The National Guardian’s Day Out with the PHSO: Claims & Rebuttals

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 9 December 2018

Summary: The National Guardian has been assisted with her public relations programme by an interview broadcast by Rob Behrens the Parliamentary and Health Services Ombudsman. A transcript of the interview is in the appendix. Below I examine a few of her comments and claims, and I rebut them. The PHSO solicited interview questions for the National Guardian via Twitter, and put them all to her save for a question about reform of UK whistleblowing law.

 

Unsubstantiated claims of effectiveness

In its annual report of November 2018 the National Guardian’s Office made the following unsubstantiated claim:

“When a case is raised with a Freedom to Speak Up Guardian the worker can be assured that actions will be taken and they will receive feedback.”

In a data report of September 2018, the National Guardian commented that case numbers had possibly increased because the Freedom To Speak Up project was having “impact”:

“This may be as the roles become more established, better communicated and workers start to see the impact of speaking up.”

 These claims echoed a letter to The Times June 2018, by Henrietta Hughes responding to the inquiry on the Gosport deaths. She wrote:

“If our new system of “freedom to speak up” guardians had been in place when the nurses at Gosport spoke up they would have been listened to and the right actions would have been taken.”

These assertions are unsupportable as there continue to be cases in which whistleblowers complain of lack of help from Speak Up Guardians and or Speak Up Guardians themselves complain of being bullied and obstructed. 

Some whistleblowers complain that they have been failed by the National Guardian’s Office.

In any case, the National Guardian has insufficient data upon which to claim that whistleblowers’ concerns will be reliably acted upon, because she does not track whether whistleblowers’ concerns are addressed.

 

The interview

 PHSO supported the National Guardian’s publicity campaign in October 2018, the so-called Speak Up Month:

Rob Behren’s related interview of the National Guardian painted a sympathetic picture of Henrietta Hughes, as a local GP who wanted to be a doctor from age two.

There was no acknowledgment that she was a senior doctor promoting a non-evidence based model, which is against the principles of her medical training. Instead he portrayed her as a “pioneer” doing “innovative” work, commenting that her work was “clearly making a difference”.

The National Guardian used the PHSO interview to repeat her claims of “impact” by the Freedom To Speak Up project, despite the absence of any proof.

Nonetheless, there has been a fall in the proportion of Speak Up Guardians who think whistleblowers in their trusts do not suffer retaliation:

	Proportion of Speak Up Guardians who agreed that: “People in my organisation do not suffer detriment as a result of speaking up”
National Guardian’s survey of Speak Up Guardians 2017	43%
National Guardian’s survey of Speak Up Guardians 2018	39%

 

 The National Guardian was only able to cite anecdote about “impact”. For example, a claim that a staffside rep from an ‘Outstanding’ trust reported a fall in grievances. Despite being a senior doctor trained to evaluate evidence, Henrietta Hughes implied that association equates to causation by claiming that a few anecdotal improvements were due to the work of Speak Up Guardians, without providing any proof of a causal relationship.

As whistleblowers will say in chorus, good trusts do not need Freedom To Speak Up Guardians, and in bad trusts they make no difference and may be mistreated.

Another of the National Guardian’s claims was that short term achievements in a few cases were evidence of success. For example, a whistleblower returning from sick leave after being relocated to another part of an organisation. However, the natural history of whistleblowing cases is that employers often make token concessions to buy time, whilst covertly working to seriously undermine whistleblowers. Her comments either reflected lack of expertise on whistleblowing, or something else.

 

A recently published report by Dr Ashley Savage, academic lawyer who has extensively researched whistleblowing and whistleblowing law, describes a typical process of attrition by employers: “it is important to consider the retaliation of whistleblowers as a process, which can result in a number of continuing efforts to retaliate against a whistleblower rather than a single act of detrimental treatment or dismissal. This is particularly relevant for those considering the drafting of whistleblowing laws and implementation in practice. We must consider protecting whistleblowers much sooner in the process before the situation causes irreparable harm. Many whistleblowers effectively experience a process of ‘attrition’ whereby employers can continue to retaliate against the whistleblower through ‘express/hard’ measures such as litigation and court action requiring expensive legal resources that many whistleblowers simply do not possess to more ‘implied/soft’ measures such as removing whistleblowers from their duties leaving them with little or nothing to do.”

 

Moreover, the National Guardian’s Office appears to have no policy of robust follow up to ensure that whistleblowers are not quietly disposed of after the cameras have departed. In the Office’s last case review,  on Nottinghamshire Healthcare NHS Foundation Trust, there was a recommendation that the trust should commission an independent review of whistleblowing governance within 6 months. That is, the National Guardian effectively left harmed whistleblowers at an employer’s mercy, despite evidence of poor governance by that employer.

 The National Guardian acknowledged that poorly managed conflicts of interest undermine Speaking up Culture. However she continued, astonishingly, to minimise the conflict of interest at the heart the Freedom To Speak Up project; that internal Speak Up Guardians, employed by trusts, must choose between protecting their employment or defending the public interest. This repeated denial does not build trust and confidence, especially when some have suffered seriously, such as in the case of Munwar Hussain, a Scottish equivalent of a Freedom To Speak Up Guardian.

The National Guardian claimed that Speak Up Guardians can come to her Office if they have difficulties locally. However, the NHS workforce of over 1.3 million staff is not entrusting the National Guardian with many sensitive disclosures. FOI data has showed that the Office received only 85 legally qualifying whistleblowing disclosures in 2017/18, only 18 of which came from Speak Up Guardians.

Some Speak Up Guardians have left post. Some have indicated that they have been obstructed and bullied when trying to escalate concerns in their trusts. Shockingly the National Guardian’s Office admitted via FOI that it does not track whether Guardians are being bullied and obstructed. Neither does it measure their experience of whistleblowing to the National Guardian.

Notwithstanding the innate flaws of the ‘project’, if the National Guardian’s Office is to have any credibility, it needs to be the trusted resource to whom Speak Up Guardians can turn to if they get into serious difficulty. However, half of all Speak Up Guardians, from NHS trusts, arms length bodies and the private sector, who were surveyed by the National Guardian this year did not respond to the survey.

“The survey was distributed to 725 contacts and was open between 4 and 22 June 2018. A total of 361 responses was received (a 50% response rate)”

In reporting this most recent survey of Speak Up Guardians, the National Guardian’s Office also conceded:

“The responses to this question clearly show that we are failing to respond to queries from guardians in a timely way and we are sorry for the frustration this must cause.”

 Whilst Henrietta claimed that she values feedback and considers that good organisations should respond to concerns in an appropriate tone, her Office has on several occasions brushed off concerns. A recent example of her Office responding in a dismissive manner to concerns is given below:

A Speak Up Guardian and the husband of a seriously harmed whistleblower disagreed on social media about a significant technical, legal issue. The Speak Up Guardian was wrong, but the National Guardian’s Office intervened by retweeting the erroneous comment. It ignored the person who challenged when they expressed concern that misleading information was being recirculated. I wrote to the National Guardian about this, and raised an issue of whether the training for Speak Up Guardians needed to be reviewed, in view of the technical misunderstanding. The only response that I received came from her Comms manager, which was a single sentence in an email about other matters: “You asked about our retweet of a tweet from a Freedom to Speak Up Guardian. Hopefully, our Twitter profile makes it clear that re-tweets are not endorsements.” The issue of whether the training for Speak Up Guardians was sufficient was ignored.

 

The National Guardian went on to maintain that her Office has been listening to whistleblowers through its Advisory Working Group(AWG). I have been a member of this group but will not be continuing because I found it tokenistic and little serious work was done. Fellow whistleblowers have given similar feedback. By agreement with the National Guardian, one of the whistleblower members of the AWG provided an advisory document. However, it was reported that this has been ignored.

No depth of understanding was shown when the National Guardian was asked about the way whistleblowers are driven into the Employment Tribunal where they face impossible inequality of arms. She commented:

“And you know, personally, from the experience of people who’ve told me about going to Tribunal it sounds as if it’s an incredibly difficult situation.”

Make of that what you will. But these are not new problems, there is plenty of evidence on how UK law fails whistleblowers. It has been failing for twenty years. The National Guardian previously declined to support law reform, and told Rob Behrens:

“That’s why we’re working very much on the prevention side, so that when people speak up they are guaranteed their confidentiality and to avoid victimisation as well.”

This is hollow if she continues to ignore vital, basic requirements in preventing whistleblower reprisal and suppression.

Fit for purpose law, encompassing a protection infrastructure, is needed.

The PHSO solicited questions for the National Guardian interview via Twitter, and received five questions, Four were asked, but a question on whether she would change her mind on law reform was not. Copies of the tweeted questions are provided in the appendix.

Finally, the National Guardian’s Office has briefed unpleasantly  against whistleblowers. It was found to have mishandled a complaint about one such instance. However, Robert Francis as Chair of the National Guardian’s Accountability and Liaison board would not uphold the substantive complaint in this matter

Francis was later revealed to be biased by disclosed correspondence pre-dating the above complaint. This showed that Francis refused a request to meet me regarding concerns about the National Guardian’s Office, on the rum grounds that he anticipated that he could not change my mind:

Set in this context, a question put to the National Guardian during the PHSO interview was:

“Do you believe there is a bullying culture in your own Office?”

 Her response was not reassuring:

“It’s always impossible to know unless people start telling you about things. And this is where I believe that having the right speaking up culture but then acting appropriately about things is the way forward. And I think it’s one of those things where we really want to ensure that everybody within my Office but also across different parts of the NHS feel safe that if they’ve got a concern that they can raise it. That they know they’ll be thanked, they’ll be listened to, it will be acted upon and that they will get the feedback on that as well.”

So, a National Guardian of Freedom To Speak Up who distances herself from cultural issues in her own, very small Office on the grounds that she doesn’t know about problems, because no one has told her.

Splendid.

 

RELATED ITEMS

The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project

What could a new whistleblowing law look like? A discussion document

Prescribed Persons or the Pretence of PIDA. How UK whistleblowers are ignored

National Guardian’s Hidden Bulletins & Disappearing Freedom To Speak Up Guardians

  

APPENDIX 

I transcribed an undated interview by Rob Behrens Parliamentary and Health Services Ombudsman with Henrietta Hughes, NHS National Guardian for Whistleblowing, first broadcast by PHSO on 30 November 2018:

The broadcast can be found here.

Apart from a few minor differences, my transcript maps onto a transcript published by PHSO here.

RB Good morning today my guest is Dr Henrietta Hughes the second National Guardian for the NHS.

This crucially important role was created following the Freedom To Speak Up Review by CQC board member Sir Robert Francis

Dr Hughes is a practising GP with over twenty years’ experience across primary, secondary and community healthcare.

She was medical director at NHS England London Region from 2013 to 2016 where she provided system leadership across twelve clinical commissioning groups and twelve NHS trusts.

And she was the Responsible Officer for more than 3,000 GPs.

This provided her with extensive leadership experience and an overview of the day to day challenges the NHS faces.

Dr Hughes became the National Guardian in 2016 and she advises on good practice in responding to staff concerns and provides challenge and support for the NHS system to encourage a truly safe and open culture.

Well that’s a big task.

Henrietta thank you very much for joining us today, you’re very welcome.

HH Thank you

RB So the custom on Radio Ombudsman is to start by asking you a bit about your background. Where were you born and brought up.

HH I was born in London and I’ve lived in London all my life. I think that for me, as a medical director, in a part of London where I’ve been born, went to school, got married, had my children, meant that I had a lot of understanding about the area and my patients as well.

RB What sort of values did you gain through your upbringing?

HH I think the overriding one was about fairness. And certainly, as a GP my experience is that people who need more support often find it more difficult to access, and so I hope that my role as their doctor is to help them navigate through the system, to provide information and support. Listen to what their concerns are and then act on those so that we can find a plan to move forward.

RB So listening to people who can’t obviously articulate their own views is very important?

HH (2.53) Well I think it’s really about exploring their ideas, their concerns and their expectations. And that’s very much a GP’s consultation model, which I’ve adapted into the role of National Guardian.

Thinking very much about the views and ideas of members of staff and the workers in the NHS, and how we can then translate those into improvement for patient care.

RB When did you set out to become a GP?

HH Well my journey towards medicine really started when I was two. I come from a family of doctors and my grandfather who was a surgeon made me a surgeon’s outfit when I was two and it was made from the surgical drapes, the sort of paper drapes that there were in the 1970s and that smell of the sort of carbolic and the design of the outfit was a great inspiration to me. And that really set me on the path towards medicine.

RB So do you still practice now?

HH I still practice in the Borough where I was born actually, and I think there’s something about that continuity of experience. But as I said about really understanding of the context of patients’ lives, but also having a really good understanding of the services that are available and good relationships with the people that provide them are as well.

RB Now the previous roles which I described have given you huge access to frontline NHS staff and provided you with leadership experience within the NHS. What was it that inspired you to take on the role of the National Guardian, which is a hugely difficult and challenging role?

HH Well I suppose I’ve always been attracted to the difficult roles. In the area of London where I was medical director for in North, Central and East London it had its issues in terms of challenged health economies in lots of different ways. And my experiences as a medical director is that I would dealing a lot of situations where things had gone wrong and then we were picking up the pieces. Patients had already experienced harm and we were investigating what had happened. In those investigation reports, I often saw that they were far too aware of the issues in advance of when things had gone wrong. Either had spoken up about them and nothing had happened or that nobody had said anything. And also, we had individuals who came directly to us with concerns which we acted upon and it struck me that if we could deal with the issues before they caused harm, that would be of benefit to everybody.

Obviously to the patients and their families but also to relieve the burden, the psychological distress that that would cause the staff as well who are often the second victim in this situation.

(5.34) And so when I heard Sir Robert Francis on the radio talking about the National Guardian role, it really struck me that there was a great opportunity for driving improvements by attending and listening to the concerns that staff had and making sure that those are acted on in order to prevent harm to patients.

RB This is a huge job and you want to promote a big cultural change. You recognise that a big cultural is a massive undertaking in the NHS.

HH Absolutely. Clearly this is not something that I’m going to be doing on my own. I have a small team and a national office but I work with over 800 Freedom To Speak Up Guardians and Champions and Ambassadors across England, a network of people who provide a range of backgrounds including nurses and midwives, physios, doctors, but also facilities managers, chaplains, board secretaries, people from lots of different aspects of the NHS workforce who have a common enterprise of supporting their colleagues, listening, thanking them when they speak up, and then acting on the results.

And more importantly, giving them feedback on the actions that have been taken.

I’ve also found that there’s been a real enthusiasm in not only boards in NHS trusts in England, but also in the leadership organisations, in the arms length bodies, many of whom have already appointed Freedom To Speak Up Guardians.

And Rob, I was just going to ask whether the Ombudsman’s Office was thinking of appointing?

RB That’s a very good question and the answer to that is yes…

HH Oh I’m very pleased to hear that.

RB ….we’re in the middle of making sure that we have a Speak Up Guardian by the beginning of 2019.

HH That’s wonderful news because we know that the cultures in the providers are influenced by the cultures in the bodies that lead them, commission, regulate, inspect. And you know, if we can get the cultures right in those organisations, then I think we’ve got a chance for improving the culture across the whole of the NHS.

(7.41) RB I was interested to see in the latest survey that, you’ve done your October 2018 survey, asking Guardians about their experience, that the less effective operations are amongst the regulators rather than amongst the trusts. Is that a fair…?

(8.00) HH I think that’s a slightly harsh way of looking at it. What I would say is that in the organisations that aren’t inspected by CQC, the perceptions of the Guardians are on a par with trusts who are struggling. So we’ve thought very hard about how we can support the arms length bodies that have appointed to buddy up with the Guardians from the trusts who are really getting this right, to share that learning and ensure that we can get the best from the NHS into the arms length bodies.

Clearly, the ones who have already appointed are the ones who are thinking about how they can support their staff and improve the cultures in their own organisation. It’s the arms length bodies who are yet to appoint are the ones that I’m interested in informing, helping and providing training for their staff as well.

RB It’s a very interesting account, this report and obviously you’re documenting information which we haven’t had before. Many of your Guardians are good people who don’t actually have access to trust boards or chief executives. Presumably it would be better if they did have that access.

HH Well what we’ve found is that over 40% of Guardians don’t have any ringfenced time and it makes me wonder how the leaders of those organisations could imagine that their Guardians could be an effective resource for staff, an investment really, to provide the proactive nature of their work where they’re able to go out into the organisation and look for hot spots of culture but also reactively to be there for staff who are often in great distress and need a lot of time to be able to describe their experience.

(9.39) And what we’ve found is that the Guardians who don’t have any ringfenced time are less likely to have access to their chief executives, present their reports in person, attend regional meetings, attend training and most importantly, complete feedback on their own performance.

And so the call that I would make is to the leaders of all organisations that have appointed guardians that they think carefully about ‘What investment you need to make in your Guardians so that they’re able to provide an excellent service?’

And more importantly, I think to boards to say ‘Are you happy with the speaking up culture in your organisation? Have you met your Guardian yet? Has your Guardian presented to you? And have you been able to ask them the pertinent questions.’

RB Yes. What is your frank view about the challenges of opening up the culture in the NHS and how Speak Up Guardians can assist in doing this?

(10.33) HH Well we’ve already seen the impact that we’ve having. The feedback that I get from unions, for example, one staffside chair said that the number of grievances in their organisation has gone down from sixteen to two, which has had a dramatic impact on the amount of hours that she’s spending on this each week. But I also think it also tells a story about the culture that’s developing in that organisation and that’s an ‘Outstanding’ trust. In another organisation I’m aware of a senior member of staff who was very distressed that the patient safety issues they’d raised hadn’t been investigated. They were so distressed they were off work with sickness and were thinking about going to an Employment Tribunal, and the situation was really stuck.

But by working in partnership with the Freedom To Speak Up Guardian, their union rep told me that they were able to get an external, independent investigation commissioned, and also that the individual was found another role in another part of the organisation and came back to work successfully. So in my view, to be able to preserve the health of a member of staff they’re able then to come back to work and deliver care, and avoid the stress and the trauma of the Tribunal, really strikes me as positive progress.

(11.51) RB OK. One of the issues is about the status of the Guardians themselves. So you’re independent. But the Guardians are appointed by trusts. Do you think that hinders the credibility of the system?

(12.06) HH There’s quite a lot of different models actually. So some Guardians are existing members of staff. Others have been appointed as external indviduals. And there’s also an independent Guardian service which is commissioned by organisations. The point that I would make is that if you have a member of staff, for example a nurse, in your organisation, their colleagues trust them. And if they trust them as a nurse, why would they not trust them as a Guardian?

Where Guardians are coming up against difficulties, when they’re trying to escalate issue and they’re not getting the reaction, and the response that they would expect, then they flag that to my Office. And we would give them advice and guidance or potentially, we would do a case review, to see if the speaking up hadn’t been handled well by the organisation.

(12.57) RB OK. And I’ve seen in your survey report that one of the recommendations is to focus much more on potential conflicts of interest, to make sure that people have the moral authority to take cases forward.i

(13.13) HH Well, conflicts of interest abound across the NHS. And n fact we published a case review yesterday into a situation where there were conflicts across the organisation. In fact there is a standard NHS England conflict of interest policy which trusts are expected to adopt. And in that particular organisation only one member of staff out of a workforce of 9,000 had signed their conflicts of interest declaration. And we’re seeing this in lots of different ways. What we feel is that for the Guardians, they need to think about whether they have any conflicts of interest so for example, if they’re in a line management chain, they need to think about what the alternative route might be for somebody if they don’t think that the Guardian is appropriate for them.

And we’ve seen many trusts appointing a network of champions and also they have non executive directors and Executive leads with responsibility for Freedom To Speak Up.

So although this is new, we’re thinking very much about what the barriers might be to speaking up and how we can mitigate some of those potential conflicts so that every member of staff can feel confident that they’ve got an appropriate route to use.

(14.21) RB OK You’re doing a lot of innovative work. You’ve just had a Freedom To Speak Up month. Tell us a bit about that.

(14.30) HH It always interesting that much as you try to communicate, there’s always more that can be done. And certainly over the last two years since I was appointed, I do feel that there’s an increased understanding and awareness of our role but you know, with 1.3 million staff across the whole of the NHS, getting the message out across the very crowded landscape about an initiative can be difficult. So with the Freedom To Speak Up Guardians we’ve had an awareness raising month called Speak Up Month with a hashtag #SpeakUpToMe, and have to say, the response across England has been really tremendous.

Guardians have been doing lots of innovative work, including films and press interviews. There were animations, pop up stands and events. I spoke at quite a few of those, and also a board game was developed at Great Ormond St Hospital called GHOSHOPOLY to help their staff understand a bit more about the speaking up process.

So I’m really delighted. It’s not unusual really in the way that we’ve started something off, the Guardians have taken in on, and developed it in a really magnificent way.

There’s still so much more to be done and we know that there are some particularly difficult to access groups. So the more that we can do and that’s where I’m really grateful to you for this interview today to continue to increase the awareness of the role so that everybody knows they’ve got somebody they can turn to if they want to speak up.

RB I’ve got some questions from Twitter that I want to put to you, but before that, could you just reflect a bit about the relationship between you do and what the Ombudsman does and how we should be working together to learn from complaints and whistleblowing to improve the quality and safety of care?

(16.18) HH I think there’s a huge overlap in what we do because it’s about how organisations respond to challenge and personally as a medical director part of my role was signing off responses to complaints that came into NHS England about GPs. And you could learn so much about the organisation by the tone of the letter they wrote and the way that they responded to complaints about patients and families.

And I think the same is true when it comes to the way that organisations listen, thank and respond to their workforce when they also raise concerns. So in terms of developing best practice, I wouldn’t be surprised if there’s an overlap between the organisations that you’re dealing with and the ones that are of concern my Office as well.

(17.04) RB I think that’s right. I have had a number of GPs come to my office who’ve said to me that they would like to make a complaint but they can’t, because they fear the victimisation that they’ll receive in the NHS if they make that complaint. But they wanted me to be aware of the situation.

That’s a common issue for us, there’s no clear dividing line between what you do and I do in that situation.

(17.26) HH Absolutely. I’m really delighted that NHS England are extending the funding to my Office so that we can bring this out into Primary Care as well, because there are issues that lie unresolved in Primary Care as much as there are in trusts as well. I really want every person who works in Health to be able to know that they’ve got somebody they can turn to.

(17.56) RB OK. On twitter we have, as you would expect, questions from the redoubtable Dr Minh Alexander.

First one: “Will the National Guardian model best practice and publish all her so far hidden bulletins for Guardians?”

(18.13) HH We have a range of different information that we publish, including a newsletter, social media and we publish reports on our website. There’s some information that we share with Guardians where they may want to be able to contact us for advice and guidance, so some of that advice is management information but I think it’s really helpful feedback and I’ll make sure that we share as much information as we can with members of the public as well as with the workforce.

(18.44) RB OK. Thank you for that. She also asks if you’ll increase the productivity of the Office, accept more NHS whistleblowers for case review and review current exclusion criteria?

(18.57) HH Absolutely. So we had a one year pilot of our case review and I think with everything that’s new we’ve been learning by doing. The Office is set up with a budget which really didn’t assess the possible work that we would be doing would include and so it’s actually quite interesting to see the depth and the impact of the case reviews that we’ve done but we recognise the fact that there’s so much more to be done and so we’ve had an evaluation of the first year’s pilots which we are already reflecting on and thinking about how we can use that to expand and improve the process, and we’ve had really good advice back from the advisory working group which includes a range of different organisations and individuals who’ve spoken up and had a bad experience.

And we want to take all of that feedback and the learning from the case reviews that we’ve done already, so that we can improve and expand the process going forward.

(19.57) RB OK. Thank you. Can I just ask, someone has raised the issue of the Tribunal involving Dr Day and the great difficulty that whistleblowers have when they are faced with the legal resources of the NHS in court. Do you think that’s something that we need to reflect on?

(20.19) HH I think Tribunals should be the exception rather than the rule. And you know, personally, from the experience of people who’ve told me about going to Tribunal it sounds as if it’s an incredibly difficult situation. That’s why we’re working very much on the prevention side, so that when people speak up they are guaranteed their confidentiality and to avoid victimisation as well.

(20.45) When it comes to junior doctors for example, I welcome the fact that Health Education England has extended the protection for junior doctors and we’ve heard some really interesting cases where junior doctors have spoken up to Freedom To Speak Up Guardians and actually have been taken as a result in a way that they haven’t been able to get those actions through using other speaking up routes.

(21.10) RB OK. Thank you. Last question from Twitter: “Do you believe there is a bullying culture in your own Office?”

(21.16) HH It’s always impossible to know unless people start telling you about things. And this is where I believe that having the right speaking up culture but then acting appropriately about things is the way forward. And I think it’s one of those things where we really want to ensure that everybody within my Office but also across different parts of the NHS feel safe that if they’ve got a concern that they can raise it. That they know they’ll be thanked, they’ll be listened to, it will be acted upon and that they will get the feedback on that as well.

(21.51) RB I have three final questions. First of all, your job is an immensely difficult one. You must get quite a lot of negative comments, sometimes abuse. How do you deal with that?

(22.05) HH I always take the view that feedback is a gift and everything that we’re doing is new, and to be able to learn and improve I want to be able to take all the feedback. And, you know, positive feedback is always pleasant but negative feedback is the thing that can often drive improvement further and faster.

(22.23) RB But there must be a limit to what you’re prepared to accept on the personal front?

(22.31) HH So my experience is that it’s actually comments which may be made in a well meaning way which can sometimes be more derogatory than comments from people who’ve potentially had bad experiences and really want to drive the improvement in what we do. I think that my personality is probably one where that drives me on to do even more and better to support people. May be it’s because I’m a GP.

(23.00) RB OK. Second to last question. You’re a pioneer, what you’re doing is very unusual, you don’t have a lot of resource, you don’t have a lot of powers. You’ve clearly made a difference. What would you say is the biggest difference that you and your Office have made so far?

(23.16) HH In the first year we collected the speaking up data and over 7,000 cases brought to Freedom To Speak Up Guardians. So I don’t think it’s a difference that I’m making, I think it’s the difference that Freedom To Speak Up Guardians are making, day in, day out supporting their colleagues. And if those cases have led to improvements in patient care then it’s the positive impact that’s having on people across the whole of England. And that’s what makes me really proud.

(23.45) RB OK. Last question. It’s a traditional question on this programme. What advice would you give to young graduates coming into the Health service, the Ombudsman world in relation to Health, on the basis of your experience?

(24.02) HH I’m always guided by what’s best for my patients. And I think if we always focus on patients then the decisions that come around that will always feel the right ones to be made.

RB Dr Henrietta Hughes, I’m very grateful, it’s been very interesting, thank you very much.

HH Thank you very much for having me.

 

Tweeted questions for the National Guardian

The PHSO solicited questions via Twitter to put to the National Guardian in the above interview:

I contributed three questions as follows:

 

Another NHS whistleblower contributed this question:

A third person contributed this question:

All of these questions were put to the National Guardian, apart from my question on whistleblowing law reform.