A Study in Delay II : The National Guardian, maternity safety & University Hospitals Sussex NHS Foundation Trust

By Dr Minh Alexander retired consultant psychiatrist 30 March 2022

Summary: This post looks at the National Guardian’s role in continuing poor culture at Sussex. After the former National Guardian Henrietta Hughes’ shameful treatment of whistleblowers at Brighton and Sussex University Hospitals NHS Trust, and her protection of powerful trust directors, time inevitably caught up with these improprieties. Further staff whistleblowing and patient complaints about maternity safety forced an unannounced CQC inspection late last year which revealed very serious ongoing failures of whistleblowing governance in maternity and surgical services. Staff reported that their concerns were not always acted upon. This even included serious concerns about critical care capacity. At one trust unit, inspectors found that managers had not reviewed or investigated 128 incidents. Astonishingly, staff were told to stop raising concerns about staff shortages on the basis that this was a known issue. This saga further illustrates the failure of the Freedom To Speak Up project. The National Guardian’s Office was established primarily to carry out reviews of NHS trusts but it has only completed 9 reviews since 2016 – less than two a year. Of the trusts that it has reviewed, most continue to show signs of problems with whistleblowing governance. It is time to stop wasting precious public money on sham whistleblowing agencies, and to replace them with strong, genuinely protective law and infrastructure.

Today, the long awaited Ockenden review into large scale maternity safety failings at Shrewsbury and Telford Hospitals NHS trust is due to be published. Inevitably, it has already been revealed that there was whistleblowing about the safety issues that was not acted upon by managers.

In the background is another avoidable maternity safety failing, in which the National Guardian’s Office played a part.

In 2017 the former National Guardian Henrietta Hughes badly failed patients and whistleblowers at Brighton and Sussex University Hospitals NHS Trust by stalling and protecting a powerful in group of NHS trust directors about whom whistleblowers raised concerns.

She deviated from her own procedures to give the trust time to cover its tracks:

The matter was reported in this piece:

A Study in Delay: The National Guardian & Brighton and Sussex University Hospitals NHS Trust

Much later, in 2019, Henrietta Hughe carried out a review which came to glowing conclusions  about the all the “improvements” being made in culture and whistleblowing governance.

Marianne Griffiths the trust CEO naturally crowed about this PR victory:

Praise for BSUH culture change   “Trust Chief Executive Dame Marianne Griffiths said: “Since our arrival at BSUH, we have made it our absolute priority to work with colleagues and support them to help make further improvements to the culture of the organisation, particularly in relation to equality and diversity. It is extremely encouraging, therefore, to see our improvements recognised through such a comprehensive review.”

In September 2021 as a result of more staff whistleblowing and patient complaints, the Care Quality Commission carried out an unannounced inspection of maternity services at the trust , now renamed University Hospitals Sussex NHS Foundation Trust after a full merger of its two predecessor organisations.

Serious failings were found and several units were downgraded in December 2021, one received a rating of “inadequate” for both surgery and maternity services.

There was adverse publicity for the trust:

Sussex hospital trust told it must make immediate improvements after staff whistleblowing and patient complaints led to inspection

Trust keeps ‘outstanding’ rating despite not listening ‘enough’ to staff concerns

The CQC press release emphasised poor culture and the difficulty that staff experienced with raising concerns:

“Other concerns raised with inspectors by staff, or observed by inspectors, included a poor culture – bullying and harassment was reported by some staff – and a perception that leaders were doing little to address concerns. After listening to staff about their experiences working in main theatres and recovery, inspectors had serious concerns about the culture amongst colleagues.”

Extraordinarily, trust staff had been told to stop raising concerns about safe staffing issues because it was a “known risk”:

“They told us they been instructed to stop reporting low staffing as an incident as it was a known risk”

Surgical as well as maternity services were found to have shortcomings.

Patients were put at risk because of staff shortages and failures of governance. Staff did not always have time to report incidents and when they did report, their safety concerns were sometimes not acted upon. Shockingly, at the Royal Sussex County Hospital site, “at the time of inspection there were 128 incidents within the service that had not been reviewed and investigated by managers.”

This included very serious incidents about lack of critical care capacity, for example:

“We reviewed an incident form completed in April 2021, in relation to patients requiring high dependency care, being cared for in recovery. On the day the recovery unit was full and included four patients who required high dependency care one of these patients deteriorated and required intensive care. Concerns within the incident related to not being able to keep up with all the care patients needed and although some support was provided by an advanced care practitioner and anaesthetist staff did not always feel supported. The incident was not investigated by managers until 12 October 2021 we were not assured that the actions recorded, or the time taken to investigate the incident reduced the risk of further similar incidents. The only recorded action was that staffing concerns were being managed through the directorate and divisional recruitment programme. The trust also provided a narrative for this incident and stated that the care and supervision of a significantly complex post-operative recovery period was appropriate.”

Despite these very serious failings, the Dame kept her overall CQC rating of ‘Outstanding’.

So, is the National Guardian’s Office working any harder to conduct reviews? This is after all the core function for which it was established.

Sadly, the answer is ‘no’.

Since inception in 2016 the work-shy, publicity-hungry agency has only completed 9 reviews – less than two a year.

 

CASE REVIEWS COMPLETED SO FAR BY THE NATIONAL GUARDIAN:S OFFICE Southport and Ormskirk NHS Trust 2017 Northern Lincolnshire and Goole NHS Foundation Trust 2017 Derbyshire Community Health Services NHS Trust 2018 Nottinghamshire Healthcare NHS Foundation Trust 2018 Brighton and Sussex University Hospitals NHS Trust 2018 Royal Cornwall Hospitals NHS Trust 2018 North West Ambulance Service NHS Trust 2019 Whittington Health NHS Trust 2020 Blackpool Teaching Hospitals NHS Foundation Trust 2021

Issues of poor whistleblowing governance have continued at most of these trusts that were reviewed by the National Guardian. For example, there has been a high rate of whistleblowing employment claims against Nottinghamshire Healthcare NHS Foundation Trust, and I am aware that whistleblowers have continued to approach the National Guardian’s office but have been very unhappy with its response. There have been similar issues with North West Ambulance Service NHS Trust. Only very recently, there has been fresh whistleblowing to the press by staff of Northern Lincolnshire and Goole NHS Foundation Trust and Blackpool Teaching Hospitals NHS Foundation Trust:

Blackpool Victoria Hospital nurse calls out ‘toxic’ bullying which left staff ‘physically shaking’ with fear

‘There’s a culture of bullying in the trust’ claim Northern Lincolnshire NHS staff

Moreover, since being reviewed by the National Guardian in 2017, Southport and Ormskirk NHS Trust has repeatedly been in the news for bullying. The trust recently lost an Employment Tribunal for causing injury after managers failed to respond to repeatedly raised concerns about bullying:

Lancashire nurse went home in tears before resigning over bullying

So what is the point of the National Guardian’s Office?

Does the NHS need an idle, ineffective if not harmful, sham whistleblowing agency?

Here is Marianne Griffiths the trust CEO congratulating Henrietta Hughes former National Guardian after it was announced in the New Years Honours List that Hughes was listed for an OBE:

PETITION

Please click and add your signature to this petition to reform UK whistleblowing law – whistleblowers protect us all but weak UK law leaves them wholly exposed and it is a threat to public safety

Replace weak UK whistleblowing law and protect whistleblowers and the public

RELATED ITEMS

A perfect, clear cut example of why UK whistleblowing law – PIDA – is completely unfit for purpose. The case of a gold standard whistleblowing case, Tribunal tested and fully upheld – which still resulted in a six year ordeal of persecution and harassment for whistleblower Dr Jasna Macanovic consultant renal physician and very importantly, still left patients unprotected.

Portsmouth Hospitals University NHS Trust sacked Dr Jasna Macanovic consultant nephrologist for whistleblowing to the General Medical Council

Some broad background on the inadequacies of the UK government’s Freedom To Speak Up Project:

The toothlessness of the National Guardian’s Office: Why it cannot be a model for protecting whistleblowers

The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project