By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 22 February 2019
Summary: This piece looks at what happens after the National Guardian has conducted an NHS whistleblowing case review. The answer so far is a long paper trail and much box ticking, but little of much substance.
The Department of Health and Social Care and Robert Francis have bought the establishment some more years of obfuscation and delay by proposing the Freedom To Speak Up Model of a completely powerless National Guardian, and local Speak Guardians employed by the organisations they are supposed to hold to account.
It is a blatant recipe for ineffectiveness.
Robert Francis’ excuse for this floppy offering was that the National Guardian would have borrowed power and authority from the system regulators, CQC and NHS Improvement, who fund and back her Office.
He suggested that the National Guardian could always ask regulators to make a “direction” if needed, as part of her case reviews, to bring regulated bodies to heel:
“7.6.12 The INO [National Guardian] should be authorised by these bodies to use his/her discretion to:
• review the handling of concerns raised by NHS workers where there is cause for concern in order to identify failures to follow good practice, in particular failing to address dangers to patient safety and to the integrity of the NHS, or causing injustice to staff
• to advise the relevant NHS organisation, where any failure to follow good practice has been found, to take appropriate and proportionate action, or to recommend to the relevant systems regulator or oversight body that it make a direction requiring such action.
This may include:
– addressing any remaining risk to the safety of patients or staff
– offering redress to any patients or staff harmed by any failure to address the safety risk
– correction of any failure to investigate the concerns adequately
– correction of any non-compliance with good practice identified
– appropriate recognition of the contribution of the worker who raised the concern to improving patient safety and quality of care
– suggesting support and remedies for former employees including referral to the employment support scheme to get staff back to work referred to in 7.3 and Principle 12
– act as a support for Freedom to Speak Up Guardians referred to under Principle 11
– offer guidance on good practice about handling concerns
– publish reports on the activities of the office, including any findings in relation to non-compliance with good practice, advice offered, and recommendations for action.”
This was predicated on the assumption that:
- The National Guardian would make such requests,
- The system regulators would accede when the National Guardian asked them to make directions.
The National Guardian has now published reports on five completed reviews, since November 2017.
To test Robert Francis’ claims that the National Guardian would easily borrow powers from the system regulators, I asked NHS Improvement about the interaction between them:
FOI request to NHS Improvement 25 January 2019:
“Please advise if the following information is centrally held and disclose it if disclosure is possible within the cost limits. If the total request exceeds the cost limits, please prioritise question (5):
1. The number of occasions on which the National Guardian’s Office has alerted NHS Improvement to governance breaches by NHS trust
2. The number of occasions on which the National Guardian’s Office has alerted NHS Improvement specifically to whistleblowing governance breaches by NHS trusts
3. The number of occasions on which the National Guardian’s Office has requested that NHS Improvement takes regulatory action of any sort in relation to NHS trusts
4.Any actions that NHS Improvement has taken as a result of any of the case reviews undertaken so far by the National Guardian’s office.
5. Please advise of the number of occasions on which the National Guardian’s Office has requested that NHS Improvement makes a ‘direction’ regarding an NHS trust, as set out in the report of the Freedom To Speak Up Review by Robert Francis, pages 167 and 168”
This was the curious reply from NHS Improvement:
NHS Improvement FOI reply 21 February 2019:
“We will address each question in turn.
We have been involved in shaping and overseeing the implementation of improvement action plans for the five trusts that have had published case review reports. Up until now this has focused on the delivery of the action plan but we have begun to carry out trust visits which include a focus on measuring the over all impact of the National Guardian’s Office (NGO) case review and working out next steps in their improvement journey.
NHS Improvement’s reply appears somewhat self-contradictory in that it both claims that the National Guardian has asked three times for a direction to be made, but it also claims that the National Guardian has not asked for any regulatory action to be taken. I have asked for further clarification.
But whatever the exact truth of the matter, all that NHS Improvement admits to doing is ‘shaping and overseeing’ trusts’ response to the National Guardian’s case reviews.
Judging from action plans/ progress reports so far by trusts, this does not seem to amount to much.
Southport and Ormskirk Hospital NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust were the first two trusts reviewed by the National Guardian. The deadline for action on case review recommendations is up for both trusts (the longest timeframe for delivery on recommendations was 12 months in each case).
Progress reports disclosed under FOI reveal a tokenistic, corporate, box ticking exercise with few meaningful measures.
As anticipated, the National Guardian’s process spins gold into straw. Racism, cover ups, managerial misconduct, bullying and a trust Chair’s extraordinary public attack on a whistleblower at Northern Lincolnshire and Goole are defused and transmuted into bland, colour-coded assurance schemes.
No mention of the personal redress for wronged whistleblowers, or patient casualties of cover ups, as originally set out in the Freedom To Speak Up Review. No mention of investigated or re-investigated concerns that were ignored or handled poorly.
And it appears from these documents that KPMG, with whom the National Guardian has had un-minuted meetings, has picked up a piece of work at Northern Lincolnshire and Goole NHS Foundation Trust on the back of National Guardian’s review:
Also, Michael West of Kings Fund Thought Leadership fame, who spoke at the National Guardian’s glitzy conference in March 2018 , which an FOI request revealed cost a total of £40K, seems to be in on the act at Northern Lincolnshire and Goole.
The trust Chair even tweeted that he was “fabulous”:
Lastly, Alder Hey Children’s NHS Foundation Trust revealed yesterday that a
….“past Department of Health official/current chair of a health Think Tank”
gave controversial former CQC Chair Jo Williams a reference when she was appointed to Alder Hey’s board.
We have yet to see who this “current chair of a health Think Tank” was, but taking in the whole picture, it is not surprising that little changes on the insular magic roundabout of senior NHS management and its supporters.
The public should not have to depend on unreliable and reluctant governance scraps from a club that primarily protects itself. It needs genuine law reform to compel better practice in the public interest.
UPDATE 28 MARCH 2018
NHS Improvement advised it made an error in its above FOI response and that it had in fact received zero requests from the National Guardian to make a direction following the five case reviews completed so far.
Northern Lincolnshire and Goole NHS Foundation Trust advised that KPMG’s services were included in a contract.
The Trust also revealed (FOI 4574) that Michael West was paid a fee for speaking at the trust as part of its case review action plan, but it declined to share a copy of his presentation.
The extraordinary saga of Paula Vennells Post Office Group Chief Executive and soon-to-be Chair of Imperial Healthcare NHS Trust, the Horizon computer system fiasco and the Post Office’s sacking and prosecution of innocent Subpostmasters:
More about the ongoing class action against the Post Office at https://www.postofficetrial.com/ and Twitter hashtag #PostOfficeTrial
The unfair sacking of Andrew Smith, NHS whistleblower and trade union representative. A heady cocktail of tainted ingredients. Or how CQC, NHS Improvement & Mid Essex Hospital Services NHS Trust worked together on FPPR.