By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 19 January 2017
Governments have a habit of establishing satellite bodies that they pretend are independent, for public relations purposes, and for deniability and outsourcing of accountability for controversial decisions.
The fragmentation of the NHS in recent years often allows the government to claim that it has no operational responsibility or cannot answer questions because it holds no information.
CQC the health watchdog has been criticised as a government device for denial. The latest criticism comes from the Centre for Welfare Reform, whose Director commented:
“The illusion that it [CQC] is performing a useful function is critical to Government policy. As severe cuts and rising cost savage an already inadequate social care system, it may be that the Government will not want to address these problems. For the CQC adds a patina of respectability to its failed policies”
A similar masquerade seems to be unfolding with regard to the National Freedom to Speak Up Guardian’s office. Its independence has been much questioned because the Department of Health located the office within CQC. CQC, along with NHS England and NHS Improvement also fund the office.
The accountability arrangements for the National Guardian are not entirely clear, yet there has been repeated insistence by Robert Francis, the Department of Health and CQC that the office is operationally independent.
However, CQC has also repeatedly made comments which indicate that it will have some oversight of the National Guardian’s office. A CQC Board paper stated:
“The Commission consists of the Board (including committees), Chief Executive and employees. Whatever the manner of appointment, the Board will require some oversight of the National Guardian role, given its own accountability for CQC to Ministers and Parliament.
There needs to be a formal arrangement with Monitor, TDA and NHSE that governs their responsibilities in terms of funding, and expectations in terms of input into the delivery of the role.” 1
A CQC consultation document stated:
“We propose that the relationship between the National Guardian and appointing arm’s length bodies (Monitor, TDA and NHS England) would be governed through memorandums of understanding (MoU), an annual steering group, and an annual report from the National Guardian presented to each arm’s length body’s Board”
“They remain accountable to the Chief Executive of CQC for the overall delivery of their role and functions, just like the Chief Inspectors.” 2
In May 2016, CQC’s response to the consultation about the National Guardian’s office stated:
“The National Guardian’s Office will be hosted by the CQC, reporting to the CQC’s Chief Executive as its Accounting Officer.” 3
(This report was issued as if the decisions therein came from the National Guardian’s office, but the office was in fact vacant at this point and being steered by Robert Francis CQC NED).
Moreover, the latest National Guardian has also just issued a report, about her first 100 days in office, which stated:
“The National Guardian meets with the main sponsor boards once a year; more frequent meetings with Sir David Behan as the lead Accountability Officer (AO) for the National Guardian’s Office. The National Guardian provides an annual report to the Board of each of the sponsor boards.” 4
Curiously, at a CQC Board meeting on 18 January 2017, David Behan CQC’s Chief Executive cheerfully denied any oversight at all of the National Guardian’s activities, save for accounting for how the National Guardian’s budget is spent, in his role as Accounting Officer.
Accounting Officers of course do not simply scrutinise the use of funds, but must link this to performance measures, to make judgments about value for money.5
Behan also contradicted past CQC statements by stating that his relationship with the National Guardian would NOT be the same as his relationship with CQC Chief Inspectors.
For those who are not aware, Behan was also the appointing officer both for the first National Guardian Eileen Sills, and her replacement, Henrietta Hughes. The CQC has also stated that the appointment will be reviewed periodically, possibly every three years.
“The National Guardian appointment will be reviewed periodically (eg every three years).” 2
It would be unrealistic to pretend that this could not be a potential compromise to the office’s independence, if this review is conducted by the DH or its allegedly arms lengths bodies.
The transcript of the relevant comments by Behan at yesterdays Board meeting is given below.
It would be a rum do if the National Guardian, who is responsible for leading improvement in culture, is not truly accountable to anyone.
Notwithstanding the additional muddle caused by Behan’s denial, there is perhaps an argument that the National Guardian should answer only to parliament.
The National Guardian’s recent report states that she will provide “updates to the Health Select Committee” but no details are given about how this will be achieved and whether hearings will be held. 4
There have been calls for her to seek statutory independence, as Keith Conradi, HSIB Chief Investigator has done. 6 Whether she does so will surely be a test of her mettle.
TRANSCRIPT OF A DISCUSSION ABOUT THE INDEPENDENCE OF THE NATIONAL FREEDOM TO SPEAK UP GUARDIAN AT CQC BOARD 18 DECEMBER 2017
Member of the public at 26.18: “Is there any clarification around the 20th ….it seems there’s a group of whistleblowers only being allowed to go in the afternoon, but the meeting is in the morning, so not really quite clear how that’s working. Does anybody have any ideas?”
David Behan at 26.43: “That’s not something that this Board is overseeing. The National Guardian…..”
Member of the public: “I thought she was reporting to you though?”
David Behan: “No, she has an operational independence. I need to account for the money. We host the function but Henrietta has the role and she discharges that function on behalf of CQC and NHSI and NHS England.”
Member of the public: “But doesn’t she report back to you?”
David Behan: “No. She doesn’t report to me, no. She’s not accountable to me.”
Member of the Public: “Who’s she accountable to then?”
David Behan: “It’s a role which is established… I occupy the role of Accounting Officer so that if the Public Accounts Committee wants to know what the money is being spent on, they would expect me to explain what she’s doing and what the money is. But in the same way that I’m the Accounting Officer for this organisation but I am managerially accountable for Mike, Andrea, Steve etc…I do not enjoy, or she does not enjoy that relationship as Mike, Andrea and Steve will tell you…”
David Behan: “So it’s completely independent of the…you ask Henrietta – it’s a completely independent office of the National Guardian”
THE FOOTAGE OF THE CQC BOARD MEETING ON 18 JANUARY 2017 CAN BE VIEWED HERE:
1 CQC Public Board Paper 29 July 2015, by Charles Rendell / Sarah Bickerstaffe, Sponsor: Eileen Milner, CQC Executive Director of Customer & Corporate Services
2 A National Guardian for the NHS – have your say. CQC consultation document September 2015
3 The National Guardian for the NHS – Improvement through openness. CQC May 2016
4 Dr Henrietta Hughes. First 100 Days Report. 12 January 2017
5 Accountability to Parliament for taxpayers’ money. National Audit Office, February 2016
6 NHS has nothing to fear from new investigation body says chief. Shaun Lintern HSJ 5 January 2017
“The head of the NHS’s new patient safety watchdog has said it needs statutory independence and extra powers to demand that NHS organisations respond to its warnings.”