Dr Minh Alexander retired consultant psychiatrist 15 March 2023
The University Hospitals Birmingham scandal continues to unfold like a slow motion car crash.
Birmingham and Solihull Integrated Care Board currently nominally hold the poisoned chalice of managing the UHB reviews, but seem very much out of their depth.
Professional crisis managers have been called in. But not before the ICB appeared to document in their board minutes that former UHB senior managers, who now sit on the ICB board, were allowed to have input into the terms of reference for the UHB reviews by Mike Bewick.
Also, BBC Newsnight has revealed that the ICB CEO wrongly told the Joint Health Overview and Scrutiny Committee that Parliamentary and Health Service Ombudsman’s concerns about UHB had been resolved, when this was anything but the case.
The PHSO continues to be vocally concerned about UHB. His public intervention amounts in my view to a thinly veiled accusation of a high-level cover up, and with some face validity.
Astonishingly, PHSO shared correspondence with Newsnight and gave an interview to Newsnight about his concerns, which featured in a broadcast of 14 March 2023.
Extraordinary times when agencies are “whistleblowing” about each other.
My transcript of the relevant sections of the programme and screenshots of disclosed correspondence to Ruth May NHS England CNO and the current UHB chief executive Jonathan Brotherton is provided below.
Scandalous though recent events have been, NHS England is by its opacity and incompetence actually helping to make the case for a properly independent judge led inquiry, with powers to protect witnesses.
EXCERPT FROM 14 MARCH 2023 BBC NEWSNIGHT BROADCAST
“Kirsty Wark BBC: In an exclusive interview safety investigator the Parliamentary and Health Service Ombudsman the last port of call for people who are unhappy with the NHS in England tells Newsnight of his serious concerns about the different roles and his difficulties investigating University Hospitals Birmingham. Here’s David.
David Grossman BBC: For the past six months Newsnight has been investigating one of England’s worst performing health trusts. We were repeatedly told it had a toxic culture. We heard from a governor of the trust who said he resigned after his warnings were ignored.
We heard allegations that patient safety warnings were ignored. And from doctors who feared that if they spoke up they’d be punished. Despite strenuous denials from UHB, NHS England took action. From the very moment that these reviews were announced, we were warned by insiders in the health service that they wouldn’t be rigourous or independent enough to get to the truth.
And now, in an unprecedented move, the most senior health service investigator in England the Parliamentary Health Service Ombudsman has complained to us that he has been excluded from giving evidence to the review.
He says he won’t be able to share the wealth of information that he’s gathered about repeated patient safety issues at UHB.
Rob Behrens Parliamentary and Health Service Ombudsman: By law and practice I’m the last resort for people who believe they’ve had either poor service or have been subject to some some clinical failure in the health service.
David Grossman BBC: Rob Behrens is the last chance investigator for health service complaints in England. If you’re unhappy with how your complaint has been treated, the Parliamentary Health Service Ombudsman and his team may look at it. He says they have to examine hundreds of complaints at UHB in the last three years, more than any other trust.
Rob Behrens Parliamentary and Health Service Ombudsman Some are about avoidable deaths, where unfortunately , sadly, tragically people have died on the balance of probability as a result of the failures of the clinicians to address the issues at the time.
David Grossman BBC: What’s been happening when you approach them?
Rob Behrens Parliamentary and Health Service Ombudsman A number of things. A lack of cooperation, a failure to engage with the Ombudsman in order to resolve cases and to learn from them.
The trust is continuously late or has been continuously late in providing us with the evidence which we’ve requested.
They have rejected our draft findings.
When we’ve had meetings to take the issues forward, under their previous leadership they were aggressive.
They failed to understand the seriousness of the issues and there was no learning culture in the organisation that we could see at all.
And that is very serious indeed because the issues are about patient safety.
David Grossman BBC: The Ombudsman was so worried about what was happening at UHB that last summer he took the extremely unusual step of issuing what’s called an Emerging Concerns Protocol to alert NHS England.
Rob Behrens Parliamentary and Health Service Ombudsman This is the first time that I have done it, so that represents the seriousness with which we regard these issues. So when the reviews into UHB triggered by Newsnight’s investigation were announced, Rob Behrens and his team fully expected to turn over their huge body of evidence of serious failings at UHB to those inquiries.
Rob Behrens Parliamentary and Health Service Ombudsman In those early days we figured our concerns we were told by NHS England that we would be invited to participate into the second of the reviews and subsequently that invitation was withdrawn.
And my concern, general concern that the NHS is not good about commissioning independent reviews to make sure there’s proper learning from what has happened. I need to be reassured that in this case, that is not also the case. But I’m sceptical.
David Grossman BBC: The Parliamentary Health Service Ombudsman and his team have written to NHS England have written to NHS England to protest about being excluded.
You’re sceptical about whether this is going to be the thorough job that you said needs to happen?
Rob Behrens Parliamentary and Health Service Ombudsman: Yes
David Grossman BBC: How serious is that?
Rob Behrens Parliamentary and Health Service Ombudsman: Well, it’s a serious issue for a patient safety organisation not to want to involve Ombudsmen, leaders and regulators in giving evidence to try and address the operational that have caused the inquiry to be commissioned.
To me, it doesn’t make sense.
David Grossman BBC: The reviews are being run by the Integrated Care Board in Birmingham and Solihull, part of NHS England. Even though the reviews haven’t been completed, the chief executive of the Integrated Care Board recently suggested to councillors that they wouldn’t find anything seriously wrong that would affect patient safety.
[At this point Newsnight showed footage of David Melbourne reporting to Birmingham and Solihull Joint Health Overview and Scrutiny Committee as follows:
“I did want to update you on where we were with the review commissioned following the allegations in Newsnight”
“All three of the reviewers were very clear that they would be happy for their families to be treated at University Hospitals Birmingham.”]
Rob Behrens Parliamentary and Health Service Ombudsman It does not chime with my experience. I’m surprised that at this stage someone would make a statement like that when the first review has taken place entirely in private. We don’t know what evidence has been taken.
I would need to see evidence documented before I accepted that view.
David Grossman BBC: The Ombudsman is so concerned about what’s happening at UHB that at the end of last week he wrote to trust management.
These concerns are entirely at odds with what the chief executive of the Integrated Care Board told local councillors.
He reassured them that any issues that the Ombudsman may have had, had quote “been resolved”.
[At this point Newsnight showed footage of David Melbourne ICB CEO telling the Joint Health and Overview Scrutiny Committee:
“What has happened is that has been… the issues Parliamentary Ombudsman raised have now been resolved through that process”]
David Grossman BBC: Is that your understanding?
Rob Behrens Parliamentary and Health Service Ombudsman It’s not my understanding. The issues in broad terms have not been resolved. A small number of issues have been addressed. But the reason I wrote to the new chief executive was to express my concerns that there was still a lot to do, and we needed convincing that change of culture was going to take place that was going to impact on operational practice.
David Grossman BBC: UHB told us that they’d responded to the Ombudsman’s letter to provide reassurances that his concerns were being taken seriously. They’d previously told us that patient safety is always their primary concern. The Integrated Care Board in Birmingham and Solihull they hadn’t heard from the Ombudsman, they would welcome the opportunity to provide assurances to the Ombudsman. A spokesman for NHS England Midlands told us that the three reviews have been commissioned to rigorously to scrutinise leadership and culture in the organisation to ensure they are providing safe care for patients, and that they welcome the offer of support from the Ombudsman’s Office.
The stated purpose of these reviews is to learn lessons and restore confidence in one of England’s biggest and most trouble health trusts.
But with such a significant voice as the Parliamentary Health Service Ombudsman questioning their rigour, that job looks harder than ever.”
Regarding Mike Bewick’s and other’s honorary professorships:
When is a Professor a Professor: Does the routine use of honorifics reduce confidence in public life?
What the UHB Freedom To Speak Up Guardian told the BBC
Mr Tristan Reuser’s whistleblowing case: Scandalous employer and regulatory behaviour on FPPR