By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 21 November 2016
The powerless National Guardian’s office for NHS whistleblowing is Robert Francis’ brainchild. It is an expensive but rickety exercise in PR. It is not evidence based and is built on unstable sands of useless whistleblower legislation, un-remedied rotten culture and brazen impunity for those who have orchestrated cover ups and reprisal but who still prosper and roam free. In an important parliamentary debate in July about NHS failure and continuing whistleblower suppression, Ben Gummer Under-secretary of State for Health held that the government had taken adequate action by creating the National Guardian’s office. I subsequently asked Mr Gummer how the DH would track and evaluate the effectiveness of the office. Four months on, the DH reply so far amounts to “We will have meetings with the CQC”. A lack of evaluation would help the government to continue its can-kicking on whistleblowing reform.
An important parliamentary debate took place in July, which revealed that the NHS continues to make exactly the same errors that led to the Mid Staffs disaster.
The debate revolved around events at the very troubled Liverpool Community Health NHS Trust (LCH), which in its haste to please regulators and achieve Foundation status had made impossibly harsh, unsafe cuts. The trust suppressed staff concerns and it neglected clinical quality and safety. Regulators were slow to respond to the failings. Even after all the serious failings had been fully revealed, regulators behaved in an underhanded way to help recycle senior trust managers, even to the extent of misleading local MP Rosie Cooper:
For all the hot air and political capital that Jeremy Hunt has made out of MidStaffs, LCH is an important example and proof of the fact that the NHS and senior officials have not genuinely learnt the lessons of Mid Staffs.
Ben Gummer Under-secretary of State for Health attended the LCH debate and pointed to the establishment of a National Guardian for NHS whistleblowing as evidence of government action.
After the debate I asked Mr Gummer how the DH planned to evaluate and track the effectiveness National Guardian’s office.
“I would be grateful if the DH would share its plans for evaluating and tracking the effectiveness of the National Guardian model…”
You might think this was a fair question. The DH has now had 21 months to think about it. It is also a crucial question as the role is not supported by any evidence base.
However, four months after the question was asked, the best that the DH can do is:
Response from Department of Health 18 November 2016
“Dear Dr Alexander,
Thank you for your email of 15 July to Ben Gummer about the National Guardian. I have been asked to reply and apologise for the lengthy delay. The National Guardian will lead and support a network of individuals within NHS trusts appointed as freedom to speak up (FTSU) guardians.
The FTSU guardians will provide support and be a point of contact for those who wish to raise concerns locally. The National Guardian will share good practice, report on national or common themes, and identify any barriers that are preventing the NHS from having a safe and open culture. The National Guardian is independent and will speak freely and honestly about where changes are needed among NHS Trusts and Foundation Trusts.
The Department of Health holds monthly assurance meetings with Care Quality Commission (CQC) Directors and quarterly accountability meetings with the Chief Executive and Chair. The Department is finalising the Framework Agreement with the CQC, which will cover reporting and accountability arrangements with the National Guardian.
I hope this reply is helpful.
Ministerial Correspondence and Public Enquiries Department of Health”
A question arises about whether this sketchy DH response is symptomatic of a lack of seriousness about whistleblowing governance. Why bother expending much effort on something that was never really intended to work?
I will continue to press for details.
The right thing to do is to scrap the National Guardian and to protect staff with genuine reforms. However, the DH will inevitably continue playing for time and take as many years as it can to say that it is “too soon to tell if the National Guardian works”. A lack of measurement and evaluation will help the DH prolong the delay.
A snippet on the exploits of the latest National Guardian, her introduction of compulsory smiling for staff and views on cheerfulness, oxytocin and Love actually.
On the lack of independence of the National Guardian’s office.
No one believes Jeremy Hunt on patient safety and whistleblowers, not even his own appointees
A critique of the National Guardian’s office and report on the debacle of the previous National Guardian’s resignation two months after her appointment.