Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 9 March 2019
In advance of the Health and Social Care Committee hearing on the Kark FPPR review report, on what should be done about poor NHS managers, I have written to the Committee about the CQC’s incestuous mechanism for assessing the Well Led domain.
The Kark FPPR review team observed a CQC ‘Well Led’ inspection and that part of the Kark report is well worth reading (see from 4.45 onwards).
Kark remarked witheringly at 4.24:
“This is not intended as criticism of the CQC, but it underlines the issue which is that the assurances given by the CQC via their ‘Well-Led’ rating, if based (as in part they are) upon the Trust’s application of the FPPT, may be optimistic and in this respect at least not well-founded.”
However, Kark did not comment on who conducted CQC’s ‘Well-Led’ inspections, but it is often the directors of other NHS trusts. I found this through a formal analysis in 2016. A brief glance at CQC’s recent inspection reports shows little change.
The awkwardness that this introduces into executive peer relationships and the potential for bias and backscratching are plain. The issues are summarised below in the letter to Health and Social Care Committee.
LETTER TO HEALTH AND SOCIAL CARE COMMITTEE 9 MARCH 2019
Dear Dr Wollaston and colleagues,
FPPR and potential conflicts of interest due to NHS Trust directors inspecting each other’s ‘Well Led’ domains
I omitted in my evidence to the Committee for the hearing on the Kark FPPR Review report to make this point.
An analysis that I previously conducted on this was kindly published by Open Democracy in September 2016:
In addition to NHS trust directors chairing CQC inspections of each other’s trusts, there was also an issue of managers from the private sector chairing inspections on the NHS and thus gaining access to market intelligence.
I have not repeated a formal analysis but my impression is that not much has changed, and that CQC inspections remain incestuous. There is a development in that CQC now sometimes fields so-called ‘executive reviewers’, instead of inspection Chairs, who are also drawn from other trusts’ boards. Some CQC reports hide the identity of these ‘executive reviewers’.
I provide some specific examples below if needed.
Dr Minh Alexander
Cc Tom Kark QC
The Royal Wolverhampton NHS Trust
The latest CQC inspection report on Royal Wolverhampton hid the identity of the ‘executive reviewer’ for the Well Led domain:
This CQC inspection concluded that the Royal Wolverhampton NHS Trust was “Good” on the Well Led domain.
There has been significant controversy surrounding the chief executive of this trust in respect to a string of whistleblowing cases. For example the case of Prof David Ferry who gave an account of his ordeal to BBC File on Four in 2017:
“Somebody entered my office and wrote racist graffiti on the wall, smashed my precious family photographs.”
“It is very worrying and my eldest daughter was doing her GCSEs at the time and my wife is black, of course, and you have to consider carefully what you do. I think that some people were hoping I would react to that and say perhaps some inappropriate things, which would give them an excuse to suspend me or exclude me, but I think I managed that difficult episode with more control and dignity than I thought I might in the first days after it occurred.”
“Things were deteriorating, and after a particularly difficult day in the department, there was a lot of upset and that night, when I went to my car, there was a sticker on my car that said ‘Death to the bastard Geordie whistle-blower.’ You think, this is getting very difficult. And shortly after that, it was decided there was going to be an external inquiry into rectal radiotherapy treatments in the Trust. Ultimately, that inquiry by national level experts in rectal cancer supported my perspective.”
Prof Ferry was referred to the GMC, as Raj Mattu had been before him, and also exonerated:
It is also worth noting that CQC previously misrepresented a critical finding in an inspection report that was related to Prof Ferry’s whistleblowing case. When Prof Ferry questioned this, Mike Richards the then CQC Chief Inspector reportedly maintained that the misrepresentation was due to a typo:
“When the report came out, the CQC report, I read it and it said in the report, the first version of the report, that the chemotherapy the patients had received had been standard. In other words, there was no error made. Now when I raised this issue, there was a lot of fuss, the report had to be rewritten and Sir Mike Richards, who heads the hospital inspection process, stepped in and said there had been a typographical error, so that was very interesting.”
University Hospitals Bristol NHS Foundation Trust
The 2017 CQC inspection (which is the most recent) was chaired by Dr Andrew Welch, Medical Director of Newcastle Upon Tyne Hospitals NHS Foundation Trust:
Colchester University Hospital NHS Foundation Trust (now known as East Suffolk and North Essex NHS Foundation Trust)
The most recent CQC inspection report shows that the ‘executive reviewer’ Dr Sean O’Kelly who was at that point the Medical Director of University Hospitals Bristol NHS Foundation (UHBT).
As above, UHBT has been at the centre of controversy about more baby deaths.
Dr O’Kelly moved to NHS Improvement last summer:
“We’ve appointed Dr Sean O’Kelly as our Medical Director for Professional Leadership to work alongside clinical leaders and improve the way we engage with clinicians.
In his new role, Dr O’Kelly will help ensure effective engagement between NHS Improvement and front-line clinicians. He’ll work as part of a team to provide clinical and professional guidance across NHS Improvement and the sector to help support the continued professional development of clinicians. He will also be working closely with commissioners, patient groups and providers to encourage innovation and support the development of new service and care models.”
Birmingham Women and Children’s NHS Foundation Trust
The most recent CQC inspection was chaired by Dr Michael Anderson, the Medical Director of the Chelsea and Westminster Hospital NHS Foundation Trust:
Brighton and Sussex University Hospitals NHS Trust
BSUH has had stricken governance for years now and the flow of coroners’ warning PFDs has not stopped.
However, it was unexpectedly upgraded to “Good” by CQC recently, and in this inspection the ‘executive reviewer’ who looked at the Well Led domain was David Melbourne the Finance Director of Birmingham Women and Children’s NHS Foundation Trust
East London NHS Foundation Trust
During the most recent CQC inspection, ELFT’s ‘Well Led’ domain was reviewed by Angela Dragone, the Finance Director of Newcastle Upon Tyne Hospitals NHS Foundation Trust:
Northumberland Tyne and Wear NHS Foundation Trust
During the most recent inspection, the ‘executive reviewers’ were Neil Carr Chief Executive of Midlands Partnership NHS Foundation Trust and Dr Olubukola Adeyemo Medical Director of North Staffordshire Combined Healthcare NHS Trust.
Norfolk and Suffolk NHS Foundation Trust
The most recent inspection of NSFT was chaired by Paul Devlin Chair of Lincolnshire Partnership NHS Foundation Trust:
Salford Royal NHS Foundation Trust
Barking Havering and Redbridge University Hospitals NHS Trust
The ‘executive reviewer’ for the most recent CQC inspection was Trish Armstrong-Child, Director of Nursing at Bolton NHS Foundation Trust:
Hull Teaching Hospitals NHS Foundation Trust
The ‘executive reviewer’ for the latest CQC inspection was Martin Earwicker, Chair of Berkshire Healthcare NHS Foundation Trust.
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.
Steve Field former CQC Chief Inspector was recently appointed Chair of the Royal Wolverhampton NHS Trust: