communities, and the results of this directed the activities that were carried out during consultation.

The Bristol Health Services Plan consultation was carried out in 2004 and there continues to be some local resistance to some elements of that plan, for example the planned changes at North Bristol Trust. This was reflected in a significant number of the individual responses opposing our plans for foundation trust status, where people took the opportunity to comment on the outcomes of the Bristol Health Services Plan consultation.

It is also worthy of note that North Bristol Trust undertook their consultation on foundation trust status in 2006. This resulted in a significant number of community groups declining our offer to meet with them to explain our application. North Bristol Trust has given us permission to use the general feedback from their consultation as intelligence on what people in Bristol generally think about foundation trusts.

ABOUT THE COMMENTS

8. Responses received from major stakeholders?

The full details of responses are at appendix three and they are summarised in the table below.

Broadly Broadly Broadly Main Issue Raised Name in Neutral Opposed Favour Joint Overview Y Very positive about increased local involvement, and Scrutiny decision making and involvement with Avon Wiltshire Committee Partnership. Positive feedback regarding proposal for Bristol, South elections. Slight concerns regarding the risk involved in Gloucestershire making local decisions and regarding the breaking up of and North services. Somerset Suggested using South Bristol Councillors and Councillors who live in South Bristol to help membership grow.

Broadly Broadly Broadly Main Issue Raised Name in Neutral Opposed Favour South Y Supports proposals providing positive response. Gloucestershire Support for the Members Council proposed with PCT specific suggested 3 additions to strategic aims: - Local Authority children’s director - Access and parking - Serving the community. Stressed the importance of the appropriate representation of children’s service. Support the idea to share the Integrated Business Plan. Fully support the opt-out approach to membership. Highlighted the importance of community and voluntary sector. Would wish to continue to be involved in developing the Trust strategy. Bristol PCT Y Full support of this timely application. Suggests that UBHT should expect competition and the PCT emphasises the alignment of Foundation Trust Status with contestability. Considering up to 7 Executive Directors on the Board. Comment relating to UBHT considering how to select one or more community groups. North Somerset Y Supportive of plans and agreed that FT Status would PCT allow quicker decision making and allow more investment in improving services. Welcomed assurance that Trust would continue to work as partner with major commissioners particularly in continuing to reduce avoidable hospital stays. Trust welcomes representation on the governing body and agrees that there should be a mix of roles represented from the PCTs. Patient and Public Y General feeling that assuming financial stability of the Involvement (PPI) Foundation Trust, the proposals would benefit local Forum people. Doug Naysmith Y Supports Trust in their application. Highlights concerns MP (Member of relating to the principle of Foundation Trusts Parliament for summarised as : Bristol North -The level of competition that will occur locally West) -Neglect of smaller services less financially viable. -Dual role of chair of Membership Council and Board. Highlights the importance of making services more local and working with other trusts as a comprehensive service. Also emphasises the need to train members of the Council and the need for administration and recording of meetings. University of Y The University fully understands the value of Bristol appointing a governor to the Council of Governors particularly to ensure that clinical research and teaching realises its full potential. The University wanted clarity whether they could nominate a non-executive director. Recommended stating and emphasising the importance

of academic affiliations, research and education to the Trust which is necessary to maintain interest of academic partners. Broadly Broadly Broadly Main Issue Raised Name in Neutral Opposed Favour University of the Y Fully supports application with particular support of the West of England proposed governance arrangements and membership of Council. Engaged in discussion regarding implication for strategic aims for teaching in future and appropriate representation from UWE. The University is keen to appoint a governor to the Council of Governors, and understands the value of this. Great Western Y Supportive of application and pleased to accept a place Ambulance as a governor. Had some queries about the logistics of Service having both non-foundation and foundation trusts within the NHS. Some concerns relating to the dual chairing of the Board and Trust. Also raised concern about how people understand or identify with UBHT. Avon and Y Full support of proposal and keen to see continued Wiltshire Mental commitment to city centre emergency services. They Health are keen to be involved and to appoint a governor they Partnership NHS also want to learn from the Trust for their Foundation Trust Trust application. Particular interests in focussing more on; substance misuse, alcohol and drug needs and services and liaison psychiatry for the elderly and children. Highlight need to look at 16yr cut-off in the carer groups. Weston Area Y Supportive of application with some comments about Health NHS Trust the sustainability of the Trust in relation to the size and the CEO leaving. Required some reassurance regarding the Bristol Health Service Plan not being lost and being implemented. Suggested that there was disproportionate representation of tertiary areas- change to 2 and 6 for local. Requested more formal links between the Trust at board level and discussed rationale for them not having a place. North Bristol Y Supportive of application. Expressed that consultation NHS Trust material and website are very clear. Need to ensure that recruitment of patient data in recruiting members abides with data protection. Above and Y Supports application and keen to support Trust in Beyond (The developing strategy. Charitable Trusts for the United Bristol Hospitals) Bristol Compact Y Positive about emphasis on ‘governance, accountability Steering group and involvement’ benefits. Voluntary Sector Sought clarity in distinguishing ‘volunteering’ and Organisations ‘voluntary organisation’ representation. Emphasised need to empower governors through support.

Queried BME representation.

Broadly Broadly Broadly Main Issue Raised Name in Neutral Opposed Favour Voluntary and Y Supported application and were pleased at financial Charitable surplus being reinvested locally. Welcomed chance to Organisations: comment on plans and influence development. Sought Patient Support reassurance that management costs will not rise. Cardiac, Bosom Emphasised the need for flexibility and support of Buddies, The people who are difficult to reach with training and Grand Appeal, translation. League of Friends Stressed disproportionate representation of tertiary Bristol Dental areas- change them to 2 places with 6 for local. Hospital, Guild of Felt there was a need to separate voluntary and Friends Bristol community groups. Royal Children’s Stressed need for training and support of all governors, Hospital concern this could be focussed on public and patients to the detriment of staff. Assurance of time-out pay for governor responsibilities.

9. Apart from those listed above in 8 how many other responses were received in total?

In addition to the key stakeholder responses listed in section 8, a total of 50 formal responses were received from other stakeholder meetings and 94 individual responses. This is a total of 144.

9a. Was there an overview and scrutiny process?

There was not a formal scrutiny process, however information was provided to the Joint Overview and Scrutiny Committee for Bristol, South Gloucestershire and North Somerset. This was followed by a presentation to the Joint Committee. Their response was broadly in favour and is summarised in the table in section 8.

10. Excluding those recorded in Section 8, how many responses were there?

Broadly in Favour Broadly neutral Broadly opposed 100 27 9

Some local groups declined to comment as they said they had done so in the North Bristol Trust Consultation process. North Bristol have given us permission to use their summary consultation report and, on review of it, there are no additional issues for us to consider. The response to them was consistent with the responses to us, with emphasis and concern on the same issues, which is reassuring.

TRUST’S RESPONSE

11. Does the Trust have any comments about the general tone of responses received? For example were those opposing the proposals expressing fundamental objections or picking up minor [possibly technical] issues?

In general the comments were supportive and did not fundamentally oppose the proposals in significant numbers. There were a small number of anonymous individual objections which were quite clear about their fundamental objections. These however, articulated their objections to issues that were not being consulted upon or had been misinterpreted e.g. privatising the NHS, the ‘closure’ of Frenchay or issues relating to the wider political context.

In the main, where reservations were expressed they were in the context of the respondent stating they did not have enough information. A significant number felt that it was too early to comment and only ‘time would tell’ if the benefits would be achieved. In this context there were useful suggestions about the Trust getting established foundation trust staff and governors to come and talk to local people to give them examples of successes and to explain how things work. Many of the comments were about the practicalities of the governance arrangements and were, positively, supported by positive ideas and suggestions.

There was a lot of positive comment on the benefits of local accountability, local people having a say in strategy and the ability of the Trust to reinvest surpluses for local benefit.

There was a lot of interest in the Membership Council and the governors, and how effective contributions and broad representation could be achieved.

12. What were the main topics that attracted critical comment and what is the Trust’s response?

Issue Trust’s Response [please include in brackets the name of the main person(s)/bodies raising it] Vision / Strategy

 Concern that the specialist and  The Clinical Services Strategy is clear tertiary services will dominate the about the core service commitment of Trust Strategy at the cost to local the Trust. Emergency Services are people and core services central to our strategy. The Trust must [Administrative leads, Ambulance make more effort to emphasise this in Trust, Individual Patients, Individual documents and to work to communicate Staff]. the commitment it will make to core services at authorisation, which will be

overseen by Monitor in performance management.  Concern about the lack of mention of  The Trust has already acknowledged wider patient services such as this gap during the Board’s discussion facilities e.g. car parking, cleaning on the Integrated Business Plan. There and also patient needs such as are strong strategies and plans in place privacy and dignity [Shopmobility, for the facilities and customer care Public Meeting Knowle West, issues, but they are not articulated Individual patient responses]. clearly in the wider plans for the Trust. This will be rectified.

 Concern about the exclusive  The Trust will in future review all language in the strategies and the strategy documents for readability and need for the information to be clear plain English. It will consider using its and in plain English for public patient and public involvement groups consumption [Administrative Leaders to assist in this. and Individual responses].

 A concern that the smaller less  The Clinical Services Strategy is broad financially viable services may suffer and does not give detail by each small [MP]. service speciality. It is around broader large specialities so that the smaller specialities can be accommodated within the Strategy and are seen as interdependent rather than stand alone services. Membership

 Questions about the practicalities of  The Trust knows that it is one of the having no age limit and effectively first trusts not to have an age limit. involving children and young people However, it is committed to the unique [Clinical Reference Group, Allied contribution that children and young Healthcare Professionals]. people can make and have a right to make, into a trust which has such a large service for them. The Trust has experience in involving them and it will build on this in its membership strategy for those aged 16 years and under.

 Question as to why Bath and North  The Trust carefully considered its East Somerset are not covered in a boundaries and catchment areas when constituency [Trust Operational Group defining constituencies. The activity and Trust Services Division Heads of patterns in previous years have been Departments]. consistent and the three public constituencies identified each have significantly more activity referred to

the Trust than Bath and North East Somerset. Secondly, if the latter were to be included a number of other tertiary areas have comparable activity rates too and would have to be included. This would then lead to too many constituencies from a practical and cost point of view.

 Suggestion that the staff constituency  This was considered by the Trust, should be divided on a structural or however it was decided that the organisational basis as opposed to a organisational structure was well professional staff group one [Band represented within the management 6+7 nurses, Sisters, Oncology Centre structure. In addition, a division by Heads of Department]. structure not staff group might lead to the exclusion of certain staff from a place on council.

 A concern that some carers may wish  The Trust acknowledges this and to choose their group e.g. a carer of a proposes to allow the carer members to 17 year old may have their needs identify which carer group they wish to better met by the carer group for belong to when they opt in. 16years and under Mental Health Trust. Governors

 Concern that the tertiary patients  The Trust considers that this is a valid constituting only 15% of activity are point and as the activity has been the over represented with 4 places along basis of allocating governor places in side 4 local patient places [Voluntary the 3 public constituencies this Groups, Nurse Consultants, Clinical approach should be consistent in Reference Group, Administrative allocating places for the tertiary areas. Leads, Consumer Advisory Group]. The Trust will adopt now 6 governor places for local patients and 2 for tertiary.

 Concern that one place for both  The Trust considers that this is a very voluntary and community groups valid point. It acknowledges that was inadequate and difficult to volunteering is represented in the staff allocate [Voluntary organisations, constituency but that voluntary groups Bristol Compact, Clinical Reference are distinctly different and should be Group, Consumer Advisory Group, and represented separately to the Bristol Primary Care Trust]. community organisations. The Trust proposes to increase the number of invited places from one to two. The Trust will enter discussions with local

groups as to how the nominations can be appropriately and fairly invited.  Concern that voice of members will  The Trust acknowledges that it will be heard effectively via the governors have to support the governors in a [Bristol Deaf Centre, individual varied and individual way to ensure that responses]. they can represent their constituencies effectively. The Membership Development Strategy defines how this will be achieved and the suggestions from consultation will be added to that.

 The Trust acknowledges that it will  How will members of the public need to support the Council in access information from the Council communicating its work and and governors? [Cardiac Intensive information in a wide variety of ways. Care Patient Group].  The Trust acknowledges that to staff  Concern that staff are not and the public the number of staff represented enough on the Council places appears small. However, it and that the split of places for considers that it is adequate in the professional groups is not adequate context of staff in the Trust also having in numbers [Eye Hospital, Band 6+7 access to other routes where they can be nurses, Oncology Centre Patient Group, involved in strategy decisions e.g. staff Physiotherapists, Cardiac Heads of involvement mechanisms, management Department, Administrative leads, structure. It is also noted that there are Individual staff and general]. limits set by Monitor on the number / proportion of governors not in the elected public and patient group.

 The Trust believes that the allocation of staff governor places according to the  A view that more nurses or more size of the constituency for that staff doctors should have governor places group is fair and appropriate. It does [band 7 nurses, individual responses]. not believe that one staff group should be represented more than another.

 The Trust acknowledges that it must be very explicit about the governor role  Questions and comments on the and provide support to governors in a training needs of governors and their varied and individual way to ensure that role [individual responses, Bristol they can represent their constituencies General Hospital, Consultants effectively. The Membership Women’s and Children’s]. Development Strategy defines how this will be achieved and the suggestions from consultation will be added to that.  The Trust acknowledges these

concerns, but feels that this can be managed by the appointment of the  Concern about a potential conflict Senior Independent Non-Executive who for the Chair of the Board of the Council can access. The role of the Directors also being Chair of the Chair is defined and recommended by Membership Council [MP, Monitor, and it is noted that established Ambulance Trust, individual foundation trusts have not had responses]. difficulties in this area.

 The Trust has considered this carefully and decided that this would not be appropriate. There are many ‘groups’  Suggestion that we should define who could request similar approaches some governor places for children and from an age point of view older and young people {Local Children and people could argue the same way. One Young People Network Board]. proposal the Board will be asked to consider is splitting the 6 patient groups by 3 broad age bands of 16 years and under, 17 to 65, and 65+. Finance

 Is this just a means of privatising the  This is not the policy nationally and the NHS? [Learning Difficulties Group, Trust must make more efforts to be individual responses from public and clear about the Foundation Trust policy generally]. and what it is and what the benefits are.

 Concern about the costs of managing  The Trust is very aware of the need to the governance systems [Public be prudent and make value for money Meeting Clevedon, individual general decisions on the governance responses]. arrangements. The Governance Rationale and Membership Strategy clearly state where decisions on matters have been made because to do otherwise would not be acceptable in terms of the costs of administration. The Trust will monitor the costs of administering the new arrangements and make this information public. General  Unconvinced about the value of a  The Trust must now make more efforts foundation trust and the benefits to convince people about the benefits Bristol Older Persons Forum. by getting examples from existing trusts and also by demonstrating the benefits through implementation and effective communication.  Concern that when we are a  The Trust must be more explicit about

foundation trust we will move to this not being a priority or plan for fundamentally change the terms and when we are a foundation trust. It must conditions of our staff also get staff from established [ Physiotherapists, Band 7 nurses, foundation trusts to talk to our staff to Allied Healthcare Professionals, discuss their experiences. Individual Staff].

13. What were the main areas attracting support locally? Please indicate in brackets the main source[s] of this support e.g. patient, public, staff.

Membership Generally supportive of the way in which a membership will make the Trust more locally accountable, ensure that our services meet the needs of users and local people, and that financial surpluses will be used locally for reinvestment. Strong support for not having an age limit. [Voluntary and charitable organisations, Shopmobility, Local Children’s and Young People Network Board, Schools, Public meetings, Nurse Consultants].

Governors Welcoming of the greater involvement with key partner NHS Trusts and the Universities [Public Meetings, Nurse Consultants, Ambulance Trust, Primary Care Trusts, Mental Health Trust].

14. Specifically, what was the general tenor of responses with regard to:

Membership Support for increased democracy and patient involvement. Key points raised:  The importance of a patient led culture.  The need to integrate with existing groups and involvement mechanisms.  Support for no age limit.  Interest in the role of members.  The need for more information for members.  The need to ensure representation and to use varied approaches according to the needs of seldom heard groups. Membership Council Considerable interest in the Council and the role of governors. Key points raised:  A need to support and train the governors generally and according to individual needs.  To pay them expenses and support with crèche, and think about time of meetings for those working. Staff governors to be assured of time out of work.  A need to ensure governors represent their constituencies and can communicate with them. Membership Council cont.  Are meetings in public?

 To shift from 4 to 6 local patient places and 4 to 2 for tertiary.  To split the voluntary / community place into two places.  Welcome the University places in relation to Teaching and Research roles.  Welcome the involvement of key partners in mental health and ambulance.  Support for strong commissioning input from three primary care trusts. Board of Directors  Some confusion still around this and the role of the Membership Council.  A few questions around democracy and elections for directors.  Strong comment, neither for nor against, the fact that this is more or less unchanged.  The importance of the relationship with the Council. Elections Very few points raised other than support from the transparency of the approach proposed. Constituencies Support for these broadly with some comments around:  How the staff constituency is constructed.  Some questions about other local areas not included e.g. Bath and North East Somerset.  Strong support for carer groups. Boundaries General support for coverage in the public constituencies of all wards in Bristol, North Somerset and South Gloucestershire. Constitution No comments recorded. Age limits / Youth Strong support for innovative approach with no age representation limits. Key points:  To use existing structures.  To use Schools links.  To consider patient constituencies being split into broad age bands. Staff representation Staff side support proposals and welcome their place on the Membership Council. There was varied and conflicting comment on the staff constituency and governor places depending on the staff group involved and commenting. Vision / Strategy Broad support on this and our clinical services strategy, with other NHS Trusts and Primary Care Trusts requesting further dialogue. Members of the public and patients particularly unable to comment as did not feel they had enough information. Transitional arrangements No comments received.

Human Resources Strategy No comments received. Communications Comments were received on many communication aspects and broadly were in three areas: 1. The need for all communications from the Trust and to members in particular to be jargon free, in plain English and avoiding acronyms etc. 2. The need to tailor communications for those with individual needs e.g. English not first language, blind, children. 3. The need for effective communications between:  Board of Directors and the Membership Council  The Governors and their member constituents  The Trust and the membership Financial Concerns Some concerns from individual responses about the cost of membership and the Council, and the application for foundation trust status. Also a handful of comments about this being privatisation of the NHS and a desire to keep the NHS free at the point of delivery.

15. Is there anything else about the public consultation exercise and outcome that you would like the Secretary of State or Monitor to know?

The Trust considers that it undertook a successful and comprehensive consultation exercise. We are particularly pleased about the level of response in light of the many comments we have had generally from the public in Bristol regarding the many consultations that have taken place locally by the NHS. For example the Bristol Health Services Plan, individual consultations on changes resulting from that and the North Bristol Foundation Trust consultation in 2006.

The approach was to cover a wide geographic area and to reach a range of community groups, with particular emphasis on the ‘seldom heard’ minority groups and, children and young people.

The Trust has carefully considered the responses and comments, and throughout the process ensure that our approach has been one focused on understanding the issues being raised and the general tone of them. The Trust considered all of the responses carefully in order to identify how the responses should impact on our proposals. A report on the consultation exercise was provided for the Trust Board on the 17 July 200. This highlighted how our governance proposals, which were approved by the Board at its June meeting, should be changed in the light of consultation.

These are the changes approved by the Trust Board:

 For the two carer groups within the patient constituency, members will be able to choose which group to join according to which best suits their needs.

 The number of governor places for the tertiary patients will be reduced from 4 to 2, with a consequential increase in places for local patients from 4 to 6.

 The invited governor place for voluntary groups / community groups will be moved to two potential places. One will be allocated for voluntary organisations and the Care Forum and other local voluntary ‘umbrella’ organisations will be consulted regarding the process of selecting the representative organisation. Further work will be done with other local groups to determine if ‘community groups’ can also be represented via the second place.

 The Trust will appoint one of the non-executive directors as Senior Non- Executive Director for the Membership Council to approach in confidence if they have any issues they wish to be addressed which they do not feel appropriate to take directly to the Chair.

In addition to this the Trust formally notes the following issues raised in consultation and will take the suggestions and ideas to strengthen existing plans in the Membership Development Strategy and Constitution:  Members of the public stressed the need for clear and transparent elections. The Trust will therefore confirm its approach of using first past the post method within the Model Election Rules and secure the services of the Electoral Reform Society.  Concern was expressed that the Membership Council would not have a meaningful role and would not be able to influence the work and direction of the Trust. The Trust will therefore give detailed consideration to the role of the Council and recognises the resources and commitment which will need to be made available to empower the governors.  The language used in public documents, particularly Clinical Strategies, etc must be in plain English for the governors if they are to be engaged in meaningful discussions on the plans.  The Clinical Services Strategy and other plans must be more explicit about and place more emphasis on the facilities within our services and the customer care needs of patients.  Ideas on how to engage members and, in particular, the ‘seldom heard’ minority groups will be used in our plans.  Examples from and staff from established Foundation Trusts will be accessed for our membership to provide reassurance regarding the benefits of being a foundation trust.  The staff membership will be given more information about the Human Resources Strategy for the Trust and, in particular, their concerns about terms and conditions being changed will be addressed.  The Trust needs to be generally more transparent and provide more information on the following issues: - Foundation Trusts still being part of the NHS. - Management Costs. - The costs of establishing and running a foundation trust [extra to existing costs].

16. Please provide the contact details for the person who will be available to answer detailed queries on the public consultation and provide copies of any responses required for further scrutiny?

For queries:

Lindsey Scott Chief Nurse and Director of Governance United Bristol Healthcare NHS Trust Trust Headquarters Bristol BS1 3NU

For copies of responses:

Anne Reader Foundation Trust Project Manager United Bristol Healthcare NHS Trust Trust Headquarters Bristol BS1 3NU

STAFF ENGAGEMENT, INVOLVEMENT AND WIDER CULTURE CHANGE

17. How have staff been given ample opportunity to play an active part in the dialogue and deliberations around the application? Where has staff dialogue and views influenced the broad human resources strategy, which in turn supports the service development plans and organisational goals for the Trust?

The Trust considers that staff have been given full opportunity to play an active part in the dialogue and deliberations around the application. Prior to consultation there was a period of internal informal consultation with staff in order that they could be party to the deliberations and help shape the proposals which were articulated in the Membership Development Strategy and the Consultation Document. Details of this activity between January and March 2007 are provided at appendix X.

During formal consultation staff through out the Trust were consulted with using a variety of media. They are summarised below:

 Regular Newsbeat articles – 8 in total.

 52 staff meetings – total attendance was 736 [three meetings unknown numbers].  Access to the intranet foundation trust site.  6 specific briefings for staff without access to the intranet.  Displays at main entrances.  Posters in staff bistro and restaurants.  A letter from the Chief Executive to all staff with their payslip.

There has also been activity and discussions via the line management structure which has not been included in the above list.

The Trust has a number of working strategies which have been developed through consultation with an extensive range of stakeholders including staff side representation, line managers and the clinical healthcare professionals.

The Organisational Development Framework for 2006 – 2009. An important element of this is the development programme which has been carried out over the past two years in partnership with Keele University, to support the development of the five Clinical Divisions and one corporate Division. As a second stage, a programme has also been run for senior staff reporting to Divisional Board members, which covered just under 90 staff across the Trust. This was delivered through a mixture of internal and external facilitation under the guidance of Keele University working with the Director of Workforce and Organisational Development. A third programme for Ward Sisters has commenced in 2007, delivered by a facilitator from the University of the West of England, but explicitly linking into the themes and materials used by the previous programmes in order to ensure continuity of cultural message. A specific e-learning website has been developed by the Learning Resource Centre to support these programmes. We fully intend to continue this whole organisational approach to development, whilst at the same time supporting specific individual development.

The overall purpose of the Workforce Strategy is to ensure that the Trust has sufficient numbers of staff with the appropriate capabilities to deliver high quality services over the period 2007 – 2012. Members of staff will be well supported and led, and reflect the population to whom they are providing services. Changes to roles and the introduction of different ways of working will be managed sensitively and skilfully. The Workforce Strategy is intended to:  support the achievement of service modernisation and productivity gain  enable the delivery of capital developments  ensure that the Trust is an attractive choice for people seeking work in both the local community and nationally  enable good retention of employees and robust succession planning

 provide the skills training and infrastructure to give managers the ability to plan workforce requirements effectively

The Workforce Strategy and Clinical Services Strategy are integral components of the Trust’s future development. Workforce modelling will be an essential part of the model of care development as it informs the scoping of available options for models of care, as well as supporting the models once they are developed. The Workforce Strategy incorporates the Recruitment and Retention Strategy for the Trust and also supports the drive for healthy working practice within the Trust. There is a significant amount of current work on visioning the healthcare workforce over the next ten years, including skill mix, role extension and new roles. The Teaching and Learning Strategy was consulted upon extensively in 2006/07 and the workstreams that have arisen from underpin the Workforce Strategy. Both the Workforce Strategy and, the Teaching and Learning Strategy have Steering Groups to oversee their implementation.

All of these strategies and frameworks provide the context for specific workforce plans within a range of business cases which are the result of the Bristol Health Services Plan. They include the plans for:

 The Bristol Royal Infirmary Development.  The new Cardiothoracic Centre.  The transfer of specialist paediatrics from North Bristol.  The closure of Bristol General Hospital and the establishment of the South Bristol Community Hospital.

Meaningful consultation with staff and their representatives has been conducted as an integral part of the planning process. Staff receive regular updates on progress and have the opportunity to feedback and comment generally on projects and key issues.

18. How did [and for the future how will] the organisation ensure effective staff involvement and participation in shaping cultural change and service development and delivery, and in embracing social partnership in its broadest sense?

The Trust has a strong history of working collaboratively with Staff Side organisations which has been strengthened further through partnership working with the implementation of Agenda for Change. There are two regular meetings with Staff Side organisations: a monthly Industrial Relations Group which concentrates on operational and performance issues, and bi-monthly Trust Consultative Committee, which concentrates on more strategic issues. The former is chaired by the Head of Human Resources and attended by the Chief Operating Officer as a member of the Executive team. The latter is chaired by the Director of Workforce and Organisational Development and attended by the Chief Executive, as well as regular inputs or presentations from other members of the Executive team. Agreement of employment policies is achieved through a sub-group of the Industrial Relations Group. The

9th July 2007 19 Integrated Business Plan – Report on Consultation nomenclature for the Industrial Relations Group is currently under review to reflect the partnership flavour more closely.

The Trust involves individual representatives of Staff Side on key committees and groups to enhance the involvement in important projects and programmes. Some examples include membership of the Innovation Board and the Electronic Staff Record project.

The Local Negotiating Group specifically addresses issues affecting medical and dental staff and is attended by the Medical Director, the Chief Operating Officer and Director of Workforce and Development. The chair of the group, who is a local British Medical Association representative, also attends Trust Consultative Council.

There are arrangements for facilities and central financial support to staff side colleagues who hold positions of office, and this is captured in a formal policy to underpin the Trust’s commitment to working in partnership.

A Staff Charter was drawn up in December 2000, which reflects the Trust’s aim for all staff to feel valued by being involved, supported and given appropriate development in the work environment. The three overarching aims within the Charter are that all staff should be:  Involved in the planning and work of the Trust, and in decisions which affect staff  Supported in the workplace, and also supported in maintaining a work- life balance  Developed in their current role, and in continuing development for future roles

Staff involvement is supported through a range of Divisional meetings and mechanisms, including involvement in business planning, in service redesign and improvement, and in change management. At Trust level, the Chief Executive holds a quarterly forum which any member of staff can attend, to talk about current issues and take questions. This is very well attended and will be further strengthened through greater use of the redesigned Intranet to provide areas of particular interest for staff groups and a way of posting important information and answers to frequently asked questions.

The key principles of the Staff Involvement Policy are that the Trust will:  invest in developing leadership and team working skills across the Trust, which will support development of open, participative working styles and greater empowerment of teams  foster good partnership working with staff and trade unions  show commitment to sharing and learning about staff involvement and partnership, from both inside and outside the NHS  constantly work to improve communication systems and to provide a culture of openness within the Trust

 regularly monitor and evaluate its progress in terms of partnership working and staff involvement As result of previous years’ surveys, the Trust has developed an ancillary forum and an administrative and clerical forum. There is a black and ethnic minority workers forum and a forum for disabled staff, with the former being well established, and the latter currently being re-launched. Ward sisters have their own self-directed forum. The Junior Doctors Committee is made up of all grades of doctors representing all specialties across the Trust. A very positive development as part of the implementation of the Divisional structure was the establishment of the Clinical Reference Group. This cross-cutting group provides clinical advice on a wide range of issues to both Trust Executive Group and Trust Operational Group. A similar mechanism has now been established on matters affecting administrative and clerical staff. Projects such as the Patient Safety Initiative, in which United Bristol Healthcare Trust is partnered with North Bristol Trust, will enhance staff involvement in the coming months.

Communications at Trust level include a weekly bulletin called Newsbeat, which is circulated through the Trust through both electronic and paper based methods, and a bi- monthly publication called Pulse, which is in magazine style. Team briefing has been introduced within the organisation.

Staff involvement will take a further significant step forward through the governance arrangements for Foundation Trust, which will include staff members of the Council of Governors. It is the Trust’s intention to embrace the opportunities which this provides and is already working with Staff Side organisations to look at the way in which staff council members and staff side representatives will be able to work effectively to increase the voice of staff within UBHT. Staff side colleagues have made contact with other Foundation Trusts to consider issues about communications and involvement.

19. How has the organisation engaged with [and how will it continue to engage with] clinicians in determining the future direction of service provision and how have outcomes of such discussions been analysed from a cost/benefit perspective and integrated into the service development plans outlined in the Business Plan?

Through out recent years clinicians have been extensively involved in the shaping of the future direction of service provision for the Trust and the local health community.

During 2003 – 2005 clinical staff across the Trust were engaged in developing plans as part of the Bristol Health Services Plan. Subsequent to this work clinical staff have been central to the individual business plans for the transfer of general paediatrics [completed] from North Bristol, the Bristol Royal Infirmary redevelopment, the new Cardiothoracic Centre and the transfer of specialist paediatrics from North Bristol. All of these processes are managed as business cases and include the cost / benefit perspective and full business planning methodology.

The Clinical Services Strategy has been led by clinicians within the divisions. Each division held specific workshops to engage clinicians and other staff in their planning.

Clinical engagement is central to the Trust’s approach to service planning and this engagement is supported by the following infrastructure:

 Clinically led Divisions and required clinical roles on divisional boards.  The Clinical Reference Group.  Professionally based advisory mechanisms and committees.  Staff side involvement mechanisms.

20. How is the Trust developing and managing new and existing relationships with local health organisations and other local networks, social care, good citizenship and social responsibility, and playing a role in the wider community?

As well as involvement internally, the Trust is committed to being focused externally, particularly in the local community. The Trust is a member of groups such as the Bristol Race Equality Health Partnership, Avon and West Wiltshire Mental Health Partnership Mental Health Steering and Operational Groups, Bristol Intermediate and Long Term Care Service Development Group and Bristol Safeguarding Children Board. There are proactive links with networks such as the Cancer Network and Change for Children, incorporating multi-organisational links.

The ‘UBHT in the Community’ programme is our commitment to corporate social responsibility and there are very close links with schools, colleges, Job Centre Plus and Connexions. Whilst there is a well established volunteer programme in place within the Trust, we have recently commenced an arrangement whereby staff can offer some time within the community on certain projects. One of the first projects undertaken was the planting of a garden at Monks Park School, which is also being opened to the community. This scheme is in its infancy but will be developed further over the course of the next year. The opportunities which Foundation Trust status offers to link in further with community groups and develop programmes which enhance the city of Bristol in general, are considerable. The programme also involves staff in programmes which are global, including the partnership with Mbarara University Hospital in Uganda, whereby members of staff recently visited to offer clinical and technical expertise, whilst at the same time learning from their experiences overseas. An exchange scheme with two major health organisations in Canada and Australia, for both clinical and managerial staff, has been put in place this year.

21. What is the degree of ‘integration’ of first rate HR practice in all the main functions of the organisation [operational, strategic and clinical] – with a view to demonstrating that good HR practice and thinking is present in the wider organisation and not only in the specialist HR function itself?

The specialist human resources team are highly professional and professionally qualified, with an extensive range of people management experiences. The Trust recognises that good people management and human resources practice does not sit with this team but needs to prevail throughout the Trust.

Operational managers have responsibilities for a wide range of people management activities within their roles. The specialist team supports the divisions and these managers in an advisory and leadership capacity, ensuring that there is a consistent approach and equal service across the Trust.

The Trust has a strong divisional management structure, where the authority and responsibility for delivering key targets are in place. Divisions have objectives which include human resource elements linked to programmes of activity and relevant performance metrics. These are discussed at divisional performance meetings and reported to the Trust Board.

22. How has the organisation demonstrated its commitment to unlocking the potential of all staff and enabling all staff to progress their skills and careers through lifelong learning and development?

A partner strategy to the Workforce Strategy is the Teaching and Learning Strategy 2007 - 2012 which aims to:

 ensure that staff providing direct clinical care services within the Trust are able to provide safe, effective and high quality patient care, upholding the core values of the NHS, and that staff working in support services are able to provide efficient, customer focussed services to the same high standards of quality and governance  develop existing partnerships with education providers and partner organisations, ensuring that curricula are fit for purpose and that students receive an excellent teaching and learning experience, both in the formal learning environment and during placement  foster a climate in which staff of all disciplines embrace personal and organisational development, are committed to working and learning in multi-disciplinary teams, are given real opportunities to progress  encourage innovation and a ‘can do, will do’ culture across the organisation  support the Trust in being an employer of choice for people seeking work in both the local community and nationally

The Teaching and Learning Strategy will work in synergy with the development of the Clinical Services Strategy, Research and Development Strategy and Workforce Strategy, so that the four strategies are mutually exclusive. The Teaching and Learning and Workforce Strategies should enable the Trust to achieve internal and external quality and accreditation standards for service, teaching and research, as well as providing the skill levels required in our workforce, both now and in the future.

The Trust has a very strong reputation in the area of training and development and has a very wide portfolio of programmes offered internally, either at corporate or divisional

9th July 2007 23 Integrated Business Plan – Report on Consultation level, as well as accessing a wide range of external opportunities through neighbouring academic institutions and external training providers. There are particularly close working relationships with the University of Bristol, the University of West of England and the City of Bristol College. The Trust is also the host employer for Skills for Health, which covers all four countries of the United Kingdom. The Director of Workforce and Organisational Development represents the Trust on the Skills for Health Management Board. The Trust has a strong track record in terms of hosting General Management, Finance and Human Resources trainees and is committed to maintain this role in the future.

Foundation Trust status will provide an opportunity to work more closely with our local community on issues such as the Leitch Review (published December 2005), which aims to ensure that the UK should become a world leader in skills by 2020, with significant increases in functional literacy and numeracy, higher levels of core skills and a shift upwards in intermediate and advanced skills. Within Bristol there is considerable disparity in skills development, reflecting both the high student population in higher education and the secondary school performance, which is below the national average. The level of educational attainment at National Vocational Qualification level 2 and above within South Bristol, in particular, is low compared to national levels. As one of the major employers in the community, UBHT is committed to supporting the intentions in the Leitch review as well as continuing to develop the very highest levels of skills attainment to ensure that we invest in providing the experts of the future. Work with partner organisations such as Ablaze at Whitefields School in Bristol is one example of this developing role.

Lindsey Scott Chief Nurse and Director of Governance 10th July 2007

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