By Dr Minh Alexander retired consultant psychiatrist 6 December 2022
The NHS Freedom To Speak Up project is discredited by serious continuing whistleblowing scandals in the NHS, despite Robert Francis’ claim that his project would make injustice “very rare”.
The project is currently under extra pressure because of BBC Newsnight’s ongoing investigation of University Hospitals Birmingham NHS Foundation Trust’s culture and mistreatment of staff who speak up.
The National Guardian’s Office (NGO) is part of this system. It is not a liberator of whistleblowers but a government instrument of control.
It helps to keep a lid on NHS whistleblowers whilst spinning endless good news stories.
It has no powers, and it interprets what narrow remit is has in a restrictive manner that deprives whistleblowers of any real support.
It has set its exclusion criteria to delay and withhold help from whistleblowers in extremis.
The NGO is not trusted by NHS staff. Few of them whistleblow to the NGO, as evident in the annual statistics of qualifying disclosures received by the NGO from NHS staff.
The National Guardian often tells NHS trust staff to go back to their organisations, which causes great distress to fearful staff, who may already have been victimised:
| YEAR | Proportion of staff who made qualifying disclosures whom the NGO signposted to Trust Freedom To Speak Up Guardians |
| 2017/18 | No data given |
| 2018/19 | 43.5 % (17 of 39) |
| 2019/20 | 39.6 % (23 of 58) |
| 2020/21 | 34.1 % (28 of 82) |
| 2021/22 | 43.3 % (13 of 30) |
It is unclear how many of the qualifying disclosures that NHS trust staff made to the National Guardian resulted in case reviews by the National Guardian, because the reports are worded in a way that does not clearly give this figure.
But extraordinarily, there is an admission that in 2021/22 the National Guardian stopped even giving advice to NHS staff on how to apply for a National Guardian case review:
| YEAR | Number of cases in which the National Guardian’s Office “Initiated a case review, providing information on how a referral for a case review could be made, or explaining the case review process” [following disclosure by NHS trust staff to the National Guardian] |
| 2017/18 | No data given |
| 2018/19 | 12 (out of 39) |
| 2019/20 | 24 (out of 58) |
| 2020/21 | 19 (out of 82) |
| 2021/22 | 0 |
What happened in 2021/22?
Was the purportedly independent National Guardian told to resist all requests for case review? If so, why?
Importantly, a previous FOI request revealed that the National Guardian receives very few qualifying disclosures from NHS Trust Freedom to Speak Up Guardians, even though trust Freedom to Speak Up Guardians are supposed to escalate outside of their trust if needed.
Of 85 qualifying disclosures received by the National Guardian in 2017/18, only 17 came from NHS Freedom To Speak Up Guardians.
The fact that so few NHS Trust Freedom to Speak Up Guardians whistleblow to the National Guardian exposes the lie that Guardians employed by NHS trusts are independent.
Also of concern, the FOI response showed that even whistleblowing by NHS trust Freedom To Speak Up Guardians did not result in case reviews:
“The actions taken in response to the 17 qualifying disclosures from Freedom to Speak Up Guardians or their equivalents are detailed further below:
* 14 disclosures led to the office providing information, advice or guidance to a Freedom to Speak up Guardian or equivalent to help them support workers to speak up.
* 3 disclosures led to the office signposting the worker to other sources of advice or guidance, or to an appropriate regulator, authority or body.”
The NGO has breached confidentiality.
The Office yet again showed itself to be unaccountable when recently asked for audits of its case record keeping and handling of whistleblower confidentiality.
Whistleblowers keep reporting that they are fobbed off by the NGO. Recent examples of this are the cases of Dr Jasna Macanovic and Mr Shyam Kumar, both vindicated whistleblowers.
The NGO has also been accused of trying to persuade people to drop their concerns.
It is wilfully blind to whistleblowers’ concerns both by design and choice.
- Robert Francis recommended that the NGO should have no responsibility for investigating whistleblowers’ concerns, and as a matter of policy, he left control of such investigations to employing NHS trusts.
- The NGO collates data from NHS trust Freedom To Speak Up Guardians, but this expressly does NOT include whether whistleblowers’ concerns are safely resolved, despite a past challenge about this omission.
Further evidence has now arisen which again shows that the NGO does not take its responsibilities to whistleblowers seriously.
An FOI request has revealed that the NGO does not apply the same standards to itself as those that it expects of NHS trust Freedom To Speak Up Guardians:
The NGO asks NHS trust Freedom To Speak Up Guardians to submit quarterly data on:
- The number of cases raised
- Whether the cases are raised anonymously
- Whether cases feature an element of patient safety/quality
- Number of cases with an element of bullying or harassment
- Number of cases with an element of inappropriate attitudes and behaviours
- Number of cases in which people report experiencing detriment after speaking up.
The NGO also expects NHS Trust Freedom To Speak Up Guardians to track patterns in cases for learning and to identify systemic issues.
The FOI has revealed that with regard to cases of NHS staff who contact the National Guardian, the National Guardian does NOT collate data on:
- Whether the cases feature an element of patient safety
- Whether individuals report any detriment after speaking up
This failure to collate crucial information suggests that the National Guardian is not tracking important safety patterns, and that she is not fully sighted on important variations in detriment between NHS trust.
Is that because it would be inconvenient to know which NHS trusts are the most abusive?
The FOI shows that the National Guardian’s central database about NHS staff who contact her Office focusses on administrative process and it features the following items:
| Name of person Organisation Position/Type of contact (FTSUG, worker etc) Date in 20 working day response date Date responded Responsibility Same day 2-5 days 6-10 days 11-20 days Overdue Action taken |
In my opinion, this suggests a tick box attitude.
The FOI shows that since 2016 when the National Guardian’s Office was established, it has received only 223 contacts from NHS staff.
It also shows that the number of NHS trust staff contacts to the National Guardian has ranged between zero to 5 for each of the NHS trusts in question.
In 20 instances, the worker did not even disclose the identity of their trust.
The FOI showed that the National Guardian has received disclosures from all NHS ambulance trusts as follows:
| NHS AMBULANCE TRUST | Number of workers who have spoken up to the National Guardian since 2016 |
| North East Ambulance Service | 0-5 |
| North West Ambulance Service | 0-5 |
| East Midlands Ambulance Service | 0-5 |
| West Midlands Ambulance Service | 0-5 |
| East of England Ambulance Service | 0-5 |
| Yorkshire Ambulance Service | 0-5 |
| London Ambulance Service | 0-5 |
| South Central Ambulance Service | 0-5 |
| South East Coast Ambulance Service | 0-5 |
| South Western Ambulance Service | 0-5 |
NB The NGO has not given the exact numbers on grounds of possible identifiability
The National Guardian has also received disclosures from a sample of NHS trusts which have been troubled.
This includes Greater Manchester Mental Health NHS Foundation Trust, where BBC Panorama recently uncovered patient abuse following a tip off from whistleblowers:
| NHS Trust | Number of workers who have spoken up to the National Guardian since 2016 |
| University Hospitals Sussex NHS Foundation Trust (and predecessor bodies) | 0-5 |
| Greater Manchester Mental Health NHS Foundation Trust | 0-5 |
| West Suffolk NHS Foundation Trust | 0-5 |
| South Tees NHS Foundation Trust | 0-5 |
| Royal Free London NHS Foundation Trust | 0-5 |
| Portsmouth University Hospitals NHS Trust | 0-5 |
NB The NGO has not given the exact numbers on grounds of possible identifiability
When did Greater Manchester Mental Health NHS Trust staff whistleblow to the National Guardian?
Did the National Guardian respond supportively to the worker(s) at Greater Manchester Mental Health NHS Foundation Trust?
Did the National Guardian take adequate action in response to these disclosures?
Could the National Guardian have helped to end the abuse?
Or was it the usual story of whistleblowers being fobbed off by her Office?
Did Greater Manchester Mental Health NHS trust staff whistleblow to BBC Panorama because they received no meaningful help from the National Guardian?
These questions need answers and I will ask NHS England to ensure that the independent investigation that it has commissioned considers these questions.
It is time for the government to stop wasting public money on window dressing and to give us fit for purpose UK whistleblowing law and infrastructure.
PETITION
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The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project
Alexander's Excavations 