Bewick’s silence on patient complaints at University Hospitals Birmingham NHS Foundation Trust

Dr Minh Alexander retired consultant psychiatrist 10 April 2023

On 28 March 2023 the compromised Bewick phase one report on UHB, a rapid review of clinical safety, was published.

The Parliamentary and Health Service Ombudsman triggered the multiagency Emerging Concerns Protocol in August 2022 because of concerns about poor culture, leadership and lack of learning from complaints and incidents at UHB.

PHSO expected to contribute to Bewick’s review but claimed it had been excluded, and this revelation was broadcast by BBC Newsnight. The transcript of Newsnight’s interview with Rob Behrens can found here:

PHSO alleges it has been excluded from NHSE/ICB’s reviews on UHB & ICB’s factual inaccuracy to the Joint Health Overview and Scrutiny Committee

Extraordinarily, Bewick’s rapid review of UHB safety indeed omitted any mention of evidence from PHSO or of the PHSO’s concerns.

Bewick and his small crew of fellow investigators, a paediatrician and a “chartered secretary and governance expert” also did not mention patient complaints in their report.

Is this because raising the spectre of patient complaints would inevitably remind the public and NHS staff of the missing PHSO data?

How can a report on clinical safety ignore patient complaints about clinical care?

Astonishingly, despite ignoring this core data on patient experience and outcomes, both from trust records and from the PHSO, Bewick and co concluded that UHB was “safe” overall.

Page 30 “….our overall view is that the Trust is a safe place to receive care”

As the silence about patient complaints seemed an important indicator of establishment discomfort, I took a quick look at UHB’s patient complaints.

The most recent UHB annual report 2021/22 gave almost no statistics on patient complaints. The bare bones provided were as follows:

“In 2021/22 a total of 1,716 complaints for investigation were received. This is a 36.8% increase from the previous year.” [my emphasis]

The trust produces an annual complaints report, but I was unable to find this on searching.

Some trusts publish their annual complaints report, but it appears that UHB does not.

The most recent annual quality report by UHB also gave few details about complaints patterns.

But under the subject of “Improving nutrition and hydration”, the trust did reveal more details of relevant complaints.

As you can see from the above table, these included failures of very basic care such as not monitoring food or fluid intake, not providing assistance with eating and drinking and leaving food and drink out of reach.

Where have we heard of such failures before?

Neglect and Indignity

The UHB complaints about hydration and nutrition are consistent with this week’s news coverage. UHB families’ and patients’ reported food and drink being left out of reach and patients being left in their own waste:

Woman says her dying mother’s hospital care was ‘absolutely disgusting’ after report finds toxic culture at NHS trust

I found an old FOI response Ref 5043 by UHB of 8 March 2017, on complaints received from both staff and patients regarding staffing levels.

It is not clear how UHB collated data for this FOI response, or whether the data is a reliable reflection of the original FOI question. UHB has also been known to mislead in FOI responses on sensitive topics such as FPPR.

With those caveats in mind, the data published suggested that complaints about clinical care comprised about half of the complaints.

YEAR	Total number of complaints from patients	% of complaints that related to clinical care
2013/14	956	52.3% (n = 500)
2014/15	1044	51% (n = 533)
2015/16	1075	48.5% (n = 522)
2016/17	949	41.5% (n = 394)

Looking at an overlapping and better-defined dataset from NHS Digital, data on written complaints in the English NHS, shows that complaints about clinical treatment accounted for less than a third of complaints:

YEAR	TOTAL NUMBER OF COMPLAINTS ABOUT CLINICAL TREATMENT	% OF ALL COMPLAINTS THAT WERE ABOUT CLINICAL TREATMENT
2015/16	59,678	32.0%
2016/17	51,145	26.7%
2017/18	48,904	26.2%
2018/19	53,084	27.5%
2019/20	53,018	27.1%
2020/21	40,854	26.9%

A proper interrogation of UHB’s complaints data and an examination of UHB’s response to complaints is needed.

Journalists might be interested to pursue the records relating to this event in 2021/22, as described in the foreword by David Rosser ex UHB CEO, in the trust’s quality account for that financial year:

“A wide range of omissions in care were reviewed in detail during 2021/22 at the Executive Care Omissions Root Cause Analysis (RCA) meetings chaired by the Chief Executive. Cases are selected for review from a range of sources including serious incidents, serious complaints, IT incidents, infection incidents and cross-divisional issues.”

Surely Bewick could hardly have been hampered by poor data systems as UHB’s former CEO and current CMO are ardent fans of digital health and data.

Rosser’s foreword in the 2021/22 proclaimed:

“Data quality and timeliness of data are fundamental aspects of UHB’s management of quality. Data is provided to clinical and managerial teams as close to real-time as possible through various means such as the Trust’s digital Clinical Dashboard. Information is subject to regular review and challenge at specialty, divisional and Trust levels by the Clinical Quality Monitoring Group, Care Quality Group and Board of Directors for example.”

The fact that Bewick was prepared to declare UHB safe without any evident discussion of UHB complaints data suggests two possibilities.

Either he decided it would be unfavourable to examine or report on complaints, or he did not consider patient experience or patient voice important when assessing patient safety.

Either option would suggest he should not be directing the UHB reviews.

And who directed Bewick?

It strikes me that the only NHS England or the Department of Health would have the power to ensure the exclusion of PHSO’s evidence from Bewick’s review.

Such high-level interference only additionally points to the need for a judge led inquiry with powers to compel evidence, as well as to protect witnesses and ungag silenced staff and former staff.

I think we should brace for more misdirection.

UPDATE 12 MAY 2023

I obtained data on the number of concerns raised by the public with Birmingham and Solihull Healthwatch. The data shows marked and continuing escalation beginning in 2021. Healthwatch disclosed under FOIA that it started meeting with the CQC on the basis of this sharp escalation in concerns and that these meetings continue:

Healthwatch Birmingham & Solihull has been receiving increasing concerns from the public about UHB and has held monthly meetings with the CQC

I have sent the Healthwatch data to Bewick and suggested that he should examine and report on UHB’s patient complaint data, with both quantitative and qualitative analysis.

RELATED ITEMS

This is a statement of 4 April 2023 by the external reference group on Bewick’s reviews, which criticised some of the gaps in Bewick’s report:

Statement from the UHB Cross-Party Reference Group

However, this statement also did not mention the PHSO’s exclusion from Bewick’s review or the absence of any reference to patient complaints.

The latter is a little surprising given that Richard Burden former Labour MP is the current Chair of Healthwatch Birmingham and Solihull and a member of this external reference group.

A statement by Burden on 28 March mentioned the PHSO but not Bewick’s omission of patient complaints.

Healthwatch Birmingham statement 28 March 2023

The only patient related outcome measures mentioned by the external reference groups were as follows:

“We do remain concerned about above average mortality rates and the number of ‘never events’.

This is the full membership of the external reference group, according to Birmingham and Solihull ICB, which commissioned the Bewick reviews:

• Preet Kaur Gill, Labour and Co-operative MP for Birmingham, Edgbaston
• Gary Sambrook, Conservative MP for Birmingham, Northfield   
• Richard Burden, Healthwatch Chair       
• Andy Cave, Healthwatch CEO   
• Dr Chaand Nagpaul, clinical representative
• Mitzi Wilson, RCN representative
• Councillor Mariam Khan, Health & Well Being Chairman & Cabinet Lead for Social Care and Health, Birmingham City Council
• Councillor Karen Grinsell, Deputy Leader & Cabinet Member with responsibility for Partnerships & Well-being, Solihull Metropolitan Borough Council
• Gail Adams, Unison representative
• Peter Mayer, citizen representative
• Mustak Mirza, citizen representative    

NHSE, ICB and UHB’s three-ring circus and Rosser’s digital assignment

This post shares FOI data which showed that UHB and the ICB colluded to give a false impression that David Rosser had left UHB when he in fact remained an employee of the trust, and was just temporarily parked at the ICB, answering to the ICB’s CEO.

When is a Professor a Professor: Does the routine use of honorifics reduce confidence in public life?

Bewick styles himself “Professor” on the basis only of an honorary professorship from UCLAN.