By Dr Minh Alexander and Clare Sardari @SardariClare, NHS whistleblowers, 9 March 2017
Senior NHS silence continues about Paula Vasco-Knight, who bullied whistleblowers, ahead of her sentencing for fraud tomorrow. There is no evidence of learning. The National Freedom To Speak Up Guardian is also proving selectively deaf. Questions by whistleblowers, submitted to her conference yesterday, were deleted. Amazingly, the National Guardian is splashing cash on glitzy events even though she is not yet open for business, despite distressed whistleblowers pleading at her door. She will also help save ministerial blushes by restricting the number of whistleblower cases that she reviews to just twenty a year.
Tomorrow, Paula Vasco-Knight former NHS CEO will be sentenced at Exeter Crown Court for a fraud. 1
The NHS Protect investigation of this fraud started in March 2014, after a referral by NHS England and South Devon Healthcare NHS Foundation Trust. 2
Before Vasco-Knight was prosecuted for the fraud, an Employment Tribunal found in January 2014 that she had bullied whistleblowers, breached the Code of Conduct for NHS Managers and was not a reliable witness. 3
Despite this, Vasco-Knight was protected and recycled by NHS regulators, until the fraud came into the public domain, in May 2016. 4
There are signs that some NHS bodies are singing from the same hymn sheet regarding her case. The bodies associated with her recycling have all but one missed a deadline on FOI requests about their knowledge of, and response to, the fraud. Several have refused to explain the delay.
CQC, NHS Improvement and NHS England are amongst those feet dragging in this concert of silence. One may be forgiven for wondering if the gaming tables have been opened, with a view to minimising the further embarrassment of tomorrow’s sentencing.
The Department of Health frequently claims that NHS regulators and other oversight bodies are independent. Are they really, or is this simply a convenient political device for deniability? In fact, the Department of Health has the power to orchestrate and intervenes when it pleases.
The professional regulator for nurses, the NMC gave Vasco-Knight a pass when she was referred after the whistleblower reprisal. It provided the CQC with part of the assurance for closing down a Regulation 5 Fit and Proper Person referral. 5 There was no obvious consequence for the NMC resulting from this behaviour.
However, when other NMC misdeeds arose in connection with one of Jeremy Hunt’s political hobbyhorses, he stepped in to order an investigation of the NMC. 6
The National Guardian’s office for NHS whistleblowing is demonstrating that it too is part of the NHS Denial Machine.
The office has resisted meaningful involvement of whistleblowers. It has reluctantly allowed them tokenistic access to its policy making, after protest and only when plans for closed meetings were leaked. 7
Unlike the Chief Investigator of the Healthcare Safety Investigation Branch, Henrietta Hughes is not rocking any boats by challenging her masters. Nor is she seeking statutory independence or powers. 8 She is however taking an excessively long time to open for business. She is still not taking referrals of whistleblower cases, 8 despite requests for help from desperate whistleblowers, and her policy proposals are unfair to whistleblowers. 9
Yesterday, despite not yet being open for business, the National Guardian surreally held an inaugural national conference for Speak Up Guardians, facilitated by Public Concern at Work (PCaW). 13
Few whistleblowers were invited. The event was not advertised on the National Guardian events page 14 as usual. The conference was only discovered by most whistleblowers the day beforehand, because a delegate let it out of the bag.
At the conference, a tiny handful of carefully chosen whistleblowers – some currently working as Speak Up Guardians – were paraded to suit a certain narrative.
Trite statements like “follow your conscience” 15 were made.
It is in fact reckless to encourage staff to whistleblow without ensuring that they are fully informed, taking account of the personalised risk assessment of each case.
Revealingly, questions that were submitted electronically to conference speakers were tightly controlled. Several questions by whistleblowers who had not been invited were airbrushed out.
One of the authors of this piece submitted these questions:
but they were deleted, twice.
When the second author submitted the same question about the jailed Speak Up Guardian, but anonymously, it was accepted and trended.
But eventually, it too was deleted despite being the second most “liked” question.
There were other disallowed and deleted questions from whistleblowers and their supporters. This included a question to the Torbay Guardian who was a conference speaker, about the learning at Torbay from the Vasco-Knight scandal.
In response to protest about the deletion of this question about Torbay, PCaW explained that delegates’ questions were being given priority.
This did not explain why awkward questions by named delegates, such as those about Race, were also deleted.
Also, this tweeted question about Race remained unanswered:
The final published conference questions looked nothing like the real number and type of questions that had been asked (www.sli.do conference code #3093 )
Most tellingly, many of the questions were submitted anonymously, apparently by Speak Up Guardians. For example:
There were also questions which exposed the lack of training and preparation for Speak Up Guardians:
Robert Francis attended the conference and reportedly told the assembled Speak Up Guardians:
“You are the pioneers, there’s not another model like it in the world”
(Reported via a tweet by PCaW)
That’s one way to spin and justify his un-evidenced proposals. 18
At a time of underfunding and immense financial pressure for the NHS, when patients are dying in A&E corridors 19 and coroners are issuing warnings on deaths due to bed shortage 20, it is shocking to see money thrown away on a political vanity project and spangly events.
Francis, Hunt and CQC would do well to remember that one of the seven pillars of clinical governance is “resource effectiveness” 21 Eg. Don’t fritter away precious money that could benefit patients, through waste, inefficiency or untested measures.
The conference generated much of the usual NHS self-congratulation, self-promotion and sycophancy. Selfies with the great and the good abounded, “I’m so honoured…” tweets (see twitter hashtag #FTSU), much hot air about “passion” and so on.
All very jolly, and some of it probably well intentioned, but a million miles away from the unpleasant reality of injustice to harmed patients and whistleblowers.
Importantly, Henrietta Hughes gave whistleblowers the finger by announcing at the conference that on a budget of £1 million, she will review only twenty whistleblower cases a year. 22
Whistleblowers expected her office to be a political bottleneck, and have now been proven right.
Twenty cases is a laughably small figure.
Robert Francis’ explicit purpose in recommending the creation of the National Guardian’s office was to ensure that whistleblowers had a place to go, if their employers let them down.
No one knows how many NHS whistleblower cases run into difficulty, because this has never been properly measured. But the data available from PCaW and the CQC suggests there are hundreds of cases a year where health staff are either forced to make external disclosures (as a result of employers’ failures) or where they have experienced reprisal. 23 24
So with an annual caseload of only twenty, it looks like the National Guardian will leave most of the whistleblowers who ask her for help hanging out to dry.
The Freedom To Speak Up project is dreadful waste of opportunity and public money. Worst of all, it leaves patients exposed.
Henrietta Hughes has quipped several times that things are “fantastic”. 8
Fantasy, more like.
Some of the selfie-fest
1 Former NHS trust chief faces jail after she gave £20,000 of taxpayer’s money to her husband, Tom Payne, Daily Mail 27 January 2017
2 FOI disclosure by NHS Protect 21 February 2017
3 Employment Tribunal Judgment, Sardari and Gates v South Devon Healthcare NHS Foundation Trust and Torbay and Southern Devon Health and Care NHS Trust
4 A Chief Inspector doesn’t call. Minh Alexander 27 January 2017
5 FPPR closure letter by Mike Richards CQC Chief Inspector 16 February 2016
6 Jeremy Hunt orders investigation into nursing regulator over Morecambe Bay scandal, Paul Gallagher, Independent 17 February 2017
7 Employment Scheme (but not as you know it), 19 December 2016
8 Newspeak at the National Guardian’s office. Minh Alexander 8 February 2017
9 National Guardian: Letter from Wonderland, Minh Alexander 20 February 2017
10 Good News culture at the National Guardian’s office, 23 December 2016
11 Hooray Henrietta, Minh Alexander 10 October 2016
12 Blame….or accountability? Minh Alexander 28 February
13 Programme for National Guardian conference 8 March 2017
14 National Guardian events information, on the CQC website
15 Tweet by Public Concern at Work 8 March 2017
16 Freedom To Speak Up Guardian jailed, Minh Alexander 7 March 2017
17 Tweet by CEO of Public Concern at Work 8 March 2017
18 Critique of Francis’ model of trust appointed Guardians, Minh Alexander June 2015, from evidence submitted to the DH
19 Three patients die at Worcestershire hospital amid NHS winter crisis, Steven Morris, Matthew Weaver and Haroon Sidddique, Guardian 6 January 2017
20 Stroke patient died after surgery denial ‘over lack of beds’. BBC 1 March 2017
21 What is clinical governance? Carl Gray, BMJ 25 June 2005
22 Tweet by Neil Churchill, NHS England Director of Patient Experience, 8 March 2017
23 The UK whistleblowing report. 2nd edition. July 2015
Data from PCaW shows that the organisation received a total of 1,876 whistleblowing calls in 2014, 16% (300) of which were from the Health sector.
Whilst not all NHS whistleblowers call PCaW, 8 out of 10 of the individuals who called PCaW reported experiencing reprisal.
Therefore, it likely that many of these individuals fall within the National Guardian’s remit, as per the guidance set out in the Freedom to Speak Up Review report, page 169:
“7.6.17 The INO would in essence fulfil a role at a national level similar to the role played by effective Freedom to Speak Up Guardians locally. They would not take on cases themselves, but could challenge or invite others to look into cases which did not appear to have been handled in line with good practice or where it appeared that a person raising a concern had experienced detriment as a result of raising the concern.”
24 The Care Quality Commission receives thousands of disclosures from Health and Social Care whistleblowers every year. Most of these disclosures will represent some sort of governance failing by employers, which made it necessary for staff to whistleblow externally.
CQC has not published whistleblowing data in a consistent format and has given incomplete data in most years. There have been about eight to nine thousand whistleblowing contacts to the CQC by staff of regulated organisations in the last four years.
The CQC indicated that most of the whistleblowing disclosures that it received in 2012/13 came from Social Care (86%).
Assuming the ratio between Health and Social Care whistleblowing contacts does not vary, this gives a rough estimation of well over a thousand whistleblowing contacts from Health workers every year.
Source: CQC annual reports