By Dr Minh Alexander and Clare Sardari @SardariClare 21 February 2018
Concerns about NHS England’s and NHS Improvement’s whistleblower employment support schemes rumble on, including from the man who came up with the idea, Robert Francis:
At the NHS Improvement Soup Kitchen
Jeremy Hunt’s Secret Whistleblower (Non-Employment) Scheme
More loopholes in Jeremy Hunt’s ‘support’ scheme for whistleblowers
Comments by Robert Francis on 7 November 2017
The evaluation of the scheme commissioned from Liverpool John Moores University by NHS England and NHS Improvement is now part of the concerns.
A letter has been sent today to the University about these concerns.
BY EMAIL
Research Ethics Unit
Liverpool John Moores University
21 February 2018
Dear Sir,
Concerns about Liverpool John Moores University’s evaluation of the NHS Whistleblower Employment Support Scheme
We write to raise concerns about the operation of Liverpool John Moores University’s online evaluation of NHS England and NHS Improvement’s whistleblower employment support scheme. (ESS).
Please see copied in the appendix below the University webpage which gives access to its online evaluation survey about the ESS, and the online evaluation survey questions.
Our concerns about the University’s evaluation of the ESS are as follows:
- Lack of meaningful, properly established measurement
It has been revealed that although the evaluation by the University was meant to be predicated on KPIs set by NHS England, no such KPIs have actually been set.
On 8 September 2017 NHS England circulated a ‘High Level Plan’ on evaluation of its ESS by the University which referred to KPIs set by NHS England.
Subsequent repeated enquiries, initially to the University and then to NHS England, failed to reveal what these KPIs were. Eventually, on 29 January 2018, NHS England answered thus:
“Dear Minh
Thank you for your message.
The outcome we are seeking from Working Transitions is the provision of a support service to the current participants on the pilot scheme in line with their personal development plan. Each participant, through engagement with their coach, develops a bespoke package of support and a personal development plan. This plan is monitored by WT and is confidential between each individual on the scheme and Working Transitions. We have asked that WT report to us on the timing of the development of the action plans, but not the content.
We also hold regular financial and other contract assurance meetings and have ongoing quality improvement conversations with Working Transitions which help shape the support scheme for the benefit of all the participants. As a result of this engagement activity we have made some live changes to the pilot scheme.
In moving forward as we reflect on the learning from the pilot scheme and move to the final programme of support we anticipate that we will set formal KPIs in the following areas:
A financial KPI to ensure that the provider works within the budget allocation
A KPI relating to the establishment of the first coaching session
A KPI relating to the development of the action plan (which will probably be by the third coaching session)
A KPI relating to the delivery of the individual development plan.
Sent with kind regards
Kate,
On behalf of
Whistleblowing Support Scheme
Freedom to Speak Up Programme Team
Experience Participation and Equlaities Group |Nursing Directorate |NHS England”
That is, NHS England effectively admitted that although the University’s evaluation of the ESS had commenced, no KPIs had been set for the ESS.
Partly in consequence of the above, the University’s evaluation will be measuring data that is not meaningfully standardised and therefore not comparable or easily interpretable. Instead, it will be more akin to anecdote gathering.
At an NHS Improvement event on 22 September 2017 attended by Daz Greenop, Daz was asked by whistleblowers to ensure that the evaluation was designed with reference to the original goals set for the ESS in the Freedom To Speak Up Review, which the Government accepted.
This does not appear to have happened.
There is no specific reference in the University’s evaluation questionnaire to the essential components of the original Freedom To Speak Up Review recommendations, which included:
- remedial training
- trial work experience
- access to a pool of employers
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“7.3.8 Beyond that, I believe that there is an urgent need for an employment support scheme for NHS staff and former staff who are having difficulty finding employment in the NHS who can demonstrate that this is related to having made protected disclosures and that there are no outstanding issues of justifiable and significant concern relating to their performance. This should be devised and run jointly by NHS England, the NHS Trust Development Authority and Monitor. As a minimum, it should provide: • remedial training or work experience for registered healthcare professionals who have been away from the workplace for long periods of time
• advice and assistance in relation to applications for appropriate employment in the NHS
• the development of a ‘pool’ of NHS employers prepared to offer trial employment to persons being supported through the scheme
• guidance to employers to encourage them to consider a history of having raised concerns as a positive characteristic in a potential employee.”
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Instead, the University’s evaluation questionnaire asks questions about matters of subjective experience. Again, this will end up with much anecdote and not enough hard performance data.
The University’s evaluation will not properly measure what the ESS was established to do.
The University will effectively not be conducting a comprehensive, rigorous evaluation despite whistleblowers pointing out relevant source material, and it will risk giving the government a soft ride.
For the University’s information, NHS Improvement and NHS England continue to seriously fail in their delivery of basic components of the ESS, and it is arguably somewhat nonsensical to be evaluating the scheme in this context:
Sir Robert Francis, the author of the Freedom To Speak Up Review, has been critical of NHS England and NHS Improvement’s handling of the ESS:
- Equity of access to the evaluation
The University has not taken sufficient responsibility for ensuring appropriate distribution of the link to its online evaluation survey, and has thereby allowed NHS England and NHS Improvement to potentially skew the results in their favour by restricting access to groups who are likely to be less critical.
A formal complaint is currently being processed by NHS Improvement about the fact that NHS Improvement did not share the link to the evaluation survey with the official group of stakeholders (mostly whistleblowers) whom it established to help steer the ESS, nor did it publish the link on its relevant webpage about the ESS.
Instead, NHS Improvement gave the link to a small number of whistleblower groups that have been less challenging of the scheme.
This irregularity was discovered through a third party, after which NHS Improvement was questioned about its actions.
Moreover, NHS Improvement was asked to advertise the scheme in the national press but has failed to do.
The University’s evaluation will be skewed by NHS Improvement and NHS England’s omissions in not adequately publicising the scheme and its evaluation.
We ask that the University should at the very least acknowledge this major methodological flaw when it produces its report.
- Sampling bias
At the above NHS Improvement event of 22 September 2017 attended by Daz Greenop, Daz was asked by whistleblowers to address a fundamental issue of sampling:
Daz accepted on 22 September 2017 that this was a significant issue.
But there appears to be nothing in the materials shared so far about the University’s methodology to demonstrate that it has given specific thought to this issue or that it has taken steps to reflect this issue in its methodology.
We ask that at the very least, this sampling bias is reflected in the University’s final report.
Briefing by the University to NHS Improvement
Lastly, we have been informed by the NHS Improvement ESS manager that the University has been providing regular ‘verbal updates’ to NHS Improvement about its evaluation and that these are reportedly ‘positive’.
The University has also reportedly disclosed to the NHS Improvement ESS scheme manager that an individual in Australia has taken part in its evaluation.
Please can the University advise what the rationale is for releasing such informal updates prior to final report.
This is with particular reference to the following passage from the University’s Code of Practice for Research:
“3.15.1 Researchers should accept their duty to publish and disseminate research in a manner that reports the research and all the findings of the research accurately and without selection that could be misleading.”
Please can the University also confirm that it is abiding by its commitments to confidentiality for those who participate in its evaluation.
Yours sincerely,
Dr Minh Alexander
Clare Sardari
NHS whistleblowers and members of NHS Improvement’s ESS Design and Monitoring Group
Cc
Prof Raphaela Kane JMLU Head of Faculty
Dr Daz Greenop JMLU
UPDATE 26 FEBRUARY 2018
Despite previous objections, NHS Improvement’s consent paperwork for the Employment Support Scheme remains coercive and requires participation in evaluation research as part of signing up for the scheme:
FAQs produced by NHS Improvement for whistleblowers assumes participation in the evaluation research and does not make it clear that whistleblowers may refuse to take part in the evaluation if they so choose.
NHS Improvements FAQs for whistleblowers about the employment support scheme
I have again protested and copied the correspondence to Liverpool John Moores University, to make the University aware that it is conducting research on subjects who may not be freely consenting:
Letter 26 February 2018 to NHS Improvement Wendy Webster re coercive scheme consent paperwork
Further correspondence with NHS Improvement Wendy Webster about consent paperwork 26.02.2018
Dr Minh Alexander
APPENDIX
Liverpool John Moores University webpage for the online evaluation survey about the NHS whistleblower employment support scheme:
https://ljmu.onlinesurveys.ac.uk/whistleblowers-support-scheme-error-copy
Whistleblowers Support Scheme
Page 1: Participant information
We are currently evaluating the Whistleblowers Support Scheme but are also interested in the work-related / work-seeking experiences and activities of whistleblowers who are not participating in the pilot. If you are a NHS whistleblower and NOT participating in the Whistleblowers Support Scheme we would love to hear from you but before you decide it is important that you understand why this questionnaire is being done and what it involves. Please take time to read the following information. Take time to decide if you want to take part or not.
What is the purpose of the questionnaire?
The purpose of this anonymous online questionnaire is to gain broader views of the work-related / work-seeking experiences and issues facing whistleblowers in the NHS. We are also interested in why people did not participate in the pilot and how enquiries about it were managed. The questionnaire is not about your whistleblowing experience but it is hoped that learning from this evaluation will help to inform and improve recruitment processes and implementation of future schemes.
Do I have to take part?
No. It is up to you to decide whether or not to take part. If you choose to participate anonymously you are still free to withdraw at any time before or during completion of the questionnaire without giving a reason. However, because the questionnaire is anonymous, you cannot withdraw after your responses have been submitted. If you choose to include contact details you may withdraw at any time up to the completion of the first draft of the evaluation report. A decision to withdraw will not affect your rights or any future support you receive.
What will happen to me if I take part?
The questionnaire asks about your work related experiences, activities and support needs. We are also interested in understanding why you did not apply for the programme. The questionnaire should take around 30 minutes to complete but this depends on how much you wish to write. Once we have received responses the information will be analysed thematically and used in a report for the NHS (and potentially other publications and presentations). We may also use direct quotes from open text comments but you will not be identifiable. We hope to talk to a small random sample of respondents so if you wish to provide contact details at the end of the questionnaire we may contact you again in four-six months time for a telephone interview. Questionnaires will be securely stored on password protected computers for five years after completion in accordance with LJMU policy and the Data Protection Act 1998.
Are there any risks / benefits involved?
There are no risks or benefits involved. However, your participation in the evaluation will help to inform the implementation of future support schemes. If for some reason you become uncomfortable or distressed during the questionnaire you can simply terminate the questionnaire without needing to submit or explain. Your Freedom to Speak Up Guardian should be contacted if additional support and advice is needed.
Will my taking part in the study be kept confidential?
Yes. We take confidentiality very seriously. We do not need your name or any personal information. However, if you wish to be considered for interview, please provide your preferred contact details at the end of the questionnaire. Again, this will be securely stored and not shared with anyone outside the LJMU evaluation team.
This project has received ethical approval from LJMU’s Research Ethics Committee: 17/NAH/019
Contact Details of Evaluators:
D.T.Greenop@ljmu.ac.uk 0151 231 4033
P.B.Clarke@ljmu.ac.uk 0151 231 4450
If you have any concerns regarding your involvement in this project, please discuss these with the researcher in the first instance. If you wish to make a complaint, please contact researchethics@ljmu.ac.uk and your communication will be re-directed to an independent person as appropriate.
Page 2: Questions
I have read the information sheet provided and I am happy to participate. I understand that by completing and returning this questionnaire I am consenting to be part of this evaluation and for my data to be used as described in the information sheet provided
1.Your professional background
Clinical
Non-Clinical
a.What was your occupation and grade at the time you made your Protected Disclosure / raised concerns?
2.When did you make your Protected Disclosure / raise concerns?
Less than 12 months ago
1-2 years ago
3-5 years ago
6-10 years ago
Over 10 years ago
3.Did you contact your Freedom To Speak Up Guardian?
Yes (go to question 3a)
No (go to question 4)
a.What information were you given?
None
Written
Online
Verbal
This part of the survey uses a table of questions, view as separate questions instead?
i.How was your query dealt with?
Please don’t select more than 1 answer(s) per row.
| Strongly agree | Agree | Disagree | Strongly disagree | |
| Response was timely | ||||
| Response was friendly | ||||
| Response was non-judgemental | ||||
| Response was clear | ||||
| Response was helpful |
a.Please use this space if you wish to explain your ratings
4.What is your current employment status? Please select as many as apply to your current circumstances
Unemployed
Sick
Suspended
Self-employed
Temporary contract
Agency work
Permanent
Full-time
In Education / Training
Other
a.Please use this space if you wish to explain your selections Optional
5.Have you heard of the Whistleblowers Support Scheme?
Yes (complete 5a then go to question 6)
No (complete 5a then go to question 9)
a.How do you think the Scheme could be advertised more effectively to whistleblowers?
6.How did you first find out about the Whistleblowers Support Scheme?
Colleagues
Line manager
NHS support systems / emails / events
Internet research
Whistleblower support systems / emails / events (e.g. Patients First)
Other
a.If you selected Other, please specify:
7.Did you make any further queries regarding the Scheme?
Yes (go to question 7b)
No (go to question 7a)
a.Please tell us why you did not make a query and then go to question 9
Not interested
Not appropriate
Not eligible
Not ready
Other
i.If you selected Other, please specify:
b.What information were you given?
None
Written
Online
Verbal
This part of the survey uses a table of questions, view as separate questions instead?
i.How was your query dealt with?
Please don’t select more than 1 answer(s) per row.
| Strongly agree | Agree | Disagree | Strongly disagree | |
| Response was timely | ||||
| Response was friendly | ||||
| Response was non-judgemental | ||||
| Response was clear | ||||
| Response was helpful |
a.Please use this space if you wish to explain your ratings
8.Why did you not apply to the Scheme?
Not interested
Not appropriate
Not eligible
Not ready
Other
a.Please use this space if you wish to explain your answer
9.What do you wish to achieve in terms of your (re)employment goals?
10.What have you done to achieve your (re)employment goals?
11.What has stopped / is stopping you from achieving your (re)employment goals?
12.What support do you think you need to achieve your (re)employment goals?
13.We hope to to talk to a small random sample of respondents so if you wish to provide your preferred contact details below we may contact you again in four-six months time for a telephone interview.
Alexander's Excavations 