By Dr Minh Alexander 19 October 2022
|Summary: North East Ambulance Service (NEAS) has like other ambulance services been under chronic, major pressure. Like other ambulance trusts, it has poor workforce metrics. Like other ambulance trusts, it has had staff suicides. Of concern, NEAS tried to obfuscate about these suicides when asked about them via FOI. There are other questions about NEAS’ reliability in reporting. NEAS appears to have under-reported bullying in another FOI response, and there are questions about the fact that it appears to be an extreme outlier in reporting a lower number of serious incidents than other ambulance trusts. Moreover, NHS England is in control of the investigation into NEAS’s deaths scandal, but the terms of reference for the investigation reportedly ignore possible manipulation of coronial reporting processes. They have been described by a “source close to the investigation” as a “white wash”. A properly independent judge led inquiry is needed given the serious questions of probity and alleged criminal breaches of coronial law.|
North East Ambulance Service NHS Foundation Trust (NEAS) is, like other ambulance trusts, a highly stressed and neglected organisation.
NEAS is currently under the microscope after whistleblowers disclosed that it had been altering staff statements for coroners’ inquests and failing to report deaths to the coroner.
NHS England has been criticised for not acting upon the NEAS whistleblowers’ disclosures, yet NHSE has been left in charge of an investigation into these matters.
That serious conflict of interest was of itself appalling, but it has since emerged through a Health Service Journal report 0f 13 October 2022 that the terms of reference for NHS England’s investigation omit a vital area, and represent an attempt by NHS England to “whitewash” the matter.
“Mr Calvert said the AuditOne review was made aware of “numerous cases” and “not just the five” being examined by the new inquiry. Another source close to the investigation, who asked to remain anonymous, echoed the concerns about the limited number of cases being examined, and added: “What’s missing is an analysis of attempts to conceal facts from coroners, there’s nothing in the terms of reference about this.
The families want a full independent inquiry, this is going to be a whitewash.” [My emphasis]
Moreover, the person whom NHS England appointed to lead its investigation is an NHS insider, Marianne Griffiths former CEO of University Hospitals Sussex NHS Foundation Trust.
When a contentious whistleblowing matter arose at her trust, she and her board were improperly protected by the then National Guardian, Henrietta Hughes:
There is a serious question over whether this obfuscation of organisational failings and poor culture at Sussex contributed to later failures of whistleblowing governance, which affected maternity safety:
NEAS staff suicides
Information about staff suicides at NEAS from several sources led to the submission of an FOI request to NEAS about this.
NEAS responded on 12 October 2022, and initially tried to evade disclosure of this information. NEAS answered as follows:
“How many NEAS trust staff have died by suicide or suspected suicide since 1 April 2016?
The Trust would confirm that it is the coroner who decides whether a death was suicide.”
(NEAS FOI disclosure ref. 22.271)
NEAS was challenged about the fact that its FOI response had not met the legal obligations under FOIA to:
- Confirm whether or not it held the requested information
- Indicate which legal exemption it relied on if it held the information, but did not want to disclose it.
On 18 October 2022 NEAS responded again, disclosing that there had been three staff suicides or suspected staff suicides since 2020:
NEAS denied that it held data before 2020.
In addition to the tragedy of ambulance trust staff’s working conditions, a very serious issue arising from this FOI matter is that NEAS initially attempted to evade the question about staff suicides.
This surely shows continuing organisational failure and secrecy?
For context this is an FOI disclosed by NEAS in 2018 about staff sickness related to mental health issues:
It has been reported that NEAS in fact established a mental health advisor post as part of Occupational Health services, following staff suicides. NEAS have been asked to confirm if this is correct, and to provide details about these issues.
Has NEAS issued a false FOI disclosure about levels of bullying?
In another area, NEAS’ reporting is also in doubt.
I have seen an FOI response by NEAS of 28 September 2022 which reports tiny numbers of reports of staff-staff bullying in recent years:
2019 < 5 cases
2020 6 cases
2021 < 5 cases
This is the relevant extract from NEAS’ FOI disclosure:
This data is strange because it does not match up with NHS Staff Survey data.
The most recent NHS staff survey on NEAS showed that:
a) 15.7% of NEAS staff reported being bullied by a manager in the previous twelve months
Scaling this up, based on an NEAS workforce of approximately 2,700 staff gives an estimate of 424 staff who experienced bullying by a manager in the previous twelve months.
b) 19.4% of NEAS staff reported being bullied by a colleague in the previous twelve months:
Scaling this up, based on an NEAS workforce of approximately 2,700 staff gives an estimate of 524 staff who experienced bullying by a colleague in the previous twelve months.
c) 43.5% of NEAS staff reported the last incident of bullying and harassment that they experienced was reported:
Therefore, the total recorded incidents of reported bullying at NEAS that year should have been something like 43.5% of the hundreds staff who experienced bullying, and not the tiny single figures reported in NEAS’ FOI disclosure of 28 September 2022.
Questions arise of whether NEAS made a false statement under FOIA about its recorded incidents of bullying, or whether there is something terribly wrong with NEAS’ systems for recording and tracking the serious workforce issue of bullying.
Both options are disturbing.
NEAS claimed in its annual report of July 2022 that it planned to investigate the numbers of bullying incidents,
“In addition to the activities that have already commenced we have identified actions that will be progressed over the next 12 months, including….. Investigating the data around bullying and harassment in more detail and triangulate with free text comments, Freedom to Speak Up Guardian, grievances and exit interviews to get a more detailed picture.”
Is it really plausible that NEAS was unaware that its FOI release of 28 September was a gross misrepresentation of its levels of reported bullying?
Is NEAS under-reporting serious incidents?
Someone has drawn my attention to a suspiciously low number of serious incidents reported by NEAS.
In contrast other ambulance trusts reported many times this number of serious incidents:
North West Ambulance Service: 86 serious incidents
Yorkshire Ambulance Service: 71 serious incident
East Midlands Ambulance Service: 38 serious incidents
West Midlands Ambulance Service: 204 serious incidents
South Central Ambulance Service – 2021/22 Quality Account not yet published
East of England Ambulance Service: 161 serious incidents
South East Coast Ambulance Service: 67 serious incidents
London Ambulance Service: possibly 81 serious incidents based on feedback, but not found in the trust quality account
South Western Ambulance Service: 74 serious incidents
NEAS has been asked about its apparent outlier status on serious incident reporting.
Public inquiry in light of allegations of criminal breaches
The charade about NEAS’ governance will likely continue, given HSJ’s revelations about the deeply flawed terms of reference for Marianne Griffiths’ investigation of NEAS.
An NHS insider investigation seems a seriously inadequate response to matters which raise Article 2 and alleged criminal breachs of coronial law.
In light of ongoing evidence that NEAS may be obfuscating, given the Article 2 issues and given the extremely serious issues of alleged criminal breaches of coronial law, a fully independent judge led inquiry with statutory powers is needed.
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