What does the National Guardian’s data hide?

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 17 November 2019

Summary: After a concern was previously raised about misleading use of statistics, the UK Statistics Authority found that the Department of Health and Social Care and National Guardian breached its code by citing unpublished statistics and the Authority issued guidance to the National Guardian’s Office. Concerns remain. Unsavoury findings about poor whistleblowing governance and unsupportive management culture, such as high rates of whistleblower detriment and marked levels of anonymous staff reporting, are hidden in plain sight by the National Guardian’s Office’s failure to present national data in a meaningful manner. Relevant analyses are not provided to the public or to NHS staff faced with difficult decisions about when and how to whistleblow. Data is presented in a format which makes it particularly difficult for the public to follow and trace patterns. The National Guardian’s PR messaging concentrates crudely on global activity data, which she claims is evidence of success, and which she inflates by including concerns that are not whistleblowing. Publication of data from the last two quarters was inexplicably delayed, and her Office has stopped providing even the basic quarterly totals that it used to issue. Examples are provided of problem trusts, which have been identified by further analysis of the National Guardian’s data. The National Guardian has been asked to provide more meaningful, accessible and transparent data including analyses by individual trust.

Whistleblowers have been concerned since the National Freedom To Speak Guardian’s Office was first proposed by Robert Francis in 2015 that it was designed to help hide the truth more than reveal it.

The National Guardian:

-Has no powers

-Does not investigate whistleblowers’ concerns

-Interprets her remit in a most restrictive manner so as to give only a tiny number of NHS whistleblowers a very weak voice

–  Sometimes bends her remit when it suits, to deny whistleblowers a voice

– Does not track crucial parameters, such as whether whistleblowers’ concerns are addressed 

What data she publishes is presented wrapped up and knotted so tightly, that only the most superficial impression is given. It is inconvenient to look further. Data is not supplied in easily interrogable spreadsheets, but on hard to read tables in tiny font, from which data must be transferred for any further analyses.

In the published data, obviously relevant analyses are not presented, and trends are withheld. In particular, trends for individual NHS trusts are not uncovered. The data for each trust is spread nebulously through each separate, hard to decipher, quarterly report.

The National Guardian’s main public relations thrust is to claim that the government’s Freedom To Speak Up project is a success because large numbersof staff have spoken up through NHS trust Freedom To Speak Up Guardians, which is a highly questionable assertion.

The Low Fact National Guardian The National Guardian claimed: “Patient’s lives have been saved and untold harm has been prevented because Freedom to Speak Up Guardians have supported workers”. When asked to provide the evidence for this claim, the best explanation that her Office could provide was some superficial activity statistics, and not evidence of any actual harm or deaths prevented: “Dear Mr Alexander, Thank you again for contacting the National Guardian’s Office.  The data we have collected over the last two years from FTSU Guardians in trusts and foundations trusts documents the number of cases that FTSU Guardians handled that include elements that indicate a risk to patient safety or the quality of care.  Our report for 2017/18 shows that FTSU Guardians handled 7,087 cases, 32% of which were reported as including an element of risk to patient safety or the quality of care.  We are finalising our report for 2018/19 but our figures so far indicate that FTSU Guardians handled nearly 12,000 cases and nearly 30% of these were reported as involving an element related to patient safety / quality of care. I hope this information is helpful for you. Kind regards, Ellie Staite Correspondence Officer National Guardian’s Office 151 Buckingham Palace Road London”

Moreover, the National Guardian’s assertion of success, based just on crude numbers, relies on unverified data supplied by trusts. The numbers are inflated by the National Guardian’s decision to include all manner of issues that are NOT whistleblowing in the data gathered. I am aware from a meeting with CQC that this expansion is controversial even with the CQC. Some Freedom To Speak Up Guardians themselves see through the ruse, and are fully aware of the centre’s inflation game.

Tellingly, on the National Guardian’s  new website, the national Speak Up data is now located under the section “Resources for organisations”. Indeed, there is no section on the website that is labelled “Resources for NHS staff” or “Resources for whistleblowers”. The website is primarily directed at Freedom to Speak Up Guardians and organisations:

That is the clearest reflection of the mindset of those who front the government’s Freedom To Speak Up scam.

Most recently, the National Guardian’s Office inexplicably delayed in publishing the national Speak Up data for quarters 1 and 2 of 2019/20.

This overdue data has just been published. It does not even include the usual quarterly totals of the few parameters that are tracked:

• number of cases
• number of anonymous cases
• number of patient safety cases
• number of bullying and harassment cases
• number of instances of detriment as determined by Freedom To Speak Up Guardians.

The National Guardian’s guidance to Freedom To Speak Up Guardians on how to collect and record data is cursory and the definitions of data to be collected leave a lot of room for interpretation and variation.

But nevertheless, I took a closer look. A few lowlights of what lies beneath the National Guardian’s superficial presentation of the national Speak Up data are provided.

 

Patient  safety disclosures – mission critical except when you want inflated figures

It seems the proportion of patient safety concerns raised with Freedom To Speak Up Guardians is diminishing overall, and that there has been a recent slowing down in total case numbers:

Reporting period	Total number of Speak Up cases raised with NHS trust Freedom To Speak Up Guardians	Cases with a patient safety element, as reported by NHS trust Speak Up Guardians
Q1 2017/18	1447	464 (32%)
Q2 2017/18	1515	529 (34.9%)
Q3 2017/18	1939	614 (31.6%)
Q4 2017/18	2186	659 (30.1%)
Q1 2018/19	2348	731 (31.1%)
Q2 2018/19	2604	799 (30.6%)
Q3 2018/19	3600	957 (26.5%)
Q4 2018/19	3406	928 (27.2%)
Q1 2019/20	3473	767 (22%)
Q2 2019/20	3156	844 (26.7%)
Total	25,674	7,289

Dishing detriment

The overall level of detriment due to speaking up based on data from NHS trust Speak Up Guardians, is 4.4% of cases (1,144 cases out of a total of 25,674 since 1 April 2017).

However, some trusts show markedly higher levels of detriment.

One has to feel some concern for the welfare of the Freedom To Speak Guardians at some of these trusts, who put themselves at risk just by reporting this detriment.

Indeed, it is not the limelight seekers who dance to the National Guardian’s tune who deserve credit, but unsung, diligent Guardians doing their best under fire.

The turnover in Guardians at problem trusts will in time most likely be another marker of the weakness of the Freedom To Speak Up project.

As an example of a problem trust, East Suffolk and North Essex NHS Foundation Trust has an eye watering 44.3% overall rate of detriment – ten times the national average.

The trust’s CEO Nick Hulme has been in charge of both its predecessor bodies – Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust – since 2013 and 2016 respectively. Prior to that, he was the CEO of Croydon Health Services NHS Trust, which unfairly dismissed whistleblower Dr Kevin Beatt.

I previously asked the National Guardian to review Colchester Hospital University NHS Foundation Trust. I am not aware that she ever did so.

Of note, I see that the only listed, remaining Speak Up Guardian at East Suffolk and North Essex is a NED.

Closer inspection of the National Guardian’s data also shows that Croydon Health Services NHS Trust, another trust previously managed by Nick Hulme, has failed to submit data for the last two quarters and for almost a year before that it had zero returns. Both have been acknowledged to be ominous signs by the National Guardian.

Another eye waterer is Walsall Healthcare NHS Trust, which has 40.5% detriment rate (58 cases out of 143 since 1 April 2017):

The level of detriment at Walsall Healthcare NHS Trust is of especial concern, given that a higher than average proportion of the concerns raised with its Speak Up Guardians relate to patient safety (69.2%). Not to mention that Walsall failed to provide data returns for the first year.

Of note ‘Outstanding’ Northumbria Healthcare NHS Foundation Trust, whose CEO Jim Mackey was former CEO of NHS Improvement, also shows above average levels of detriment:

Berkshire Healthcare NHS Foundation Trust which has to my knowledge rid itself of at least two whistleblowers in recent years, also has above average levels of detriment: 24.3% (19 of 78  Speak Up cases since 1 April 2017). The level of detriment has risen sharply in the last two quarters, to 91% in Q2 2019/20 (10 out of 11 cases).

The notorious Royal Wolverhampton NHS Trust, which has seriously harmed whistleblowers such as Prof David Ferry who was targeted for racist abuse regarding his marriage to a black woman and who was vexatiously referred to the GMC, has above average levels of detriment as might be expected:

But who cares? The Freedom To Speak Up machine not only looks the other way, but it actively provides a reputation polishing service for individuals such as the CEO of the Royal Wolverhampton:

 

 

The fear that dare not speak its name

Nationally, the overall proportion of Speak Up cases that are raised anonymously is 13.8% (3538 cases out of 25,674 since 1 April 2017).

Some trusts show markedly higher levels of anonymous reporting.

For example, at Oxleas NHS Foundation Trust which is rated ‘Good’ overall and ‘Good’ on the well led domain by CQC, the vast majority of cases (88.5%) raised with the Freedom To Speak Up Guardian are anonymous.

This is very worrying given that a higher than average proportion of Oxleas’ Speak Up cases are about patient safety (41.6%), and it is harder to investigate concerns that are raised anonymously. It does not reflect well on a trust’s safety culture if staff are too frightened to even identify themselves.

At Manchester University NHS Foundation Trust, rated ‘Good’ overall and ‘Good’ on the well led domain by CQC, a whopping 77.6% of Speak Up cases are anonymous.

The listed Freedom To Speak Up Guardians at Manchester are:

a) Dr Ivan Benett trust NED

b) David Cain former Chief Executive of Trafford Healthcare NHS Trust, who according to his LinkedIn details also sells management consultancy services.

It’s mystifying why Manchester staff are reluctant to speak up on a named basis, it truly is.

At Great Western Hospitals NHS Foundation Trust where board members have also appointed themselves as Freedom To Speak Up Guardians, 60.6% of Speak Up cases are raised anonymously.

Recidivist non-reporters & apparently disappearing Freedom To Speak Up Guardians at Worcestershire Acute Hospitals NHS Trust

The number of trusts that failed to submit Speak Up data to the National Guardian’s Office was high initially when data collection started in 2017, but settled. In the last two quarters, non-compliance has increased again.

Reporting period	Number of NHS Trusts which failed to return data to the National Guardian’s Office
Q1 2017/18	106
Q2 2017/18	23
Q3 2017/18	18
Q4 2017/18	10
Q1 2018/19	7
Q2 2018/19	6
Q3 2018/19	6
Q4 2018/19	7
Q1 2019/20	27
Q2 2019/20	23

Are trusts suppressing bad news? Are there enough hands to process the data or have an increasing number of Freedom To Speak Up Guardians hung up their lanyards, or worse, been hounded out?

At Kingston Hospital NHS Foundation Trust, there has been recent, persistent failure to report:

But who cares? Here is the selfie-afficionado-NHS-Chief-People-Officer lauding Kingston’s Director of HR, formerly of Capsticks LLP, for work on culture:

There as also been persistent non-reporting by West London NHS Trust, (formerly West London Mental Health NHS Trust which unfairly sacked whistleblower Hayley Dare):

Notably, the listed Freedom To Speak Up Guardian at West London is Sally Glen, one of the trust Non Executive Directors, who also sits on NMC Fitness to Practice panels.

How would Glen view directors of nursing who are referred to the NMC for whistleblower reprisal?

At Worcestershire Acute NHS Trust, controversial David Nicholson  joined the trust as chair last year.

This year, the trust defaulted on data reporting for Q1 and Q2 of 2019/20:

As well as the appointment of David Nicholson as trust chair, an NHS trust director who was personally criticised for whistleblower reprisal at Mid Essex Hospitals NHS Trust   became an Improvement Director at NHS Improvement, and is the assigned NHSI relationship manager for Worcestershire Acute NHS Trust.

Here she is synergising with David Nicholson:

Old versions of the National Guardian’s directory of Freedom To Speak Up Guardians showed that at one point, Worcester Acute Hospitals NHS Trust had an absurd number of Freedom to Speak Up champions (25) in addition to a Freedom To Speak Up Guardian:

Curiously however, the currently published National Guardian’s Speak Up Guardian directory does not list any Freedom to Speak Up Guardians for Worcestershire Acute Hospitals NHS Trust:

Has Worcester Acute Hospitals NHS Trust  been deemed a FTSUG-free zone?

Has the Worcester Acute Speak Up Guardian decided to hand in their lanyard?

Something’s up at Kent and Medway

Another lowlight from analysing the National Guardian’s data is a marked escalation of reporting at Kent and Medway NHS and Social Care Partnership Trust in the last two quarters, much of it anonymous:

A supportive and dutiful National Guardian’s Office would try to get to the bottom of it.

 

A request for better data

There are plenty more examples of concern in the long grass of the National Guardian’s data, hidden in plain sight by failure to analyse data, or at least to publicly acknowledge any analyses that have been conducted.

The National Guardian’s Office is quick enough to construct simplistic league tables of the professions that speak up:

Her Office has also regrettably retweeted a post which implied criticism of staff who do not speak Up:

But meaningful, analysed comparative data on named trusts? God forbid such a thing. It might result in transparency and accountability by the powerful. As the National Guardian’s new website let slip, her Office is there to serve institutions, not the public or the NHS frontline.

I have written to the National Guardian to request that she publishes her data via interrogable spread sheets and to suggest that she provides  cumulative analyses by individual trust. These should be updated with each quarterly reporting period. The request is posted below in the appendix.

It is very unjust to mislead NHS staff about the realities of whistleblowing, whether by omission or commission. Staff need complete data to make informed decisions that could affect the rest of their lives.

But ultimately, the Freedom To Speak Up project cannot genuinely help whistleblowers or patients because it is designed to be ineffective and is wielded by the unwilling.

We need reform of UK whistleblowing law.

 

UPDATE 18 NOVEMBER 2019

The CEO of Worcestershire Acute Hospitals NHS Trust has advised that there is a current Speak Up Guardian vacancy because the last Guardian passed away, and that interviews for a new Guardian are scheduled on 3rd December. However, the trust still has approximately the same number of Freedom To Speak Up Champions as previously listed (25), so I will ask the National Guardian’s Head of Office why they are no longer listed .

 

RELATED ITEMS

Another empty promise by the National Guardian’s Office:  Freedom To Speak Guardians will listen and learn from ex-employees

Servalan rewards Rotherham, Doncaster and South Humber NHS Foundation Trust

NHS Improvement’s Kark FPPR implementation process & dissing dissent

Whistleblowers in Their Own Words: What’s wrong with UK whistleblowing law and how it needs to change

 

APPENDIX

BY EMAIL

Dr Henrietta Hughes

National Freedom To Speak Guardian

Care Quality Commission

16 November 2019

 

Dear Henrietta,

Presentation and analysis of national speaking up data, whistleblowing detriment at East Suffolk and North Essex NHSFT

1. I write to ask if you would kindly publish the national NHS speaking up data in interrogable spreadsheets in future. This would give the public greater access and allow greater transparency.

At present, your Office’s published data tables are hard to read and the data within them has to be transferred to spreadsheets in order to be analysed, thus deterring those who do not have the time or other means. It means that the public cannot easily test the headlines reported by your Office

2. I would also be grateful if you would provide the public with running averages of the parameters that you already track, (number of cases, number of anonymous cases, number of patient safety cases, number of bullying and harassment cases and number of instances of detriment as determined by Freedom To Speak Up Guardians)

3. I also suggest that your Office publishes analysed data for individual trusts according to the data parameters that you already track.

At present, any trends are hidden from anybody but the most determined searcher, willing to hop from quarterly table to quarterly table of hard to follow text.

I provide below a table of summarised data on East Suffolk and North Essex NHS Foundation Trust, which has an extraordinary rate of 44.3% detriment (51 out of 115 cases since 1 April 2017). This is a marked outlier from the national average of 4.4% of cases (1,144 cases out of a total of 25,674 since 1 April 2017).

You may recall that I previously suggested that you review one of East Suffolk and North Essex NHS Foundation Trust’s predecessor bodies, Colchester University Hospital NHS Foundation Trust. As far as I am aware, no review of the trust took place.

As I am sure you are aware, Nick Hulme the CEO of East Suffolk and North Essex, has been running both its predecessor bodies for some years now, and before that he was CEO of Croydon Healthcare NHS Trust which an Employment Tribunal determined had victimised and unfairly dismissed whistleblower Dr Kevin Beatt.

You will also be aware I believe that Dr Beatt’s FPPR referral to the CQC was one of those which were strangely rejected, despite being well supported with ET findings.

Yours sincerely,

Dr Minh Alexander

Cc Ted Baker CQC Chief Inspector of Hospitals

Tom Grimes NHS England and NHS Improvement whistleblowing lead

Dido Harding NHSI Chair

Tom Kark QC

Ed Humperson UKSA