Attachment 5 Report to the Board of Directors 2015/16 Date 29 May 2015 Subject Response to Savile Reports Report of Associate Director of Governance, Safety and Compliance Author Anna Hills, Associate Director of Governance, Safety and Compliance Previously considered Safety and Quality Governance Committee 8 May 2015 by Board Action Required Approval X Discussion Decision Information Executive Summary and purpose It has come to light that over the course of many decades Jimmy Savile abused at least 500 victims, including some as young as two, males and females, and he is said to have boasted about having sex with corpses. He used the NHS and his celebrity status to exploit and abuse vulnerable patients and staff at hospitals across the country. His association with hospitals began with an unofficial role in patient entertainment, but within a few years at some hospitals he had hospital accommodation, a car parking place and even keys allowing him access to secure areas, including the mortuary. Savile used his status as a television personality to develop relationships with politicians, including the health secretaries, and exploited these relationships to strengthen the impression that he was in a position of authority leading to him being given access to patients, often unsupervised. His celebrity status allowed him to move around hospitals unchallenged by-passing security and safeguarding measures. A multi-disciplinary group was convened on 12 August 2014 to review the recommendations within the reports published from the Trusts who had an association with Jimmy Savile at some point in their history. This group developed an action plan for implementing these recommendations at the Trust, as appropriate. On 26 February 2015 a further report was published regarding the allegations made against Savile in relation to his association with Stoke Mandeville Hospital. This report identified five themes for ‘lessons for learning’ and eight recommendations. These have been cross referenced to the action plan developed by the Trust and the same multidisciplinary group will continue to review, update and take forward the outstanding actions. A further meeting was held on 1 May 2015 and the action plan was updated as presented. A formal response to Monitor regarding the actions we have taken is required by 15 June 2015. Hence, most of the recommendations focus upon strengthening safeguarding and security measures ensuring they are equally applied to all staff and visitors, irrespective of their celebrity and/or policitical status. Strategic Context/Objective(s) and Board Assurance Framework links Strategic aim(s) To be safe X To be effective To be caring To be responsive To be well-led Strategic 1 objective(s) BAF reference(s) 1d This paper provides assurance against the Trust objective(s) identified This paper is to close a gap in control/assurance in relation to the objective(s) Legal/regulatory Safeguarding Adults and Children Monitor requirement in relation to actions taken Equality Impact/risks: Impact Equality Delivery System 2 – EDS2 Nov Positive Negative Neutral 2013) X Assurance/monitoring Safeguarding Committees 29052015 Savile Anna Hills, Associate Director of Governance, Safety and Compliance pg. 2 May 2015 REP/BOD/AH1005/V1 ACTION PLAN: TO MONITOR PROGRESS FOLLOWING JIMMY SAVILE REPORTS Dated: 10/05/2015 (V7) Aim: The aim of this action plan is to ensure actions are taken at the Trust following the investigations at other trusts in the activities of Jimmy Savile. Content: This action plan captures all of the issues highlighted following discussions around each individual Hospital’s Report and includes responsibilities and timescales for delivery. Responsibility for delivery: Director of Nursing Monitoring and Assurance: Strategic Risk Group; Safety and Quality Governance Committee Key for RAGBW rating of Actions: (B)lue = Ongoing monitoring to be (W)hite = Not yet started (G)reen = Completed (A)mber = In progress (R)ed = Due but not complete assured of continued achievement ID Recommendation Comments/Current Situation Action Responsibility Timescale Progress (RAG) 1 LEEDS TEACHING HOSPITALS NHS TRUST 1.1 The Trust’s safeguarding policies To review Trust Safeguarding policy to include Deputy 31/12/14 (R12.1) extend explicitly to the care and deceased patients. Policy has been revised Director of transportation of deceased patients and it not appropriate to capture this within Nursing - Julia this policy. Action complete. Hunt 1.2 Policies and controls in place Review with Mortuary Manager i) To review Trust Mortuary policy 30th (R12.2) covering security at the mortuary, November and that these are regularly audited Electronic access limited staff group Security and 2014 has access to mortuary, suitability is Emergency reviewed by Mortuary Manager the Planning Slippage to th system can be audited as required. Manager – 30 June Keith Wilson 2015 Review with Mortuary Manager and ii) To monitor frequency of access to the Available as Local Security Manager about spot mortuary a report any checks time Action Plan: To monitor progress following Jimmy Savile Reports pg. 3 Version 7 (10/05/2015) Document Owner: Anna Hills, Associate Director of Governance, Safety & Compliance ID Recommendation Comments/Current Situation Action Responsibility Timescale Progress (RAG) iii) To assess the suitability of who should have access to the mortuary iv) To review the audit programme that 30th assesses the Mortuary policy. Spot November checks would be appropriate. 2014 Slippage to 30th June 2015 1.3 Quality of the Trust’s safeguarding DBS audit planned 2014. i) Audit programme to include a review of Deputy 31/03/15 (R12.3) compliance in respect of adult and Staff training audit ongoing for the safeguarding of adults and children. Director of child patients, and its duty to protect safeguarding children. Audit undertaken of Children & DBS and Nursing - Julia Slippage to th staff. Working with the Safeguarding Spot check/face to face audit of spot checks completed for Adults. Audit Hunt 30 May Boards for Children and Adults in the safeguarding children awareness programme for 2015/16 will be 2015 city, an audit programme should planned Autumn 2014. developed by Named Leads when in post. Named Nurse, include a review of the safeguarding Standards subject to review by CCG Safeguarding of adults and children in in-patient Safeguarding Lead Nurse. Observational, Children – areas; staff training; and staff interviews and reviews of Alison employment checks documentation Reypert ii) Spot check of information in clinical areas - completed 1.4 Current Disclosure and Barring DBS checks - Human Resource led To review current DBS policy to ensure it is fit Associate December Policy reviewed (R12.4) Service (DBS) checks are in place for action Rigorous checks are in place, for purpose and assess our compliance. Director of 2014 and fit for all relevant employees, volunteers policy being re-written for approval Human purpose. and, where appropriate, contractors process Resources – Slippage to Currently as a matter of urgency, and that this Ginnie 30th May undergoing position is reviewed to inform each Stevens 2015 corporate Board meeting ratification. Action Plan: To monitor progress following Jimmy Savile Reports pg. 4 Version 7 (10/05/2015) Document Owner: Anna Hills, Associate Director of Governance, Safety & Compliance ID Recommendation Comments/Current Situation Action Responsibility Timescale Progress (RAG) 1.5 Quality of the complaints system; Detailed action plan in place with (R12,5) the Board should monitor full monitoring process adherence to the recommendations of the 2013 Clwyd/Hart Review 1.6 Robustness of the Trust’s processes Whistleblowing policy has been To ensure Executives are familiar with the Associate 30/11/2014 Reports (R12.6) for staff and others to raise reviewed, updated and re-launched. issues brought up in these reports via Director of provided to SQG concerns, and on how such matters Confidential raising concerns email monitoring of this action plan by SQG. Governance – and Board are responded to and addressed. address introduced. Anna Hills Particular attention should be given to allegations of sexual impropriety 1.7 There should be a Trust-wide Current safeguarding adult’s policy To review training materials to incorporate Deputy 31/01/15 Domestic (R13) campaign to raise awareness of the does cover domestic violence etc. Jimmy Savile issues. Reference is made in Director of Violence safeguarding duty to patients across training. To further extend overall content of Nursing – Julia campaign all patient contact staff and Safeguarding training Adult/Children a review Hunt planned in volunteer groups of CLAW Day 2 is planned. This will be led by November. Named Leads for Safeguarding Adult Safeguarding training is linked to policy. 1.8 All safeguarding promotional See 1.7 See 1.7 See 1.7 See 1.7 See 1.7 (R14) material, educational material or information used in the Trust should be explicit in the inclusion of all patient contact and support services 1.9 The quality of work carried out by Our porters currently have adult and To review approach taken regarding Security and (R15) porters should include reference to children safeguarding training and appraisals, to establish who the line manager Emergency patient experience and values and behaviours training. is for the porters in the first instance. Planning safeguarding, in addition to the Manager – measurement of time to complete Peter Huttley is the line Manager Keith