By Dr Minh Alexander retired NHS consultant psychiatrist 21 June 2011
Yesterday it was announced that Henrietta Hughes, former regional Medical Director for NHS England London, is Health Secretary Sajid Javid’s preferred candidate for Patient Safety Commissioner.
Many harmed NHS whistleblowers, who know her from her last government job as National Freedom To Speak Up Guardian, will likely groan inwardly at this news.
The Patient Safety Commissioner is a new role, which is as yet ill-defined. Perhaps predictably so.
It is limited in scope to the safety of medicines and medical devices:
“The core role of the Commissioner will be to promote the safety of patients in the context of the use of medicines and medical devices and to promote the importance of the views of patients and other members of the public in relation to the safety of medicines and medical devices.”
It was proposed in a 2020 review led by Julia Cumberlege which had been tasked with making “recommendations for improving the healthcare system’s ability to respond where concerns have been raised about the safety of particular clinical interventions, be they medicines or medical devices.” The review examined the care failures over pelvic mesh surgery, valproate and primidos.
The review proposed the creation of a Patient Safety Commissioner, which in its general description sounded very similar to the slippery job description of the NHS National Freedom To Speak Up Guardian.
A loose, vague remit to do what it pleases, with limited accountability attached to this freedom. The Cumberlege review states:
“The Commissioner would be free to look at whatever they wish to within her/his remit of patient safety, open to requests for areas to consider and free to publish their findings. The Commissioner would be accountable to the Parliamentary Health and Social Care Select Committee. Alongside annual hearings and using the power to bring matters to the attention of the Committee, the Commissioner could receive and act on information and requests from the Committee, and from the Secretary of State for Health.”
“…the Commissioner would have a general statutory power ‘to do anything which appears to it to be necessary or expedient for the purpose of, or in connection with, the performance of its functions. This would give the Commissioner the power to take a permissive and flexible approach to gathering information necessary for specific issues and to issue advice to those who are engaged in activities relating to improving patient safety. Giving the Commissioner the power to bring matters to the attention of both Houses of Parliament and the Secretary of State for Health and Social Care would provide a proportionate and focused means of highlighting where improvements are needed.”
Something that could have been written by Sir Humphrey.
Or perhaps the long-served William Vineall, Director of NHS Quality, Safety and Investigationsof the Department of Health and Social Care since 2016, who appears to be the appointing officer judging from the DHSC job advert.
The person specification is tragi-comic:
“Set an example of integrity and ethical leadership, reinforcing the position’s reputation as an open and independent role, which puts the needs and interests of the public, patients and service users first.”
There is the briefest of draft legislation in play with respect to the Patient Safety Commissioner’s office.
The DHSC webpage about the Patient Safety Commissioner basically says that the job description hasn’t quite been written yet.
“The PSC will be under an obligation to publish a set of principles to govern the way in which they carry out their core duties. The PSC must take steps to consult patients and to ensure that patients are aware of their role.
The everyday workings of the PSC are to be finalised. Regulations will be made setting out further details about the appointment and operation of the commissioner, for example the terms of office.”
There is no guarantee therefore, that the final Office will reflect the recommendations of the Cumberlege review.
It seems more likely that the Patient Safety Commissioner will be another political tool for the DHSC, and more waste of public money on window dressing.
The Department doth protest too much about independence:
“How independence will be safeguarded
We expect the Secretary of State to work with the PSC to agree how their independence will be safeguarded.
It is common for commissioners to be sponsored by the government departments with relevant policy responsibility while maintaining their independence.”
So good they had to say it twice:
To be effective, it is fundamental that the commissioner has the freedom to act independently.
It is common practice for commissioners to be sponsored by the government department with relevant policy responsibility. The Children’s Commissioner does an exemplary job whilst being sponsored by the Department for Education. The Victims’ Commissioner does the same and is sponsored by the Ministry of Justice.
A relationship with DHSC would allow the commissioner a powerful place within the system. A commissioner which is entirely removed from the policy department can be more easily overlooked by government. It is crucial that the right person is appointed into the role, someone who is confident and knowledgeable of the sector to bring weight and intelligence to the commissioner position.
Independence will necessarily be exercised in the carrying out of the commissioner’s functions. For example, the commissioner will have the power to make recommendations or reports to the Secretary of State, who will then be under a duty to consider and respond, ensuring that the department is kept accountable. We will expect that the commissioner makes any such reports or recommendations independently, without recourse to or clearance from the Secretary of State or DHSC.”
So we are to believe that the woman who introduced compulsory smiling for her staff, and who started her tenure as National Freedom To Speak Up Guardian by opining that NHS staff should be less grumpy,is a weighty appointment?
Are we to believe that Hughes, who oversaw an embarrassingly small number (nine) of case reviews in her five years as National Guardian and turned away desperate whistleblowers based on objectionable exclusion criteria which put patients at risk, will always put patients first?
Are we to believe that Hughes, who tore up her own rule book to help NHS trust managers in Brighton to the disadvantage of whistleblowers, with later impacts on maternity care when whistleblowers were again sidelined, will never side with the NHS establishment?
Are we to believe that Hughes, who spent part of her meagre National Guardian budget on PR, awards which she and her Office judged and paid for and rose tinted stories in the trade press, will soberly pursue her core role as PSC without gimmicks and self-serving stunts?
Are we to believe that Hughes, whose optimistic statistical claims have been found wanting by the UK Stats Authority, and who made an extraordinary unsubstantiated claim that the Freedom To Speak Up project prevented harm and saved lives, will have the authority to hold organisations to account over the accurate handling of clinical outcome data?
I complained yesterday to the new Chair of the CQC about the National Guardian’s Office ongoing public communications, which mislead NHS staff about the real risk of whistleblowing.
In my correspondence, I included an example kindly supplied by vindicated whistleblower Dr Jasna Macanovic Consultant Nephrologist, who received a typical rebuff by the National Guardian’s Office during Henrietta Hughes’ tenure. Dr Macanovic wrote:
“I contacted the national office myself and was told that they do not get involved in individual cases or disciplinary processes and that I will be free to submit a case review form if/ and when I win a case for unfair dismissal in court.”
“This approach is appalling. I was lucky enough as I had a cast-iron case, and was resilient and financially capable of taking the case to the court. I do not know anyone else around me who would have survived this process. The ferocity and avalanche of unwarranted insults would have destroyed anyone.”
It is preposterous to tell whistleblowers to come back years later after they have been mauled by the litigation process. It is not only a great injustice to the whistleblower, but an incomprehensible reaction to the patient safety issues that have been buried along with the whistleblower. What happened on Hughes’ watch was the equivalent of more soil being shovelled on top.
Under Hughes’ leadership, other NHS whistleblowers received similar responses.
This was a far cry from the role described in the Freedom To Speak Up Review on NHS whistleblowing which proposed the role of the National Guardian. It was supposed to be a “nimble” office that sought redress for both harmed whistleblowers and patients who were harmed by failures to handle whistleblowing properly:
“…to recommend to the relevant systems regulator or oversight body that it make a direction requiring such action.
This may include:
– addressing any remaining risk to the safety of patients or staff
– offering redress to any patients or staff harmed by any failure to address the safety risk
– correction of any failure to investigate the concerns adequately”
Conveniently for the government and many senior NHS managers, Hughes never accepted responsibility for helping to ensure such redress.
She also refused to support the one thing that would make a real difference to whistleblowers and therefore patients – legislative reform and replacement of useless UK whistleblowing law. Even though her role included identifying and acting on barriers to speaking up.
If Hughes is confirmed as Patient Safety Commissioner, it would be surprising to see any real change of direction.
Henrietta Hughes’ declaration of interests
Since leaving her post as National Guardian in September 2021, Hughes has been busy.
In December 2021, she set up a company, Accelerate Improvement Ltd Company number 13784948. This is categorised under “Other human health activities”. The firm has not yet filed accounts according to Companies House. I have been unable to find any digital footprint for the firm beyond basic company details.
Her SCAS declaration of interest was most interesting:
The declaration revealed interests at the heart of government with a seat on the Health honours committee – a useful lever on power, in company with David Behan and Dido Harding amongst others.
There is also a seat at the General Medical Council and at the Medical Protection Society – a medical defence union, defending doctors against negligence claims.
The latter is an awkward fit with her putative role as the Patient Safety Commissioner.
Hughes is also Chair of Childhood First South, Childhood First East Anglia and Childhood First Midlands three businesses categorised as “Other residential care activities not elsewhere classified”, for children. They have charitable status. According to Companies House, she became a person of significant control of these companies on 10 November 2021.
It was also announced that she would take up the Chair of the Institute of Integrated Systemic Therapy in September 2021, of which she is listed as the person in significant control.
The Institute of Integrated Systemic Therapy was formerly a company named “Childhood First” until 2015, and appears to be the parent company for the regional Childhood First branches. It has charitable status. According to the company’s reports, it runs children’s homes, as therapeutic communities, and fostering services. Fee income in 2020/21 was almost ten million pounds:
Which of these many jobs will Hughes give up to become the Patient Safety Commissioner?
Whatever, the trajectory is clearly one of an insider, not a challenger.
Here is Henrietta Hughes and her former Office, independently and rigorously challenging NHS England – her former employer and one of the key sources of suppression and top-down bullying in the NHS:
Oh how they trembled.
One can see why the Minister is delighted too:
As one commentator from Left Foot Forward quipped after Hughes’ supremely embarrassing oxytocin/Love Actually gaffe,
Patients and families similarly need to brace for problems with the Patient Safety Commissioner. The likely scenario will be that a few cases/ issues will be paraded, but under the iceberg’s waterline, more people will be failed.
And expect propaganda. Lots and lots of it.
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, lets abusers off the hook and it is a threat to public safety.
Here are just some cases of NHS whistleblowers who continued to be severely harmed during the years in which Henrietta Hughes was the NHS National Freedom To Speak Up Guardian:
This case of ‘Paul’ (a pseudonym for the story) reported by Byline Times documents how an NHS whistleblower was failed by Henrietta Hughes’ Office, in a repetition of behaviour very similar to her strategic inaction at Brighton:
“But Paul did not have much luck with the National Guardian’s Office. It turned out that it had previously given the trust in question three months to improve its treatment of whistleblowers – in a case review which the NGO confirmed to Byline Times was published in 2018 – and this deadline had been far exceeded. Instead of recognising this as a systemic issue, the NGO decided not to do anything in order to give the new trust chief executive time to deal with these issues. This appears to be the complete opposite of being a ‘guardian’ of helping people to speak up.”
Henrietta Hughes’ Office breached a whistleblower’s confidentiality at Harrogate. The trust chief executive told the whistleblower that it was Hughes herself who breached confidentiality. An NHS Improvement investigation concluded that it was an underling who breached confidentiality. But Hughes failed to ensure that the whistleblower received a timely apology from her Office or that there was proactive learning:
Other whistleblowers harmed on Hughes’ watch have included:
These are some of the posts about the policy failures relating to Hughes’ role as National Freedom To Speak Guardian: