Dr Minh Alexander retired consultant psychiatrist 3 May 2023
I was interested in Healthwatch as a source of patient intelligence after Bewick declared University Hospitals Birmingham NHS Foundation Trust safe overall without mentioning patient complaints.
Local Healthwatch services support local communities to make use of health services.
They are ultimately funded by the Department of Health and Social Care. The funds are routed through local authorities. There are currently 152 local Healthwatch organisations which collectively receive £250,400,000 via local authorities to carry out their statutory activities for year 2022/23.
Healthwatch organisations are social enterprises which are contracted to carry out statutory activities. These statutory duties consist of:
(i) advising the Care Quality Commission through information supplied to Healthwatch England – a subcommittee of the CQC, and of
(ii) providing local communities with information about access to local services.
The government also intended that local Healthwatch organisations should:
“…act as local consumer champion representing the collective voice of patients, service users, carers and the public, on statutory health and wellbeing boards”
and to assist with complaints:
However, Healthwatch Birmingham does not publish data on concerns received from the public.
It has an online feedback page where some comments by the public can be seen, good and bad, and some organisational responses can also be seen.
I asked Healthwatch Birmingham for its data on complaints and concerns.
I also asked if there was any restriction on whether this data could be routinely published, and whether commissioners request that the complaints and concerns data is reserved only for commissioners and regulators. This is because Healthwatch Birmingham informed me that despite not publishing the data, it did in fact collate it and routinely sent a report to commissioners and regulators on a quarterly basis.
Healthwatch Birmingham has now shared the numbers of concerns received from the public since 2018, but with no qualitative summary about these concerns. It has also not answered the question about whether its contract requires it to reserve data on complaints and concerns for commissioners and regulators only.
Notwithstanding, HW Birmingham has indicated that due to escalating concerns received from the public in 2021 about UHB, it asked to meet with the CQC and has continued to do so on a monthly basis.
“Over the course of 2021, we raised additional concerns with the CQC on several occasions following an increase in negative feedback and concerns from the public received by Healthwatch Birmingham and Healthwatch Solihull, and intelligence personally received by our Chair. We had also noted UHB’s poor performance in published NHS waiting list statistics and we raised these issues with the CQC. As a result the CQC agreed to meet us monthly to update us on their monitoring of UHB. These meetings continue.”
CQC conducted an unannounced inspection of UHB in June 2021 when it concluded that: “Managers shared feedback from complaints with staff and learning was used to improve the service.”
Although CQC dropped the overall UHB trust rating to “Requires Improvement”, its inspection report implied that much of the turmoil at the trust was COVID-related.
CQC maintained, despite several FPPR referrals on UHB’s then CEO David Rosser, the trust was “Good” under the Well Led domain.
In July 2021, the CQC was additionally warned by UNISON who submitted a formal dossier of staffside concerns about mismanagement at UHB.
The figures now released by HW Birmingham show that concerns from the public spiked even more sharply in 2022.
Figures for 2023 so far suggest that the rate of concerns remains much elevated.
This is the FOI disclosure by HW Birmingham about concerns raised by the public on UHB.
This is the correspondence exchange with HW Birmingham Chair and CEO.
As was reported by BBC Newsnight, in the summer of 2022 the Parliamentary and Health Service Ombudsman triggered the CQC’s multiagency Emerging Concerns Protocol for the first time ever, because of concerns that UHB’s leadership was not learning from serious incidents and was “aggressive” in response to the PHSO’s interventions.
According to HW Birmingham, although Healthwatch England is a sub-committee of the CQC and the Chair of HW England is a CQC board member, local Healthwatch organisations do NOT have the power to trigger CQC’s Emerging Concerns Protocol. So there is structural inequality – the patients’ champions may report upwards but they have no hands on any levers. Supplication only.
Neither did the PHSO think to alert the local Healthwatch, the nearest thing to the official local voice of patients, when it triggered the Emerging Concerns Protocol.
HW Birmingham’s Chair is a member of the external reference group which has the role of maintaining independent oversight of the ongoing Bewick reviews of UHB governance.
HW Birmingham has through its Chair made a number of statements about the UHB scandal:
Healthwatch statement on investigation into University Hospitals Birmingham (UHB) 9 December 2022
In none of these statements is it disclosed that there was a very marked spike in concerns received by HW Birmingham, or that HW Birmingham has been holding frequent meetings with the Care Quality Commission in consequence. I appreciate there may be contractual constraints on Healthwatch organisations.
There is an expression: The truth, the whole truth, and nothing but the truth.
The scandal at UHB was allowed to happen. It did not spring forth fully formed. It was conceived when government policy failed to protect clinical quality, it was nourished when certain directors were appointed. It was incubated when whistleblowers were ignored and thrown back to the wolves, when safe staffing was deemed an optional extra. As at MidStaffs, poor care was normalised and regulators did not put patients first. Poor culture was not addressed and was instead perpetuated when abusive executives were excused and protected.
Taking the microscope, and not a very good microscope at that, to UHB alone is not enough. What happened at UHB happens elsewhere still, and there will be more UHBs.
It is the central governance of the NHS and government policy that needs proper examination, as acknowledged by the HW Birmingham statement of 9 December 2022.
But how likely is that? Rather, secrets and Bewick’s Bendy Hall of Mirrors prevail.
UPDATE 7 MAY 2023
I have written to Mike Bewick to formally ask that he reviews UHB patient complaint data as part of his reviews:
BY EMAIL
Dr Mike Bewick
4 May 2023
Dear Mike,
FOI data from Healthwatch organisations on concerns received from the public about UHB
Please find attached FOI data from local Healthwatch organisations which shows escalation in concerns received from the public about UHB since 2021, which was such that Healthwatch has been holding monthly meetings with CQC since 2021.
I hope your reviews into UHB will now include some examination of patient complaints data, with both quantitative and qualitative analysis.
With best wishes,
Minh
Dr Minh Alexander
Cc BBC Newsnight
Nancy Cole ITV
Becky Johnson
Rob Behrens PHSO
Preet K Gill MP external reference group
Dr Chaand Nagpaul external reference group
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Can Healthwatch Birmingham please let us see its complaints & concerns data on UHB?
Bewick, the ICB, misinformation by UHB about GMC referrals and a late correction
NHSE, ICB and UHB’s three-ring circus and Rosser’s digital assignment
What the UHB Freedom To Speak Up Guardian told the BBC
Why is CQC not investigating UHB under CQC Regulation 12?
Alexander's Excavations 
Another brilliant damning expose of a system designed not to pick up and respond to evidence of patient harm and other serious concerns of services there to protect us and save lives and have a duty of care to staff carrying out a difficult job in difficult circumstances. Much more than a health service scandal this is a health system scandal which deserves urgent. Otherwise where is patient staff and public safety? Where is the independent fearless empowered patient voice? And an accountable responsive safe system? Non existent.
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In my experience, HealthWatch at local and national level, is yet another utterly useless organisation, that does nothing to protect patients, support their complaints, or hold health service leaders to account.
It is unsurprising as it is effectively part of the CQC. The Chair sits on CQC’s board and under Robert Francis, did absolutely nothing to enforce his own findings from Mid Staffs or support complainants. His outlook shifted to align with his maters. HW should be made up of truly independent minded evaluators, who have no allegiance to any health service organisation and are not afraid to say it how it is.
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What committee oversees accountability of HW? I know PHSOthefacts dealt extensively with PACAC over PHSO. Who if any addresses apparently toothless HW?
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I think primarily Health and Social Care Committee primarily, but other committees might also have a remit. Such as Public Accounts Committee, PACAC and Joint Committee on Human Rights, depending on the issue. The other committees have all had dealings with either CQC , public administration or patient safety and patient rights issues at some point.
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At the end of the day, HealthWatch, PALS, CQC, NHSIE, NHS complaints policy, legal Duty of Candour, etc., are all one and the same body – all intent on just offering a sop to exhaust complainants, until they expire, concealing the mess that lies beneath. The only time they act against NHS Trusts, is when caught out by the media and their dalliance exposed (…. the only time…).
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Agree both, always in effect, and with too many a clear agenda: Patient voice to be suppressed as it is too partial, challenging, demanding . The question is what to do? Call it out; get acknowledgement ; get harmed patients and their advocates in the core governance processes so that the deflection, denial, victim blaming, victimisation and worse are stopped and real verifiable change occurs . A real patient led Patient safety system.
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I think what is needed is complete openness – instead of each individual complaint being hidden within Trusts complaints processes and the CQC. Trustpilot would be an excellent open platform. Each hospital & Regulator has a page, where complainants & whistleblowers can record their concerns under speciality sections – so that issues and trends can be quickly identified by others. It then requires an enforcement panel of persons totally unreliant upon the NHS & Gov. for their financial wellbeing and career, who are used to working with evidence, to enforce the regulations and ensure standards and safety. Trusts will pretty soon cotton-on that they must confirm or will be exposed.
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Hsj today! My INTRO : the whole issue of having any patient reporting portal is on hold up for review in a’ discovery phase. ‘ I am less optimistic than when I wrote this https://www.pslhub.org/learn/patient-engagement/patient-stories/how-can-patients-voices-be-heard-and-acted-upon-when-they-attempt-to-report-incidents-of-harm-r5700/
This is all about the staff one:
HSJ TODAY
‘The must-read stories and debate in health policy and leadership.
The transition towards a new national incident reporting system remains fraught with difficulties . Managers working on implementing new systems within trusts are calling for the government to push the launch date back again, from September until next year.
The creation of the “learning from patient safety events” system is a key part of NHS England’s safety strategy, with an aim of making it easier for staff to record safety events across all services, including primary care. It will replace the NRLS system, which has been around for 20 years.
However, patient safety managers have argued that an upgrade due in July to the RLDatix risk management system – which is used by the majority of trusts – will cause knock-on problems with implementing LFPSE in September.
But apparently Steve Barclay has taken a “personal interest” in the project and is keen not to have the two systems running beyond September, leaving this deadline in play and managers left worrying about getting everything done on time.
Although there is strong support for a new system, questions also remain over its design, with concerns about staff buy-in. Rushing this complex project will surely not be good for staff or patients. ‘
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