By Dr Minh Alexander and Clare Sardari, NHS whistleblowers, 10 October 2017
The Vasco-Knight affair is emblematic of a self serving managerialism that has crept into the NHS in latter years: Those with sharp elbows climbing over other people’s rights, corporate back slapping, gala events to puff up egos, endless hot air and empty lip service to service by those who primarily help themselves.
Paula Vasco-Knight was a much feted NHS chief executive before her final fall due to the emergence of a criminal fraud. She was a BME poster girl for NHS England’s rhetoric about Equality. 1
|One of Vasco-Knight’s colleagues at NHS England was Steve Field, who became CQC’s Chief Inspector of General Practice in 2013:
She was awarded a honorary doctorate by Exeter University 2 and took dubiously to calling herself ‘Doctor’. She was also favoured with a CBE.
NHS England Chair’s comments about Vasco-Knight’s CBE:
“Professor Sir Malcolm Grant, Chair of NHS England, said: “We are very proud of Dr Vasco-Knight for her achievement. She has done a fantastic job at NHS England representing the needs of all staff and promoting the call for diversity to be further up the NHS agenda across the UK. This honour is testament to the 25 years of hard work Dr Vasco-Knight has given to the NHS and is continuing to give.”
The great and the good were reluctant to believe ill of her even after an Employment Tribunal criticised Vasco-Knight and South Devon her former trust for victimising whistleblowers.
Some were solicitous about the length of her suspension in February 2014 after the ET, which was relatively brief compared to those typically imposed on whistleblowers:
Vasco-Knight resigned in May 2014 as South Devon’s chief executive. But she was quickly recycled on the locum circuit, where she was still handsomely paid by the NHS. 3 Monitor accepted her into its interim pool. 4 4b When Vasco-Knight returned to a Board position at St Georges, there were raised eyebrows but some were quick to opine that she deserved a second chance. 5
The CQC determined that a history of whistleblower reprisal was not a sufficiently serious obstacle to her recycling. The CQC’s then chief inspector Mike Richards personally shut down an FPPR referral and this allowed Vasco-Knight to be promoted to acting Chief Executive at Georges:
It was only the news of her misappropriation of NHS funds that finally led to her sacking by the NHS.
It is ironic that Vasco-Knight’s end was brought about by a paltry £11K swindle. Her nepotism and persecution of whistleblowers had previously cost the NHS hundreds of thousands, but was just shrugged off by the powers that be.
Exeter University’s bosses tried their best to ignore a complaint about her honorary doctorate on the basis of her victimisation of whistleblowers and conviction for fraud. 6
The university still did not respond to a reminder after she was sentenced. 7
But further enquiries now reveal that Vasco-Knight was stripped of the degree in April in this year, after her sentencing for fraud.
NHS Protect had advised that its fraud investigation commenced in March 2014 and was triggered by a joint referral from Vasco-Knight’s former trust and NHS England:
Enquiries to NHS England about its role in the fiasco by Clare Sardari @SardariClare , one of the South Devon whistleblowers, were met with predictable circumlocution.
Initially, Simon Stevens’ office claimed that NHS England had been innocent of Vasco-Knight’s fraud until informed about it in April 2016 by NHS Protect:
“Paula Vasco-Knight worked for NHS England on a part-time basis up to January 2014. On 28 April 2016, we were informed by NHS Protect that a member of our staff was being charged with fraud, together with Paula Vasco-Knight and her husband. I informed NHS Improvement the following day as I was aware that Paula Vasco-Knight had recently been appointed to an interim role at Georges Foundation NHS Trust.
As far as I can establish, NHS England was not aware that Paula Vasco-Knight was under investigation prior to 28 April 2016. I understand that she was referred to NHS Protect by South Devon Healthcare NHS Trust, and I can’t find any record of NHS England being involved in the referral. I can confirm that we haven’t disclosed an further material on this matter to NHS Improvement (i.e. in addition to the notification I shared with them in April last year).”
When this was queried with opposing facts, Simon Stevens’ office revised its account:
I can now confirm that NHS England did indeed make a formal referral to NHS Protect in April 2014. I was not aware of this when I wrote to you on 11 July.
Referrals to NHS Protect are confidential and it would not be appropriate for us to inform other bodies when such referrals are made. This is for two reasons: first, there has to be a presumption of innocence while investigations are taking place and second, NHS Protect’s investigations could be undermined if the individual being referred should become aware of the referral.
As I previously explained, I did alert NHS Improvement at the point I became aware that Paula Vasco-Knight was to be charged with fraud.
Director of the Chair and Chief Executive’s Office
Health and high quality care for all, now and for future generations”
When it was pointed out that NHS England’s date did not tally with the information from NHS Protect, Simon Stevens’ office again revised its position. It specifically admitted that it did not warn NHS Improvement about Vasco-Knight’s fraud:
Thank you for your email. To respond to your questions:
- I am told that an informal referral was initially made to NHS Protect by South Devon Healthcare NHS Foundation Trust and this was then followed by a formal referral by South Devon Healthcare NHS Foundation Trust and NHS England in April 2014.
- No disclosure was made to NHS Improvement so there is no further correspondence to share.
- As I previously explained, referrals to NHS Protect are confidential and it would not have been appropriate for us to inform other bodies that we had made a referral to NHS Protect. It is the responsibility of employers to assure themselves that potential employees are fit and proper persons.
Director of the Chair and Chief Executive’s Office
Health and high quality care for all, now and for future generations”
This is the full correspondence with NHS England:
CQC was evasive about when it learned of Vasco-Knight’s fraud, but disclosed that there was also an internal meeting of senior CQC managers on 28 April 2016 about Vasco-Knight’s fraud:
“We do not hold a record of the exact date when CQC first became aware of the fraud allegations.
We can however confirm that a meeting took place on 28 April 2016 between David Behan, Chief Executive of CQC, Professor Sir Mike Richards, Chief Inspector of Hospitals, Ellen Armistead, Deputy Chief Inspector of Hospitals and Rebecca Lloyd-Jones, Director of Legal Services and Information Rights, where the fraud allegations were discussed.”
This is a redacted email chain between Jim Mackey, Mike Richards and others in early May 2016 when Vasco-Knight’s fraud hit the headlines:
NHSI has also revealed that irregularly, an un-minuted meeting took place between Mike Richards and NHSI’s Head of Private Office about Vasco-Knight and FPPR on 26 May 2016. 8
But the full details of what passed between the regulators and NHS England are not available as both CQC and NHSI have drawn a veil over it all on grounds that it might prejudice the conduct of public affairs. That usually just means that important people do not wish to be embarrassed:
“Section 36(2)(b)(ii) free and frank exchange of views
The correspondence in question represents senior executives exchanging views about the investigations against Paula Vasco-Knight and the fit and proper person test. The correspondence was intended to prompt discussion and learning from the case of Ms Vasco-Knight, and how this situation could be avoided in the future. Sharing information between bodies ensures that we are able to respond to situations effectively and efficiently. In order to carry out their functions, the officials of NHS Improvement, NHS England and the CQC must be able to exchange information freely, without concern that the detail of that information exchange will be disclosed inappropriately. If the information were published, it would be likely to restrict the organisations’ willingness to share and discuss information, due to the possibility that this information may be made public. That would have an adverse impact on the ability of NHS Improvement, NHS England and the CQC to liaise effectively on leadership and operational issues at NHS trusts and foundation trusts and would inhibit the free flow of information.”
NHS Improvement 19 July 2017
“Mr Behan has reviewed the information and expressed the opinion that disclosure of the information would inhibit the free and frank exchange of views for the purposes of deliberation; would be likely to prejudice the effective conduct of public affairs, and that the public interest to be served by withholding the information outweighs the public interest that would be served by disclosure”
CQC 24 March 2017
“No other person’s opinion can be substituted for that of the qualified person but, where we receive a request for internal review, a non-executive member of our board is asked to perform the review and consider whether the opinion of the qualified person is a reasonable one, and whether the public interest in withholding the information outweighs the public interest in disclosure. In this case, Mr Paul Corrigan performed this review. Mr Corrigan’s decision is that the exemption was correctly applied, therefore we will not release the content of the email.”
CQC 13 July 2017
Intriguingly, NHSI also considered that full disclosure of all relevant correspondence might damage its relationships with NHS England and CQC:
“This exemption is engaged as disclosure of correspondence on how to prevent similar conduct in the NHS as that in the Vasco-Knight case may damage the relationship of trust and confidence between NHS Improvement and other national bodies involved, as well as inhibit the free flow of information.” 8
One wonders if recriminations lurk in the undisclosed correspondence.
But whatever words were exchanged, it seems clear that NHS England simply stood by and kept shtum when Vasco-Knight was recycled to board positions at St Georges, despite knowing that there were serious questions about whether she was a Fit and Proper Person.
So much for Safeguarding principles.
NHS England defends keeping its hands in pockets on grounds that Vasco-Knight was innocent until proven guilty.
No such latitude was given to the whistleblowers who were persecuted on her watch.
NHS whistleblowers are still suspended at the drop of a hat and shown the door quicker than you can say ‘interim executive pool’.
CQC’s and NHSI’s approach to assuring that NHS executives are Fit and Proper Persons looks unchanged. A few deck chairs have been re-arranged but the process continues to rely on self assessment by regulated bodies:
“NHSI have no direct involvement in the completion of the fit and proper person test for executive staff by NHS Trusts. Owing to the confidential nature of the content within the FPPT, we rely on a self-assessment by the NHS Trusts that this process has been completed. NHS Trusts are asked to complete a template notifying NHSI of the outcome of the selection process and within this template includes a box for the trust to confirm the FPPT has been completed.” 8
Indeed, when NHS England was asked if it would do things differently in future it retorted:
“It is the responsibility of employers to assure themselves that potential employees are fit and proper persons.”
NHS England email 9 August 2017
So despite the recent jailing of Jon Andrewes trust chair who falsified a CV 9, and Paula Knight’s conviction for fraud after ineffective vetting by St Georges with collusion from the CQC, we are simply back at square one.
Any old patter may pass.
Comments by Vasco-Knight in a blog she wrote for the NHS Leadership Academy after receiving her honorary doctorate from Exeter University in 2013:
“The most important thing you can bring to work with you is your common humanity – your kindness and compassion. Think of your patients or your customers or your colleagues as if they might be members of your own family. What would you want for them and how would you wish them to be treated?
I live these values in my everyday life and so far they have served me well.”
Mike Richards claimed at the outset of implementing Regulation 5 in 2014 that it would be too difficult to remove too many managers. To our knowledge, CQC has not triggered the removal any NHS managers under FPPR yet.
Shortages of management staff are of course a challenge, but tolerating a solid contingent of poor quality appointments seems unlikely to make the NHS attractive to better managers.
And as for Clare Sardari, a robustly and repeatedly vindicated whistleblower, the NHS still not made any meaningful amends.
UPDATE 19 DECEMBER 2018
The PHSO has partially upheld a complaint about CQC’s handling of the Vasco-Knight FPPR.
CQC is defiant.
PHSO has also pulled some punches.
This is a summary of the PHSO report, and unresolved governance and policy issues:
Open letter by Clare Sardari to St George’s governors
NHS Gagging: How CQC sits on its hands
Engineered failure to investigate whistleblowers’ concerns
1 Paula Vasco-Knight was appointed as NHS England’s National Lead for Equality in 2013, under David Nicholson’s reign
3 Management consultant’s £1,000 a day slap in face for Lancashire NHS Staff Peter Magill, Lancashire Telegraph, 5 August 2015
4 FOI disclosure by St Georges 24 March 2016
- “Mrs Vasco-Knight was interviewed for the post of Interim COO on 28th September 2105.
- The interview included questions about the reason for Mrs VascoKnight leaving South Devon Healthcare Trust.
- References were taken up from Hunter Healthcare on appointment
- Verbal approval to the interim appointment had been given by Monitor and Mrs Vasco-Knight was confirmed to be on the Monitor interims approved list
- When concerns were raised by staff and governors, the trust obtained a copy of the ET findings and took advice from Capsticks Solicitors.
- A member of the executive team interviewed Mrs Vasco-Knight.
- Further references were taken from Monitor, which had provided support for the Monitor FPPT process.
The findings were considered by Christopher Smallwood, Chairman on 27th October 2016.”
4b FOI disclosure by Monitor 23 December 2015
“Ms Vasco-Knight submitted her application for the Monitor interim pool on 16 April 2015. Monitor subsequently undertook its validation process to obtain references and verified case studies, and accepted and confirmed Ms Vasco-Knight’s membership, over the course of May 2015.”
8 NHS Improvement FOI response 19 July 2017