DH, Robert Francis’ National Guardian and the dark art of delay

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:

https://hansard.parliament.uk/commons/2016-07-13/debates/16071339000002/CapsticksReportAndNHSWhistleblowing

capsticks-report-on-lch

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…”

letter-to-ben-gummer-re-ng-15-july-2016

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.



Yours sincerely, 
  


James Shewbridge 


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.

letter-to-jeremy-hunt-re-ng-evaluation-21-november-2016

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.

 

delay-deny

 

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4 thoughts on “DH, Robert Francis’ National Guardian and the dark art of delay

  1. Delay (makes the complaint ‘historical’ then all the faded memories, staff changing, retained noted etc kicks in!) Deny helps delay and so does defend….in fact delay, deny and defend have become the default setting!

    Like

  2. Thank you for this post, Dr A.
    My interpretation – with added background info – of the DoH 18.11.16: – Secure funding for regular meetings in warm, comfy offices to look at, and exchange, papers resulting in self-congratulatory and mutually supporting bureaucratic outcomes.
    Meanwhile, in the real world, problems, issues and basic morality will continue to be happily ignored thus ensuring that frontline staff and patients can continue to suffer.
    In fact, it will be even worse – knowing that there will be even less funding available for effective treatments as “the Guardians” and associates will have their funding prioritized for their token PR contribution.
    Thank you, Dr A, for your stoicism in the face of a tsunami of wilful ineffectiveness.

    Like

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