Standards of Conduct Committee

Diolch. Bore da. I'm happy to meet you all. Thank you for the introduction, Hannah. My name is Angela Lewis. I'm director of culture change in the Welsh ambulance service. I'm delighted to be with you today. We have done some significant work around cultural change, but also safety and speaking up safely in the workplace, with a particular focus on sexual safety and ensuring that our female members of staff, in particular, feel safe in the workplace.

We've done this work primarily because, very openly, the ambulance sector has had some challenges in relation to cultural issues, behavioural issues. And so for the last two and a half, three years, we've really tried to focus on the reasons for that, what's causing this sense of a lack of safety, but also more broadly, how we can make our organisation a safe, constructive, positive place to work. So, I'm very happy to share our experiences and take any questions.

Thank you. I noticed in some of the information you submitted, you talk about creating a culture that is inclusive, welcoming, tolerant and as safe as possible. I was just interested in the point you made in your opening remarks about ensuring safety, particularly for women, and for speaking up in the workplace. I obviously recognise that actually getting to where organisations want to and need to be is a cultural journey, but, I think, one of the things we're looking at as a committee here, as well as training, which may be a recommendation for the Commission, one of our roles is to look at actually what processes perhaps we need in place, and the structures. So, I don't know whether you'll be able to elaborate on any structures you've brought in that underpin that kind of journey towards cultural change.

Yes, I'm very happy to. If I rewind nearly three years ago, we did a survey across the organisation, following on from the introduction of our new behaviours, and we asked colleagues if they felt safe in the workplace, and they responded with some really concerning feedback. That was an anonymous survey and, as a result of that, what we then did is we asked individuals who perhaps had lived experience of not feeling safe to talk to us, to tell us about what was it that were some of the challenges.

As a result of that, we established a network called our Voices network, which was individuals who had lived experience of feeling unsafe in the workplace, potentially experiencing harassment, and probably the most unusual thing we did is we were led by them in terms of the types of processes we should introduce. Because some of the challenge they said to us is that, often, organisations recognise they have a problem, and then they introduce a process or a policy, and it's just delivered to the organisation, where we wanted to co-create with colleagues. So, we talked to this group of people who then became our Voices network, and we introduced different ways that individuals could share with us their experiences. That could be within the safety of a network, it may be that they wanted to talk to a specialist.

But we also introduced a speaking up safely guardian. So, it's a full-time dedicated role. I'm not sure if you're aware, but in NHS England, they have had guardians for quite a few years, and these roles are semi-independent to the organisation. They report in to the chief exec and the non-exec committees [correction: They report in to the chief exec and one non-executive member of the board]. I had day-to-day responsibility for them, but there is that sense of semi-independence. That guardian role is that extra scrutiny and challenge, and provides that additional space for individuals to come forward if they feel unsafe, or if they want to raise concerns about behaviours, other issues, but particularly around behaviours where, potentially, the more formal routes haven't worked, i.e. they haven't been able to feel confident to go to their manager, they haven't been able to go to their HR function.

So, we introduced that guardian, and alongside that we introduced a working-in-confidence platform, a digital platform, which is an anonymous platform that individuals can also use. We were able, then, with our guardian, to use that to connect with individuals who still didn't feel safe enough to give us their names, to work with them to build their confidence, to enable them, then, to potentially go through other processes, whether that be a respect and resolution, a grievance policy, et cetera.

So, they were the what I would call 'formal processes' we wrapped around this, Hannah. Because, actually, we have disciplinary processes, we have grievance policies, and what we realised is they weren't actually working. We needed to have this other way that individuals would feel safe enough to come forward, because you have to feel safe to be able to initiate a formal process. Does that help?

Yes. That's really interesting. And just the point you make about the speaking up safely guardians that report to you, and they're semi-independent, I think that's an interesting point, because some of the evidence we've perhaps had, from people who work within the Senedd, is having confidence in the system as being independent, and the way in which they would then be treated. Because, obviously, a lot of the time with incidents around, perhaps, sexual harassment in the workplace, there is often a power dynamic at play as well. So, have you found that having that speaking up safely guardian has been positive and that you've had positive feedback from the workforce?

Very positive. We saw in our staff survey results that there was a significant increase in the numbers of individuals who felt more comfortable to raise a concern, but, perhaps even more importantly, that it would be taken seriously. But what I would also say is, as a result of some—. We've also done some development with all our managers around essential conversations, how to ensure that you're taking issues seriously, how you're able to address those issues earlier.

We've also introduced allyship training. So, again, we're asking all colleagues to stand by the side of individuals where they see something that isn't right. So, I think, collectively, what we've seen is much more confidence that people have a range of routes to use. But, ultimately, that guardian is their last resort if nothing else works. So, we did see a significant increase in people coming through that route. It's dropped off a little bit, and then it does sometimes go up, depending on how people feel, but we are just trying to say this is just that other route that you could use if everything else feels like it's not appropriate.

Alongside that, we've also introduced a real focus on detriment and trying to reassure colleagues that they will not suffer detriment if they speak up, because we did find that was one of the biggest issues. Whether it's real or perceived, there is a belief that if you do come forward and you raise a concern, because of those issues you've talked about, about power dynamic or lack of confidentiality, colleagues really felt that their careers would be impacted, their colleagues would stop talking to them. So, we do a detriment risk assessment with anybody who comes forward, to talk to them about how we can support them and really wrap it around them, and the trade union working with us around confidentiality. Because I would say that one of the biggest issues we've experienced is this concern that there is no confidentiality, particularly in relation to issues that are about behaviours. So, that's an area we've really focused on.

One more from me, then I'm sure colleagues will want to come in. Training is something we've had quite a few discussions about, and questions, in previous evidence sessions. But I'm just interested in going back to—. You mentioned the working-in-confidence digital platform. So, when somebody perhaps utilises that platform, what is the next stage after that?

So, the guardian then has access to it. It's not managed by anyone else; the guardian and their administrator manage it. No-one else has access to it. And, in the first instance, people come in totally anonymous, and then the guardian will work with them to see whether they're willing to share more details, what they're prepared to share, et cetera. But even if they raise an issue completely anonymously, if it suggests there's a concern in a particular area or that we might start to see a trend in terms of a particular area, we will have looked to work with the leaders in that area to try and address it whilst also recognising we have to be really careful that we don't unintentionally expose or potentially put somebody into a position where it's apparent that they have brought the concern.

Our goal, Hannah, is that nobody should have to be completely anonymous. We want to get to a stage where individuals feel comfortable enough that they can say who they are, they can talk to us about what's been going on, et cetera. And I'm pleased to say we've moved—. The numbers of purely anonymous cases coming through now are dropping, and what we have is people feeling more comfortable to say who they are and what's actually happened for them. Because you'll know, in an organisation, if you've just got lots of anonymous complaints, it's really quite tricky to then try and address them without further information. But what we have done is be really proactive around looking for any trends or themes, not only in terms of areas where we think we may have pockets of concern, but also where we've got really good practice. If we can see areas where people are saying, 'This is a great place to work, everything is working', we'll really focus on those as well.

Sorry, I should have also said we've also done a number of independent, small-scale cultural reviews. So, we've used external third parties to come in and do cultural reviews of areas where it's apparent that there are a number of flags. So, for example, a high sick absence, high turnover, respect and resolution cases, concerns, managers themselves feeling uncomfortable about trying to deal with issues. So, we've used some third parties to help us with those as well.

Thank you. Does anybody have any questions they'd like to come in with first? Peredur, and then I'll come to you, Mick, after.

Thank you very much for coming in. It was fascinating to read the information that we've got and also some of those things that you've said there. Can I understand a little bit more about the guardian role? Is that then a full-time—? That's their paid employment; that's paid for, obviously, by yourselves, but has that direct line in. So, how do you communicate that role with members of staff? Could you talk a little bit about the cultural toolkit and those reviews and how they all link together, so that I can understand a little bit more about the route that you've taken to get to where you are now?

Yes, very happy to do that. The guardian is a full-time role—job description, role profile, senior manager in the organisation—and when we were introducing it, and actually when I bid to get the resources for that, what I used were the resources from England but also other organisations where they've appointed someone into that Speaking up Safely role. I was really fortunate; the board and our chief exec absolutely understood the need for that. And when we advertised and we recruited, we involved staff in the stakeholder panel to appoint that person. We really positively promoted the value of it, but also said that it didn't replace line managers, human resources, et cetera. It was just that additional layer that we wanted to really reassure colleagues with. And then we do roadshows every six months across the country, because, obviously, we're a national organisation, and, at those roadshows, we were with staff from across the business for two hours, and we had half an hour with them where I and our guardian talked about the role, shared examples of what it was, talked about scenarios where we might use that particular route, and that really helped raise the profile. We also have a dedicated space on our intranet where people can find out about that.

But I think the main thing is to say is that that was a continuation of the other activities that I've talked about. So, we started with building a people and culture plan, and the development of what we called a 'rich picture', to say, 'What's not right about our culture at the moment? What do we all recognise we need to improve?' And I'll be really honest with you, there was a real recognition that there were some things that were brilliant, but there were also some things we needed to improve. And so, the guardian was just that further extension of what we'd been doing—so, the training that I just talked about, the allyship training, that speaking up, that idea that we have thriving people networks. I mentioned the Voices network, but we also have our carers network. We have a broad group of networks that are absolutely committed and understand the importance of safety in the workplace. We have cultural champions. I have probably about 250 people in the organisation who want to be part of the culture change we're trying to deliver. So, through all of those routes, what we've tried to say is, 'This isn't something we're just doing and it's just a one-off; this is part of all of the practices we can put in place to make this the best place to be and allow you to do your best work, because then you're going to benefit the patients.' That seems to have worked. If we'd just done the guardian, I just don't think it would have landed. It would have just been seen as, 'Well, who is this person?', because they can't work in isolation. Everything else has to be wrapped around that. Does that make sense?

Definitely. Yes, it does. Thank you for that. And then, on the guardian's role, can that guardian take things forward themselves, independently from the potential victim? Or if they've heard something, or seen, or been told something anonymously, what's the process, I suppose? You said it's wrapped around the disciplinary process and everything is wrapped around this. What role does the guardian have within that? Is it more working with that individual to make a formal complaint, or can they take it forward on their behalf as, effectively, a bystander in that sense?

So, the goal is to get the individual to drive it forward, because actually it's not helpful. I think we'd lose trust if guardians suddenly started trying to solve everything. I mentioned earlier to Hannah that what the guardian really tries to do is to make somebody feel safe enough to share who they are and share where they work, because, often, if you get an anonymous complaint, it will be so generic. You might get a few clues, but it won't help you identify everything. So, our goal is always: how can we make people feel safe enough to tell us where they are and what's going on? If it's completely anonymous and it's so generic, there's very little we can do. That doesn't mean—. The guardian meets with me once a month and with a clinical psychologist, so we would talk through, 'Well, is there anything that we can capture from this? Is there any sort of suggestion?' But if we've just got an anonymous complaint, it's really quite tricky. But we don't close it. We would never close a case, because we would then see if anything else comes in, to follow up from that, and, again, that role is all about trying to get people to be open enough to say who they are.

When you say, 'Does the guardian solve or try and address things on their own?', what that guardian role does then is that they would, obviously, reassure the individual about wanting to help them to take the right formal processes, but they do hand it off to, potentially, HR or they may hand it off to the managers. What is really good about the role, though, is that they hold us to account—so, has something been closed or resolved; has it been dealt with in a timely manner; are we seeing themes in relation to a particular manager, a particular area, a particular individual? But they are only one part of the puzzle, I suppose, because we also then will have our HR colleagues who will also have information.

So, I think that at the heart of what I want to get across today is that we have so much intelligence in the organisation about what's going on. We do have it there. Our job is to bring it all together, triangulate what we're hearing and see where we need to take action, because often—. I mentioned the cultural reviews, but we've also got a tool we use, which is called CEWS, the cultural early warning score tool. And we use that just to assess are there any other factors that give us an indication that there is a problem in a particular area, because what we want to try to move away from is making it all about individuals, because, actually, normally, if there are issues, it's not just isolated to one individual. So, that seems to help, then, to make it feel less victim focused and it being about the victim having to come forward and deal with all of the challenges that come with that, and more organisationally focused. And I would say that we've been doing that for about two years, but we've still got lots to do, because there is so much rich information that we need to use. And I think that that's partly why I said to you that we also put the focus on where it's working really well—so, celebrating when we've got great teams, great leaders, really good high-performing stations, because otherwise it becomes very, very negative.

Thank you very much. That was very interesting. Thank you. Diolch, Cadeirydd.

Before I bring Mick in, can I just ask another question regarding the role of the guardian? How do you ensure the quasi-independence of it?

It's tricky. What the guardian has is that external network as well. So, there is a guardians network across the UK. I mentioned to you the clinical psychologists—so, they get, I would call it 'clinical supervision' as well, because it is a tough role. And it's about who you appoint. What I would say is that, when we look to appoint that, it has to be somebody who is very comfortable in terms of talking truth to power, because there is a hierarchy, isn't there, and they have to feel very comfortable in that. They also have the support of our non-exec vice-chair as their other independent—. So, I've tried to wrap around as much support because I do recognise that we're still working in our hierarchical organisation. But, it's also about the individual. So, I've got an absolutely fantastic guardian who is really very comfortable in terms of challenge, understanding that, but she also gets a lot of support from outside the organisation. And we've also been really clear with her, 'If at any point you feel that, actually, I'm not listening, our chief exec isn't listening, you have another route, which potentially might be to the Welsh Government or others, because we're all accountable.'

Thanks very much. Mick.

It's really just to follow on, as you've been very comprehensive in what you're doing, and, obviously, talking about an ongoing journey of culture change. How do you actually evaluate and measure your success so far?

I'm happy to share that, and, in fact my chief exec, who is leaving to go to London, asked me the same question on Friday. We talk about shifting the dial, because culture change takes years to deliver, but I think some of the key—. We use soft and hard measures. So, if I talk about hard measures: sick absence has gone down; turnover has gone down; we've got more people wanting to join the organisation. I was at a newly qualified paramedic event on Friday, where we were recruiting significant numbers of paramedics. All of them talked to us about the thing that they were interested in being involved in is the work that we've been doing around speaking up and feeling safe in the workplace. So, we've got those types of measures. We've got, again, measures in terms of people being willing and contributing to our allyship and bystander training, because it's not mandatory and they're attending it. We've got colleagues attending our sexual safety training. We've got evidence that our trade union partners are aligned and working with us to ensure we're delivering. And then we've also got the softer—it's individuals joining our network and telling us that they want to be part of this and they want to really see the change.

I think I mentioned our staff survey results, the NHS staff survey results, showing that they recognise that we are listening, we want to take things seriously, and also more participation in that survey. We went from 20 per cent of people participating to 36 per cent, which is a massive increase for an organisation that's across Wales, and it's hard to get people engaged. So, there are lots of measures that we use, but, for me, we also have those soundbites from individuals who are very willing to share their stories, so we often put a focus on individuals and they come to our committees and our board meetings to talk about their experience. Often, it's been a really tough experience, but then they'll talk about how they feel the organisation is supporting them.

So, I think, Mick, my message is that we use everything, but, instinctively, what I'll always say is that you have to ask the staff, and they will tell you. We spend a lot of time around the country asking people, 'Well, how is it?' And what they'll often say to us is, 'It feels different. We can feel that you're trying. There's still lots to do; our day-to-day work experience is still challenging, if we're outside a hospital waiting to be relieved, et cetera. But do we believe that you are trying to make this a better, more effective, safer place? Yes, we do.'

So, all of those measures are used, but, every six weeks, I present a paper to our executive team. One time I'll do it on quantitative, and the next time I'll do it on qualitative, just to sort of say you've got to look at both. And I think the fact that it's on our agendas means that we're putting far more scrutiny on it and we're really challenging ourselves to say, 'We can't just accept that we've finished, we've done it,' because it doesn't ever stop.

Okay. Thank you very much.

Thanks, Mick. Tom, any questions or observations from you?

No, I think my last question was the one Mick asked there, so I'm good.

Thanks. We are getting to the end of our scheduled time for this session, but just a couple of final points, perhaps, Angela, if I may. You talked, I think, earlier on in an earlier contribution about working with the trade unions. What does that look like and what form does that take?

So, we have really close relationships with them. They're on every one of our formal committees, but they also have really worked closely with me as well around, as I mentioned to you, our people and culture plan, the allyship and bystander training—they've all done that—the sexual safety training, the cultural reviews. So, if I commission a culture review with a line manager, there'll always be a trade union alongside us to be that commissioning party. So, it is absolute partnership in terms of that.

And that regular meeting every couple of weeks—. Again, I talk about intelligence; what they give me is that intelligence, that early messaging around, 'There's a problem here. We're seeing a pattern here, we need to be addressing it.' And I think the reason it works is because there is an organisational commitment to address things early. So, that's how it shows up, Hannah, in that we would never do a cultural review without a trade union being part of the commissioning team.

The final question I'd like to ask, really, is: I'm aware there is a national ambulance programme of work, particularly looking at reducing misogyny and improving sexual safety. Is that something that you link into or the guardian network links into as well?

So, Bron, who was leading that, worked with us, so she started it with us, and then, obviously, she was seconded into the national ambulance association forum. So, we've just continued to feed in, work with her, work with the team, share good practice across other ambulance services, share good practice across the NHS in Wales, because what we all recognise is we haven't got all the answers and we've got to keep learning. So, yes, we closely collaborate across the piece, because what we've got to keep reminding colleagues of is that it just doesn't go; you have to keep working, and not just in the agenda of sexual safety. This is safety for all protected characteristics, but also, more generally, safety for people in the workplace to be able to call it out if they see something that isn't right, because, if they do that, that will make us a much better organisation and it'll benefit our patients.

Great. If there are no further questions from colleagues, then can I thank you for your time this morning joining us? That was actually really interesting. There may be some points, perhaps, that, once we reflect on the evidence, we might wish to follow up to see if there's anything you can share with us on some of the things that you've referenced, to help us with some of our inquiry and potential recommendations. But I'll just say that a copy of the transcript will be provided as soon as possible. That's so you can check it for factual accuracy. But thank you, once again, for your time and your contribution this morning. Diolch yn fawr.

Diolch, and good luck. Thank you.