By Dr Minh Alexander retired consultant psychiatrist 10 December 2022
Last night BBC Newsnight broadcast further investigations into poor culture and whistleblower reprisal at University Hospitals Birmingham NHS Foundation.
At the same time, the NHS announced three reviews into material uncovered by the BBC. This will be controlled by the Integrated Care Board, a new commissioning structure that has recently replaced the CCG structure.
There are serious concerns that these reviews will not be independent or rigorous because the trust and the ICB are too close. Indeed, some of the senior UHB managers have now moved to the ICB.
Crucially, the new Deputy Chief Executive of the ICB is Lisa Stalley-Green, who was UHB’s Chief Executive Nurse from 2018 until she recently moved to the ICB. She is therefore steeped in all the events of recent years, and a member of the trust board that was collectively responsible for flawed FPPR process applied to UHB’s former CEO David Rosser.
Moreover, Dr Clara Day the ICB’s new Chief Medical Officer was a consultant renal physician at UHB and latterly UHB’s Assistant Medical Director for Finance.
In a tragi-comic twist, the musical chairs also involves the ICB chair Yve Buckland, who has just been appointed as interim UHB Chair. This poses issues of conflict of interest for the ICB and whether it will rigorously hold Buckland to account as UHB Chair.
Some other members of the ICB board have been NHS senior managers in the local area with responsibility for commissioning services. That also places them in a position of conflict of interest, as commissioners must bear some of the responsibility for UHB’s failings.
Preet Gill MP Birmingham, Edgbaston has criticised the planned ICB reviews, and called for a properly independent investigation.
This seems critically important.
I am aware that UHB has gagged some of its critics, and they will not be free to disclose to a low-level review by the ICB.
A judge led inquiry with the legal power to un-gag vital witnesses is needed.
Last night’s BBC Newsnight’s focus turned to UHB’s lead Freedom To Speak Up Guardian since 2019, Professor Julian Bion.
Like UHB’s controversial former CEO David Rosser, Bion was an anaesthetist/ intensivist at UHB, working in this capacity for thirty years (1987 to2017).
In an interview by the BBC, Bion appeared ambivalent about the cultural problems at UHB.
He produced a report for the UHB board last year which made it clear that the trust’s Speaking Up arrangement was not working, because staff both feared and experienced detriment for raising concerns.
In last night’s broadcast, he was asked if he recognised the picture painted of the trust by whistleblowers. Bion replied hesitantly: “A bit”.
When asked if it was not more than a “bit”, Bion defended senior trust managers on the basis that they were working in a difficult system.
This does not of course explain why UHB’s culture is so much worse than other trusts. Nor the fact that UHB used to perform better but deteriorated in recent years.
It is possible that Bion provided balancing testimony of which we are as yet unaware, as not all of his interview would have been shown.
Of concern though, as part of his defence of senior trust managers, he stated that:
- He knew all of the UHB board
- They did not “enjoy making people frightened”
Did this reflect a loss of objectivity?
In my experience, the most abusive managers have no qualms about harming whistleblowers, and some derive satisfaction from doing so.
Certainly, Bion’s former CEO David Rosser displayed little regret or insight into the harm that he had caused to whistleblower Tristan Reuser, in a revealing interview by the Health Service Journal.
Bion’s comment that he recognised the poor culture reported by UHB whistleblowers only “a bit” is not consistent with further comments that he made later in the interview to explain poor management conduct at UHB .
He stated that the system within which managers works is “tense” and that it takes away their ability to put patients first:
“…so much focus on performance, so many competing demands, fear of failure is corrosive and it’s one of the biggest problems we’ve got. Because it takes away people’s sense of courage, self respect and doing the right thing for patients.”
This suggests to me that Bion in fact feels there is more than “a bit” of the poor culture reported by trust whistleblowers.
But it must be difficult to be fully candid about a community of which you have been a part.
Therein the core problem of the Freedom To Speak Up model.
There is also an issue of proportionality in how pressures on senior managers are viewed in contrast to those experienced by frontline staff. False equivalance should not be drawn.
Trust executives have six figure salaries and large pension pots. They are much better buffered against the consequences of doing the right thing than frontline workers, whose lives they sometimes ruin for doing the right thing. Unfair dismissal, serious ill health and loss of economic security are what they inflict on those less powerful than them.
Whilst one might seek to understand what they do to frontline staff, I think there is no excusing it. Not even “a bit”.
These are UHB directors’ unusually large salaries, as published in the trust’s annual report of 2021/22:
Importantly, although I wrote to Bion in June 2022 about FOI data which showed that the trust appeared to be referring too many doctors to the GMC without sufficient grounds, he has not advised me if the trust has acted on this.
I copied him into correspondence of 5 December 2022 to Nick Crombie another anaesthetist and , a UHB Associate Medical Director who had tweeted that he did not “recognise the picture painted by Newsnight”, which again raised the GMC issue.
Bion informed me in response that he would be talking to the BBC, but added no information about the GMC issues.
There was also no response from Bion about the GMC issues in the interview sections shown in last night’s BBC broadcast.
Neither have I received any response whatsoever from the above UHB Associate Medical Director about the GMC issues.
It is relevant to note that the UHB directors reporting to the board (David Burbridge and Jon Glasby) about Freedom To Speak Up are individuals who took part in UHB’s disciplinary action against whistleblower Tristan Reuser, and/or the deeply flawed UHB FPPR process which cleared Rosser. The former UHB CEO. Rosser was cleared by his board colleagues despite very critical Employment Tribunal findings and despite the GMC’s disciplinary action against Rosser.
Burbridge and Glasby are also the trust directors to whom Bion reports as Freedom To Speak Up Guardian:
Has Bion objected to their designated roles for Freedom To Speak Up, given their actions in the Reuser case…..or not?
Moreover, Bion seems to have accepted a UHB arrangement where a trust comms manager also had a role as a Freedom To Speak Up “confidential contact”:
This seems to me to be highly questionable and laden with conflict of interest. Those responsible for an institution’s reputation management, and who report to the trust’s Director of Communications, should have no power over whistleblowers nor be entrusted with their sensitive confidential data.
UHB’s media policy emphasises reputation and it spells out disciplinary consequences for staff who break ranks and speak out of turn:
UHB’s policy does not acknowledge that trust staff have a legal right to make a wider disclosure under UK whistleblowing law, such as to the media, in certain circumstances.
It should also be noted that after Newsnight broke the story, internal UHB comms included a statement from management which implicitly denigrated disclosures from unnamed staff.
This of course drove a coach and horses through UHB’s own whistleblowing policy, which like the national NHS whistlebowing policy, purportedly recognises the validity of anonymous whistleblowing.
The ultimate confirmation that a Freedom To Speak Up Guardian is properly independent is if they escalate concerns outside of their organisation, when they have evidence that the trust board is not acting appropriately.
There was no discussion of this with Bion in the clips shown by the BBC last night.
What was Bion’s position on UHB’s response to the critical ET and GMC findings from Reuser v UHB, and the trust board clearing Rosser under FPPR?
Did he question any of it, and did he escalate externally?
My transcript of last night’s BBC Newsnight’s broadcast is provided below.
Newsnight transcript 9 December 2022
Faisal Islam BBC: Now, a week ago a Newsnight investigation uncovered what whistleblowers told us was a mafia-like leadership at one of England’s biggest hospital trusts. A punitive culture, we were told, by current and former clinicians from Birmingham University Hospitals Trust, which frightens from staff raising concerns about patient safety.
In the wake of our report, not one but three reviews have now been announced by the NHS in the region.
The under-fire trust serves two million patients across four Birmingham hospitals recently ranked 119 out of 120 in England. Politicians are now calling for a Mid Staffs style independent inquiry.
Our Chief Correspondent David Grossman has more.
David Grossman BBC: We uncovered what insiders told us was a culture of fear at one of England’s biggest and worst performing hospital trusts.
Unnamed interviewee: I and other consultants have raised concerns about patient safety and we realised that if you do, you will get punished quite quickly, quite harshly. So they will make all kinds of spurious investigations and they will try to intimidate you that way.
David Grossman BBC: Since we broadcast our investigation last week, we’ve been contacted by several clinicians at this hospital trust, both current and former, who told us a similar story: that they felt unable to come forward with their concerns about patient safety because they feared some sort of retribution.
The local MP says that she’s been contacted too, by concerned hospital staff.
Preet Gill MP Birmingham, Edgbaston: Many of them are from different parts of the UHB trust, raising absolute concerns with me which were very, very distressing to see. These are doctors that have worked here for a very long time. These are doctors from different departments. This isn’t just disgruntled doctors. This isn’t just a department at the Heartland Hospital. This much more broader. This is people that have worked here fifteen, ten, twenty years and this is really concerning because this is showing a culture within the organisation there where was bullying, intimidation, and it’s been far, wide reaching. And of course it’s been going on for some considerable amount of time.
David Grossman BBC: Birmingham and Solihull Integrated Care Board has announced three separate reviews of our evidence. The first into the specific allegations made in our report. Second, a more general review into the culture and alleged bullying at the trust and the third, is into leadership. However, the Integrated Care Board was formed only in the summer and some its senior team were until very recently, senior managers at UHB trust.
Richard Burden Chair of Birmingham and Solihull Healthwatch: If it was the board of the ICB that was going to conduct this inquiry, I’d have big reservations about that. But the important thing is will the person or people conducting the inquiry be independent both of the trust, the ICB and indeed, independent of NHS England/ Improvement as well?
Will they be able to go where ever the evidence takes them, to look at whatever they need to look at, and will their findings be made public at the end of it? So everybody can see what’s been found out. Those are the three important criteria in my view.
David Grossman BBC: There is supposedly already a structure in place to allow people to raise patient safety issues. Each NHS trust has a Freedom To Speak Up Guardian, who can hear concerns and raise them with management.
The Guardian has no real powers, just to listen and warn.
The Freedom To Speak Up Guardian at University Hospitals Birmingham is Professor Julian Bion. His most recent report noted that a majority of staff were worried about raising concerns because they feared adverse consequences, what the report calls “detriment”.
Julian Bion UHB FTSU Guardian: The process of investigation is so slow that people won’t wait…[inaudible, volume trails off]
David Grossman BBC: I spoke to Professor Bion before the reviews into the allegations contained in Newsnight’s investigation were announced.
Julian Bion: The question is does detriment occur? And I think there have been a number of instances of which I am aware, where I’ve taken concerns to the trust and in the end I felt that the individuals who had done so had suffered detriment.
And I raised these with the trust board in public, last year. And I, I didn’t describe the individual cases of course because I can’t, but I did describe what it felt like to the individuals who felt they had suffered detriment. And this was very hard for the trust board to listen to.
David Grossman BBC: Do you feel that characterisation that we heard from several consultants and several people behind the scenes who didn’t wish to be named, that there was something of a culture of fear. Do you recognise that at UHB?
Julian Bion: [pause] A bit.
David Grossman BBC: Not more than “a bit”?
Julian Bion: I know all the individuals on the trust board. They didn’t enjoy making people frightened. But when you work in a such a tense set of circumstances as we are at present, with so much focus on performance, so many competing demands, fear of failure is corrosive and it’s one of the biggest problems we’ve got. Because it takes away people’s sense of courage, self-respect and doing the right thing for patients.
Richard Burden Chair of Birmingham and Solihull Healthwatch: The first important thing is that a Speak Up Guardian has got access to staff. The second important thing is that his or her findings are made public. The third important thing is that they’re acted on. Now the first two of those happened in relation to UHB. The third of those, has a much bigger question mark around that. Which is why we need the investigation that we’ve been calling for since last week’s Newsnight’s report.
Preet Gill MP Birmingham, Edgbaston: We’ve got to have a whistleblowing procedure that has confidence of the staff, knowing that not only will they be able to raise issues but they will be taken seriously and something will happen. It’s very clear that system isn’t working. The doctors that have been contacting me, one of the things that they have been saying is:
“Please do not share our name. Do not share details of where we work. We are really, really worried about reprisals.”
David Grossman BBC: The hospital trust has a new chief executive taking over in January and a new interim board chair, who’s just started in post. Some see the possibility of a fresh start.
Julion Bion UHB Freedom to Speak Up Guardian: The past chair of the trust has been extremely supportive, Harry Reilly. He’s been replaced by Dame Eve Buckland. She has already been in touch with me. She has asked if she can meet online with my entire team, the thirty confidential contacts my two deputies, which is excellent. So I’m very pleased about that.
David Grossman BBC: The reviews of whistleblowing at UHB we are told will be concluded early in the New Year. So far this announcement has not silenced or even reassured the trust’s critics.
Faisal Islam BBC: A spokesperson for University Hospitals Birmingham said “We welcome the support that’s been put in place and we look forward to working positively and constructively with our NHS colleagues. This will build upon the work already underway across UHB to understand the issues that have been highlighted. It’s clear that there is a strength of feeling in a number of areas and we are committed to addressing these.”
UPDATE 11 DECEMBER 2022
I have written to Yve Buckland the new UHB interim Chair (who is Chair of the ICB) about unpleasant messaging by the trust, which appears to have been sent out in her name, which has the effect of denigrating staff and former staff’s disclosures to the BBC.
UPDATE 16 DECEMBER 2022
I have come across data which suggests that a UHB FOI disclosure of April 2022 about the outcomes of trust GMC referrals was incorrect.
I have written to the interim Chair Yve Buckland requesting clarification.
Letter to Yve Buckland UHB interim Chair 16 December 2022
Related items:
Under the microscope: The Freedom To Speak Up model and University Hospitals Birmingham
National Guardian’s gaslighting exclusion criteria: the never ending story
The National Guardian’s Office does not put a blue light on for ambulance staff.
Staff suicides at West Midlands Ambulance Service NHS Foundation Trust
The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project
Alexander's Excavations 
Thank you for your report. I found it difficult to read and not respond by being profoundly sarcastic towards the main ‘characters.’
However, (deep, slow breaths) as it’s the Christmas season, goodwill towards all men (plus women and all other genders), perhaps I can merely comment that, although they may earn a comfortable salary and are not on the frontline of medicine with all of the emotional stresses that can bring, these characters do work in a dispiriting, impotent-inducing, menticidal system.
The NHS is now a centrally controlled, top-down, one-way-only structure. As such, it is doomed. But unfortunately, it is far from being unique amongst our institutions. To make matters worse, it is mature, which only exacerbates the original problems.
Management consultants, or checkout staff in supermarkets for that matter, undoubtedly have advised, and would advise, that the solution is to schedule regular, structured meetings (say half an hour every month), where all staff have the opportunity to flag problems, promote useful ideas and discuss such with their colleagues. It will then be agreed with the supervising manager which issues are important enough to not only be recorded but also passed up the chain of command. Such formal meetings have innumerable benefits. They allow all staff to make their contributions, remind everyone they are part of a team, identify problems in their early stages and therefore be more easily addressed and increase loyalty to purpose. ‘Workers’ and frontline staff will no longer be considered potential enemies determined to undermine those at the ‘top’ but regarded as they indeed are – the indispensable and respect-worthy foundation of the NHS.
However, we know that the NHS has long been dominated by politicos who seem to view everything as a tool for monetising or propaganda for their benefit as opposed to the patients (or taxpayers as they are known when healthy). I must also express regret that the public has been most reluctant to exercise its democratic duty by keeping its politicos and its institutions accountable.
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