A patient safety campaigner has reported that Henrietta Hughes the National Guardian has indicated that she is seeking good news stories about NHS whistleblowing:
Good news culture has been highlighted as an obstacle to patient safety and NHS transparency, by the Mid Staffs Public Inquiry and other authorities.
I have now written to Dr Hughes about lack of engagement by her office and the need for robust evaluation of NHS whistleblowing governance, rather than spin about selected cases.
Dr Henrietta Hughes National Freedom to Speak Up Guardian
Care Quality Commission
26 December 2016
Dear Dr Hughes,
Comfort seeking organisations and other matters
Further to your email to me of 7 July 2016 1, advising that you could not liaise or answer my questions about your role at that point but would be consulting widely, I note no invitation to participate in any consultation has been sent to me by your office.
Rather, I was refused when I asked to attend and observe an event for local trust Guardians. Indeed, a further enquiry to you about the timetable for your office’s development resulted in no response, such that I asked CQC to confirm your correct email address. This resulted in an incorrect and misleading reply from CQC, which insisted that you had to be contacted via a CQC email address. CQC later retracted this false claim. I twice wrote, without reply, to your National Engagement Manager. Furthermore, I sent you a copy of correspondence from me and other whistleblowers to the CQC chair about CQC’s serious and continuing failures on whistleblowing (see attached and below). 2 3 I have yet to hear from you about these important matters.
I hope therefore that you can appreciate that whilst you have undertaken numerous public engagements since starting your post in October, I – as a whistleblower – have to date found you largely inaccessible. This is disappointing as there are important, unresolved issues of NHS whistleblowing governance that require discussion. The majority of whistleblowers have serious concerns about government inaction since the Freedom to Speak Up Review. 4
I understand from Richard von Abendorff, Patients Association Patient Safety Ambassador and NHSI Public and Patient Voice, that you recently indicated at a patient safety conference that you plan to seek good news stories about whistleblowing in the NHS. 5
As the Mid Staffs scandal and other evidence shows us, it is important that NHS institutions listen to all voices and not just those that provide comfort and good news.
In 2008, external auditors concluded thus of Mid Staffs trust’s comms:
“The communications strategy lacked credibility, as it consisted of releasing good news stories.” 6
Sir Robert Francis wrote in his 2013 report of the Mid Staffs Public Inquiry:
“The Trust’s culture was one of self promotion rather than critical analysis and openness. This can be seen from the way the Trust approached its FT application, its approach to high Hospital Standardised Mortality Ratios (HSMRs) and its inaccurate self declaration of its own performance. It took false assurance from good news, and yet tolerated or sought to explain away bad news” 7
Dixon-Woods et al found that NHS mortality measures were inversely related to positive organisational culture:
“Our analyses of NSS data showed that hospital standardised mortality ratios were inversely associated with positive and supportive organisational climates.” 8
Dixon-Woods et al described negative cultures as “comfort seeking” and “preoccupied” with good news. They also tended to be dismissive of concerns and to view dissent as “disruptive”:
“Comfort-seeking behaviours are defined here as being focused on external impression management and seeking reassurance that all was well; consequently, what was available to organisations was data, but not intelligence. Serious blind spots could arise when organisations used a very limited range of methods for gathering data, were preoccupied with demonstrating compliance with external expectations, failed to listen to negative signals from staff or lacked knowledge of the real issues at the frontline. Comfort-seeking tended to demonstrate preoccupation with positive news and results from staff, and could lead to concerns and critical comments being dismissed as ‘whining’ or disruptive behaviour.” 8
Dixon-Woods et al concluded that a defining characteristic of safe and successful (“problem sensing”) organisations was their active search for evidence, in all forms
“While sometimes discomfiting, this less routinely gathered knowledge enabled fresh, more penetrating insights to complement quantitative data.” 8
Dixon-Woods et al concluded that safe and successful senior teams were also cautious about claiming success:
“Senior teams displaying problem-sensing behaviours tended to be cautious about being self-congratulatory” 8
In the Freedom to Speak Up Review, Francis quoted some evidence that he received about dysfunctional good news culture:
“Ultimately there needs to be a change in culture across the NHS which must start at the top. Significant pressure for positive results and good news stories from politicians and senior management often results in efforts to hide problems for fear of reprisals” Page 59 Freedom to Speak Review report 4
Francis also suggested in his report of the Freedom to Speak Up Review that examples of successful whistleblowing should be “celebrated”:
“Employers should show that they value staff who raise concerns, and celebrate the benefits for patients and the public from the improvements made in response to the issues identified.” Page 25 Freedom to Speak Up Review report 4
Whilst this may sound like a good idea, it is important that there is balance in how matters are reported. I am aware that some NHS employers have publicised such purported ‘good news’ whilst simultaneously seriously victimising whistleblowers behind closed doors.
Accordingly, I hope that you will take a circumspect view of any purported good news and seek out robust evidence of progress beyond the mere self report of employers and selected cases brought to your attention.
It would be very useful to meet and discuss your intended approach to evaluation of NHS whistleblowing governance and how in particular you propose to respond to the evidence of regulatory failure to listen to and help protect whistleblowers.
I look forward to your response.
Dr Minh Alexander
cc Sir Robert Francis
Katherine Murphy Chief Executive Patients Association
Public Accounts Committee
Public Administration and Constitutional Affairs Committee
New Employment Scheme (But not as you know it)
Published 19 December 2016
Leaked information about the National Guardian’s plans reveals that a very important forthcoming consultation event is a largely corporate affair with few frontline whistleblowers invited. This reluctance to engage with those whose very misfortunes and insights led to the creation of the National Guardian’s office undermines the office’s credibility. The last body that should be replicating comfort-seeking club culture is the National Guardian’s office.
1 Email from Henrietta Hughes 7 July 2016
“Dear Dr Alexander
Thank you very much for your kind email.
I plan to start in my new role in October and until then I am not dealing with any queries about the office as I have ongoing responsibilities in my current job. Over the coming months the precise scope and design will be defined. I will be seeking views from a wide range of individuals and organisations both from within the NHS and externally to ensure that best practice can be shared.
For any specific queries that you have at this time please may I redirect you to the office at the following phone number 0300 067 9000.
With warm regards
2 Tall Stories by the CQC, letter to Peter Wyman 9 December and related article
3 Whistleblowers unheard by the CQC, report 30 November 2016 and related Times letter and article 6 December 2016
4 Report by Robert Francis of the Freedom to Speak Up Review, 11 February 2015
5 Stop the tokenism used as cover. Letter by Richard von Abendorff 23 December 2016
6 Volume 2 of the report of the Mid Staffs Public Inquiry
7 Executive summary of the report of the Mid Staffs Public Inquiry
8 Culture and behaviour in the English National Health Service: Overview of lessons from a large multi-method study. Mary Dixon-Woods et al 9 September 2013