The Christie NHS Foundation Trust Rapid Review: Published November 2021

The new Research Director should be asked to review the Wendy Fisher report, ’Initiating Research’ and the 2012 report, ’External Performance Review of the Systems and Processes in the R&D Division’ together with the progress on the action planning for both with a view to engaging a wide range of parties on the issues raised.

The Board of Directors should actively review the content of both these two reports to assure themselves that the appropriate level of attention has been given to the findings and recommendations.

That the Trust reviews the FTSU arrangements in the light of the latest national guidance and the MIAA report.

That the Trust should consider how to ensure that the FTSUG, while receiving the support of directors and having access to them, is also seen to be independent of directors in providing guidance where there may be a conf lict.

In line with the MIAA report, the Trust should clarify how the FTSUG should seek advice and support with complex whistle-blowing cases. This may also be a general point for FTSU arrangements. elsewhere. There will be occasions when the FTSUG is not able to escalate an issue within her/his organisation and there is a need for clarity on the options available outside the organisation which may include NHSEI regionally or the National Guardian’s Office.

That the Trust considers changing the reporting arrangement of the FTSUG.

The Trust is in the process of identifying FTSU champions to raise awareness to the opportunities for and encouragement to speak up. This is welcome. It is also recommended that the Trust considers recruiting additional FTSUGs f rom a diversity of backgrounds, to provide choices f or individuals to approach with concerns.

That the Trust reinforces the messages to staff that it is important to speak up and raise concerns; that they will be listened to and receive a reply. Timescales for receiving responses should be set and met.

The Trust should invest in organisation development f or the R&I Division which will fully engage staff of all grades.

The Board of Directors should reinforce its commitment to Freedom to Speak Up, and raising concerns generally, without personal detriment.

The Board of Directors should be clear in its zero tolerance of poor behaviours anywhere in the organisation.

That the Trust should review its policies and processes related to database access

That the Board of Directors considers the f ull report ’Independent Assessment of the Progression of Real-World Evidence/Big Data Partnership Opportunities at The Christie 2018-2020’, Professor Andrew Hughes and the Non-Executive Director’s ’Freedom to Speak Up – a Review June 2, 2020’ to draw out the key learning points for the board’s oversight and governance arrangements and to determine the policies and protocols for entering into future large scale commercial partnerships which potentially impact on service delivery.

The Trust should develop a clear policy supported by protocols to support decision-making regarding entering into major commercial relationships. This should identify the role of the Board of Directors.

Any plans to enter into commercial partnerships in future should be supported by clearly articulated programme management arrangements including a lead director, assigned responsibilities, timescales, risk management arrangements and escalation points. This should incorporate a communications plan f or engagement with key stakeholders and reporting to the Board of Directors or an agreed sub-committee of the Board.

That there should be a clear communication strategy for any major projects to ensure that they key stakeholders are well informed and have the opportunity to contribute to planning and implementation.

The Trust’s Audit Committee may wish to commission a study of the procurement processes in relation to the relationship with Roche and corporate partners in order that the Trust can develop SOPs for future ventures.

The Audit Committee should review the Trust’s Hospitality Policy to assure itself that it is appropriate for protecting the Trust and individual colleagues when there are active discussions with a potential commercial partner of the scale envisaged with Roche.

To review all acting up payments in the R&I Division to ensure that they have the necessary approvals.

The Trust should undertake an audit of the use of FTCs and review their policy with a view to developing a more supportive approach to this dedicated and often long-serving group of staff. This could include appropriate briefing and guidance documents for line managers on the use of FTCs.

Each individual on an FTC should have a one-to-one meeting with their line manager to consider their personal employment situation and the legal implications.

In view of the comments received about the turnover of staff from BAME backgrounds in the CRF it is recommended that a look back exercise is undertaken to establish the actual position.

That the use and effectiveness of exit interviews be reviewed.

The new Director of R&I needs to be fully supported to lead the development of the R&I strategy.

The leadership of the Trust should be fully engaged in working with stakeholders to clarify The Christie’s ambitions for research within Greater Manchester, nationally and internationally.

The Christie leadership should review the management arrangements for the division.

The new RD should be supported to develop a strong, knowledgeable, and inclusive leadership team.

The Trust should invest in organisation development f or the R&I Division which will fully engage staf f of all grades.

The Trust should consider whether it would be of value to initiate widespread organisational development/cultural interventions within R&I to identify and address underlying behavioural issues.

The Trust are advised to review their Positive Working Relationships Policy particularly in relation to the intent of the alleged perpetrator. Current ACAS guidance around harassment states that harassment must have violated a person’s dignity whether it was intended or not or created a hostile environment for the person whether it was intended or not. This is consistent with the Equality Act 2010 which makes it clear that it is not the intent of the perpetrator that is important but how the individual was made to feel.

It would be beneficial for the organisation to consider the introduction of Bullying and Harassment Champions or supporters so staff have someone who they feel they can approach f or informal support and advice other than HR who may have to deal with any formal processes.

The Trust should seek feedback from BAME staff on their experiences and examine information provided in exit interviews f rom the last three years.

Through an external organisation, the Trust should examine how BAME colleagues have been treated in recruitment, promotion, disciplinary and grievance hearings over the last three years.

The Trust should examine the feedback mechanisms from both staff and service users and seek assurance that all, regardless of their background (and particularly those from marginalised groups), are fairly and equitably represented when services are reviewed, and feedback is sought.

That either the full Board or a limited-lif e sub-committee, with a majority of non-executive directors reviews the reports that have been received about R&I including ’External Performance Review of the Systems and Processes in the R&D Division’f rom 2012; the Wendy Fisher report; the report of the Non-Executive Director into the ’Concerns in the R&I Division’ raised with the FTSUG; internal audit reports; ’Independent Assessment of the Progression of Real-World Evidence/Big Data Partnership Opportunities at The Christie 2018-2020’, (Professor Andrew Hughes) December 2020; Review of the Clinical Research Facility, Professor Jaclyn Smith, December 2020; and the responses to these to assure themselves that f ull attention has been paid to them and that learning has been acted upon.

The Board should review its structures for the escalation of issues and scoring of risks. It would be helpful for this to be facilitated and overseen by the Audit Committee.

That the Board reviews its arrangements for communicating with and listening to the experiences of the employees of The Christie.

The review team would recommend to the Board of Directors that they consider the evidence, observations and recommendations f rom this review, with a view to assuring themselves that colleagues throughout the Trust are conf ident that they will be supported to speak up through compassionate management arrangements and an assertive FTSU service; that the Board has mechanisms to hear the experience of colleagues; that the Board can be held to account as a f air employer through its culture and transparent processes.