Inaction. Inefficiency. Indifference. The NHS whistleblower employment support scheme and NHS Improvement’s employer pool

By Dr Minh Alexander with kind contributions by Clare Sardari, Mr ZA, Noel Finn and Dr Kevin Beatt, NHS whistleblowers, 7 June 2018

 

Summary

Three years after Robert Francis urged the Department of Health to “urgently” ensure that an employment support scheme was set up to offer exiled whistleblowers trial employment and other help to return to the NHS, little real help has been provided.

According to FOI data gathered so far, only three NHS trusts have confirmed that they have provided support to whistleblowers as part of the NHS employment support scheme.

This does not mean there are no other examples, but it does suggest that there are very few in total. In one of the three cases so far, the support provided, after several months of an elaborate return to work assessment process, is reported to be merely library access.

First hand reports by various whistleblowers reveal a considerable gap between the rhetoric and the reality.

 

The current story began over three years ago in February 2015 when Robert Francis produced his report of the Freedom To Speak Up Review on NHS whistleblowing. Whilst he refused to support a public inquiry and spared ministerial blushes by drawing a veil over many serious past cover ups, he at least recommended that a whistleblower employment support scheme should be ‘urgently’ established. He later made it clear that he expected this to be a re-employment scheme. 

The main bodies charged with this ‘urgent’ task, NHS Improvement and NHS England then dawdled despite being aware of shattered lives and injustices. NHS Improvement did not even start the process of consulting and designing its part of the scheme, for trust whistleblowers, until over two years after Francis’ ‘urgent’ recommendation.

NHSI has continued to disgrace itself with unpleasant behaviour and lack of convincing commitment. An especially ludicrous example being its heavy handed gagging of the proceedings of the scheme after whistleblowers were vocal in criticising the lack of progress.

A vital component of the NHS whistleblower employment support scheme was supposed to be a pool of NHS employers willing to offer trial employment. This after all was the central reason for setting up the scheme. NHSI prevaricated, and most recently announced that it would not even establish an employer pool. It claimed that it would be enough just to approach local employers on an ad hoc basis whenever it identified a need in a particular case. This was a post hoc rationalisation for inaction. NHS Improvement had previously agreed that prospective employers should be vetted for possible risks to vulnerable whistleblowers attempting re-entry after serious victimisation, and it had started developing criteria for vetting.

It is difficult to see how last minute searches for openings are compatible with NHSI’s previous acceptance of the need for systematic evaluation of employers’ suitability.

FOI requests were sent to NHS trusts asking whether they had received requests from NHS Improvement to participate in the scheme, whether they had agreed to provide support and what support had been provided. Supporting documents were requested.

About 10% of trusts, listed below, failed to respond at all to the FOI, but it is unlikely that the silence signifies that these trusts had much to trumpet about.

 

Some trusts appeared to churn out responses taken from an NHSI hymnsheet, as the same phrases kept re-appearing, and some even forgot to re-phrase the information that had evidently come from NHS Improvement, revealing its original source:

“The support was requested through the workshops. Attached is a list of the types of support that trusts have made an initial commitment to providing/considering, although there are many trusts that have also communicated with us directly outside of the events to offer support.“

Trusts varied greatly in their willingness to share documents. Some disclosed comprehensive trails of correspondence, newsletters, spreadsheets and slideshows by NHS Improvement. Others responded with a single sentence. This is representative of the range of documents disclosed by various trusts:

NHS England and NHS Improvement invitation letter to trusts to employer workshops

NHS Improvement email invitation to employer workshops

NHS Improvement employer workshops agenda

NHS Improvement leaflet circulated to trusts on Chatham House Rule

NHS Improvement correspondence about training sessions for scheme panel members

NHS Improvement correspondence about employment scheme panel meetings

NHS Improvement letter to all trust Chairs and CEOs about launch of the employment support scheme

NHS Improvement presentation on whistleblower employment support scheme September/ October 2017

NHS Improvement presentation on whistleblower employment support scheme February 2018

NHS Improvement Newsletter July 2017

NHS Improvement Newsletter September 2017

NHS Improvement Newsletter November 2017

NHS Improvement Newsletter February 2018

A key disclosure was a spreadsheet compiled by NHSI showing how many trusts had attended initial workshops in autumn 2017, and what initial pledges of support were made. Only a few trusts disclosed this spreadsheet:

FOI disclosure 9.03.2018 NHS Improvement’s autumn 2017 employer workshops spreadsheet

 

Noel Finn fellow whistleblower made a similar FOI request to NHS Improvement and received a smaller range of disclosed documents, but the same spreadsheet was included.

 

The NHSI spreadsheet revealed:  89 trusts attended the workshops 59 trusts pledged at the workshops to provide some or all of the following types of support: ·      Shadowing ·      Temporary employment ·      Mandatory training ·      Guaranteed interviews ·      Library access

 

NHSI insisted in its FOI response of 28 March 2018 to Noel Finn:

“Opportunities were discussed during these events. Further correspondence and conversations are continually being held with trusts that participants on the pilot scheme NHS Improvement is the operational name for the organisation that brings together Monitor, NHS Trust Development Authority, Patient Safety, the National Reporting and Learning System, the Advancing Change team and the Intensive Support Teams have identified as being within their area. This is so that we can communicate with trusts/organisations within participants’ catchment areas to focus on opportunities locally.”

 

However, juxtaposed against the NHSI workshop records, the subsequent FOI responses from individual trusts showed that 187 trusts variously indicated that they were had not agreed to provide support, claimed that they had not been asked to do so, failed to respond to the FOI request at all, failed to respond to the specific question or provided vague or unintelligible answers.

This is a spreadsheet of collated FOI responses from NHS trusts, with supplementary information added from the NHSI workshop spreadsheet to additionally show what initial pledges of support were made last year by some trusts:

Spring 2018 FOI responses by NHS trusts about their participation in NHS Improvement’s whistleblower employment support scheme

Of the trusts that initially pledged support at the workshops, only 16 trusts (listed below) subsequently clearly confirmed via FOI that they intended to provide support to whistleblowers broadly as intended:

Another seven trusts (listed below) that initially pledged support at the workshops later only tentatively confirmed in FOI replies that they were “potentially” willing to offer support, or might do so on a “case by case” or “individual” basis, or “dependent upon an individual’s needs and discussion with them at the time”.

 

Only three trusts, 2gether NHS Foundation Trust , Manchester University NHS Foundation Trust and the Whittington Health NHS Trust indicated that they had actually provided support to whistleblowers. The Whittington has provided library access. The nature of Manchester’s support is not known. There is some question about whether 2gether NHSFT should be included in the figures as they may have cited a case resolved (with a permanent appointment) prior to the establishment of the scheme. This is to be further clarified.

There were a number of anomalies. Some trusts that according to NHSI’s records had participated in the initial workshops later claimed, in response to FOI requests, that they were never even invited to the workshops. For example, Barts:

“The Trust has not been asked by NHS Improvement (NHSI) to take part in workshops about the NHS whistleblower employment support scheme.”

 Some trusts defensively pointed out that participation in the scheme was not compulsory:

“Yes the Trust was invited to make nominations but not required to do so.”

 Some trusts gave single sentence responses. For example, ‘Outstanding’ East London NHS Foundation Trust stated:

“East London NHS Foundation Trust (ELFT) has not been asked   by NHS Improvement to take part in workshops about NHS whistle-blower employment support scheme”

 

A number of trusts similarly denied being contacted. This was surprising as most trusts and NHSI itself confirmed that all trusts were contacted. The anomalies raise the possibility of muddle or even dissembling, but overall there are questions about the adequacy of NHSI’s overall oversight.

Some trusts made careful use of language. For example:

“BSUH NHS Trust has not formally engaged with the NHS whistleblower employment support scheme”   

Brighton and Sussex University Hospitals NHS Trust

“Not to the best of our knowledge.”

Royal Brompton and Harefield NHS Foundation Trust 

“This has yet to be progressed by the Partnership Trust.”

 Staffordshire and Stoke on Trent Partnership NHS Trust

The last of these three is significant because Staffordshire and Stoke on Trent Partnership NHS Trust was Robert Francis’s exemplar trust and prototype for the Freedom To Speak Up Guardian model. There was no evidence base behind his claims. 

Moreover, in his report of the Freedom To Speak Up review, Francis acknowledged that organisations’ willingness to hire whistleblowers was a measure of cultural health:

“All NHS organisations should support such a scheme. Doing so would send a clear signal to their staff, and to staff across the NHS that they are willing to value people who are brave enough to raise concerns. Organisations that do should be given appropriate recognition.”

So if Staffordshire and Stoke on Trent is dawdling on supporting exiled whistleblowers, it hardly augurs well for Francis’ stratagem of changing NHS culture with Speak Up Guardians.

Northumbria Healthcare NHS Foundation Trust, the former NHS Improvement CEO Jim Mackey’s trust, had a double entry in NHSI’s workshop records. One entry indicated that the trust had pledged several forms of support. The other indicated that it had only pledged library access. A subsequent FOI reply by the trust clarified that the trust was offering only library access.   It later added that it was “still” working with NHSI to offer more.

Jim Mackey wrote as NHSI CEO in September 2017:

“This is very important work and we must make sure we get it right. We want the scheme to meet whistleblowers’ needs as fully as possible, within the criteria outlined in the Francis report.

If the former CEO of NHSI could not ensure that his own trust straightforwardly offered trial placements as Francis recommended, that says a great deal about the NHSI scheme.

Of note, Northumbria has confirmed that its former acting CEO Dave Evans is a panellist on the employment support scheme.

Questions arise about whether the senior manager of a trust that was only willing to offer harmed whistleblowers library access, thus implying certain organisational attitudes of unwillingness and unhelpfulness, should be a scheme panellist.

A similar concern arises about a scheme panellist who is a trust Freedom To Speak Up Guardian from Surrey and Borders which replied to “No” when asked via FOI if it had agreed to provide support via the scheme. The trust gave this interesting detail in its FOI reply about appeals:

“Our Freedom to Speak Up Guardian is a trained panelist and has taken part in one appeal and is scheduled to undertake a second next month.”

 This is this the first indication to my knowledge that whistleblowers may have had to appeal against panel decisions, and further clarification seems desirable.

Whistleblowers continue to be very concerned that NHSI’s scheme is generally unsupportive and under-resourced. There is a sense that NHSI is going through the motions without real intention to provide much help. The obligatory coaching sessions by a private contractor are not popular and their usefulness is much questioned. What whistleblowers want is re-entry to work, but NHSI has not made this attractive to employers. There is no money that follows whistleblowers, just more responsibility and perceived complication at a time when services are under great pressure.

I am gagged as a member of the working group on NHSI’s  whistleblower employment support scheme from reporting recent interim results of an evaluation of the scheme, but I really wish I could share the results.

NHSI’s own workshop records show that some trusts raised issues from the outset about resources. For example, one employer said it would offer temporary employment “as long as [it was] funded”. Another employer raised an issue of “access to resources”. One trust asked: “DBS costs – who would meet”.

Equally, there was also recognition from some employers that all NHS employers should sign up:

“There has to be engagement from all trusts to support the scheme.  Needs to be a programme in place for all to sign up to.  Important not to loose [sic] trained and experienced staff”

 The disclosed NHSI spreadsheet from its autumn 2017 workshops revealed that besides NHS trusts, only a handful of other organisations attended:

NHS Employers Virgin Care Working Transitions (the private company provider coaching services to whistleblowers on the scheme) Welsh Government North Somerset Community Partnership CIC

 

It is unimpressive that the Department of Health and Social Care has not shown leadership in ensuring that all NHS employers have been more strongly encouraged to participate and that there has been better uptake. Ensuring a better budget for the scheme and holding NHS England and NHSI to proper account might have made a difference. As might have some more creative approaches in matching whistleblowers with trusts that genuinely wanted to help, and making practical arrangements to overcome geographical barriers, and help with travel and temporary accommodation for short placements.

 

A case vignette of whistleblower ZA’s case raises disturbing questions:

ZA is a secondary care whistleblower who was accepted onto NHSI’s scheme. He is London-based and in January 2018 he asked NHSI for work placements at three NHS trusts nearest to him (UCH, the Royal Free and the Whittington). However, he would be willing to travel further, as nowhere in London is very far. NHS Improvement put him forward to the Whittington despite the fact that (unbeknown to ZA) the trust had not indicated that it was willing to provide work placements, and it has since declined a request to provide him even shadowing. Whittington Health NHS Trust FOI response Inexplicably, the regulator has not put him forward to the Royal Free which would have been willing to provide a work placement. Royal Free London NHS  Foundation Trust FOI response Camden and Islington are also in ZA’s local area, and this trust had indicated to NHSI that it was willing to provide work placements Camden and Islington NHS Foundation Trust FO response Since starting the scheme six months ago, the support that ZA has received from NHSI has amounted to 3 one hour work coaching sessions. ZA feels his needs are not being met by scheme. ZA intends to make a complaint to Dido Harding, the chair of NHS Improvement and to ask for a work placement to be expedited.

 

Another whistleblower, Lloyd Armstrong has had equally difficult experiences of the scheme and was unable to access appropriate support when he asked for help from NHSI to ensure a guaranteed interview:

The Greasy Freedom To Speak Up Freedom To Review is Stuck

 

Clare Sardari, South Devon whistleblower applied to be a whistleblower panellist on the scheme but was cold shouldered.

A session of training was cancelled and promises of further training did not materialise despite prompting. She was excluded from the pool of panellists because of this failure. Eventually, she was offered an irregular telephone ‘training’ session but told that there was no further demand for panellists. After a formal complaint, an opportunity to sit on a panel arose, but she declined because a heavy handed confidentiality agreement was sent at the last minute. Unsurprisingly, NHSI largely did not substantively uphold Sardari’s complaint, and excused the delays and failures in its handling of her request as oversight due to workload.

Outside of the scheme, Sardari approached her former employer after it emerged that the trust had agreed to offer whistleblowers the full range of employment support services.

To date, the trust has offered Sardari nothing despite further enquiry. This questions the robustness of the trust’s commitment and whether it would provide a genuinely safe environment for any whistleblowers placed there.

 

A similar tale is reported by Dr Kevin Beatt, who in January 2018 also approached his former employer Croydon Health Services NHS Trust outside of NHSI’s scheme, to ask if it would consider providing him with re-employment support services.

Croydon attended NHSI’s workshops last year and pledged to offer the full range of employment support services, with the additional enthusiastic comment:

“How can we use apprenticeship levy to support the development of the individual.  Mentoring, buddying”

However, Croydon did not even respond to my FOI request about its participation in the scheme despite being prompted. It also twice shut the door in Dr Beatt’s face. Letter from Croydon Health Services NHS Trust Chair 29 January 2018:

In response to a request from Dr Beatt for the Trust Board to acknowledge the findings of the Court and assist him in securing future employment, theTrust Chair of Croydon Health Services NHS emailed on 28 March 2018:

“The only outstanding issue between you and the Trust is the remedy hearing in respect of your Employment Tribunal claim…. the Trust will not be entering into further correspondence with you on those points.”

Again, the tone does not suggest much learning or that Croydon will clearly be a safe haven for other whistleblowers.

There are also other matters regarding the employment support scheme that are not in the public domain.

You can be sure that NHS England and NHS Improvement will do their best to capture and parade a few feel good stories of plucky whistleblowers who have made it against the odds, through sheer positive thinking. It’s an easier sell than whistleblowers who won’t go away until problems are properly fixed and who make folk feel awkward. Whilst some of the individuals on the good news wagon will be entirely well meaning, others will be less so. But divide, rule and spin is to be expected, when little of substance is proffered.

There has been job creation on the scheme, but mostly not for whistleblowers. Whilst whistleblowers continue to suffer out in the cold, with a pittance set aside for whistleblowers on the employment scheme, Jeremy Hunt et al have blown £628K on evaluating the non-evidence based Freedom To Speak Up network of Guardians. A study that hardly glances at whistleblower detriment has been commissioned. 

The Freedom To Speak Up project is a three-ring circus of the vainglorious, the futile and the cynical.

But what this all demonstrates is that UK law to protect whistleblowers must be strengthened to avoid such obvious and protracted injustices.

Robert Francis’ arguments on appealing to people’s better natures are weak and fall flat where poor culture and the wrong values are ingrained and come from the top.

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