By Dr Minh Alexander and Russell Dunkeld @RussellDunkeld , NHS whistleblowers, 21 April 2018
As many NHS whistleblowers are aware, the Department of Health and its arms length bodies sometimes declare failing organisations as turnaround successes whatever the truth of the matter.
CQC slaps on the green ratings and the trust executives start being showered with conspicuous accolades. Ministers may contribute a plug or two.
University Hospitals of Morecambe Bay NHS Foundation Trust is an example of re-branding. Morecambe Bay was notorious for the maternity safety scandal, which was the subject of a major report by Dr Bill Kirkup in March 2015
Morecambe Bay was also exposed for victimising whistleblowers who raised concerns about the accuracy of breast cancer screening. The trust admitted in 2016 that it was still gagging whistleblower, details of which follow below. In 2016, a former nurse who was treated by Morecambe Bay revealed a picture of chaotic shortages.
Despite such ongoing governance issues, Morecambe Bay has featured prominently in Jeremy Hunt’s publicity schemes and his superficial claims to be a patient safety champion, whilst overseeing a programme of disinvestment and resultant NHS crisis.
Maternity safety has been a key element of Hunt’s patient safety shtick.
Hunt has repeatedly used Morecambe Bay for political gain:
Although Hunt et al have been spinning the above line of transformation, Morecambe Bay staff have not stopped whistleblowing outside of the organisation. Such external whistleblowing usually reflects internal whistleblowing governance problems – staff are either deterred in some way from using internal routes, or they have tried internally but been unable to progress their concerns.
FOI data from the regulator the Care Quality Commission (CQC) revealed that Morecambe generated the third highest number nationally of whistleblowing contacts to the CQC over 2015/16 and 2016/17.
Additional FOI data from the CQC, obtained by former Morecambe Bay whistleblower and nurse Russell Dunkeld revealed more detail about whistleblowing disclosures to CQC between 2014/15 to 2016/17:
Russell Dunkeld is a nurse who whistleblew about serious patient safety issues at Morecambe Bay, including incorrect, undetected insertion of a nasogastric tube into a patient’s airway. This is a so-called ‘Never Event’ because it is a very serious but avoidable form of medical harm and should never happen. Dunkeld also whistleblew about concerns that a nurse colleague was hastening patients’ deaths by tampering with intravenous fluids.
Dunkeld’s safety concerns have never been fully resolved.
He believes a recent offer of employment from the trust to help improve its whistleblowing governance was withdrawn because he would not stop pursuing the unresolved patient safety and Safeguarding issues. The trust denied all:
“Different people within the Trust have tried to engage with Mr Dunkeld over the past three months, and it is disappointing that he has yet to take up these offers as we believe that insight would help us in developing our approach to Freedom to Speak Up further”
Out of 47 recent whistleblowing contacts to CQC about Morecambe Bay, only one triggered a follow up inspection. CQC dealt with the rest of the concerns mostly by speaking to the trust or sticking the information in a drawer, purportedly to be used at the next inspection.
Notably in 2017, the CQC was contacted twice by trust whistleblowers about the trust slipping back into old ways:
“Concerns about returning to old practices to save money”
The CQC simply noted in its log that an investigation was ongoing.
As regards a 2015 disclosure of ongoing concerns about the breast cancer screening affair, CQC played pass the parcel with a related concern and appeared to it brush off with the conclusion:
“Met with complainant. Matter raised with Public Health England . This was a matter between the whistleblower, Public Health England and NHS England.”
Not only were significant patient safety failings revealed by a November 2014 Public Health England investigation report , but other evidence of patient harm continued to emerge in 2015: New calls for Morecambe Bay breast cancer review.
Moreover, Morecambe Bay has continued to gag staff, including whistleblowers. The trust was evasive when questioned about its practices in this area but eventually admitted that it had gagged two whistleblowers and spent £92,519 on legal services in two whistleblower cases.
In October 2016 the Health Service Journal lavished praise on Morecambe Bay for revealing that past trust managers had reached an irregular settlement with one of the midwives from the maternity scandal, which included an undertaking from the trust not to investigate her performance.
But beneath this razzamatazz, the trust failed to fully answer enquiries about whether or not there were other such past non-investigation agreements. The trust disclosed a summary report which waxed lyrical about how much had been learned:
A snapshot analysis of Employment Tribunal decisions about NHS organisations revealed that Morecambe Bay was in the top ten of employers most claimed against.
The trust has also scored poorly on the Workforce Race Equality Standard (WRES). There have been pledges to improve. Morecambe produced a glossy strategy document featuring the obligatory token gesture by a smiling CEO, with a zippy declaration slapped across the cover: ‘Our Journey to Effortless Inclusion’.
But the trust’s WRES score remains poor. 38% of BME trust staff reported bullying by other staff in the previous 12 months, compared to a national average of 27% for comparable trusts. 19% of BME staff reported experiencing discrimination in the previous 12 months, compared to a national average of 15% for comparable trusts.
In view of the poor WRES scores, Morecambe Bay was asked about its governance with respect to Race concerns. It twisted and turned in response. The trust initially tried not to answer at all, and would not even confirm or deny that it had conducted or commissioned any review into its poor WRES scores. It speciously claimed that no data was disclosable under exemption 41 FOIA – information given in confidence.
“Q5, 6 and 7 The Trust considers the request in questions 5, 6 and 7 exempt under Section 41 (1) of the Freedom of Information Act (2000) regarding the disclosure of confidential information The Trust considers this information exempt under Section 41 (1) (a) regarding information obtained by the public authority from any other person and (b) that disclosure would constitute a breach of confidence. We consider our obligation of confidence and will be unable to provide you with this information.”
After challenge, Morecambe Bay then delayed a response until two days after its outgoing CEO Jackie Daniel had been anointed and enthroned as the new CEO at Newcastle, following the acrimonious removal of Newcastle’s previous CEO amidst recriminations of wrongdoing on both sides.
Morecambe Bay admitted that there had been Race concerns serious enough to warrant an external review by Prof Carol Baxter which had cost the trust a total of £25,000.
But the trust still maintained that none of the contents were disclosable.
The same FOI disclosure dated 2 March 2018, and received on 9 March 2018 revealed that a total 124 staff concerns had been raised through the trust Speak Up Guardian, but fewer than 5 of these related to Race issues.
The trust has also later revealed that 87 feedback forms were sent to staff who raised concerns through the Speak Up Guardian from April 2017 onwards, of which 32 (37%) had been returned.
In the course of the above wrangling with the trust about release of the data, a trust governor was copied into the correspondence. He commented:
“…as governors, we are aware of, and support, efforts made by the Trust to improve staff morale and the quality of relationships throughout the organisation. To this end we are aware that internal surveys of staff views in relation to the issues you raise are carried out on a routine basis, the results of which are shared with governors.
For my part I am confident that good work is being done by the Trust in these areas and that progress is being made.”
Email 1 February 2018
One wonders if the trust has been totally open with its governors about the full extent and seriousness of its Race issues.
In complicated twist, it has just been reported that a white male surgeon alleges that he was persecuted at the trust for whistleblowing, and was subject to false Race allegations.
As for the CQC, it last rated Morecambe Bay as ‘Good’ overall (despite admitting that Morecambe Bay was sub-standard on ‘Safety’) and ‘Good’ on the well-led domain.
With regards to Race Equality, the CQC was contradictory – it largely gave Morecambe Bay a good report, but conceded that bullying of BME staff had increased.
Perhaps CQC’s Chief Inspector of hospitals should take another look at what are clearly very troubling and complicated issues of Equality and Diversity. Assuming CQC is bothered, and is not fettered by political instructions from on high.