Dr Minh Alexander retired consultant psychiatrist 25 August 2022
Henrietta Hughes the former NHS National Freedom To Speak Up Guardian is a non executive director at South Central Ambulance Service NHS Foundation Trust. She took up this role in January 2022, after leaving the National Guardian’s Office at the end of 2021.
Embarrassingly for the government’s Freedom To Speak Up project, South Central Ambulance Service has just been rated “Inadequate” by the Care Quality Commission.
SCAS has been rated ‘Inadequate’ on Safety and the Well Led domain:
The trust board was criticised for insightlessnes, out of touch, “extreme positivity”:
“The board saw the culture as a strength of the organisation. It was sold with positivity, with many examples of forward thinking, innovation and high profile projects. There was undoubtedly much good work taking place and a genuine desire to be the very best. The risk of such extreme positivity was that this could feel dismissive of reality to the frontline staff and limit the feeling that raising or reporting concerns was a good thing to do.” [my emphasis]
As National Guardian, Henrietta Hughes used to be employed by the CQC, an arm’s length body of the DHSC. She has since been further embedded into the DHSC as Patient Safety Commissioner for medicines and devices.Her SCAS declaration of interests shows that she has fingers in quite a few pies:
A trademark of Hughes’ style is her “extreme positivity”. This was ridiculed from the outset of her tenure as National Guardian when she gave an interview to the Times in which she said the highly complex and engrained issues of poor NHS culture would be improved if only staff were more cheerful.
Most people with basic analytic capacity and emotional intelligence would more likely say that the NHS has a serious leadership problem, not that it was staff’s fault for being grumpy.
Even before she became National Guardian, Hughes had shown herself unusual in her own leadership style in that she wrote about the fact that she introduced compulsory smiling for staff in her previous role.
If that’s not overbearing intrusiveness and out of touch “positivity”, what is?
The CQC itself has form for over-rating trusts. It has fought a valiant battle against ambulance service reality for some years now. CQC insisted on rating West Midlands Ambulance Service as ‘Outstanding’ despite coroners’ warnings, other service failures and staff suicides.
Only in February this year CQC conducted an inspection triggered by whistleblowers and rated South Central Ambulance as ‘Good’ overall and ‘Good’ across all domains despite the whistleblowers’ concerns, although that rating seems to have now been removed from the CQC’s website. There are still some digital traces of the February ‘Good’ rating:
The latest CQC report on South Central Ambulance Service is based on an inspection in April-May 2022. It seems as ever, that whistleblowers were a catalyst:
“We were contacted by a member of staff who had raised serious concerns during the inspection. They agreed for us to reveal their identity so that we could address the concerns.”
The CQC has also reportedly noted issues of very poor whistleblowing governance, with management smearing of the named whistleblower. Other SCAS whistleblowers who were not willing to be identified expressed understandable fears of retribution:
“It was suggested that the whistle blower had acted maliciously and was not behaving in line with their professional code of conduct. This was untrue and the whistle blower was able to produce documentary evidence that they had repeatedly raised concerns internally, although there was no requirement for them to do so. This aligns with information from others who shared concerns with the Commission but wanted their identities protected because they were afraid there would be retribution.”
CQC reported failure to act on concerns about the treatment of female staff, especially trainees:
“We received information from someone raising concerns about some women’s negative experiences at the trust; they said that this applied especially to student paramedics. The whistle blower said that concerns had been raised with senior leaders, the Freedom to Speak up Guardian and the organisational development team, but there was no evidence the concerns were being addressed. This correlates with reports from staff across the organisation who felt that the Freedom to Speak up Guardian was solely about patient safety issues and that other concerns were not recognised by leaders as being within the Freedom to Speak up Guardian’s remit, even though the role was created in line with national guidance. “
CQC reported that there were generally gross organisational culture issues.
This is especially embarrassing for the government given that one of its anointed figureheads for patient safety, Henrietta Hughes, was also SCAS’ Workforce Wellbeing Guardian.
“Henrietta Hughes acknowledged that staff were likely to be exhausted given the sustained pressures and highlighted how she would be delighted to support from the perspective of her new role as Workforce Well-Being Guardian.”
From SCAS board papers 26 May 2022
These are some of the adverse CQC findings about culture and staff experience at SC AS:
“Review of investigation reports and discussions with leaders and staff showed that organisational learning was not an embedded part of the culture. Incident investigations resulted in apportioning or suggesting where blame lay rather than focusing on the potential learning across the organisation. The actions tended to be around retraining for individuals rather than wider dissemination to mitigate future risks. Some reports blamed the patients for not providing accurate information to crews and many were judgmental about patients in their reporting.”
“Some staff felt the organisation’s leadership were visible, but others were concerned about the lack of recognition at senior level of the situation frontline staff were facing. Data provided by the trust showed two key executives, the CEO and the Director of Operations had visited sites and spoken with staff throughout the pandemic, but other executives and non-executive staff had not. Visible leadership is vital to support staff and could be achieved in a safe and pragmatic way either virtually or in person with appropriate PPE, meeting outside and other safety measures. Following receipt of the draft report, the trust shared details of additional visits by executives. It is acknowledged that face-to-face visits were reduced in line with national guidance to limit footfall and reduce the risk of viral transmission.”
“The trust had appointed a freedom to speak up guardian. However, several staff told us they could only access this service in their own time, which made this less accessible to those who had already worked a long day and needed a break. After the inspection the trust said that they freedom to speak up guardian worked flexibly to support staff, however this was not the experience of the staff which we spoke with. No impact on ratings.”
“The organisation employed in excess of 4,500 staff, but only had one Freedom to Speak up Guardian. They reported to the Interim Director of Patient Care and Service transformation; some staff said that they felt uncomfortable raising concerns that would be reported to someone in their own line management structure and worried that they could be identified.”
“Following the inspection, the provider said that there was a process in place for when the FtSUG felt there was a conflict of interest in the management structure; an alternative route for speaking up was in place. However, the staff we spoke with were not aware of this and said that they did not feel comfortable raising concerns because they felt there was a conflict of interest.”
“Our CQC survey had several comments made relating to harassment and bullying. One said, “When sexual harassment is reported it seems to be brushed under the carpet and the person is given a second chance. In the eyes of the law sexual harassment and abuse is never given a second chance and as a result people are reprimanded for their actions.”
Henrietta Hughes is not of course responsible for all the failures at SCAS.
However, in addition to sitting on its board for the last seven months, she was the National Guardian for over five years and shaped the insulting, happy clappy, PR approach to NHS whistleblowing.
As the good ship Freedom To Speak Up slowly sinks, and is exposed for the sad charade that it is, Henrietta Hughes has stepped into a air-sea rescue helicopter.
It is also fitting that ambulance trusts, which she neglected in her tenure as National Freedom To Speak Up Guardian, are helping to torpedo the government’s lies about progress in NHS whistleblowing.
But be positive.
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