By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 27 February 2019
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Summary: The NHS Freedom To Speak Up project defines waste. It has committed millions in public money across the NHS to an un-evidenced vanity project. Not content with that, the government is trying to spread and embed the dubious model. Once embedded, it will be a bulwark against real whistleblowing reform. The National Guardian expends much energy on glad-handing and self-promotion instead of the day job of actually protecting patients and whistleblowers. The Defence Medical Forces have fallen to the Speak Up charm offensive, and has now adopted the model. Disclosed documents are provided.
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The NHS National Guardian has a small annual budget of one million pounds for protecting NHS trust whistleblowers. NHS England recently gave her office an additional bung for expanding into primary care as well: “NHS England will triple their contribution for my office”.
She does not make best use of this precious resource, and does not conduct enough whistleblowing case reviews. Too many whistleblowers are turned down on spurious grounds. For example:
The Greasy Freedom To Speak Up Review is Stuck. More Tales of Silence about Silence.
A Study in Delay: The National Guardian & Brighton and Sussex University Hospitals NHS Trust
Even when Freedom To Speak Up Guardians repeatedly escalate case issues to her Office, this does not always result in a case review. For example, FOI data has shown that she has not reviewed a troubled NHS trust not long out of special measures, despite the local Speak Up Guardians escalating case issues to her on five occasions.
Whistleblowers whose cases are reviewed by her Office are not adequately protected. They are merely substrate for the production of reports. I have been contacted by several whistleblowers who have had concerns about their experiences of case review.
The National Guardian’s case reviews do not threaten employers or erring regulators. They defuse and reduce serious corruption and managerial misconduct to a bureaucratic paper chase.
NHS regulators are not taking the case review process seriously and cannot produce any evidence that real action has been taken. Poor leaders who are responsible for serious failures are allowed to stagger on.
The annual NHS Staff Survey was released yesterday. It showed that despite a massive and most distasteful PR push by the National Guardian’s Office last October, the wet and windy “Speak Up Month” just before data collection for the NHS staff survey, the dial has barely flickered on staff confidence in speaking up:
NHS STAFF SURVEY OVER THE PERIOD IN WHICH THE NATIONAL GUARDIAN’S OFFICE HAS BEEN ESTABLISHED:
| YEAR | NATIONAL AVERAGE SCORE ON “I WOULD FEEL SECURE RAISING CONCERNS ABOUT UNSAFE CLINICAL PRACTICE”
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| 2016 | 70% |
| 2017 | 70% |
| 2018 | 70.5% |
Source: NHS Annual Staff Survey reports
More on the NHS staff survey next month, when the full question level data is published.
Inversely related to the energy that the National Guardian has expended on her day job of protecting patients and whistleblowers, she has noticeably hit the selfie and self-promotion trail.
She established the embarrassing ‘Pan Sector Network’ early in her tenure. She has courted corporate whistleblower slayers:
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The Ministry of Defence was an early invitee to the National Guardian’s Pan Sector Party:
A reciprocal invitation was made, with the obligatory mutual admiration:
Notably, the MoD has had terrible whistleblowing governance, and attracted savage criticism from even the very conservative Civil Service Commission, which investigates whistleblowing disclosures about breaches of the Civil Service Code.
In a case of suspected criminality over contracts handling at the MoD, the Civil Service Commission’s decision notice had this to say on the MoD’s repeated Code breaches:
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Decision Notice: MoD March 2015, Ref. AP000122 – Specialist police investigation by MoD CID into the concerns concluded that the complainant had raised his concerns reasonably, and that there was “flagrant disregard for competition which could possibly indicate criminality”. – MoD policy was incompatible with the Code, because prevented MoD staff from making public interest disclosures unless it concerned their area of work – There was “…a lack of appetite within the Department to either consider the concern against the framework of the Code or to take account of the evidence that their own internal investigation had uncovered” and a lack of objectivity in the Department’s handling of the concern – which was an additional Code breach. – “there is clear evidence of a culture which discourages dissent and does not take allegations of breaches the code seriously” – The Commission concluded that overall, the MoD’s behaviour in this matter was so poor that it went to “the heart of whether from the top to the bottom of the organisation there is an unwavering commitment to the values of integrity and honesty which are fundamental to the Civil Service.”
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A tweet last month revealed that the National Guardian, had a day out with the Defence Medical Services (DMS). It also revealed that Freedom to Speak Up Guardians have now been established in the DMS.
It should be noted that the Armed Forces are not covered by the Public Interest Disclosure Act, but civilian personnel in the DMS are.
However, the Service Authorities have at least given an undertaking to: “honour the spirit of the Act in that they will recognise and adhere to the criteria for protected disclosures for military personnel and follow the prescribed procedures whether dealing with or making a qualifying disclosure.”
Doctors and other registered clinicians who are Armed Forces personnel also remain bound by the requirements of their professional codes to protect patients and raise concerns as needed as part of this. This seems a rough deal given that they do not have the same legal cover under whistleblowing law.
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“The GMC states that you should contact a regulatory body where you cannot raise a concern with a responsible person or body locally because you believe them to be part of the problem; or you have raised concerns through local channels but are not satisfied that the concern has been addressed seriously; or that there is an immediate serious risk to patients, and a regulator or external body has a responsibility to act or intervene. Regulated healthcare workers have professional responsibilities to raise concerns regarding patient safety to their regulator.”
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An FOI enquiry to the DMS produced the following documents yesterday:
Defence Medical Services FOI reply letter 26.02.2019
Air Vice Marshal Alastair Reid letter to Henrietta Hughes 7.02.2019
Email between Henrietta Hughes and the Defence Medical Services November 2018
Whistleblowing policy ‘Raising concerns including by Defence Medical Services personnel’
The above whistleblowing policy document gives sparse information about the DMS Freedom To Speak Up Guardians. It merely signposts DMS staff to the woeful government propaganda material on the NHS Employers’ website:
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“Freedom To Speak Up Guardian 30. Freedom To Speak Up (FTSU) Guardians have a role to promote the profile of raising concerns in their organisation and provide confidential advice and support to staff in relation to concerns they have about patient safety or the way their concern is being handled. Further information on FTSU Guardians can be found at the following reference9” 9 http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at-work-and-whistleblowing/freedom-to-speakup-guardian-hub Accessed 18 Mar 16
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The DMS disclosed that it appointed two Freedom To Speak Up Guardians “in the last six months”, and that there are also FTSU “champions”.
According to the DMS, their Guardians may escalate concerns to:
“One of the DMS FTSU Guardians works in Defence Primary Healthcare (DPHC) and reports to the DPHC Command Board. Both FTSU Guardians have direct access to the Medical Regulator within the Defence Safety Authority and can, within their remit, report concerns directly to Professional Bodies, the Care Quality Commission and the National Guardian’s Office.”
And wouldn’t you know it, but there is no ringfenced time for these Guardian roles.
Enough to make you wonder if this isn’t just more managerial tokenism.
Excellent empire building and nice selfies though.
RELATED ITEMS:
Part of the evidence of the UK government’s resistance to reform of totally ineffective whistleblowing law – an explanatory memorandum by BEIS Minister Andrew Griffiths to the parliamentary European Scrutiny Committee last summer, pouring cold water on the new EU Whistleblowing Directive:
The EU Directive proposes ludicrously unreasonable measures, such as ensuring the investigation of whistleblowers’ s concerns. Why would any self-serving club culture wish to adopt this?
Fakery such as the Freedom To Speak Up project is much more conducive to preserving the status quo.
What could a new whistleblowing law look like? A discussion document
The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project
Spinning death at Gosport: The Department of Health and the National Guardian
Alexander's Excavations 
A picture is worth a thousand words.
I intend to build a portcullis and undertake a self-defence course.
To be frank, I have no objection to people working a fiddle, i.e. accepting payment for an easy admin/schmoozing job with no useful outcome. Little wonder this hollow, taking-the-taxpayer-for-a-ride model is popular and will undoubtedly spread like cholera.
The problem I have is with the necessary sacrifice of those who are competent and principled and, therefore stand no chance of being appointed a guardian and, by extension, the frightful abandonment of, and harm done to, those whistleblowers speaking up on behalf of the innocent and the vulnerable.
Not keen on smugness in response to suffering, corruption and worse.
But, I thank you, Dr A for charting our decline so vividly.
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