Dr Minh Alexander retired consultant psychiatrist 31 August 2023
A kind person sent me an important BBC Wales piece covering the experience and views of an expert witness in the Letby trial, Dr Dewi Evans.
They believed it was a more profound criticism of the way our NHS is run than had been seen in any English media coverage. The article featured Dr Evans’ forthright comments about the problematic political management of our NHS, in which doctors suffered. He compared this with suppression of dissidents in the Soviet Union.
I agree that political management of the NHS is a serious barrier to transparency, improvement and patient safety. The Mid Staffs public inquiry heard evidence of how NHS senior management culture is based on not doing anything to embarrass the Minister.
Other reviews have noted how NHS managers “look up”, ultimately to the Department of Health, instead of looking “out” to patients and communities.
I posted the BBC Wales article on social media, with an English translation of Dr Evan’s comments on the Soviet-like nature of a politically controlled NHS management culture:
“What you have in the health service is a dictatorial system where the chairman of the health board is appointed by politicians. The chairman then appoints other members of the board, which are political appointments, who then appoint a chief executive , and all the way down.
“So, the system is something I believe anyone who lived in the Soviet Union would understand very well.
“That’s what’s happening – they’re completely out of control, and I’m sorry to say that people I know, like doctors and consultants, have lost their jobs because they challenged our management, and of course the health service is a monopoly so if you lose your jobs in Wales or Britain, that’s the end of your career unless you’re willing to go work abroad.
“How in heaven can something like this happen? This is something very unusual. But in terms of system, things don’t work and there are problems in every department, in every hospital where there is a lack and negligence in terms of how we are looking after patients.
“And if you make a complaint and say that the system is not good enough (the whistleblowers) there is a risk of losing jobs, as their feelings are a threat to the managers who want to keep things quiet.”
Importantly, the BBC piece also noted that Dr Evans was strongly in favour of regulating NHS managers:
“Is it necessary to regulate Health Service managers as a result of this? “Without a doubt,” said Dr Evans.”
I posted Dr Evans’ comments about political management of the NHS shortly after I had posted information questioning Robert Francis and Bill Kirkup’s media messaging that a statutory inquiry was not needed into the Letby killings. I had also pointed out that Kirkup had encountered past problems with witness cooperation in non-statutory investigations despite a claim to the media that non-compliance had not been a problem in his experience.
Statutory inquiry announced on Letby The government has now given in to overwhelming public pressure and announced a STATUTORY public inquiry into the Letby killings, so NHS managers will be compelled to give evidence. This should ideally include those who were party to a decision to apply an NDA to Tony Chambers the former CEO of the Countess of Chester Hospital NHS Foundation Trust. Ministers indicate support for statutory inquiry into Lucy Letby killings |
Unexpectedly the Titanic editor of the Health Service Journal, then descended from the clouds to elegantly respond:
“Always surprises me that people who claim to support the NHS are happy to share pieces that give succour to its critics.
‘Soviet union’ my arse!”
I responded with candour but sans anatomical references. Various other parties also stepped in to engage with the buttock waver. Some tried to reason, another compassionately sent him a suggestion for haemorrhoid relief.
Sadly, the buttock waver only added:
“I wouldn’t share posts saying the MMR vaccine causes autism – and saying the NHS is like Stalinist Russia is just as misleading”
This was a heavy imputation because it was a reference to the case of a doctor who was struck off by the GMC after controversy over the MMR vaccine.
The Tory politician Jacob Rees Mogg had similarly made such a comparison when publicly attacking another doctor in 2019, and subsequently had to apologise in the glare of national media coverage.
The buttock waver then fell silent and emitted no more.
As the Healthcare Service Journal describes itself as a product for healthcare leaders, one can understand that Buttock Waver might need to be attuned to his constituency.
It is ironic that an article which criticised NHS Stalinism was followed by a repressive response.
It is also surprising given past HSJ surveys on NHS Trust CEOs, highlighting the very hostile and abusive environment in which trust CEOs are forced to work.
As in all self-respecting totalitarian regimes, the NHS hunts down and neutralises dissidents through unfair dismissals, gagging, and blacklists. Whilst along with the government, senior NHS managers have resisted a tracking database about their own misconduct, such as suggested by the 2019 Kark review, they have not objected to sharing information that results in NHS whistleblowers being blacklisted.
Between those who would tear down our NHS, and those who think they defend it by deterring debate about its faults, lies a reasonable ground of open learning, efficiency and improvement.
The NHS should stop using the blunt instrument of crude terror against its workforce, and should also dispose of its unfair disciplinary processes which have more in common with the Spanish Inquisition than modern HR practice.
Gulags need to give way to glasnost.
Part of the instruments of terror is the public protection of senior wrongdoers, which sends a very chilling message the workforce.
There is no end to the number of inappropriately recycled, failed NHS managers and bullies. A particularly egregious case was that of Paula Vasco-Knight former Devon NHS trust CEO who an Employment Tribunal determined had harmed nepotism whistleblowers Clare Sardari and Penny Gates.
After resignation from her post as trust CEO, Vasco-Knight was helped by NHS regulators and given harbour by Kevin McGee at East Lancashire Hospitals NHS Trust.
The Nursing and Midwifery Council and the Care Quality Commission batted off concerns about her misconduct and fitness.
She was then appointed as interim CEO at St Georges.
In a past social media exchange, the buttock waver agreed with another party that Vasco-Knight should be given a second chance:
Very shortly after being appointed as interim CEO at St. Georges, Vasco-Knight was charged and later convicted alongside her husband Stephen of defrauding the NHS. Vasco-Knight and her husband claimed they could not repay the full amount stolen. According to the NHS Counterfraud Authority, a proceeds of crime investigation revealed “assets that the couple had not previously volunteered to tell NHSCFA about, namely personal pensions”.
The cycle in Devon appears to continue.
Clare Sardari has asked her local ICB, Devon, to confirm reports of a controversial interim ICB CEO appointment, Allison Williams.
Williams was CEO of Cwm Taf Health Board and resigned after a maternity scandal, and controversially received a golden goodbye of £131,000.
This is the report of an invited review by the RCOG, commissioned by the Welsh government into the Cwm Taf maternity deaths scandal:
The RCOG concluded there had been “suboptimal” management, under-reporting of serious incidents and a lack of “basic governance”.
An important prior investigation report was not properly disclosed to RCOG investigators by the Health Board:
“An earlier report, prompted by the identification of the unreported SIs, was submitted to the Health Board in September 2018. This review was undertaken by a consultant midwife. The report provides an in depth review of the shortfalls of the service and has produced very similar findings to this report. The existence of this 2018 report was only discovered and made available to the assessors when on site. The significance attached to this report by the Executive Team and what actions have been initiated remains unclear.”
The RCOG found concerns about poor team working and probity in how managers were appointed, which the Health Board had reportedly ignored:
“They [staff] were also concerned about senior managerial posts being filled without advert or interview. They felt they had raised their concerns many times with no apparent response from the senior midwifery team or the Health Board Executive team.”
The RCOG baldly reported:
“The culture within the service is still perceived as punitive. Staff require support from senior management at this difficult time.”
Devon ICB has not responded so far to Clare Sardari’s enquiries, despite chasing. This is a reminder that she sent to the ICB on 30 August 2023:
“Please see my email below.
I am a Devon resident and would therefore would be grateful for an answer to my question below please.
– Has Alison Williams been appointed as the interim CEO of Devon ICB?
As you have stated your commitment to a citizens-led approach to health and care, I assume this also means that you will be open and transparent in your approach to questions and queries asked of you, by the residents of Devon, of which, I am one.
I look forward to your response.
Clare”
UPDATE: At the time of publication the ICB has finally responded and simply stated:
“We wanted to confirm that we have received your messages and colleagues will be in touch with a response as soon as possible.”
If it is correct that Allison Williams was appointed as interim CEO of Devon ICB, what does it say about NHS culture that the commissioning bodies are willing to recycle managers who have been criticised for presiding over punitive cultures, feared by staff?
Is that a little….Stalinist? Da.
And why has there been no announcement of Williams’ appointment?
Did NHS England realise, in the face of the public outcry over NHS managerial probity after the Letby verdict, that appointing yet another failed NHS executive would attract political shrapnel?
An FOI has been submitted.
I have also shared my recent experiences with BBC Wales and Dr Evans.
I did wonder about pitching this article to HSJ but on mature reflection decided against it.
UPDATE 1 SEPTEMBER 2023
Devon ICB Comms have today written to Clare Sardari to confirm that the ICB did indeed appoint Allison Williams the former CEO of Cwm Taf Healthboard who left in storm of controversy over badly handled baby deaths and bullying in maternity services, as the new interim CEO of the ICB. HOWEVER, it is reported that she has decided not to take up the post. It also revealed that Williams has in fact been working for Devon ICS for the past two years:
“Allison Williams has been working with the Devon system on a part-time basis for the past two-years supporting the recovery programme. In the interest of continuity of delivery and with the full support of the NHS Devon Board and local NHS Trusts, Allison agreed to extend her support to cover the interim CEO responsibilities for the brief period between Jane leaving and the new substantive CEO starting.
The proposed arrangements were communicated internally to staff in mid-August but no external announcement was made pending confirmation of the shortlist for the substantive post and the full suite of interim arrangements.
In the intervening period, circumstances have changed, which mean that Allison, who lives in Wales, is regrettably unable to commit to being present in Devon full-time as required of her in the role and as such will not be taking up the interim CEO position. Allison has been discussing this with colleagues over the last couple of weeks.
Interim cover arrangements will be confirmed in due course.”
Was the Letby verdict and public outcry about poor NHS management appointments in any way a contributing factor?
The full response by the ICB can be found here.
UPDATE 5 SEPTEMBER 2023
Amusingly, after Buttock Waver’s little display of peevishness, his organ has today covered the story about Allison Williams pulling out of the Devon ICB job.
And the attribution printed at the end of the HSJ article? “Information provided to HSJ”.
RELATED ITEMS
Dr Dewi Evans has also criticised the Countess of Chester Hospital manager for commissioning a report from the RCPCH which excluded a review of case notes. This was a bizarre omission. One has to ask whether the RCPCH was right to accept the commission on these terms.
Destructive managerialism in the NHS has been criticised by many over a prolonged period. Here is one significant example from 2012 by Prof Jarman:
When managers rule Patients may suffer, and they’re the ones who matter, BMJ Editorial December 2012
There has been a cacophony of panicky messaging following the Letby murder verdict. Folks rushing about claiming that a statutory public inquiry is not needed, then swaying in the winds of public opinion, others U turning on trenchant resistance to disbarment of NHS managers for serious misconduct and managerial regulation. Some deflected attention to a voluntary charter for candour in public life after the Chester families signalled that they are seeking mandatory reporting. Fortress Department of Health has skilfully seen off many a past serious challenge and crisis. But will the naked failure of managerialism at the Countess of Chester prove too much even for the Denial Machine to contain?
Lucy Letby murders: Countess of Chester Non Executive Director James Wilkie
Waste Industry: The NHS disciplinary process & Dr John Bestley
The Dismissal of over Ten Thousand NHS Staff via ‘Some Other Substantial Reason’
Alexander's Excavations 
You have my admiration for engaging with, and then responding to, less than constructive responses to the current NHS scandal, the result it seems of many long-standing, unattended problems.
I really am doing my best to exercise self-discipline, but I do wish the personnel involved would focus on the issues instead of their ‘positions.’ Nevertheless, one indulgence – please pass on my sympathies to Mr McLellan who seems to be showing signs of deep distress. I do hope the caring NHS can provide him with some relief – or at least cover it up!
Btw, if it helps I have my smudge stick to hand.
Inevitably, this sad affair has brought up records of previous unsatisfactory events – let’s hope that the Inquiry will address at least some of the reasons and suggest their remedies and that, against the odds, they will be applied.
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