By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist, 10 April 2018
There is no evidence base for Robert Francis’ model of Freedom To Speak Up Guardians, employed by the very trusts whom they are supposed to hold to account:
Good trusts don’t need them, poor trusts will most likely obstruct, ignore or bully them, or appoint Guardians in their own image.
It’s a waste of time and money for the public, but an investment by Jeremy Hunt for political capital.
This time last year, the national NHS staff survey was published and showed that only 70% of NHS staff felt secure to raise concerns:
A year later, millions of pounds later – spent on appointing local Guardians and fuelling the Department of Health and Social Care PR machine that is the National Guardian’s Office, the dial has stayed firmly stuck at 70%.
This fact was omitted from the NHS Staff survey briefing report, but was publicly acknowledged by Simon Stevens on 6 March 2018, and the CEO of the Picker Institute has since confirmed it.
Both the National Guardian and the CQC have conceded that there was no evidence for Francis’ model of Speak Up Guardians.
At one level, it was breathtaking that the government squandered so much money without a pilot. But on the other hand, why bother with a pilot if the intention is merely to spin, and not to seriously administrate an issue fundamental to patient safety?
On 2 February 2017 the National Freedom to Speak Up Guardian told me that she was discussing evaluation of the Speak Up Guardian model with academics.
“HH We’re commissioning our own research on SUGs
We want it to be external and credible
– Find out more about the roles
– How they’ve been established
– Number of cases”
“MA That sounds like a descriptive piece of work on how the SUGs were set up. Anything on effectiveness?
HH We’ll be looking at SUGs’ measures of their effectiveness
MA How will you measure SUGs’ effectiveness?
HH We’re having a conversation with academics about that”
Over a year later, there was no activity evident and to my knowledge none of the specialist academics in the field had been approached. Notably, not even David Lewis Prof of Employment Law who led the research which informed Francis’ review, had heard anything.
I wrote to Henrietta Hughes to ask for information and I also raised questions on social media.
Dr Aled Jones from Cardiff who largely researches on nursing practice responded to my questions on twitter and advised that he and others were conducting an evaluation.
Further enquiries revealed that this time, the NGO and DHSC were playing safe and keeping it all under an NHS umbrella. The research was commissioned by NHIR, which for the purposes of FOI requests is legally constituted as part of the DHSC.
Aled Jones has advised that his fellow researchers are Danny Kelly, Davina Allen (Cardiff), Russell Manion (Birmingham), Jill Maben (Surrey) and Mary Adams at KCL.
Aled Jones kindly sent me a copy of the research protocol, but asked me to keep it confidential until the official release.
However, review of the protocol showed that an expert group has been established to help steer the research, which includes as yet undisclosed whistleblower organisations and the charity/ lobby group Action Against Medical Accidents (AvMA).
So most likely the usual suspects from the whistleblowing scene have been quietly consulted when the majority of whistleblowers have been shut out, including significantly, those appointed by the National Guardian to her own advisory group.
That is, opponents of DHSC policy have been tokenistically installed on the advisory group, whilst cosy chats with more agreeable voices continue uninterrupted behind closed doors.
It is perhaps unsurprising, given that this is how the NGO views whistleblowers on its advisory board:
FOI disclosure CQC/IAR/1718/0854 by CQC, 9 April 2018
As for AvMA, it does good work but it is hardly expert on whistleblowing. I have on several occasions interacted with AvMA’s chief executive when he has taken the line that doctors who do not speak out are not fit to practice and should be subject to action, to point out why staff are sometimes terrified. It would be better if AvMA pursued the underlying pathology rather than the symptoms. For example, by focussing on the need for managerial regulation, to prevent overbearing managers from bullying frontline clinicians into silence.
I have significant concerns about the remit handed down to Aled Jones and his fellow researchers. Whilst I have been asked not to share details, it strikes me that the fundamental research questions that have been set lean towards generating more PR fodder for the DHSC, as opposed to looking at the effectiveness of the guardian model.
More public money down the drain for political ends and not public service.
After Aled Jones’ informed me of the research plans, the NGO confirmed that the research had been commissioned and that data collection starts in September 2018.
I have written again to the NGO to question yet again its secretive behaviour and failure to be fair and inclusive.
Is that not surreal for a body that is meant to promote safe, just culture and transparency?
This is the correspondence to date with Henrietta Hughes and her Head of Office: