By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 27 January 2017
Very serious questions remain about the CQC’s protection of senior NHS managers who have been found guilty of serious misconduct and breaches of the NHS Managers’ Code of Conduct 1. For example, by suppressing and victimising whistleblowers.
Yesterday, a two week fraud trial of a former NHS CEO Paula Vasco-Knight came to a dramatic halt as she pleaded guilty. 2
A complaint was made to CQC in October 2015 about her suitability to hold senior office at St Georges, due to a past finding of whistleblower reprisal by an Employment Tribunal. 3 Mike Richards, CQC’s Chief Inspector of Hospitals personally handled the matter, but found no fault in her appointment.
In November 2016 even Robert Francis, who had abandoned his original recommendation for criminal sanctions for whistleblower reprisal 8 and who previously eschewed managerial regulation in favour of a trial of FPPR, admitted that FPPR was not working. In consequence he called for managerial regulation 9
Paula Vasco Knight stepped down as an NHS CEO in 2014 10 four months after a critical Employment Tribunal judgment. The judgment raised questions about her reliability as a witness and concluded that her trust had victimised whistleblowers. 11 However, Vasco-Knight was later recycled by Monitor, employed by St. Georges in 2015 and then rubber stamped as “Fit and Proper” by CQC.3
Mike Richards himself wrote to St Georges on 16 February 2016 to shut down the FPPR process that had been initiated by the above referral in October 2015. 12
Regrettably, Richards did not inform me as the referrer that he had done so. I only found out through a disclosure by St. Georges on 25 April 2016.
Vasco-Knight had in the meantime been promoted by St. Georges from Chief Operating Officer to Chief Executive. 13
In May 2016 she was sacked and subject to criminal charges 3, thus exposing CQC’s poor judgment and flawed process.
Subsequently, CQC promised in May 2016 to review its FPPR practice. 7 We have yet to hear about the progress of this review. Dismally, Mike Richards noted in a recent interview that the internal CQC review was only launched in November 2016, would take ‘months’ and had no identified end date. 14
To go back to the beginning, on 17 December 2014 I took part in a teleconference with Mike Richards CQC Chief Inspector about how CQC was going to approach FPPR. At this meeting, CQC advised that it had no direct powers to remove NHS trust directors who were not Fit and Proper Persons. However, Mike Richards made it clear that CQC could bring other powers into play, to place pressure on trusts to remove unfit directors. He made it clear that he was confident that he could ensure the removal of unfit directors.
He also indicated that he would be chairing CQC’s FPPR panel, which would decide on how referrals would be handled.
Two years later, in early December 2016, Mike Richards gave an interview to the Health Service Journal in which he complained that CQC had been unfairly criticised over FPPR. 14 One wonders if he had in mind the comments by Robert Francis, his colleague and fellow CQC board member. As part of his defence against the criticism, Richards maintained that CQC could only assess trusts’ FPPR process, but could not judge the fitness of directors or remove unfit directors. Strikingly, he did not repeat the comments he made in December 2014 that he was confident that CQC could use indirect powers to force trusts to remove directors, although he acknowledged that these existed.
The Department of Health disagreed with Mike Richard’s assertion that CQC could not assess if directors were fit:
“The CQC has the powers to assess whether both executive and non-executive directors are fit to carry out their role and whether providers have put in place adequate and appropriate processes to ensure this is the case.”
The DH also considered that CQC had sufficient powers to enforce any breaches of FPPR:
“…the DH agreed with the CQC that the FPP regulations “do not give CQC the power to remove a director, but CQC could place conditions on a provider limiting what services it can deliver until such time that a breach of the fit and proper person regulation was corrected”. 14
In the case of Paula Vasco-Knight, fresh questions now arise about CQC’s FPPR process. It has become evident that an investigation into the fraud allegations against her was underway well before Mike Richards shut down the FPPR process in February 2016.16 17
This begs an important question of what CQC knew at the time that it closed the FPPR process. Did CQC know about the fraud allegations but fail to respond appropriately to them? Or if CQC did not know, why was there a failure of intelligence and information sharing between NHS bodies?
CQC’s chief officers need to investigate, clearly account and fill in the gaps as regards to CQC’s poor performance in the Vasco-Knight case, as well as others.
So far, there seems little hope of that. I made a complaint about the way that CQC and Mike Richards handled the Vasco-Knight FPPR process. The CQC’s complaint ‘investigation’ is so far a shambles.
CQC has resisted clarity about whether there are potential conflicts in the line management of its complaint investigation. I asked CQC if Rebecca Lloyd Jones CQC’s Director of Governance and Legal Services had any part in the handling of the Vasco-Knight FPPR. This was because I understood that CQC’s complaints department sat within Lloyd-Jones’ directorate and that Lloyd-Jones had assisted Mike Richards with FPPR cases. There has so far been silence from CQC on this point.
I also expressed concern that the Chairman’s office was not dealing with my complaint, given that it relates in part to a board member. Again, no response from CQC.
Bizarrely, CQC has not interviewed me as part of its investigation and refuses to show me a draft copy of its complaints investigation report. CQC in fact proposed to present me with a completed investigation report as a fait accompli and only spoke to me when I suggested this. The CQC senior complaints officer said to me (verbatim):
“I don’t see the point of sending out a draft report”
He remained immoveable when I pointed out that PHSO sets the standards for public sector complaints handling, and routinely shares draft reports with complainants as a matter of fairness. His manager has reportedly also declined my request to see and comment on the draft investigation report before CQC’s investigation concludes. Strangely though, they have indicated that I might get a copy via the Subject Access Request route. 18
In short, the CQC is a hit and run operation, which does not stop to give its details or submit to meaningful scrutiny when it has erred. It is a poor role model, and the NHS denial machine speeds on.
How does CQC’s behaviour impact on the whistleblowers who have been seriously harmed by the NHS? Clare Sardari, who won her whistleblower detriment claim against Paula Vasco-Knight and South Devon has this to say:
“Yesterday, after 4 long years, I feel totally vindicated regarding the concerns I raised about Paula Vasco Knight in 2012. But now, questions must be answered regarding the effectiveness of the current FPPR process which the CQC have responsibility for administering. I do not want anyone else to go through an experience like mine and believe that a thorough review needs to occur in order to ensure that those who commit these types of offences whilst in public office are not re-cycled back into the system but are properly held to account for their actions. There are many other whistleblowers who are currently in situations similar to mine, and these need to be addressed now.”
1 Code of Conduct for NHS Managers, Department of Health 2002
2 Former NHS trust chief faces jail after she gave £20,000 of taxpayer’s money to her husband’s company, Tom Payne Daily Mail 26 January 2017
3 CQC’s Fit and Proper Parade, Minh Alexander 29 July 2016
4 Sir Mike Richards announced retirement, Rebecca Thomas Health Service Journal 27 January 2017
5 CQC press release 27 January 2017
6 CQC published guidance on Regulation 5 Fit and Proper Persons November 2014
7 CQC to review whether fit and proper person rule ‘needs to change’, Will Hazel, Health Service Journal, 24 may 2016
8 Sir Robert’s Flip Flops, Minh Alexander 26 September 2016
9 Robert Francis calls for regulation of senior managers, Shaun Lintern Health Service Journal, 9 November 2016
10 Devon Health Boss Dr Paula Vasco-Knight resigns, BBC 30 May 2014
11 Employment Tribunal judgment Sardari and Gates v South Devon Healthcare NHS Foundation Trust and Torbay and Southern Devon Health & Care NHS Trust
12 FPPR closure letter by Mike Richards to St. Georges 16 February 2016
13 Chief of scandal hit teaching hospital steps down, Crispin Dowler, Shaun Lintern Health Service Journal 22 April 2016
“In Mr Scott’s place, Paula Vasco-Knight has been appointed acting chief executive at the beleaguered trust. Ms Vasco-Knight, who has been working as interim chief operating officer at St George’s, last held a chief executive role at South Devon Healthcare FT. She resigned from that role in 2014 after being accused of nepotism in the employment tribunal of two whistleblowers”
14 CQC cannot force removal of unfit trust directors. Sharon Brennan Health Service Journal
16 Former trust chief faces jail after pleading guilty to fraud. Ben Clover Health Service Journal 26 January 2017
“In November 2013, Mr Vasco-Knight submitted an invoice to the NHS for £11,072, from the bursary funds, to produce a 200 page leadership improvement document Transform.
Ms Vasco-Knight then authorised the trust to pay her husband’s company.
Prosecutor Gareth Evans said Ms Vasco-Knight was legally bound to declare her interest in her husband’s company as part of the NHS’s standing financial instructions, but failed to do so.
Mr Evans said the document was never submitted to the NHS, with the couple showing investigators a “complete sham” as evidence in 2014.”
17 Shock guilty plea in Torbay hospital boss Vasco-Knight fraud trial, Herald Express, 26 January 2017
“The trial heard prosecution evidence that the work he was paid to do – known as the Transform document – was not completed. In 2015 the couple gave investigators a document which they allegedly claimed was the finished work.
But the prosecution said it was a ‘sham’, containing other people’s work cut and pasted from the internet, empty pages, and was only produced after investigation started.”
18 Correspondence about CQC’s handling of a complaint about its handling of the Vasco-Knight FPPR.