Letter to Director of National Clinical Assessment Service (NCAS) 22 September 2016

From: Minh Alexander <minhalexander@aol.com>

Subject: National Clinical Assessment Service (NCAS) , NHS whistleblowers & BME staff

Date: 22 September 2016 at 14:16:04 BST

To: Vicky Voller <vicky.voller@ncas.nhs.uk>

Cc: helen.vernon@nhsla.com, Sir Anthony Hooper <AnthonyHooper@matrixlaw.co.uk>, rfrancis@serjeantsinn.com, mb-sofs@dh.gsi.gov.uk, Edward Jones <edward.jones@dh.gsi.gov.uk>, sheyda.m.azar@parliament.uk, Health Committee <healthcom@parliament.uk>, sarah.wollaston.mp@parliament.uk, philippa.whitford.mp@parliament.uk, paula.sherriff.mp@parliament.uk, julie.cooper.mp@parliament.uk, james.davies.mp@parliament.uk, andrea.jenkyns.mp@parliament.uk, andrew.percy.mp@parliament.uk, maggie.throup.mp@parliament.uk, bradshawb@parliament.uk, media@equalityhumanrights.com, “CE England (NHS ENGLAND)” <england.ce@nhs.net>, england.contactus@nhs.net, contactholmember@parliament.uk, bottomleyp@parliament.uk, ***** ***** <********************>, *** ***** <*******************>, ***** ********** <****************************>, admin@bapio.co.uk, bida@btconnect.com

To Ms Vicky Voller, Director of National Clinical Assessment Service, 22 September 2016

Dear Vicky,

NCAS’ approach to whistleblowers and BME staff

I wrote to you a year ago – see the correspondence below which summed up a meeting that I and other whistleblowers had with you and colleagues on 22 September 2015.

You kindly indicated that NCAS would contact us again and involve whistleblowers in its training activities, but I have not heard from NCAS.

I continue to hear from medical whistleblowers who report being intimidated with disciplinary action, and actual and implied threats that fault will be found with their performance, following raising concerns.

I would be grateful if you could let me know whether NCAS will involve whistleblowers in its training programme as you suggested previously.

I would also be grateful to hear if NCAS has completed the work that it said would be undertaken to routinely identify whistleblower cases, in order to ensure that whistleblowers do not suffer detriment. If so, I would be grateful if the details could be shared, and to see any new NCAS written protocol/ guidance on how whistleblower cases should be managed. I note from NCAS’ FOI response that it is in discussion with the Department of Health about work to ensure fair and consistent process, so that referred doctors (including whistleblowers) do not suffer inequality and detriment. It would be very helpful to hear more about this as well.

I need to raise an additional issue, about NCAS’ Equality and Diversity practice. I see from FOI data (attached) that NCAS’ data on referred doctors’ ethnicity is seriously incomplete – NCAS is unable to give the ethnicity of almost half the doctors who are referred. This must surely make it impossible for NCAS to fulfil its legal duty to monitor whether it is treating BME doctors equally and fairly. This is a major concern given that the data that is available shows grossly more non-white doctors are referred to NCAS. Please see the summary table below that I have prepared from the data that NCAS has provided. I am particularly concerned that NCAS informs me that it has no improvement/ action plan for ensuring a better level of ethnicity recording.



Source: NCAS 20 September 2016

White doctors Non-White doctors Doctors whose ethnicity was not known or recorded
Female 58 58 79
Male 162 206 287
Gender not known or recorded 1 2 32
Total 221 (25%) 266 (30%) 398 (45%)


  • Of the cases in which ethnicity is known, grossly disproportionately more non-white doctors are referred to NCAS (266 non-whites : 221 whites)
  • NCAS cannot produce ethnicity data for 45% (398 of 885) of referred doctors

As I think has been pointed out previously, and as evidenced by the Freedom to Speak Up Review, BME doctors are more likely to be mistreated if they whistleblow.

Moreover, I am concerned that NCAS appears to concede by omission, in its FOI response, that it has not undertaken any review of its Diversity and Equality practice in the last two years.

I would therefore also be grateful to know if NCAS will re-visit these issues, and formally review the way in which it treats BME doctors and their experience of NCAS’ process, and ensure a much better level of ethnicity recording from now on.

With best wishes,


Dr Minh Alexander

cc Helen Vernon Chief Executive NHSLA

Rt Hon Sir Anthony Hooper

Sir Robert Francis QC

Secretary of State for Health

Shadow Secretary of State for Health

House of Commons Health Committee

Equality and Human Rights Commission

Simon Stevens Chief executive NHS England

Lord Adebowale NED NHS England

Lord Prior Minister of NHS Productivity

Sir Peter Bottomley

Dr Kevin Beatt

Dr Raj Mattu

Dr Peter Wilmshurst





From: FOI foi@nhsla.com

Subject: Freedom of Information Request – F/2761

Date: 21 September 2016 at 17:19

To: Minh Alexander minhalexander@aol.com

Dear Dr Alexander

I write in relation to your email of 24 August 2016 in which you have requested information from the National Clinical Assessment Service (NCAS). Your request has been considered under the Freedom of Information Act 2000. Please find below the response to your request.

NCAS’ handling of Equality and Diversity matters

Please advise for financial year 2015/2016:

  • How many doctors were referred to NCAS?

In the financial year 2015/16, NCAS received 885 requests for advice in relation to

individual doctors.

2) What is the gender and ethnicity breakdown of these referred doctors?

The following utilises the datasets against which NCAS records ethnicity information

in relation to individual doctors:

3) In 2015/2016 how many doctors underwent Full NCAS performance assessment,

Assessment of behavioural concerns and Assessment of health?

NCAS completed 15 full performance assessment reports in the financial year

2015/16. NCAS completed 3 assessments of behavioural concerns reports in the financial year 2015/16. NCAS did not undertake any standalone occupational health assessments in the financial year 2015/16.

4) What is the gender and ethnicity breakdown of these doctors who in 2015/2016

underwent Full NCAS performance assessment, Assessment of behavioural concerns

and assessment of health?

Drawing from the data collected at the point of referral i.e. at the time NCAS is first

contacted, the gender and ethnicity breakdown of doctors who underwent

assessment in the financial year 2015/2016 was as follows:


Full performance assessments


Assessment of behavioural concerns


Occupational health assessment only

NCAS did not undertake any assessment of occupational health only assessments in the financial year 2016/16.

5) In the last 2 years, has NCAS undertaken any review of its Equality and Diversity practice in relation to referred doctors, and has NCAS reviewed BME doctors’ experience of NCAS’ processes?

NCAS recognises the importance of observing the equality and diversity issueswhich may impact on our handling of cases. All staff within NCAS are required to undertake mandatory equality and diversity training. This has been supplemented by a programme for advisers and other senior NCAS staff on the Language of Cultural Diversity held in June 2016 and focused on the impact of culture on communication. In addition, we are considering how we can ensure there is a rolling programme of diversity skills development and awareness for staff.

As part of our Case Investigator national educational programme we are currentlyrevising some of the material which will include ensuring there is clear guidance on the raising of concerns under whistleblowing procedures. We have been in discussion with the Department of Health in regard to the development of a more consistent approach procedurally to performance management to work towards reducing any potential for inequality and also any detriment experienced by whistleblowers.

Other than the routine data collected for practitioners (highlighted in 2 and 4 above)the specific experience of BME doctors has not been reviewed. However, NCAS is  being proactive in keeping up to date with research and good practice regarding potential sources of bias (including unconscious bias) and will include training in thisarea for assessors.

If so, please disclose the relevant reports from these reviews.


6) Does NCAS have a standard for the completeness of its data on the ethnicity of doctors who are referred? (For example, such as a minimum percentage of cases whereethnicity is not recorded or recorded as “unknown”).

Whilst there is not a specific percentage threshold for recording ethnicity, as part of our routine casework processes for each case we request information about the ethnicity of individual doctors about whom the employer or contracting body is seeking our advice. This information will be recorded if it is held by the employing or contracting body and they are able to supply it to NCAS.

7) If NCAS has an action plan/ improvement plan for ensuring a good level of recording of doctors’ ethnicity, please disclose this.

There is no action plan/improvement plan currently in place. Our response to question six above provides information about how NCAS collects data regarding ethnicity of individual doctors about whom the employer or contracting body is seeking our advice.

This concludes the response to your request. If you are not satisfied with the service that you have received in response to your information request, it is open to you to make a complaint and request a formal review of our decisions. If you choose to do this, you should write to Tinku Mitra, Head of Governance for the NHS LA, within 28 days of your receipt of this reply. Reviews of decisions made in relation to information requests are carried out by a person who was not involved in the

original decision-making about the request. If you are not content with the outcome of your complaint, you may apply directly to the Information Commissioner for a review of the decision by her. Generally, the Information Commissioner will not make a decision unless you have exhausted the local complaints procedure. The address of the Information Commissioner’s Office is:

Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.

Kind regards,

Joe Stock | Information Access Manager | Corporate Governance Team

NHS Litigation Authority (NHS LA

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