Summary: An as yet unpublished Kings Fund review about poor leadership at HSIB has resulted in the agency being stripped of its maternity investigations by the Department of Health and Social Care. Was the affair in any way an attempt by the government to control a mounting maternity personal injury bill, because HSIB investigations had helped to establish liability?
HSIB, the investigatory arm of the regulator NHS Improvement was one of Jeremy Hunt’s cynical and superficial ‘patient safety’ gestures created in response to pressures over unresolved patient safety issues following the Midstaff Scandal. He established it whilst he continued to defund and undermine the NHS.
In January and February 2022 HSIB became the subject of a leadership scandal, with a report leaked to the press about allegedly disastrous, bullying leadership of the worst possible kind for a safety agency. There were lurid headlines about “Rasputin-like” figures at the top of the small agency. And there were reports of rife sexism and other discrimination. Whistleblowing at HSIB was reportedly hazardous. Indeed, there had already been some whistleblowing about poor culture to the press in 2019.
Significantly, the latest scandal led to HSIB being stripped of its maternity investigations – an area which had been mushrooming with the revelations at Shrewsbury and Telford NHS Trust, with huge liability implications for the NHS and the government. HSIB had been undertaking about 1000 maternity investigations a year.
As leading lawyers Leigh Day noted after HSIB was stripped of its maternity investigations:
“We have a number of clients who have obtained early admissions of liability from NHS Trusts on the basis of HSIB findings of substandard care.”
HSIB is headed by Keith Conradi, parachuted in from the Air Accident Investigation Branch (AAIB).
In 2018, The Times reported that he was made to pay back £562 that he had charged to the public purse for a helicopter lesson.
Reportedly, after the Kings Fund review findings were shared with HSIB staff in November 2021, HSIB’s CEO announced in the same month that he was retiring to spend more time with his triathlons:
“In announcing his retirement Keith Conradi, Chief Investigator says:
“It has long been my intention to retire at 60 while my health enables me to participate in competitive triathlon.”
Other senior departures from HSIB were also reported.
When HSIB’s creation was first announced, I made attempts to obtain objective evidence of whether aviation and AAIB were truly a paragon of safety culture as Hunt had claimed. I asked for old AAIB staff survey results, but was repeatedly blocked by the government. This was despite the ICO ruling that there was no good reason for the Department of Transport to withhold the information. Litigation continues on the matter with the ICO opposing the government. It is before the Tribunal again in April.
Before HSIB became operational, I had a foretaste of things to come when I tried to engage its players in ensuring effective whistleblowing governance. They clearly knew little about whistleblowing but seemed to have minimal interest in becoming more competent. The venture seemed very insular and clubby. After being told that someone with no visible whistleblowing expertise would sort it all out, I made a challenge to the boys’ club culture. This was met with uncomprehending huffiness by one of the safety luminaries backing the project. No doubt those grand men will quickly forget their poor judgment and move on to the next vanity project dangled before them by politicians.
After the major scandal broke this January, I asked NHSI for a copy of the Kings Fund review and other information about NHSI’s handling of the HSIB affair. However, NHSI has not yet answered despite intervention from the ICO and an exchange of correspondence with Andrew Morris who said he had asked his FOI team to expedite the matter.
It is a failing by NHSI that the Kings Fund review of HSIB is not already published. It was commissioned in secret and remains withheld. NHSI bears ultimate responsibility for HSIB’s failure.
Indeed, was HSIB’s leadership substantially worse than the abusive, failing NHS trust managers than NHSI protects and recycles on a daily basis?
Indeed, how do we know if HSIB’s culture was any worse than that of NHSE and NHSI’s? Neither NHSE or NHSI routinely publish their own staff survey results and are frequently criticised for bullying provider organisations.
Notwithstanding any justified criticism of the obviously poor leadership of HSIB; was the decapitation of the agency in any way a government attempt to block transparency about NHS safety failings? Was it merely a pretext to control a huge bill from maternity injury pay outs?
And what of NHSE/I’s hireling, the Kings Fund? Did it give the HSIB leadership and its staff a fair hearing?
The King’s Fund board of trustees has traditionally been populated with the powerful, connected and sometimes recycled. I previously asked its former Chair Sir Christopher Kelly, former Department of Health Permanent Secretary, if he was one of the referees for Jo Williams the disgraced former Chair of the CQC when she applied to re-enter the NHS as Chair of Alder Hey NHS Foundation Trust:
He never replied.
Also on the Kings Fund board is the controversial Jacqui Smith former MP and former Chair of University Hospitals of Birmingham NHS Foundation Trust. She of expenses controversy, who temporarily resigned her chair of UHB to appear on Strictly Come Dancing at the height of the pandemic.
|A doctor at Smith’s trust spoke up critically about Smith’s appearance on Strictly: “Clare Gardner launched an online petition, reading: “She is the chair of the largest NHS Trust in the UK, during a time of major crisis i.e. the second Covid-19 wave. “We are already in a Tier Two lockdown. I am a haematologist within the Trust she apparently chairs. “Our Chief Executive Dr David Rosser has made numerous statements to the press recently, describing the fear and foreboding we all sense towards rising cases.” “Now that we are facing a similarly perilous situation, she has swanned off to London to dance. “This is a dereliction of duty. “If ever there was a time to have figureheads in place for NHS organisations that are struggling, it is now. “Jacqui would rather wear sequins than look after her charge.”|
One can only hope that Dr Gardner is unharmed and still prospers.
Smith was also chair at UHB during Mr Tristan Reuser’s whistleblowing ordeal. She failed to answer a request in August 2021 for data about the trust’s abusive handling of the Reuser litigation and about FPPR process regarding her chief executive, despite a reminder. The matter is now with the ICO.
The Kings Fund churns out forests of prim admonishments about how NHS leaders should behave. It calls often for compassionate leadership. It positions itself in the market as a seller of advice and reviews on how to do it right.
Some of the Kings Fund’s prominent figures have sometimes worked symbiotically with the equally virtue signalling National Guardian’s Office.
So I attempted to check out the actual quality of the goods and asked the Kings Fund to share its own staff survey data. This was because the first thing noticeable is that this data is not published.
After one email to its comms team, two emails to its CEO Richard Murray and one email finally to its Chair Lord Kakkar, I received an acknowledgment from the CEO’s office. This was followed by a minimal substantive response from the Kings Fund comms team on 3 March, giving headline figures for amalgamated years and no staff survey reports:
“Dear Dr Alexander
Thank you for your emails about staff wellbeing at The King’s Fund. We don’t have a record of your original inquiry to this account so please accept our apologies for the delay in responding and treat this as a response to this and the emails you subsequently sent to Richard Murray.
The King’s Fund has been running staff satisfaction surveys since 2008, usually every other year. They are managed on our behalf by an organisation called the Leadership Factor so that scores and narrative can be provided confidentially. Between 2008 and 2015 the overall satisfaction score was between 71 per cent and 78 per cent, placing us in the top quartile of organisations the company surveyed.
In 2017, we refreshed the design of the survey and included specific questions about engagement and wellbeing. In 2018, these factors scored 8.4 and 7.6 out of 10 respectively, where 10 is very satisfied. We were due to run the survey again in 2020 when the pandemic hit. At the end of 2020, we introduced regular pulse surveys in place of the full survey which included questions about health and wellbeing, levels of optimism and morale. We will run the full satisfaction survey again in Autumn 2022.
Press and Public Affairs Manager”
I asked for more detail, pointing out that it would be useful for example to see how minority staff groups fared.
“Many thanks for your response and the broad percentage results extracted and aggregated from past staff surveys.
It would be more useful to have actual copies of the staff survey reports from tne years in which you say the surveys were carried out.
It is hard to make much sense of broad headline results without any contextual details.
For example, the stratified results for different staff groups, (assuming that this data is collected by the Kings Fund) and particularly minority groups are important to see – as the Kings Fund itself has emphasised in the past when passing comment on the national NHS staff survey.
Your aggregation of results from different years also obscures possible variations over time.
I would be very grateful f you would share copies of the original staff survey reports.
However, if the Kings Fund does not wish to share the actual reports, would you at least be willing to share the questionnaire forms that staff filled in on the years in question?
Cc Richard Murray CEO Kings Fund
Lord Ajay Kakkar Chair Kings Fund”
At the time of writing, I have not yet received either a copy of the questionnaire that Kings Fund staff fill in, nor the original staff survey reports. I guess the Kings Fund comms folk have still got their thinking caps on. Compassionately, no doubt.
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1. NHS England/ Improvement eventually reluctantly disclosed a copy of the Kings Fund report on HSIB, terms of reference and associated correspondence, which showed that a rigorous investigation was never intended:
2. As discussed above, the dispatch of undesirable senior NHS managers is the exeception rather than the rule.
The number of cases of NHS England, NHSI and its predecessor bodies covering up, protecting and recycling abusive, incompetent and or dishonest NHS managers are too many to list.
But here is a striking example of former NHS CEO Paula Vasco-Knight, unpicked to show the lengths to which the protection often extends and why the HSIB case is different:
3. After leaving UHB in October 2021, Jacqui Smith took up two new NHS Chairs at Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust. This looks to be system preparation for a politically sensitive merger of the two trusts, which is already stirring up controversy, with Margaret Hodge stepping in.