National Guardian’s letter to NHS Ambulance Trusts

By Dr Minh Alexander retired consultant psychiatrist 27 July 2022

This is a brief post to share correspondence.

The National Guardian’s Office previously signalled an intention to carry out a thematic case review  of ambulance services, with no details provided.

In March of this year I asked for more information.

By correspondence of 6 April 2022, the National Guardian’s Office informed me that it first discussed the idea of reviewing speak up culture in ambulance trusts in June 2020.

The NGO refused to disclose any relevant correspondence with ambulance trusts, along with other requested documents, on grounds that these were all intended for publication.

The NGO later published some cursory plans for the review without publishing the withheld correspondence.

After prompting, the NGO has now reluctantly disclosed a single item of correspondence to ambulance trusts dated 13 April 2022.

This letter by the National Guardian announces an initially desk based review of information already in the public domain. The NGO also seeks access to reviews previously conducted by individual ambulance service trusts.

That is to say, the National Guardian’s work on the ambulance review did not begin until almost TWO YEARS after it was planned, and only after I made enquiries in March.

This is despite the obvious governance mess and great distress of ambulance service staff over several years and the much-publicised staff suicides at East of England Ambulance service.

Whistleblower warned of ‘suicide risk’ at ambulance trust before three deaths 25 November 2019

Report into deaths of three workers tells East of England Ambulance Service Trust to act on mental health 13 May 2020

The letter, which is signed by the National Guardian herself, claims that the ambulance service review was first decided in “early 2020” and that it did not go ahead because of the pandemic:

“In early 2020, the National Guardian’s Office (NGO) proposed a speak up review of NHS Ambulance Trusts.”

“During the pandemic, with ambulance trusts facing unprecedented pressures, it was not possible to undertake a review.”

In my view, this makes it sound like the ambulance review was planned before the pandemic got underway and was then parked because of the pandemic.

The truth is the ambulance review was planned in June 2020, when the pandemic was established. The UK had only just emerged from its first lockdown. As the NGO previously informed me:

“As you have indicated, the piece of work we are about to undertake was triggered as we seek to better understand the relationship between the FTSU Index and CQC ratings. This was first discussed with our Advisory and Liaison Board in June 2020.” [my emphasis]

Why was it not possible to at least undertake the desk based element of the review?

Tone deaf to the signs of emergency care collapse in recent months, the National Guardian’s letter maintains its self-justifying narrative for not acting until now with the following argument:

However, as the pressures ease to some degree, we would like to commence the review.”

The NGO’s flexible approach to history aside, this is the letter to ambulance trusts:

National Guardian Jayne Chidgey Clark’s 13 April 2022 letter to NHS Ambulance Service Trusts

My reading of this letter is that trust managers have little to fear and that ambulance whistleblowers have little reason to expect much from this exercise.


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Whilst the National Guardian’s Office sat on its hands, ambulance whistleblowers continued to suffer very serious detriment and patients and families suffered along with them:

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Paul Calvert one of the NEAS whistleblowers gave an interview to the Northern Echo revealing disclosures to NHSE England/Improvement in 2021. In his disclosure correspondence he reported that NEAS’ internal whistleblowing arrangements – the Freedom To Speak Up structure – was used to delay and prevent transparency:

Paul Calvert North East Ambulance Service Whistleblower says NHS internal Freedom To Speak Up mechanism is “entirely ineffective, being used to cover up and delay matters”

I have asked NHSE/I if it has looked into this extremely serious concern. The regulator has indicated that it will get back to me on this issue.

There was a conflict of interest in NEAS’ freedom to speak up arrangements in that the Freedom To Speak Up Guardian held a corporate role and reported directly to the Executive Nurse on a number of matters.

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