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By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 13 December 2017
NHS and social care staff take a great leap of faith in whistleblowing to the health and social care watchdog, the Care Quality Commission.
It is an organisation with a poor reputation, particularly for serial failures towards whistleblowers.
- Repeatedly not listened to whistleblowers properly or at all 1
- Resisted taking action on gagging 2
- Breached whistleblowers’ confidentiality and even been complicit in reprisal 3
- Refused point blank to audit how well it is protecting whistleblowers’ confidentiality in general 4
- Resisted sharing sufficiently meaningful data on whistleblowing 1 5
- Refused to hold those who have harmed whistleblowers and suppressed patient safety matters to account 6
- Falsely claimed that an investigation at Southport and Ormskirk Hospital NHS Trust into concerns by BME whistleblowers was ‘thorough’ when no one spoke to the whistleblowers 7
A year ago, the CQC was exposed for hiding important data on whistleblowing and its own inaction on very serious whistleblowers’ disclosures:
After this, CQC started publishing superficial whistleblowing data on a regular basis as part of its board papers. However, even this data revealed that CQC was shoving about half of whistleblower disclosures in drawers, by taking no action at all or just noting the disclosures as information for future inspection.
Source: CQC Board papers September 2017
Robert Francis was embarrassed enough to murmur some mild protest at the CQC Board, over the summer, about this gross level of inaction.
CQC has in particularly resisted revealing patterns across the spectrum of providers, and when asked for data under past FOI requests it has maintained that it can only release data on a limited number of providers due to cost limits.
This stance has helped to keep the lid on the national picture and to avoid revealing firm reference points by which the public can compare how organisations perform over time, and or how they compare with other organisations.
An FOI request by whistleblower Clare Sardari @SardariClare earlier this year clarified the manner in which information is stored on CQC’s whistleblowing computer database:
A recent FOI request was submitted on the basis of this knowledge, for national whistleblowing data. The request was constructed so that CQC could not refuse the substantive request on cost grounds, because no manual searches would be required.
CQC has responded and provided the core, national data requested on numbers of all whistleblowing contacts to CQC about registered providers over a two year period, 20156/16 and 2016/17:
CQC has wriggled out of some qualified requests on cost exemptions. But this has revealed that CQC – by its own admission – has recorded its whistleblowing data in such a format that it cannot easily interrogate its own database for the following information:
“5. If the data is held in is held on your central database and easily retrievable by automated search/ filter within the cost limits, whether the whistleblowing concern related to the care of a person(s) detained under the Mental Health Act
- If the data is held in is held on your central database and easily retrievable by automated search/ filter within the cost limits, whether the whistleblowing concern related to possible abuse and neglect
- It the information is held on your central database in a sufficiently anonymised format and the data is easily retrievable by automated search/ filter within the cost limits, please also include data on the broad nature of the whistleblowing concern”
This seems unimpressive given that parliament made it clear over three years ago that it expected government departments and their arms length bodies to be proactive in analysing and learning from whistleblowing intelligence. 8
Notwithstanding, CQC has disclosed that out of a total of 16,457 whistleblowing contacts in 2015/16 and 2016/17, there were 9,760 outcomes which basically consisted of shoving whistleblowers’ disclosures in a drawer (no further action or information noted only for future inspection):
The CQC points out that some whistleblowing contacts may result in more than one outcome but even so, this sheer scale of inaction is very disappointing.
I have shared the full data above so that people can search and analyse it, and make any further requests to CQC based on their own needs.
It may assist those who seek further information about particular providers to know that CQC has in the past disclosed more detailed data about the nature of whistleblowing disclosures and its responses. For example, this previous CQC disclosure on whistleblowing about North Cumbria :
I have carried out a preliminary analysis of the national data on whistleblowing contacts relating to NHS trusts:
If CQC is to be believed, 18 trusts generated no whistleblowing contacts to CQC at all in the two years in question:
BIRMINGHAM CHILDREN’S HOSPITAL NHS FOUNDATION TRUST
BRIDGEWATER COMMUNITY HEALTHCARE NHS FOUNDATION TRUST
CHRISTIE NHS FOUNDATION TRUST
CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST
CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST
GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS FOUNDATION TRUST
GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST
HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST
MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST
MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST
NORFOLK COMMUNITY HEALTH AND CARE NHS TRUST
NORTHERN DEVON HEALTHCARE NHS TRUST
POOLE HOSPITAL NHS FOUNDATION TRUST
QUEEN VICTORIA HOSPITAL NHS FOUNDATION TRUST
ROYAL MARSDEN NHS FOUNDATION TRUST
WALTON CENTRE NHS FOUNDATION TRUST
WHITTINGTON HOSPITALS NHS TRUST
WIRRALL COMMUNITY NHS TRUST
This might be more understandable for specialist and community trusts, but is a very unexpected claim with regard to acute trusts.
The data supplied by CQC showed that in 2015/16 and 2016/7, there were a total of 1535 whistleblowing contacts to CQC about 218 NHS trusts.
The number of whistleblowing contacts from NHS trusts has dropped from 951 in 2015/16 to 584 in 2016/17.
There was considerable variation between trusts from zero to a whopping 58 whistleblowing contacts by staff of Mid Yorkshire Hospitals NHS Trust, which has a poor reputation amongst whistleblowers.
The 40 trusts which generated the most whistleblowing contacts to CQC included 11 trusts currently rated ‘Good’ by CQC and two trusts (Frimley and Western Sussex) currently rated ‘Outstanding’ by CQC:
I happen to know of solid evidence that Frimley is a far from the saintly organisation that Jeremy Hunt and CQC have spun it to be, and that its whistleblowing governance leaves much to be desired.
In a similar vein, Jeremy Hunt and the CQC have for their own reasons been spinning University Hospital of Morecambe Bay NHS Foundation Trust (UHMBT) as reformed character. This is despite recent and serious whistleblower reprisal 9 and a high number of Employment Tribunal Claims. 10
UHMBT is rated ‘Good’ by CQC, but in fact had 33 whistleblowing contacts in 2015/16 and 2016/17 – the third highest number nationally.
Hot on UHMBT’s heels is Lancashire NHS Foundation Trust, which had 30 whistleblowing contacts and is also rated ‘Good’ by CQC.
Raw data on numbers of whistleblowing contacts can only be a broad indicator and more detail is required about the nature of disclosures.
However, it is a very significant event when workers go outside of their organisations to whistleblow to a regulator.
It is also important to remember for every whistleblowing disclosure to CQC, a larger number of disclosures will have been made internally within trusts.
Questions arise about why CQC is rating trusts from which it receives exceptionally high numbers of whistleblowing contacts as ‘Good’.
CQC should in future publish comparative whistleblowing data that shows the variations between providers.
CQC should also in future record its whistleblowing data in a format that allows the data to be more easily interrogated, analysed and transparently reported, so that trends about the nature of concerns and outcomes can be detected and acted upon.
CQC cannot be held properly to account on whistleblowing governance without such transparency.
I in fact invited CQC to publish its FOI response to me on its website, but it declined to do so, which suggests regrettable, continuing opacity.
Indeed, in contrast to many of the NHS providers that it regulates, CQC does not publish its FOI responses. It only publishes a catalogue of requests and whether the requests have been successful.
A genuine spirit of transparency still eludes the CQC.
I will submit this further evidence to the Public Accounts Committee for its current inquiry on CQC.
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Letter 11 September 2017 to Public Accounts Committee on whistleblowing reform:
1 Whistleblowers unheard by the CQC
2 NHS Gagging: How CQC sits on its hands
3 Breach of confidentiality by CQC and complicity in referring a whistleblower to the Disclosure and Barring Service
Helen Rochester v CQC II, Wherein a Whistleblower sueth a Prescribed Person
4 CQC denies denial
National Guardian expects
5 I had extensive correspondence with CQC following the publication of the Freedom To Speak Up Review report in February 2015 as this was singularly uninformative. CQC refused to divulge much data on whistleblowing or to engage a great deal on how its data gathering could be improved.
6 A Chief Inspector doesn’t call
FPPR: CQC has lost all moral authority but what will the National Guardian do?
7 In 2015 the CQC inspected Southport and Ormskirk Hospital NHS Trust and claimed that an FPPR investigation report into concerns raised by BME staff was ‘thorough’:
A recently published case review by the National Guardian revealed that the FPPR investigators did not speak to the BME staff who raised concerns:
8 Public Accounts Committee. Whistleblowing, 1 August 2014
9 Morecambe and wise counsel
10 The NHS in the Employment Tribunal: A five month sample