UHB: Bewick was aware of the Rosser fiction, but it did not feature in his investigation report

Dr Minh Alexander retired consultant psychiatrist

The care quality and governance scandal at University Hospitals Birmingham NHS Foundation Trust blew up in early December 2022 when BBC Newsnight broadcast concerns about poor culture at the trust.

Within days, on 8 December 2022 the commissioner of the acute hospital service, Birmingham and Solihull Integrated Care Board announced three reviews into UHB.

The first review undertaken was a rapid review of clinical safety by Dr Mike Bewick a GP and former deputy Medical Director of NHS England, who set up a private consultancy after leaving NHS England, IQ4U Consultants Ltd.

Bewick was deputy to Bruce Keogh, who was formerly a consultant at UHB prior to becoming Medical Director at NHSE. Keogh’s wife remained at UHB as a medical manager.

This connection to Bruce Keogh was amongst concerns raised in a letter of 16 January 2023 by former UHB senior medics which called for a properly independent inquiry

Bewick through his company IQ4U Consultants Ltd, which appears to have no website that I could find, has undertaken a number of investigations and reviews for the NHS.

Through this company, Bewick reviewed cardiac surgery services at St Georges in 2018 after NHS Improvement gave St. Georges “support and guidance” to appoint Bewick.

Bewick’s latter role as a purported expert in safety and governance is somewhat at odds with the fact that he and others were criticised in Bill Kirkup’s report on the Morecambe Bay maternity disaster. Bewick was the then medical director for the local PCT and chaired an odd “Gold Command” response to the trust’s governance problems, under SHA directions. The Kirkup team saw little value in this misapplication of an emergency major incident procedure to ongoing governance issues, which served to burden the trust. For example:

“1.95 On 3 October 2011 the SHA, which had continued to regard the supposedly coincidental nature of the previous incidents as evidence that there was no systemic problem up to 10 September 2011,100 called a ‘Gold Command’. The intention appears to have been to offer support to the Trust in responding and accessing additional staffing, but the evidence we heard suggested that it served as much to distract senior staff in the Trust, who had to brief twice-weekly Gold Command meetings. We could find no evidence of defined exit criteria to underpin the closing down of Gold Command by Cumbria PCT, and it was not clear exactly what had been achieved when this was done. Overall, we were unconvinced that this represented the best way to address the situation.”

The Rosser Fiction

On 18 November 2022, UHB and the ICB both announced that David Rosser the controversial former CEO of UHB was stepping down for a new regional role as strategic director of digital health and care.

This was a fiction.

Rosser may have relinquished his role as UHB CEO, but he never left UHB and remained an UHB employee. He was merely “hosted” by the ICB, answering to the ICB’s CEO.

Through an FOI response of 16 February 2023, the ICB eventually admitted that Rosser had never departed and had remained employed by UHB all along.

This fact was not revealed until it was briefly alluded to in a BBC Midlands clip days before Bewick’s phase one report was published on 28 March 2023, and then covered on BBC Newsnight on the day of publication.

Information shared with Mike Bewick by the ICB

I asked Birmingham and Solihull ICB for clarification on whether Mike Bewick was informed of the fact that Rosser had NOT left UHB as publicly announced by UHB and the ICB.

The ICB answered evasively and avoided my questions.

After I pressed the matter, the ICB finally replied “Yes” to all three of the following elements of this question:

“Did the ICB inform Mike Bewick upon appointing him, to undertake the phase 1 rapid review into UHB, that David Rosser:

a) Was still employed by UHB?

b) Was “hosted” by the ICB?

c) Was reporting to the ICB CEO?”

That is to say, Mike Bewick has apparently known since early December 2022 that David Rosser was still a UHB employee, and had not left the trust as claimed by UHB and the ICB.

This is the ICB FOI response of 5 May 2023.

I am not surprised that the ICB was reluctant to reveal this information.

A number of questions arise.

Has Bewick investigated the misleading claims by UHB and the ICB?

If not, why not?

This is in the context that Bewick’s investigation terms of reference were unlimited and allowed him to go where the evidence took him.

Why did Bewick not comment on the irregularity in his rapid review report on UHB?

Was he unwilling to criticise the ICB, who commissioned his services?

Or did Bewick see nothing wrong in the way that UHB and the ICB misled the public and partner agencies?

For example, Healthwatch Birmingham have indicated to me that they received only the official briefings that Rosser was stepping down from UHB and knew nothing of Rosser’s continued employment by UHB.

Does the fact that Bewick did NOT report the Rosser fiction raise a concern about his role as an investigator of UHB’s governance?

This is not the only omission from Bewick’s rapid review report.

For example, he deviated from his terms of reference in respect to the UHB staff suicides and left serious unanswered questions.

Bewick also did not examine UHB patient complaint patterns in his report, yet claimed that the trust was “safe” overall.

He repeated the claim to the BBC:

“We haven’t found any evidence that the trust is in disarray in terms of clinical safety.”

The word “any” is troubling given issues such as recurrent haematology never events, A&E delays and such unsafe staffing that the CQC issued a warning notice in December 2022 at Good Hope Hospital. Revisiting Bewick’s report, it is clear that he knew about the warning notice, page 27: “Good Hope Hospital is the only one with a CQC regulatory notice at present (S29a for quality of healthcare requiring significant improvement, issued in Dec 2022”, but he claimedthat mitigation was in place.

Moreover, FOI evidence obtained from local Healthwatch questions Bewick’s denial of safety issues. It revealed marked and ongoing escalation in concerns from the public, with monthly meetings with the CQC to reflect this.

Bewick also did not call up medical staff suspension, NCAS(PPA) referral stats or quote full GMC referral and outcome stats in his report, despite major concerns in these areas.

Bewick’s lack of data on suspended and disciplined UHB doctors, despite complaints of medical management cronyism

Bewick, the ICB, misinformation by UHB about GMC referrals and a late correction

But fiction did become fact in one respect. Rosser’s retirement was announced on the day that Bewick’s report was published.

In a theatrical flourish, Bewick told the BBC that there might be more departures. This was not in his report.

But then neither was a reported claim that Bewick would be happy for his family to be treated at UHB, parroted by the hapless ICB CEO David Melbourne at a Joint Health Overview and Scrutiny Committee in February after briefing by Bewick.

What is needed is not theatre and misdirection, but facts and the whole truth.

Which would likely lead us to bad government policy and unsafe staffing.

Which is ultimately what so many NHS staff have been whistleblowing about. And so many compromised senior NHS managers with fat salaries and pensions have been trying to obstruct them, and are often richly rewarded for such efforts.

So, the ICB confirmed that Bewick knew from early December 2022 that Rosser had NOT left UHB’s employ. But Bewick kept mum.

Does that suggest that the reviews are a face-saving confection?

One thought on “UHB: Bewick was aware of the Rosser fiction, but it did not feature in his investigation report”

Square777 says:

May 6, 2023 at 10:10 am

Face saving confection is what all NHS organisations and regulators are generally about. Prioritising their reputations and careers ahead of patient safety.
As your article amply illustrates, the NHS and associated regulators, is all one giant, inbred family – all looking out for each other and leaving the back door open.
But who is actually looking out for the patients and standing up for their rights?? Or backing the whistleblowers when they do come forward?? That would have saved so many, from becoming drawn into the mass scandals we have now witnessed across the NHS.

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