NHS CV fraud, Peter Knight & CQC’s failure to safely implement Regulation 5 Fit and Proper Persons at Oxford University Hospitals NHS Foundation Trust

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 25 January 2020

Summary: The NHS continues to appoint senior officials without robust checks and the CQC continues to fail in its regulation of the Fit and Proper Person requirement. A glance at the small print in the case of convicted fraudster and former Department of Health Deputy Director Peter Knight reveals that CQC failed to detect or report failure by his employing NHS trust to check his primary qualifications. CQC then later glossed over the scandal of Knight’s fraud in another inspection report. There is little sign that the government and NHS Improvement intend to meaningfully reform Fit and Proper Persons practice in the NHS.

This week, Peter Knight former Department of Health Deputy Director and latterly a director of Oxford University Hospitals NHS Foundation Trust (Chief Information and Digital Officer) received a two year suspended prison sentence for CV fraud. He had claimed a Classics degree which he did not possess, to land a job which paid £130K.

A past list of Department of Health National Information Board members gives his summarised CV as follows:

“Peter Knight – Deputy Director and Head of Information Intelligence

Biography

Peter Knight is Deputy Director for Research Contracting, Information Intelligence and Stakeholder Engagement in the Research and Development Directorate at the Department of Health. Peter joined the Department in April 2010 having established the Research Capability Programme in 2008 that established a secure research data service now operated by the MHRA call the Clinical Practice Research Datalink. Prior to his these roles Peter was a Managing Director and interim Chief Executive at Winchester and Eastleigh Health NHS Trust.”

Oxford University Hospitals NHS Foundation Trust, its board stuffed full of illustrious big names, had apparently not seen fit to check Knight’s primary qualifications since his appointment at the trust in 2016:

“Additionally, in November 2017, the trust updated the files of its executive and non-executive staff as part of its duties under the fit and proper persons check, but when checked during the investigation Knight’s HR file did not contain a copy of the degree he claimed to have, according to the NHS Counter Fraud Authority.”

But why would chaps check up on other chaps? T’would be the height of rudeness under Club etiquette.

Oxford University Hospitals NHS Foundation Trust’s crown, as one of the powerful Shelford Group trusts, has slipped latterly. CQC downgraded its overall rating to ‘Requires Improvement’ in June 2019, and ‘Requires Improvement’ on the well led domain.

However, worryingly I found no mention of any Fit and Proper Persons issues in CQC’s June 2019 inspection report. This was despite the fact that the allegation about Knight’s CV fraud was raised anonymously with the trust in May 2018, and passed on to local counter-fraud, with Knight reportedly admitting in August 2018 that he did not have a Classics degree as claimed.

Did the CQC fail in its pre-inspection due diligence to liaise with NHS Counter-fraud services? Did the CQC know, but deliberately gloss over the scandal in its report?

Perhaps CQC did not wish to look foolish, because in an earlier inspection report of March 2018 it had declared the trust compliant with the Fit and Proper Persons regulation:

“Fit and Proper Person checks were in place. The trust was satisfied that staff with director level responsibilities, including the NEDs, were fit and proper persons in accordance with Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”

The unenthusiastic CQC, in that earlier inspection, had checked only three of the trust’s director files:

“We reviewed a random sample of three board level director’s personnel files and found all the necessary fit and proper person checks had been undertaken. Throughout our inspection, we had no concerns about the fitness of the board to undertake their individual roles”

Instead of thorough checks on the basics, CQC’s 2018 report threw in some guff:

“In April 2017 an independent review of divisional Leadership arrangements at the trust was undertaken. The review focused on leadership and governance within individual divisions and corporate oversight and support for divisions. The report was positive about the Divisional Directors (DDs) high levels of personal and clinical credibility as well as the strong leadership capability of Divisional General Manager (DGM) and Divisional Nurses (DND’s) or equivalent. The report was positive about multi-disciplinary teams working in a cohesive manner with high levels of personal and collective accountability across the Divisional Leadership Teams (DLTs).”

In its marshalling of evidence of effective leadership at Oxford, CQC emphasised the trust’s digital initiatives:

“‘Go Digital’: To achieve digital transformation, to support excellent care and enable care to be delivered closer to home.”

which of course was flattering to the government’s digital ambitions.

And what of the Department of Health and Social Care? I cannot find any report of the Department’s HR practice in the Knight case. Yet it is likely the fact that Knight came to the trust from the Department contributed to the trust’s complacency in not checking his credentials properly.

According to the BBC, the trust’s chief executive Bruno Holtof (who since February 2019 has also been a non executive director and then Chair of Tristel, a business which supplies infection control products) had praised Knight’s expertise:

“Chief executive Dr Bruno Holthof said in the release that Knight brought a “wealth of experience and expertise” to the role.”

Moreover, in 2016 after Knight’s appointment, Jeremy Hunt the then Health Secretary bunged Oxford University Hospitals NHS Foundation Trust £10m to be a NHS “Global Digital Exemplar” and: “…to champion the use of digital technology to drive radical improvements in the care of patients.”

It remains to be seen if calls for certification of senior NHS IT leaders, which followed exposure of Knight’s CV fraud, will be heeded:

“Some 59% of NHS IT leaders say that top digital leadership roles should require certification.”

Just a few years ago, NHS Improvement was painfully embarrassed when it emerged that the regulator had appointed Jon Andrewes a fraudster, to the Chair of the Royal Cornwall Hospital NHS Trust.

Andrewes had spectacularly defrauded the NHS over a long executive career in the NHS with a fraudulent CV, which contained obvious anomalies. He was even the Freedom To Speak Up Guardian at Devon Partnership NHS Trust, where he had been appointed as a non-executive director by NHS Improvement.

I asked NHS Improvement what it had learned from the Jon Andrewes shambles, and what it would do differently in future. The response was unimpressive and not at all reassuring:

Jon Andrewes fraud: NHS Improvement responds

Senior NHS managers can do immense damage, and cause much more harm to patients than individual frontline clinicians, because they control whole systems of care.

Recurring NHS scandals such as MidStaffs, Gosport , Liverpool Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust have shown what can go gravely wrong when health services are mismanaged.

Yet there appears little intention by the government, and its proxy NHS Improvement, to robustly ensure that Fit and Proper Persons are appointed to key positions.

NHS Improvement has dragged its feet on implementation of Tom Kark QC’s review of FPP in the NHS.

And for good measure, NHSI last year also appointed Paula Vennells the disgraced former CEO of Post Office Ltd to the Chair of Imperial College Healthcare NHS Trust.

Paula Vennells, Post Office Ltd CEO from 2012-2019

This is a profile by Nick Wallis the journalist who has covered the trial about the Post Office Horizon computer system controversy:

The Ballad of Paula Vennells

During Paula Vennells’ tenure, Post Office Ltd continued to unsafely accuse and prosecute subpostmasters for financial shortfalls, despite the organisation’s knowledge of numerous computer glitches which could have caused phantom shortfalls.

The subpostmasters were vindicated after they brought a legal action against Post Office Ltd.

The Post Office Horizon IT trial also revealed some thoroughly oppressive workforce practices by Post Office Ltd, which were described by one of the judges as behaviour akin to that of a “Mid-Victorian factory owner”.

Post Office Ltd’s prolonged denial, dishonesty and “extremely aggressive” and “attritional” legal tactics meant that only a fifth of the settlement reached will be left for the badly harmed subpostmasters, after costs have been met.

There are currently calls for Vennells to stand down from her public roles at Imperial and the Cabinet Office, for her ministry as an ordained Church of England priest to cease, for the board of Post Office Ltd to be cleared out and for a public inquiry into the mass miscarriage of justice.

FPPR referrals have been made to CQC about Vennells’ appointment as Chair of Imperial.

One of the subpostmaster claimants in the trial has set up a petition for a judge led inquiry, which if you wish, you can support here:

Post Office Horizon Scandal Judicial Enquiry

Vennell’s appointment to the Imperial Chair was made despite the Kark FPPR review recommendations, and thus represents a pretty clear snub to any hopes that the government would implement FPPR more effectively in the NHS.

CV fraud in the NHS, including by managers, is a longstanding phenomenon. A list of some additional examples is provided in the appendix.

However, as the stealth privatisation of the NHS advances, and the whiff of loot intensifies, attitudes of entitlement, cronyism, backscratching, instances of unearned privilege, meritless appointments, and self-serving cover ups are likely to worsen. And the revolving door to private industry will likely spin faster.