Launching the Report + Support™ System at Royal United Hospitals Bath NHS Foundation Trust

Introduction

The Royal United Hospitals (RUH) Bath NHS Foundation Trust serves over 500,000 individuals across Bath and North East Somerset, Swindon, and Wiltshire. With over 6,500 staff, the Trust is a significant regional employer and healthcare provider. Recognised as one of the top 20 NHS hospitals to work for nationally, RUH’s commitment to enhancing staff well-being and patient care underpins its strategic initiatives, including the launch of the innovative Report + Support™ system​.

National Context

The results of the 2023 NHS Staff Survey continues to highlight a nationwide concern regarding workplace safety and inclusivity, reflecting the scale of challenges related to bullying, harassment, discrimination, and sexual harassment across healthcare organisations.

Key Findings

• Bullying and Harassment: Despite slight improvements, a significant proportion of NHS staff reported experiencing harassment, bullying, or abuse:
  • 25.15% from patients, their relatives, or the public.
  • 27.6% from managers and colleagues.
• Discrimination: Reports of workplace discrimination have gradually increased over the past five years. In 2023:
  • 8.48% of staff reported discrimination from patients or the public.
  • 9.07% experienced discrimination from colleagues or managers​.

Sexual Harassment

For the first time in the NHS Staff Survey, the survey included questions about unwanted sexual behaviour:

• 8.67% of staff reported experiencing such behaviour from patients, relatives, or the public.
• 3.84% reported incidents involving colleagues​.

These statistics are, however, in contrast with research from The BMA and Unison who found prevalence to be much higher:

• 91% of women doctors have experienced sexism in the last 2 years.
• 60% nursing staff said that they have experienced sexual harassment at work.
• 56% of women doctors received unwanted verbal comments relating to their gender in the last two years.
• 31% of women doctors had experienced unwanted physical conduct in the last two years.
• 8% of allied healthcare professionals had been sexually harassed in the last year.

Reporting Challenges

While there has been progress in encouraging reporting, only 51.80% of staff reported harassment, bullying, or abuse incidents. Reporting rates for sexual harassment incidents remain unclear, emphasising the need for enhanced mechanisms​.

Freedom to Speak Up Guardians

The Freedom to Speak Up Guardian role was introduced in the NHS in 2016 following recommendations from the Sir Robert Francis QC’s Freedom to Speak Up Inquiry. This role is central to promoting a culture of openness and safety across NHS organisations, empowering staff to raise concerns about unsafe practices, bullying, harassment, discrimination, and more​.

Role and Function

Freedom to Speak Up Guardians provide independent, confidential (nb not anonymous) support to staff who wish to report concerns. They ensure these concerns are addressed and communicated to senior leadership teams while safeguarding the identity of the individuals raising issues when requested. Their efforts aim to:

• Foster a culture where speaking up is normalised.
• Build trust among staff that concerns will be heard and acted upon.
• Reduce barriers such as fear of retaliation or inaction​.

National Impact

In 2023/24:

• Over 32,000 cases were raised with Freedom to Speak Up Guardians, a 27.6% increase from the previous year.
• Nearly 40% of these cases involved inappropriate behaviours and attitudes, such as incivility or discrimination.
• Concerns related to bullying and harassment constituted approximately 20% of cases, while issues of worker safety or well-being accounted for 32.3%.
• Detriment, or disadvantage experienced by staff for speaking up, was reported in 4% of cases, highlighting the need for continued cultural improvement​.

Cultural and Operational Implications

These findings underscore a pressing need for NHS organisations to prioritise:

1. Safety and Respect: Promoting policies and tools that encourage reporting and provide support.
2. Cultural Change: Embedding inclusivity and civility in everyday interactions.
3. Transparent Mechanisms: Establishing robust systems like Report + Support™ to enable anonymous and accessible incident reporting.

Public Sector Equality Duty (PSED)

Introduced under the Equality Act 2010, the PSED requires public bodies, including the NHS, to proactively consider how their policies and practices impact people with protected characteristics, such as age, disability, gender reassignment, pregnancy, race, religion, sex, and sexual orientation. The Duty has three key aims:

1. Eliminate unlawful discrimination, harassment, and victimisation.
2. Advance equality of opportunity between people who share a protected characteristic and those who do not.
3. Foster good relations between different groups​.

The PSED underscores the NHS’s responsibility to create an inclusive environment, address structural inequalities, and ensure that mechanisms like the Report + Support™ system are in place to uphold these principles.

Worker Protection Act 2023

The Worker Protection (Amendment of Equality Act 2010) Act 2023 strengthens the legislative framework to protect workers from harassment. Key provisions include:

• Employer Liability: Employers are now legally obligated to take all reasonable steps to prevent third-party harassment, such as by patients or the public, in addition to harassment by colleagues.
• Mandatory Training and Preventive Measures: Organisations must implement training and policies to safeguard workers.
• Proactive Duty to Prevent Sexual Harassment: Employers must actively ensure that workplaces are free from sexual harassment, fostering a culture of respect and accountability.

This legislation places greater onus on employers, including NHS Trusts, to address harassment proactively and transparently. The launch of tools like Report + Support™ directly supports compliance with these requirements by providing accessible and anonymous reporting mechanisms.

Cultural and Operational Implications

The national legislative and survey data reinforce the urgency for systemic changes within the NHS:

• A cultural shift towards inclusivity and safety is imperative for worker well-being.
• Tools like the Report + Support™ system and the presence of Freedom to Speak Up Guardians play a vital role in translating legal obligations into practical outcomes.
• Supporting staff in raising concerns without fear of retaliation ensures not only compliance but also improved workforce morale and patient care outcomes.

Local Strategic Context

Rated as one of the best hospitals to work for in the whole of England by their own staff, RHU have worked to embed all of these frameworks into its strategic priorities. In doing so, the Trust demonstrates leadership in aligning with national goals to create safer, more inclusive workplaces. RHU has built a reputation for prioritising staff well-being and fostering an environment where all team members feel valued and secure. Its You Matter strategy (2023–2028) outlines a vision of fostering a safe, inclusive, and supportive workplace. The strategy emphasises kindness, respect, and empowerment as core values, aiming to maximise staff potential and create optimal conditions for healthcare delivery.

In this year’s Staff Survey, nearly 2,500 people – or 68% of those surveyed – said they would recommend the RUH as a place to work (600 more than the previous year) putting the Trust 18th out of 122.

Survey results also show that an increase of nearly 500 people say they look forward to going to work, 530 more said they feel trusted to do their job, and 440 more said they are able to make improvements happen. The Trust is 6th nationally for colleagues saying they have frequent opportunities to show initiative, and 8th for being kind and understanding towards each other.

Although the results from the Staff Survey were positive, feedback from the Survey also highlighted further areas for improvement, including staff experiencing harassment, bullying, or abuse. The survey revealed that while reporting rates had improved, significant gaps remained, with only 48% of staff reporting incidents of harassment or abuse (below the national average for reporting). These findings highlighted the need to provide a transparent, accessible, and effective mechanism for addressing unacceptable behaviours.

As a signatory of the Sexual Safety Charter, RUH demonstrates its commitment to upholding the highest standards of safety and respect in the workplace. This charter underscores the Trust’s dedication to addressing and preventing sexual harassment and misconduct, fostering a culture of mutual respect, and ensuring that all staff members feel empowered to report incidents without fear of stigma or retaliation. The principles of the charter align closely with the Trust’s broader goals of promoting inclusivity and protecting staff well-being.

The Trust’s Equality, Diversity, and Inclusion (EDI) objectives provide a focused framework for advancing equity across the organisation. These objectives include:

1. Creating safe, inclusive, and diverse teams and environments where staff feel they belong, are valued, and can thrive.
2. Promoting and embedding diversity at all organisational levels, advocating its benefits both internally and within the wider community.
3. Reducing occurrences of discrimination, prejudice, harassment, and abuse based on individual differences across all teams, structures, and systems​.

As part of this framework, the Trust has actively:

• Strengthened and re-launched its staff networks, ensuring these groups can lead initiatives and act as safe spaces for their members.
• Implemented the Routes to Success program, promoting equitable career progression for staff from the Global Majority, with 20 participants completing the first cohort.
• Launched its first Race Equity: Anti-Racism Statement, providing toolkits and allyship guidance to foster meaningful conversations and actions​.

These initiatives, combined with insights from the NHS Staff Survey, revealed persistent challenges such as incidents of bullying, harassment, and discrimination. The survey also highlighted disparities in career progression and workplace experiences among different staff groups. These findings prompted the Trust to implement Report + Support™, ensuring an accessible, anonymous reporting mechanism was available, and a commitment to launching targeted interventions to address systemic issues.

These objectives and strategies position the Trust as a proactive force for positive change, ensuring its workforce and patients alike benefit from a culture of respect and support.

RUH recognises that a culture of safety and inclusion directly impacts patient care, making these initiatives integral to its strategic goals. The launch of Report + Support™ represents a critical step in fulfilling its obligations under the Sexual Safety Charter and its broader commitment to creating a workplace where everyone feels safe, valued, and empowered to contribute their best​.

Local Implementation of FTSU at RUH

At Royal United Hospitals Bath NHS Foundation Trust, the Freedom to Speak Up Guardian and Speak Up Champions across the Trust play a pivotal role in supporting initiatives like the Report + Support™. The Trust has one Freedom to Speak Up Guardian, while the Speak Up Champions help to develop a speaking-up culture at team level and act as conduits between team leaders and the Freedom to Speak Up Guardian. Their presence ensures staff have multiple channels to raise concerns. By working closely with leadership and leveraging tools like Report + Support™, they address issues at their roots and contribute to organisational learning.

Challenges Identified

• Workplace Safety and Inclusivity: Only 48% of staff reported incidents of harassment or abuse in the 2023 NHS Staff Survey, a statistic that, while improved, highlighted significant gaps in reporting culture.
• Mental and Physical Well-being: Burnout and stress were persistent concerns, with workforce capacity challenges further exacerbated by post-pandemic pressures.
• Consistency in Reporting Mechanisms: Staff feedback emphasised the need for simple, anonymous, and mobile-accessible reporting tools to encourage incident reporting and timely action​​.

The Report + Support™ Solution

The Trust launched the Report + Support™ system as part of its Violence and Aggression Reduction Policy in August 2024. As a 24/7 online reporting platform, it enables staff to report incidents of abuse, discrimination, and violence anonymously or with their name, ensuring their voices are heard without fear of reprisal. The Report + Support™ system is intended to provide increased psychological safety in reporting and dealing with concerns. Everything reported through Report + Support™ goes into the People Hub (unless the person requests it to go to the Freedom to Speak Up Guardian only). This enables the People Hub to support colleagues, primarily by empowering managers to take meaningful action at team and service level.

Key features include:

• Ease of Use: Accessible via mobile devices, requiring no login credentials.
• Anonymity Options: Protecting staff identities while still capturing critical data for preventive measures.
• Collaborative Development: Input from People Hub, the Culture Team, and other stakeholders ensured a comprehensive and user-focused design​.

Implementation and Engagement

The rollout of the system included a phased approach:

1. Pre-launch Activities:
   • Direct engagement with staff networks, union representatives, and senior leadership.
   • Comprehensive training sessions for Divisional People Partners and other key stakeholders.
   • Updates to intranet and communication channels​.
2. Launch Week:
   • organisation-wide communication through emails, posters, and briefings.
   • Virtual and face-to-face sessions to familiarise staff with the platform and its purpose.
3. Post-launch Monitoring:
   • Regular review meetings every two months to assess uptake and effectiveness.
   • Ongoing collaboration with governance teams to refine processes and ensure alignment with strategic goals​.

Impact and Anticipated Benefits

The introduction of Report + Support™ aligns with RUH’s broader objectives to:

• Enhance workplace culture by addressing unacceptable behaviours proactively.
• Empower staff through visible action and support mechanisms.
• Improve patient care by fostering a more engaged and satisfied workforce​​.

Conclusion

The launch of Report + Support™ is a testament to RUH’s dedication to its people-first ethos. By leveraging feedback and data from various channels to implement meaningful change, the Trust exemplifies its commitment to creating an environment where everyone feels valued, safe, and heard. This initiative not only addresses current challenges but also positions RUH as a leader in staff well-being and patient care innovation.