Executive summary

NHS England Workforce Training and Education Yorkshire and the Humber (NHS England WT&E YH) would like to thank the education and senior leadership team representatives for attending this Senior Leader Engagement (SLE) meeting. The main findings are:

• Following the SLE meeting in 2023 the trust continues to make excellent progress in the initiatives and support provided to staff. It was acknowledged that the trust is well performing and an exemplar for mental health trusts.
• The trust has proactively adopted the Safe Learning Environment Charter (SLEC) with high levels of communication to ensure essential elements are identified and acted upon (Page 9).
• Undergraduate students do benefit from the levels of pastoral care currently available to the Postgraduate Doctors in Training (PDiT), with effective links noted with Hull and York Medical School (HYMS) (Page 11).
• Expansion of postgraduate numbers has been managed well, including into the wider areas of supervision. The Quality Lead (QL) will continue to work closely with medical education to expand the understanding of the GMC National Training Survey (NTS) and National Education and Training Survey (NETS) (Page 5).
• The trust outlined their personalised approach to supporting Foundation Doctors (FD) enabling effective methods are introduced, especially the impacts of mental health within this group (Page 9).
• Medical recruitment to consultant roles and retention of PDiT at completion of training has maintained an upward trajectory (Page 6).
• Good financial management has been noted at the trust ensuring high levels of patient safety and support to medical education. Tariff was noted as being in a good position, with some concerns relating to future obligations around payment of expenses to undergraduate students (Page 6).
• The trust covers a wide range of multiprofessional placements and NHS England have engaged with the team to exchange improvements to their training, as well as challenges experienced. Practice Assessment Record and Evaluation (PARE) data has shown to be very positive (Page 10).
• The trust shows a high level of commitment to Equality, Diversity and Inclusion (EDI) with several initiatives outlined (Page 7).
• The trust has no requirements or specialty concerns, with no comments submitted through the NTS Survey.
• The trust has continued to receive no Patient Safety or Bullying and Undermining Comments from the current GMC NTS 2025, for which the trust was commended on and for the continued improvement of their overall results. A meeting will be held with medical education on receipt of the 2025 quantitative data to discuss these results.
• The trust Quality Intelligence Summary Report was reviewed to assess progress since submission of the SAQ in 2024. There has been continued engagement with staff to ensure that the best quality of education is being provided, however challenges continue in respect of those PDiT who have set fixed rotations from the acute trusts and integration into the mental health environment. Support continues to be provided to ensure the best experience, and data results suggest this remains positive, with the trust being encouraged to continue the good work being undertaken.
• The next Senior Leader Engagement meeting will be held in early 2027 and the Quality team will continue to support the trust.

Review overview

Background to the review

Senior Leader Engagement (SLE) meetings are undertaken to ensure that quality risks are managed effectively, and notable/good practice is identified and shared across the region, building on, and strengthening relationships with the organisation.

Evidence

• 2023 Quality Interventions Review Report
• 2023-24 Freedom to Speak Up Guardian (FTSUG) Annual Report
• 2024 NETS Data
• 2024 GMC Scores and Ranks
• 2024 Self-Assessment Questionnaire (SAQ)
• 2025 February – April Guardian of Safe Working Hours (GoSWH) Quarterly Report
• 2025 PARE Report
• 2025 PARE Top 5 and Bottom 5 Data

Who we met with

Trust attendees

• Head of Organisational Learning & Development
• Head of Medical – Education, Business & Staffing
• Higher Training Tutor
• Medical Undergraduate Lead
• Freedom to Speak up Guardian
• Equality, Diversity & Inclusion Lead
• Lead Educator, Clinical Workforce
• Head of Social Work
• Interim Associate Director for Psychology

Senior team attendees

• Chief Executive Officer
• Deputy Director of Finance
• Associate Director of People & OD
• Medical Director

Review panel

• Education Quality Review Lead: Professor Andy Lockey, Associate Dean (Chair)
• Specialty Expert: Alex Pavlovic, Head of School (HoS) for Psychiatry
• Specialty Expert: Lyndsay Murden, Regional Quality Lead for Nursing, Midwifery and Allied Health Professionals (AHP)
• Specialty Expert: Sarah Newsome, Senior Manager Education & Training, Integrated Care Board (ICB) Link (Humber & North Yorkshire)
• Education, Investment and Commissioning Lead: Anthony Hann, Contract Manager
• Workforce, Transformation & Education Representative: Fiona Hibbits, Director of Workforce
• Education Quality Representative: Vicky Jones, Quality Support Manager
• External Representative: Anne Brown, Lay Representative

Review findings

The review panel thanked the trust for accommodating the Senior Leader engagement meeting (SLE) and were informed that the review panel were seeking to understand any initiatives made within the organisation and challenges impacting on training where new sustainable methods of improvement could be identified.

Quality intelligence and strategic priorities

Freedom to speak up

The Freedom to Speak Up Guardian (FTSUG) had circulated the latest report and confirmed that an internal audit had recently taken place to refresh the trust’s policies and processes which has shown significant assurances that evidence is in place to support how well these are working.

There are several routes the trust has in place for staff to feel safe to speak up and it was noted that there have not been any direct reports through the Guardian. The recent staff survey indicated that staff would feel comfortable raising a concern and this would be taken seriously, with improvements on both scores from previous iterations. The trust will continue its programme of awareness raising and encouraging staff to report. This is linked with the work undertaken by the EDI Lead for a cohesive strategy supporting any uncomfortable experiences by staff, including bullying and undermining.

Ambassadors work across the trust to support the Guardian, with each Division having a medical staff ambassador who proactively speaks with the PDiT and colleagues, as well as providing much needed support in promoting the benefits of speaking up.

A presentation was given to consultants and medical staff following the outcomes of the Lucy Letby case to impress the importance of speaking up. An improvement plan, including self-reflection tools recommended by the National Guardians Office, has been helpful in ensuring target roles to ensure that individuals who have been appointed have experience to provide more specialist advice where needed. This has been complimented by a collective Board who have been very supportive of this agenda, which has resulted in an improvement suggestion aligned with the trust strategic plan and has been approved.

Governance and reporting

The NETS 2024 Survey had reported a small decline within the context of undermining and discrimination. The recent data reports included a more in-depth analysis of questions within this indicator and identified that this was stemming from patients as opposed to staff. Both PDiT and staff indicated that where concerns were being raised, these were being dealt with appropriately.

Workforce

There was a significant improvement reported on recruitment and retention within medical recruitment, especially at consultant level with interest being received from outside of the region for open posts. This has been especially noted around the conversion rate of higher training into consultant posts and reducing agency charges and financial constraint on subsequent vacancies.

The SAS Tutor /Lead (Specialty, Associate Specialist, and Specialty Doctors) provides a high level of support to trust SAS Doctors. This post is currently out for advert, with the role having more of an emphasis on the portfolio route important for these doctors. Interviews are being planned in the near future. SAS doctors are encouraged to act up and to apply for consultant vacancies.

Equality, diversity and inclusion

The trust was pleased with the growing importance of discussions around EDI and the provision of initiatives being expanded on within the organisation to support staff being impacted by issues such as bullying and undermining.

The Respect Campaign has focused around promoting the reporting of bullying and harassment by managers and staff regardless of their position within the organisation. The executive team has supported the implementation to ensure suitable materials are available to staff on areas such as protected characteristics, with posters being place around all sites. A communications campaign and launch event were well received, with the wider aim to ensure all levels of staff feel comfortable with reporting EDI and bullying issues. Safe spaces have also been created for this to happen. There is an ongoing review of how this becomes fully operationalised and where improvements in processes could still be made.

Staff composition has significantly increased to include staff with disability, long term conditions and the Lesbian, Gay, Bisexual, Transgender, Queer and Intersex (LGBTQ&I) community. Deep dives have been undertaken into areas around shortlisting to appointment and within different Divisions of the trust which have seen noticeable improvements following the recommendation of more targeted bespoke actions. It was important to note that conversations, whilst difficult, are seen to make an impact within the EDI arena.

An amalgamation of several steering groups has been undertaken into one wider Care, Culture and Equity Group, which is more collaborative but brings together EDI and specialist experts in areas such as culture of care, trauma, informed and patient care. This group also looks at race equality frameworks and health inequalities to provide more focused initiatives for all staff.

The trust confirmed they have met all requirements of the six high level actions from the NHS England EDI Improvement Plan, however a meeting with NHS Providers to understand the wider ramifications of implementing the plan was noted to be variable. The EDI Lead has been approached by other NHS EDI Leads to develop a Case Study regarding their approach, including working with the Board on meeting objectives and including this area within the appraisal process.

Submission of internal EDI related reports are coming to the end of their cyclical process, and a new area was noted around the gender pay gap, which the trust was pleased to outline they were currently at 9.8% which is the lowest since reporting began in 2018. It is important to point out that this does not relate to unequal pay, but the distribution within different grades/roles which are predominantly women. The EDI Lead is now working around ways to encourage flexible working for men to allow more equitable distribution in higher roles within the organisation. There was no negative pay gaps identified between those of ethnic minority backgrounds and white colleagues.

The EDI arena has coveted attention from several areas and the trust confirmed that there is an increase on Freedom of Information Requests, but most of the queries are dealt with through the Communications team who field any concerns. The EDI Lead outlined the process the trust follows shows close and effective use of funding for the post, with initiatives very well thought through to ensure this is directed where the highest risk is identified and this work is very much ongoing.

A ‘No Excuse for Abuse Framework’ was developed following a review of policies and procedures. Conversations with staff networks also took place to identify what types of abuse were being experienced and importantly where these incidents were being directed from. Following discussions with staff, it was acknowledged that a zero-tolerance policy may not always be the most effective approach for addressing abuse. As a result, staff suggested the development of a practical toolkit, including a flow chart outlining clear steps to follow in such situations. These discussions also confirmed that several comprehensive support packages are already in place to assist staff who have experienced abuse from patients.

An increase has been seen in the number of requests for reasonable adjustments, which are reported to have an impact on staff time. Where needed, some staff are unable to give the level of professional guidance and are directed to seek this from the appropriate healthcare professional to discuss complex needs. Physical adjustments can prove more of a challenge with respect to access to some areas due to office availability within trust estates, with availability of space reducing following the increase in remote working. Different models are being worked on to make best use of spaces and support staff where possible.

A reverse mentoring pilot project has been successful within Humber and North Yorkshire ICB and options are being pursued in developing this system wide across the patch. Trusts are being asked to submit an expression of interest in taking part in this initiative. There are experienced staff within the trust to ensure that the support is directed effectively.

The trust has also signed up to the Act Against Racism Charter from the Royal Society of Psychiatrists in 2023 and a report is produced every four months, with 15 of the aims having been met. A wide and varied contribution has been made around internationally recruited staff onboarding initiatives. Two virtual sessions on race equality were undertaken despite access for externally funded courses being restrictive, which indicated innovative ways of utilising funding for much needed training.

Safe Learning Environment Charter (SLEC)

The trust has a very high commitment to implementing the standards of the SLEC which has been evidenced in several different areas within the agenda.

Posters and supporting materials are made available to give staff guidance of working within a safe environment and reporting areas that do not work as well. Raising awareness of the charter and what it means to each individual and the ICB were thanked for the additional information that has been provided in developing case studies to showcase the excellent work being undertaken. Whilst the SLEC arose predominantly through work with midwifery within acute trusts, it was recognised that using this as a basis for inclusion of its principles within the trust have been welcomed and having an impact on teams.

Medical education team

The trust has excellent communication skills throughout the whole organisation. A review was undertaken across medical education with feedback confirming this aspect works well.

Despite the complexities of recruitment, the trust continues to encourage consultants to join the organisation. This is providing a broader range of clinical and educational supervisors and training opportunities, which had been identified as an area for improvement within the survey data.

The medical education team were reported to be well managed with staff actively encouraged to attend conferences within the required budget constraints.

Tarriff

Discussions were undertaken around the allocation within the organisation to ensure that learners are being adequately supported and the trust has confirmed that a review is underway. All contracts are all in place for the financial year, which includes any extensions to training which may need to be accommodated. However, allocations continue to be paid at 2024 rates until the new allocation is received, and payments will be adjusted accordingly once available. It is anticipated that any funding will factor in backdated where appropriate.

The trust identified concerns over the shift in financial implications of increased teaching, especially undergraduate training, due to the transfer of some peripheral costs, such as travel and accommodation, from the medical school which will need to be covered. Clarity will be sought on whether the tariff increase will be sufficient to offset this increase in costs, and it was confirmed that these costs were always included in the tariff allocation, with these having been absorbed by the Higher Education Institutions (HEIs) until this year. Wider discussions are taking place on a national level, but trusts should maintain their current processes.

The geographical area of placements is having a big impact on costs, with bases changing every 12 months and often between peripheral sites. The trust has worked hard to remain within its financial allocations and will continue to attempt to face these forthcoming challenges.

Medical training

Foundation training

• The trust reported there was an improved culture shift from PDiT coming into mental health rotations but acknowledged for some this transition from an acute setting has been challenging. Consultants are expected to receive calls out of hours where support is needed.
• A Foundation Tutor is working hard to ensure feedback sessions take place regularly to identify the PDiT needs, as surveys do not always provide the granularity of data needed to identify those placements rotating from acute trusts. Tutors and the medical education team met individually with PDiT as well as having large group discussions to identify concerns.
• Foundation Doctors were confirmed to receive clear guidance on their educational supervision arrangements and undertake at least one-hour weekly of psychiatric supervision.

International Medical Graduates

• The trust undertook a piece of work to ensure adequate support was in place for International Medical Graduates (IMG) to help integrate into working in UK society. This included accessing bank accounts and accommodation. The Social Prescribing Service provide a high level of support and have forged close links with the Medical Education Department and now forms part of the induction process.
• Coaching is available for IMGs through the work undertaken in creating local leadership, team teaching and training opportunities for experienced PDiT to provide this invaluable support, especially around language barriers.
• Constraints are dealt with by providing IMGs with local opportunities through buddy and mentoring schemes, which is working well.

Multi-professional training

Allied Healthcare Professionals (AHP) and Nursing Provision

• The opportunities for students to raise concerns has been identified and the trust utilised work undertaken by national initiatives around ‘raising flags.’ Following this a new ‘Blue Humber Flag’ has been implemented within the trust and the team have also met with the FTSUG to broaden knowledge of the scheme across the organisation. This has given the staff the opportunity to feedback on any aspect they do not feel comfortable with and seek to support adaptations to placements where possible. This is an ongoing project which is regularly evaluated for impact.
• This group has also been noted to have concerns around lived experiences similar to those in other professional areas. These are also seen to be not only with mental health issues but also include physical challenges where some adaptations to working conditions may be required to help fulfil training requirements.
• The trust has a number of professional nurse advocates to further expand the opportunities to discuss experiences amongst staff. More advanced notice of learner’s needs would provide the ability to make reasonable adjustments at an earlier stage.
• Additional work is being undertaken to engage students and some preceptors with a robust process of supporting application and interview preparation, to encourage take up of  placements with the trust. On completion of their university programme the opportunity is available for a two-week supernumerary post at Band 4, upgrading to Band 5 to expand permanent employment.
• The trust is trying where possible to increase capacity to train, especially at Whitby and Malton, with staff having an increased desire to take more students. However, it should be noted that capacity can only be accommodated by the numbers teams can take. Teams are also seeking to produce innovative ways of working such as split working between clinical practice and research opportunities to help increase their capacity.
• The recent PARE feedback was discussed which was predominantly positive. The bottom 5 areas were consistent with most organisations within the region. Interest was expressed in the student forums and the engagement undertaken at these groups.

Social work provision

• The trust employs over 100 social workers, with some having added responsibilities delegated by local authorities. Multidisciplinary Teams (MDT) are increasingly understanding the value of social workers and the trust have been key in supporting both Batchelor of the Arts (BA) and Master of Arts (MA) students in gaining the practical experience required for their final placements.
• Social work apprenticeships are becoming available but are a relatively new offering and with small numbers involved.
• The Interim Director of Psychology outlined the work being undertaken to unite the wider psychological workforce in the trust with the aim to having teams such as Cognitive Behavioural Therapists (CBT) to come within one structured leadership model. This would allow historically smaller service areas to be able to take placements.

Undergraduate training

• Year 3 students on mental health placement can often bring prior life experiences which could be triggered by some environments they become exposed to. To mitigate this the trust have implemented open door availability into the timetables and provision of ‘Talk it Out Loud’ clinics which is currently being evaluated. This was very well received by HYMS, whereby the Director of Programme requested a presentation be given to the whole School.
• A recent survey by HYMS reported that the trust had scored well above average of all providers and received positive feedback from students on their experiences.

Good practice

Report approval

Report completed by: Mrs Vicky Jones, Quality Support Manager
Review lead: Professor Andrew Lockey, Associate Postgraduate Dean
Date approved by review lead: 20 June 2025

NHS England authorised signature: Jon Hossain, Deputy Postgraduate Dean
Date authorised: 26 June 2025

Final report submitted to organisation: 17 July 2025