WELSH AMBULANCE SERVICE TRUST
DIGNITY AT WORK ANALYSIS
July to September 2013
1.0
INTRODUCTION
1.1
This Dignity at Work analysis has been conducted after the most recent
strategic review by Professor McClelland. In the technical document
accompanying her review, she identified ‘perceptions of a bullying culture’
(p8) and recommended that WAST “address perceptions of bullying and
harassment” and to indicate the “Trust’s intention to eradicate unacceptable
behaviour” (p15).
1.2
On page 28 of the technical report Professor McClelland also identified
‘evidence of bullying’, mentioned ‘on a number of occasions’.
1.3
The research report of the NHS Wales Staff Survey 2013 also highlights that
paramedics, ambulance technicians and control staff have the lowest levels of
employee engagement.
1.4
At the commencement of this exercise, senior WAST Union representatives
from Unison, Unite, GMB and the RCN were briefed and asked to encourage
any member (in any position in WAST) to come forward if they had personal
dignity at work issues. In order to demonstrate the Unions support a
partnership notice and pro-forma were created and circulated by them to
assist in the organisation of the exercise. These can be found at appendices
1 & 2.
1.5
No completed proforma were received. However, a number of individuals did
make contact and were interviewed. Each had their own story to tell. The
majority were support staff and came from different services within the Trust.
1.6
Two senior WAST Union representatives were interviewed. They came from
Unison and RCN. No contact came from GMB or Unite.
1.7
In order to obtain a relatively comprehensive picture, the request was to
interview all senior personnel from Locality Managers up to and including the
Chief Executive, Executive and Non-Executive Directors of the Board.
Support staff to these posts were also interviewed.
1.8
Questionnaire templates were created simply to provide a framework for
interviews. In the majority of cases, questions were answered and discussion
took place without the use of these templates. The general template can be
1
found at appendix 3. Interviews were conducted in a confidential environment
with assurance given to interviewees that comments would not be attributed.
1.9
Over a period of two months, 80 individuals across all departments were
interviewed for up to 2 hours each.
1.10
During the course of each interview, every interviewee was provided with
three hard copy pieces of information drawn down from a training programme
relating to Dignity at Work. These can be found at appendices 4, 5 and 6.
They relate particularly to a 15 step process to assist in identifying a bully and
the language they will use; a bully’s common profile, the ill health and staff
turnover that bullying can cause, and differentiation between harassment and
bullying behaviour.This documentation will hopefully provide all parties with
‘common ground’ and assist in dealing with future Dignity at Work issues that
may occur.
2.0
DIGNITY AT WORK – AN OVERVIEW
2.1
Since coming into post in 2011, the present Chief Executive has not been
afraid to tackle difficult situations. During his first year a major Dignity at Work
investigation involving a senior executive resulted in that person leaving the
Trust, having been found responsible for serious, continuous breaches of the
Dignity at Work policy. These breaches had previously been allowed to
continue over a period of two years, and as a consequence damaged the
health and well being of several members of staff at all levels in the
organisation.
2.2
The Chief Executive has also been proactive in establishing good working
relationships with senior Trade Union Representatives and in accordance with
the Welsh Partnership Forum requirements.
2.3
In a time of great uncertainty and continuous change he has endeavoured to
engage staff across the Trust in order to find constructive ways forward for
everyone – a challenge in itself due to the geographical spread of Wales and
Trust locations.
2.4
These tasks have not been made easier by the pressures placed upon him by
external stakeholders and the turnover of WAGMinisters that have held
responsibility for the NHS in Wales; each Minister having their own ideas on
how to improve the delivery of services to the people of Wales. The pressure
on the Trust to deliver an improved service with indeterminate funding is also
influential and challenging when Executive Directors are trying to set down
strategies and make strategic decisions that go beyond known funding.
2
2.5
The Non Executive Directors (NEDS) of WAST have also played a part in the
challenges that the Chief Executive has had to face. It is unfortunate that a
number of dignity at work breaches at Board level were not addressed as they
occurred on innumerable occasions. This may have been due to a failure to
recognise such inappropriate behaviour in the first place.
2.6
Non Executive Board members in any public body are expected to provide
leadership; they have task, group and individual functions and it’s a short step
away from functions to competencies. Competences are statements of what
a skilled and effective person would correctly do in performing their job role to
the required standard. That standard includes the knowledge and recognition
of appropriate vs. inappropriate behaviour and the need to recognise and
understand dignity at work, and how to behave towards colleagues. It would
appear appropriate behaviour has not been demonstrated by WAST NEDS on
a number of occasions.
2.7
A great deal of effort and time has been put into the most recent WAST
restructure by all parties involved – management and staff side. Since
October 2012, Locality Managers, Heads of Service and Clinical Team
Leaders – all newly appointed even if they had worked for the Trust previously
– are now in the process of development work to assist them to become a
cohesive, effective team. This work is progressing well.
2.8
Since the Chief Executive’s appointment a range of support services have
been put in place for all staff and advertised appropriately. Much has been
achieved in the areas of ‘health and wellbeing’ and all parties involved are to
be congratulated for driving forward this important aspect for staff welfare; the
vast majority of whom have one guiding principle – delivery of a first class
service where ‘the patient comes first’.
2.9
The Trust works to the national Dignity at Work Policy, agreed by the Welsh
Partnership Forum Business Committee and issued in March 2011. The
Committee includes the 16 recognised Trade Unions within NHS Wales, all
represented by full time officers or senior representatives.
2.10
Breaches of dignity at work can come in many forms. It is the perception of
the recipient whether their dignity at work is being breached. Inappropriate
behaviour observed by a third party can also relate to dignity at work.
Whether there is intention on the part of the alleged bully or harasser is not
relevant. It only indicates that in many cases individuals (or groups) are
ignorant of the fact their behaviour is causing offence.
2.11
In the case of WAST, the general consensus of opinion with regards to
behaviour included:

bullying
3
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abuse of power (not necessarily hierarchical)
intimidation
victimisation
inappropriate language
breaches of confidentiality
failure to promote
cronyism
gossip
innuendo
sexual / homophobic harassment
disempowerment
abusive emails and texts
lack of communication
misinformation
coupled with a general culture of cynicism.
2.12
None of the above can be attributed to a specific level within the organisation;
neither does it only apply to ‘management’ side. Staff side are equally
responsible for breaches of dignity at work, both in specific cases and
institutionally.
2.13
Breaches of dignity at work can go in any direction, as can abuse of power,
which can be defined as institutionalised bullying. It is not necessarily
hierarchical from the top down, but can be peer on peer or ‘up the line’.
2.14
From the employer’s perspective failure to deal with breaches of dignity at
work and bullying in particular can lead to:
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absenteeism
high staff turnover
low morale
poor productivity
poor relations between employees
Investment in recruitment, training, experience and knowledge can also be
lost.
3.0
WHY DOES BULLYING HAPPEN?
3.1
One criterion for bullying in the workplace is stress brought about by an
inability to fulfil the responsibilities of one’s role. The reasons for which
include:
4
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being promoted beyond ability – or desire
being shunted into a job by an employer regardless of need, desire,
aptitude or ability
the lure of more money without understanding the attendant obligations
the job is taken because it’s the only way to get on in an organisation
3.2
It can also occur because individuals are given power and in order to protect
their position they use it only to their advantage.
4.0
THE STAFF CHARTER (Appendix 7)
4.1
The Staff Charter was developed from ‘shared values’. The aim was to
promote a culture of partnership working; openness and mutual respect
between the ‘staff side’ and ‘management’ and the document is dated
September 2010.
4.2
There are seven ‘rights’ identified, set against responsibilities, a priority being
the need to put patients first.
4.3
During the course of interviews it became clear that parts of the Charter were
frequently being ignored or abused. For example, a number of individuals
identified a union representative who is alleged to have said “I don’t care
about the patients, it’s about my members” or words to that effect. This
statement was quoted several times during the interviews, across all the
regions and at different levels within the Service.
4.4
Many interviewees expressed genuine concern at this attitude from a health
professional.
4.5
The issue of meal breaks for ambulance crews came up frequently as an
example of where patients are not put first. The intransigent attitude and
influence of Union activists were blamed during many interviews.
4.6
When questioned as to why individuals did not challenge the representatives
if their actions were not considered appropriate, the response was frequently
a shrug of shoulders and ‘I might need the Union one day’ answer. There
was also an element of fear, as it was considered unwise to upset ‘the Union’
because of perceived repercussions.
4.7
Many interviewees expressed concern as putting the patient first and
delivering an effective and efficient service were their greatest priorities often
hindered by lack of staff resources: unfilled vacancies, sickness absence,
suspensions or union duties.
5
4.8
The Staff Charter also refers to the process of information exchange and
identifies ‘our managers’ as the first point of call for information exchange and
clarification. This does not always occur, as staff will go to their union
representative first if an issue arises.
4.9
A number of individuals also indicated that they receive no feedback from
union representatives who attend working parties etc. yet the Staff Charter
specifically refers to ‘regular communications with colleagues’.
5.0
TRADE UNIONS
5.1
There are four recognised unions in WAST: Unison, GMB, Unite and RCN.
Their membership profile provided by WAST is as follows:
Trade
Union
UNISON
GMB
UNITE
RCN
TOTALS
Number at ballot Nov 2011
not through payroll
90
150
Not known
240
Number from weekly &
monthly paid staff
1037
638
339
116
2131*
Total
1127 (47%)
788 (33%)
399 (15%)
116 ( 5%)
2371
* There are variables within the above figures, as in August 2013 a snapshot of trade
union deductions paid from salaries revealed a fall to 1,935 in total (figure also
obtained from WAST).
5.2
According to most recent figures WAST employs 2,960 staff, so between 589
and 785, or roughly 20% of staff are not represented by any recognised union.
5.3
UNISON has one full time ‘Head of Health’ Wales, three full time regional
organisers, 3 regional branches and 46 reps, some of whom hold 2 roles
within their branch or at national level.
5.4
GMB has one full time regional officer; 31 representatives, 8 of whom have 2
or more roles in the union (e.g. Health and Safety representative coupled with
steward duties.)
5.5
UNITE has 2 full time regional officers, 3 regional branches, 29
representatives, a number of whom have 2 or more roles within their branches
or at national level.
5.6
RCN has 3 full time officers and 4 representatives.
5.7
Excluding full time salaried Union officers this gives a total of 110 staff side
representatives in WAST, in one guise (e.g. health and safety rep) or another.
6
Staff Side Chair and Staff Side Secretary also receive 1,955 hours p.a. for
Union duties.
5.8
Allowing for variables, the ratio of representatives to unionised staff is
therefore in the region of 1: 20, representing approximately 80% of the staff.
5.9
Within the Trust the predominant bullying culture ‘up the line’ appears to be
from representatives of any union who, when denied time off by LM’s / CTL’s
(due to the needs of the service) to attend working groups / meetings / training
/ Board / sub committees etc. circumvent their line managers and go straight
to senior managers in order to gain release from duties.
5.10
This frequently leaves ambulance stations under-crewed to the detriment of
Key Performance Indicators. It also leaves LM’s feeling disempowered,
intimidated and at times humiliated. Their self-confidence is damaged and
their stress levels are increased.
5.11
There are ‘old school’ union representatives in WAST who have been in their
union post for years without challenge. Many have never been elected, or
stood for re-election. Individuals have simply volunteered, gained
comprehensive training with paid time off, and become part of a cohort of
people who challenge and obstruct management at every opportunity, to the
detriment of patients.
5.12
Unions have been observedby the external investigating officer abusing the
use of grievance procedure in order to gain control of any situation they don’t
particularly like, or where a member is at serious risk of losing their job.
5.13
There are paramedic / EMT union representatives who have allegedly not
worked a shift for months. They may be only representing a handful of staff,
but their influence is far greater and can affect many people – including
patients.
5.14
Others become representatives (without election) to protect themselves,
having gone through disciplinary action previously and ‘got away with it’.
5.15
Middle and senior managers have reported being in receipt of e-mails and
texts from union representatives that are both offensive and aggressive, in
clear breach of dignity at work. It is alleged that some of the e-mails are in
capital letters and underlined. The capital letters can be justified as ‘the
wrong button’ being pushed. Underlining is a conscious action.
5.16
The Unions have direct and immediate access to Assembly Members and
appear to have the ability to influence Ministerial actions. Any strategy or
project proposed by the Senior Management Team that is considered
detrimental to ‘their’ members is immediately challenged at the highest level.
7
This has bred a culture of bullying external to the Trust, but directed at the
Senior Management team.
6.0
THE TRUST
6.1
In the last decade the Trust has been subjected to a minimum of 14 reviews,
innumerable changes of strategies, 7 Chief Executives (including interims), 3
Chairmen (including interim) 6 structural changes, 2 Boards (a third one is on
its way in March 2014), continuously evolving IT development, fleet
replacement (50% requiring modification before use), incessant turnover of
Executive Directors and Ministerial appointments.
6.2
Even the logo has been changed.
6.3
One middle manager (and a registered paramedic) likened the changes this
way; “they don’t just move the goal posts, they change the game! And just
when you’ve caught up, it’s changed again.”
6.4
Set against this the Trade Unions have maintained their status quo. The least
amount of change lies within the Union’s representatives, who have watched
the disarray; identified weaknesses, divisions and personality clashes and
used them to their advantage in order to ‘protect’ their members. The irony is
that many staff admitted their representatives do not represent them and they
have no idea what the union is saying or doing.
6.5
It could also be argued that the stability of the union representatives has
assisted the Trust during continuous change.
7.0
THE ‘MANAGEMENT’ – in general
7.1
The Dignity at Work policy (point 4.6) states “the right of managers to manage
and organise the services” of the Trust.
7.2
Those who are prepared to tackle dignity at work issues are themselves likely
to be the subject of complaints, either dignity at work or grievance
proceedings. They need to be supported effectively and reassured, subject to
following correct procedures in the first place.
7.3
Actions of managers are also influenced by external forces – particularly
external stakeholders who are allegedly fed misinformation by activists who
do not want to see progressive change and prefer to maintain the 20th century
status quo. This may partially account for the rapid turnover of senior
managers and strategic changes in direction for the Trust over the last
decade.
8
8.0
LOCALITY MANAGERS (LM)
8.1
It is necessary for Locality Managers to remain neutral at all times when
making any decision and this has not always occurred. They need to follow
policies and procedures without fail. To step outside a policy can give
colleagues and union representatives the opportunity to lodge grievances or
allege dignity at work breaches. This is particularly relevant when capability
issues need to be addressed.
8.2
The LM role is often complicated by the range of personal connections crews
have both locally and across regions: partners / husbands / wives / brothers /
sisters / cousins / in laws etc. In a number of cases, it appears that
friendships and personal relationships have clouded decision making
processes.
8.3
A number of locality managers have no formal management training,
qualification or experience, although many are now undertaking internal
management training programmes. They are receiving comprehensive
support;and need appropriate and consistentadvice from both Heads of
Service and Human Resources when dealing with day to day issues. If this
does not happen, unintentional dignity at work breaches can occur.
8.4
There is a perception that Locality Managers who have not ‘come through the
ranks’ are not valued or respected by front line staff in the same way as those
who have.
8.5
When given the hard copy hand-outs, a striking number of Locality Managers
recognised the language identified as being heard on their stations, and the
‘doughnut’ effect that can be found around a bully: i.e. the bully will be
surrounded by ‘friends’, who will never challenge or upset the bully (through
fear or likeminded thought processes) and then a second ring around that
which will include excessive sickness absence of colleagues, high staff
turnover, internal transfer requests, VER’s, disciplinaries, dignity at work
allegations etc. etc.
8.6
This recognition led to discussions around the number of ‘off the record’
complaints heard by LM’s on a weekly basis. There was not one LM who said
they did not get any ‘off the record’ conversations. Many reported regular
conversations with unhappy staff. Some LM’s recorded these conversations
in writing for their own personal reference. Others did not, but were advised
to do so in future. Rarely was action taken to resolve an issue, recorded or
otherwise, but Locality Managers have a duty of care – as do all employees.
8.7
It was pointed out to LM’s that they wouldn’t dream of sending an ambulance
out with faulty brakes or a bald tyre, yet they were at times sending a crew out
9
where one or both individuals were unhappy; feeling bullied, harassed or had
complained of their dignity at work being breached.
8.8
Some Dignity at Work complaints have not been dealt with promptly
andconsequently these have escalated into formal investigations; resulting in
negative feelings, poor operational decisions and sickness absence whilst the
investigation was undertaken.
8.9
There have been times when a Locality Manager failed to recognise he or she
needed to turn an ‘off the record’ issue into a formal action, which they are
entitled to do under the Dignity at Work policy (point 7.2). Toignore alleged
breaches can indicate the LM does not have the knowledge or skills required
to manage a situation and as a consequence they hope‘it’ will just go away or
resolve itself. At this point they are abdicating responsibility for the duties of
their position.
8.10
There were also times when LM’s have attempted to address a dignity at work
issue by speaking to both parties concerned; suggesting they ‘shake hands’
and ‘let bygones be bygones’, accepting reasons like ‘it was only a bit of
horseplay’ to justify or excuse what has occurred.
8.11
This harbours resentment in any party involved, resentment which can fester
for months and cause underlying tensions that spread across the station.
9.0
THE STATION
9.1
When formal dignity at work cases have arisen at station level, a number of
negative actions have occurred. These have been observed by the writer
when in the role of external investigating officer.
9.2
Confidentiality is virtually non-existent, gossip is fuelled by half-truths and as a
result crews appear to ‘take sides’ and form cliques. Reprisals against the
complainant can include being ‘sent of Coventry’ by their peers, or being left
out of social events. The circle of friends around the alleged perpetrator will
close ranks and make life difficult for the complainant. In one such case, a
complainant had a home visit from a ‘friend’ of the alleged bully and was
threatened with violence. The ‘friend’ was not a member of WAST.
9.3
Although the complaint was upheld in the above instance, the perpetrator,
along with friends and a union representative ‘celebrated’ the outcome of the
case with a night out.
9.4
In another case, a dignity at work complaint against a crew member was
made and then two other individuals came forward to support the allegation
because it had happened to them over a two year period. When asked why
10
they didn’t complain at the time, they revealed their fear of reprisals by a
relative of the alleged bully who was senior to everyone involved.
10.0
HUMAN RESOURCES (HR).
10.1
The HR policies of the Trust are provided nationally by the Welsh Partnership
Forum. In some instances, clearer process pathways need to be better
defined. More clarity is required and realistic timescales set down for each
process. The loopholes exploited by unions need closing, but this can only be
done at Partnership Forum Level.
10.2
Complaint investigators are often appointed internally. These are people who
have their own jobs to do, have received little or no investigative training, and
are not particularly trusted by either party. Delays in investigations are not
acceptable and have been of 6 months or more duration.
10.3
When Hearing Panels are convened, it is essential that the Panel members
are completely familiar with due process and formally follow it. In one
instance an appeal was held and the Panel allowed further information
(character references and a petition supporting the perpetrator) to be put
forward by the union. This was contrary to the disciplinary policy terms of
reference for appeals.
10.4
The Human Resource team is hard pressed to meet the demands of the
service. It appears that hundreds of hours are lost through travel and this is
attributed to the geographical spread of ambulance stations, something which
cannot be changed.
10.5
The electronic HR hub provided by the Trust is viewed with scepticism, and
many managers prefer to pick up the phone using a direct line to HR to clarify
or seek advice. Some individuals indicated that when they accessed the hub
on the web site and drilled down to policies, the screen informed them the
page was either being created or updated. There may also be issues around
technophobic staff.
10.6
There is also a failure to deal with allegations of dignity at work breaches and
consequent disciplinaries and grievances in an appropriate time span by both
Human Resources and related unions. HR policies are not being adhered to
and time limits in those policies are ignored – or cannot be met due to
pressure of work.
10.7
There are instances in very serious cases, where Unions attempt to defend
the indefensible; playing for time by lodging last minute grievances, being
unavailable for meetings or hearings over a period of months – leaving
suspended parties in limbo, but on full pay. This breaches the dignity of both
11
the alleged target of abuse and the alleged offender. If suspensions are at
station level, it can also cost the Trust thousands of pounds in order to replace
suspended individuals.
10.8
There are times when HR Business partners are almost relieved by this
behaviour, as they are so inundated with work.
11.0
OPERATIONAL vs. CLINICAL
11.1
Operational and clinical sides must work together if there is to be an
improvement in service delivery to the public. Neither side knows it all, even if
they think they do. Neither will be effective without the other, neither will be
able to deliver alone. Together they stand a much better chance of success.
11.2
It is not conducive to team working when an Executive Director, by their own
admission publicly defines a colleague as “the enemy” - a clear breach of
dignity at work. This attitude spreads through the Trust and increases the
divide between individuals and departments who are expected to work in a
collaborative environment.
12.0
DELIVERING THE SERVICE (UNIFORMED STAFF)
12.1
WAST is an emergency, uniformed service, paid for out of the public purse.
The green uniform of a paramedic or emergency medical technician is often
connected to ‘help has arrived’ in the recipient’s mind.
12.2
There are issues around uniform, and who wears what. There needs to be
very clear rules relating to all those who wear uniform and the full green
uniform should only be worn when on a shift for ambulance or RRV duty.
Other than that, white shirts should be worn by LM’s and CTL’s. Green
fleeces are being worn by all and sundry across the Trust. This can be
confusing to the public, and is causing resentment in a number of individuals
interviewed who feel they have ‘earned the right’ to wear them.
12.3
Front line service delivery structure needs to be stronger with clear lines of
objective communication; particularly for Heads of Service, Locality Managers
and Clinical Team Leaders.
12.4
LM’s and CTL’s should be consistently empowered to make decisions
regarding ambulance locations, shift patterns, crews, holidays, time off for
union duties and station management. If a locality manager declines to give
time off, there should be sound operational reasons for doing so. The
judgement call is with the manager closest to the situation, not 50 miles away
with someone who is not necessarily fully briefed on station requirements.
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12.5
When refusal for time off does occur, it is not appropriate for staff to go above
the manager in order to obtain permission which is then granted. This leaves
the Locality Manager or CTL disempowered – that in itself can be interpreted
as a dignity at work breach. LM’s feel they are being set up to fail without
senior managers realising this in many cases. If such requests occur at a
higher level, they should not be granted or denied until two way
communication is established between the managers concerned.
12.6
Several LM’s confirmed that they have union representatives who insist on
external meetings held at a specific day and time in the middle of (for
example) a 4 night shift. This enables the representative to take the nights
before and after off to attend a meeting that may last two hours.
Representatives will still be paid for 4 night shifts, having only worked two.
12.7
It would be inappropriate to tar all representatives with the same brush. There
are other representatives who negotiate time off with their managers and ‘pay
back’ shifts as required. Many representatives have good constructive
relationships with their managers, working together to explore and reach
satisfactory outcomes.
12.8
Nothing should be allowed to stand in the way of managers across regions
working as a cohesive team. The term ‘silo working’ was frequently used
during interviews to describe the perceived way of working in the Trust,
justified by ‘that’s the way it has always been’. This perception needs to be
dealt with.
13.0
CLINICAL CONTACT CENTRES (CCC)
13.1
These centres have the most difficult task with the least medically qualified
staff. They are considered the ‘lowest of the low’ as far as uniformed crews
are concerned. There is no mutual respect from either group.
13.2
Paramedics admitted to not informing CCC when they have handed over a
patient to A&E until they have taken a comfort break; gone to the toilet,
bought a sandwich or a cup of tea. When asked why not, many responded by
indicating that if they talked to Control and asked for time out they wouldn’t
get it, instead being sent out immediately on another job.
13.3
A small number of LM’s expressed frustration at not being permitted by CCC
to locate their ambulances in ‘hot spots’ because CCC’s statistics indicate
from previous weeks that there wasn’t a problem in a particular location. As
rightly pointed out, every day is different and LM’s felt they should be allowed
to put their ambulances where they felt best use would be made of them,
without ‘interference’ from CCC.
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13.4
Concern was also expressed as to how calls were evaluated, resulting in
delays in appropriate delivery of service.
14.0
THE BOARD:
14.1
The non-executive members of the Board predominantly consist of white,
middle class, semi-retired or retired, successful businessmen each with their
own skill set, developed over 40 or more years. Viewed overall, they could be
defined as a ‘nice, safe homogenous group’. This begs the question whether
they reflect the profile of the population they are there to serve.
14.2
Non-executive directors (NEDS) have a responsibility to oversee the Trust’s
strategy and performance and also chair formal committees namely:
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Audit Committee
Charitable Funds Committee
Quality, Safety and Governance Committee
Remuneration Committee
Strategic Planning, Finance and Performance Committee
14.3
A number of NEDS feel the need to ‘micro manage’ in what they consider to
be their particular area of expertise.
14.4
Few appear to recognise that dignity at work principles (which should be
inherent to their management style) apply as they consider themselves to be
‘above such things’. Many of their actions and attitudes breach the dignity of
senior executives on a regular basis.
15.0
BOARD MEETINGS
15.1
Many individuals expressed their concern in relation to Board meetings.
These are open to the public and a large number of union representatives
also attend. There have been situations where Executive Directors and
senior managers have had their dignity at work breached during meetings due
to adverse comments, both from their peers and non-executive directors
(NEDS). This should not occur, and can happen due to ignorance or the need
to establish ‘one upmanship’ in front of others. Whoever is in the Chair has a
responsibility to deal immediately with these incidents and not let them pass
without appropriate comment, or wait to deal with issues until after board
meetings.
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15.2
Some individuals also flagged up a number of times when reports or
strategies presented to the Board were challenged aggressively and
inappropriately by other Board members.
15.3
Issues of strategic management should be resolved with all relevant parties
prior to any paper being presented to the Board. If a strategy is perceived to
be ineffective or weak then it is the responsibility of the Chief Executive to
deal with this prior to a Board meeting. NEDs receive Board papers at least 7
days prior to a meeting. If they have a problem with any document, then they
should not leave it until the meeting to challenge its contents, but clarify
issues promptly.
15.4
Healthy debate should take place before board meetings and in private, not
aired in public and particularly not in front of union representatives who leave
Board meetings well aware of the friction and ‘weak points’ of the senior
management team. These weaknesses are likely to be targeted in any future
negotiation.
16.0
STAFF SURVEY
16.1
This has been treated with suspicion principally due to the perception that it
was not confidential. There are strong indications that individuals who did not
complete the survey each received what they considered to be a personal
email reminder from the company engaged to undertake the work. This was
not the case as e-mails were completely computer generated and set against
the responses that had been received from all Welsh Trusts. This was
confirmed with the NHS Centre for Equality and Human Rights, as a member
of their staff was involved in the Project Board working with the external
contractor.
16.2
However, the action of ‘personal’ e-mails reinforced the perception that the
survey was not confidential and enabled union representatives to undermine
the process from behind the scenes whilst publicly promoting the exercise.
Some staff were worried that their responses would be passed on to
managers. As a consequence they did not complete the survey and a bias
response was triggered as a result.
17.0
WORKING GROUPS
17.1
There appear to be innumerable working groups where union representatives
outnumber the management side. One representative has actually put in
writing the number of hours they have spent attending one working group –
800 hours and 8,000 miles of travel. Every one of those 800 hours is
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identified as being ‘released from shift’. They also indicated that a colleague
in another union probably had the same amount of time in order to attend the
same working group.
17.2
It is right and proper that staff side are represented on working groups and put
forward their members opinions, but the number of representatives involved
and the (paid) time off they have should be of serious concern and begs the
question– who exactly is running this Trust? It is frequently the case that
more union representatives are present in a working group than managers.
18.0
MEDIATION
18.1
Mediation is sign posted in the Dignity at Work policy. It is an extremely
useful tool in the hands of a skilled person. Mediation should be activated
before a formal investigation is commenced. Once a formal process begins, it
is no longer an option.
18.2
Mediation is viewed with scepticism across the Trust and seen as a way of
‘sweeping things under the carpet’, especially around issues of dignity at
work. This indicates a lack of understanding as to what mediation really is.
18.3
Some individuals who accept mediation on the advice of their union do so in
order to avoid an investigation and potential disciplinary action.They say all
the right things during mediation, but revert to type the minute the issue is
‘resolved’.
18.4
Mediation is a voluntary process that individuals can refuse, particularly if one
party considers they have ‘done nothing wrong’ and see no reason to engage
in mediation.
18.5
The NHS Centre for Equality and Human Rights has well qualified and
experienced mediators and has provided a number of mediations for the
Trust.
18.6
Well trained mediators have the skills necessary to recognise when mediation
is not appropriate. Mediation is not a panacea and should not be the first
option if a serious breach of dignity at work has occurred. Sometimes it is
necessary to instigate formal proceedings and not use mediation simply as an
abdication of responsibility by both HR and management.
19.0
SICKNESS ABSENCE
19.1
It is generally acknowledged that sickness absence levels are high. A
contributing factor has to be the amount of bullying that occurs in the Trust.
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19.2
Bullying causes stress and the body’s response to stress is varied; ranging
from aches and pains (often focussed on the spine) to frequent illness, viral
infections to cold and flu like symptoms, headaches to irritability. It can also
lead to serious illness and disorders. Mental health can also be affected, in
extreme cases leading to nervous breakdowns and contemplation of suicide;
this has been observed as occurring within WAST by an external investigating
officer.
19.3
The sickness absence statistics of the Trust reflect a high number of stress
related issues.
19.4
A number of interviewees accepted there was a pattern of sickness absence
in stations where dignity at work issues were prevalent. Those subjected to
regular abuse had a tendency to go off sick for a few days, followed by
requests for overtime. This enabled individuals to ‘take a break’ from the
bullying for up to a week at a time (particularly if the individual was crewed
with a bully.)
19.5
Others are on long term sick due to ‘stress’ which is often attributed to the
workplace.
19.6
This is not to say that all absences are attributable to bullying.
19.7
However, there is a failure to recognise genuine breaches of dignity at work.
If dignity at work issues are dealt with more effectively and efficiently over the
coming months there is a high probability thatsickness absence statistics can
be improved. At the moment genuine breaches of dignity at work are being
ignored or not recognised.
20.0
NHSDirect
20.1
NHSD staff feel totally marginalised and not part of WAST.
20.2
The tensions between nurses and paramedic staff are palpable and neither
appears to have respect for the other profession.
20.3
As pointed out, to become a qualified nurse takes a minimum of 3 years, and
professional registration has been a requirement for years.
20.4
On the other hand basic paramedic training used to take 6 weeks; although it
is accepted that there is now an academic route for staff newer to the
profession. Registration for a paramedic only commenced 3 or so years ago.
20.5
There is ‘in fighting’ between nurses and professional decisions are being
challenged by colleagues to the point of suspension whilst investigations are
conducted. This has the ‘pebble in the pond’ effect and creating cliques.
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21.0
SUGGESTED WAYS FORWARD.
21.1
Before dignity at work can be effectively addressed in WAST, a knowledge of
basic equality and human rights would be beneficial to all employees. The
NHS Centre for Equality and Human Rights has produced an e-learning
programme of relevance. This was launched in September 2013 and could
be used as the gateway to dignity at work training.
21.2
A comprehensive dignity at work training programme is required throughout
the Trust and at all levels. Much of the inappropriate behaviour at every level
is institutionalised – ‘that’s the way it’s always been’. A 20th century
management style of ‘command and control’ is no longer appropriate; yet is
displayed by paramedics to EMT’s, CCC’s to ambulance crews etc. etc.
21.3
There is a pressing need to review the Staff Charter;its contents are being
ignored or manipulated in all directions, often detrimental to front line service
delivery. Unions have every right to represent their members, but a more
formal process of working together with management needs to be
established. One way forward would be to agree proportional representation
for unions and clear Terms of Reference – including a definition of
‘partnership’ and what is considered ‘reasonable’ time off to attend to union
duties.
21.4
Union rules regarding a representative’s election should be adhered to. Trade
union representatives should receive personal reminders regarding case
confidentiality from Union HQ’s. If a breach then occurs the respective Union
and the Trust are in a position to deal with the representative.
21.5
Open competition for internal promotion is taking place and due process is
being followed. However, there is a perception that ‘slotting in’ on the nod
and with union agreement (i.e. under their control) is still occurring. Future
posts should be advertised and due process (including reasonable
timeframes) adhered to. Posting a vacancy for 24 hours is not a reasonable
time frame.
21.6
The Trust needs more stability and cohesion within its senior management
team and strong leadership from both the Chief Executive and Chair of the
Board who should work together as one cohesive team. The constant
pressure of endless external reviews, changes of strategy, restructuring etc.
needs to be avoided. Executives need to agree a positive, constructive,
strategic way forward and adhere to it, despite external pressures. No
strategy can be judged in the space of a year or 18 months.
21.7
It is felt that this can only be achieved if individuals put personalities aside and
work at becoming a team; respecting each other’s opinions, considering union
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advice and suggestions, but making objective, sound management decisions
within budgetary requirements with the core principle of putting patients first.
21.8
A reminder relating to confidentiality for all personnel issues needs to be
circulated across WAST. The consequences of breaching confidentiality
should to be clearly identified in that communication.
21.9
Create a web page for Locality Managers and Heads of Service plus one
senior HRBusiness Partner for them to share ‘good practice’ and seek advice
from peers / managers (like a LinkedIn group) OR put them on LinkedIn and
create a closed group for them, with one administrator from the team. (Cost
free for basic membership.)
21.10 The HR policies used by the Trust are All Wales NHS policies provided by the
Welsh Partnership Forum Business Committee and are therefore subject to
their review processes. A number of these policies are in the process of
being updated. In the opinion of a number of Human Resource Business
Partners, there are loopholes within these policies that are being exploited by
the unions when dealing with cases. However, WAST is reliant on the Welsh
Partnership Forum to address the issues.
21.11 Use external investigators for dignity at work issues where ever possible and
have them work within a maximum 3 month window for each investigation.
This gives reasonable time for union representatives to provide appropriate
support for their members.
21.12 An increase in Human Resource business partners needs to be considered.
They are under resourced, which in turn leads to unacceptable delays when
seeking resolution to any personnel issue.
21.13 The very real divide between Operational and Clinical needs to be addressed.
Clinicians should be empowered to cross perceived boundaries and vice
versa. For example, teaming a nurse with a paramedic on an RRV could
reduce the need for back up ambulancesin a number of circumstances and
would allow a clinical sign off, with the nurse linking in to a care pathway for
the patient.
21.14 Permit LM’s and CTL’s to make decisions regarding ambulance locations,
shift patterns, crews, holidays, time off for union duties etc. without
interference from unions or senior managers. LM’s and CTL’s are perfectly
capable of making operational decisions. If they are not sure then they can
seek advice. If they get it wrong, then it’s a learning experience and the
mistake should not be repeated.
21.15 Sort the uniform out, as so many staff have issues about who wears what. It
is suggested that the full green uniform should only be worn when any LM /
CTL / Paramedic / EMT / Head of Service is working ‘front line’ and taking a
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shift on an RRV or Ambulance.Provide black fleeces with the crest on for
senior employees in the Trust (irrespective of whether they are a registered
paramedic or not).
21.16 Clinical Contact Centre staff could undertake ride outs with ambulance crews.
Paramedics / EMT’s not fit for active duty could spend time in Control
Centres. An understanding of each other’s roles and responsibilities needs to
be developed and worked on. Respect and understanding for each other’s
role needs to be firmly established.
21.17 2014 offers the opportunity to appoint new non-executive directors for the
Trust, and to bring in a wider skill set that complement those of Executive
Directors. It is also an opportunity to increase the diversity of the Board – a
recognised objective of the Welsh Government.
21.18 Board meetings need to be formally controlled by the Chair. Inappropriate
behaviour and ill advised conduct by anyone attending board meetings should
not be permitted to continue.
21.19 The number of union representatives at Board meetings is excessive, often
four or more. According to Welsh Partnership Forum “Working in Partnership
at Trust Boards” (published 2007) under the chapter “Development of a
Formal Link between Local Partnership Forums and Trust Boards” there
should be a “minimum of two … and a maximum of three” Trade Union
Representatives who will be elected through the Local Partnership Forum.
The tenure of these representatives is two years.
21.20 Sub committees also appear to have a high number of union representatives
and it is recommended that this is reviewed.
21.21 The confidentiality of staff surveys needs to be emphasised. Scaremongering
by WAST union activists needs to be addressed and further improved ways of
sharing information by management established – not just in relation to staff
surveys, but in all matters pertaining to change.
21.22 Working groups should cease to exist and be replaced with ‘Task and Finish’
groups that produce results in a matter of days, not months. No more than
one representative from each relevant union should take part in each task and
finish group and should attend the whole process, not step in and out as with
working groups. It is up to the individual unions to circulate information to
their members and gather opinions electronically before attending a task and
finish group.
21.23 Conflict resolution training is required so that managers at every level can
learn to engage in difficult or awkward conversations with confidence.
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21.24 Only nationally qualified mediators should be engaged to undertake formal
mediation.
21.25 Sickness absence levels are being influenced by dignity at work issues across
the Trust. By dealing with the issues, it is likely that a reduction in sickness
absence will occur over a period of time.
21.26 Paramedic / EMT shortage in the South East region is also influencing the
sickness absence figures (SE is currently running at 11%). Staff shortages
are putting huge pressure on employees who remain. This shortage needs
to be addressed without reducing capacity elsewhere in Wales.One
suggestion to address this issue is to focus marketing of WAST elsewhere in
the UK and highlight the affordable housing in SE Wales alongside beaches,
mountains, city life etc. A single person on a paramedic’s salary could afford
to buy a property.
21.27 NHSD’s position within WAST needs to be considered and a way forward
found to utilise their skills and expertise to maximum capacity. There is no
easy answer to the internal and external conflicts that presented themselves
during this analysis.
22.0
CONCLUSIONS
22.1
Not all of the issues raised are owned by all of the staff. The majority of crews
go into work; do the best they can for the patients - some of whom have
horrific injuries - work excessive overtime, tolerate the command and control,
wait outside A&E’s for hours, go without meal breaks etc. and all without
complaint.
22.2
There are union representatives who undertake their duties only to represent
their members in the best way they can and not to the detriment of the
service.
22.3
Dignity at work issues have an impact on the quality of service provided by
the Trust. WAST needs to stop working in a blame culture and learn to work
in different ways.
22.4
Above all the needs of the patient must come first, not just for the front line
crews, but for everyone.
22.5
There are two ways of dealing with this analysis; noting its contents and filing,
or taking positive but sometimes painful steps to address the very real
concerns raised within it.
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Signed:
Date:
06/10/13
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