Mr Hancock’s violence reduction plan, reportable injuries to NHS mental health staff & lack of consistent reporting by CQC

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 20 March 2019

Summary: In 2017 The government stopped central collection of data on assaults against NHS staff despite a rising trend and much criticism. A year later, it backtracked and announced a violence reduction strategy which included a promise that the CQC would scrutinise NHS trusts’ violence reduction plans. Three datasets show that NHS mental health services staff have suffered the highest rate of assaults. The Health and Safety Executive has supplied FOI data on statutory staff injury reports (RIDDOR) by NHS mental health trusts, which shows that since April 2015, 20 mental health trusts accounted for 67% of all the non-fatal RIDDOR injury reports. According to other FOI data, these 20 trust were mostly higher users of physical restraint, with very marked variation in the rates of resultant injury to staff and patients. However, the physical restraint data they supplied was incomplete and patchy. This raises questions about the governance and regulation of this area.  The most recent CQC inspections on these 20 trusts do not report reliably on violence against or injuries sustained by staff.

 

 

BACKGROUND

Amidst condemnation, the government stopped collecting central data on violence against NHS staff in 2017.

This was despite a steady escalation over several years in the number of assaults on NHS staff and questions in parliament about this.

Philip Dunne the then DH Minister of State stated in a written answer to a parliamentary question:

“We continue to collect data on physical assaults against NHS staff through the annual NHS staff survey, with trusts also collecting data at a local level, and we are making crucial legal changes to ensure those who are violent face the full force of the law.”

Some might think this disingenuous because the NHS staff survey does not give a precise idea of the number of assaults against NHS staff, not least because of incomplete response rates. Since 2012 the survey has only asked:

“How many times in the last 12 months have you personally experienced violence at work from patients/ service users, their relatives or members of the public:

  • Never
  • 1-2
  • 3-5
  • 6-10
  • More than 10”

 

Included in Dunne’s written answer is this table, which he claimed was evidence of stability in the level of assaults against NHS staff:

Screenshot 2019-03-20 at 11.09.11

 

In fact, over the last 10 years the NHS staff survey source data shows an overall increasing trend in the numbers of assaults on NHS staff by the public:

ANHS staff survey data violence

According to NHS staff survey data, NHS ambulance trust and mental health trust staff are most likely to experience violence:

ANHS Staff survey MH and ambulance trusts

NHS Protect’s pre-2017 national data collection regularly showed that mental health services had the highest rate of assaults per 1,000 staff. These are the figures for 2013/14 which show that mental health trusts had almost 10 times more assaults per 1,000 staff than all other NHS trusts combined (223 assaults per 1,000 staff per year vs 23 assaults per 1,000 staff).

Screenshot 2019-03-20 at 07.35.29

In early 2018, an FOI by the Health Service Journal on behalf of Unison to 181 NHS trusts suggested that the number of reported assaults against NHS staff had increased by 10%, from 51,447 in 2015/16 to 56,435 assaults in 2016/17.

The FOI gave the following figures for assaults in different types of NHS trust in 2016/17, and HSJ compared it against figures from 2015/16 which had been collected by NHS Protect:

TYPE OF NHS TRUST 2016/17

(FOI data from 181 NHS trusts)

2015/16

(NHS Protect data on the same trusts)

Acute* (104 trusts) 18,720 15,469
Mental Health* (39 trusts) 33,820 32,746
Ambulance (9 trusts) 2,330 2036
Community (13 trusts) 860 708
Specialist (15 trusts) 532 416
TOTAL 56,262 51,375

*Includes combined trusts with community services.

Based on its sample of 181 trusts, HSJ commented that mental health services are:

“…by far the most physically dangerous place in the NHS to work. Staff in mental health trusts are approximately seven and half times more likely to be attacked than staff in other NHS trusts.”

By October 2018 the government managed the controversy about its decision to stop national collection of violence statistics by announcing a strategy to reduce violence against NHS staff. In a speech the Secretary of State promised:

  • New legislation: The Assaults on Emergency Workers (Offences) Act 2018 which covers NHS workers as well as other services such as the police and fire services
  • Cooperation by the police and CPS to ensure that violence against NHS workers is prosecuted
  • Resumed national collection of statistics
  • Specific regulation: “CQC will scrutinise NHS trusts’ violence reduction plans”

 

HSE RIDDOR DATA FOR NHS MENTAL HEALTH TRUSTS

The Health and Safety Executive collates data reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013.

Reporting by ‘responsible persons’ (usually the employer) is mandatory.

Annual HSE RIDDOR statistics suggest that working in health services is moderately risky, and carries a greater risk of reportable non-fatal injury than construction or mining and quarrying:

Screenshot 2019-03-20 at 09.13.50

In mental health, injuries to staff can be linked to poor management of patient aggression and violence through failures of risk assessment, prevention and de-escalation, or physical restraint which goes wrong.

Factors such as insufficient staff numbers, over crowding, poor physical environment, lack of therapeutic support services and inappropriate skill mix can contribute to some of these problems.

Where mental health staff suffer injuries related to violence by patients, a concern also logically arises about the care of patients.

I asked HSE for information on recent RIDDOR reports about NHS mental health trusts, including deaths. All deaths due to work-related accident must be reported under RIDDOR, whether the deaths of employees or members of the public.

 

HSE provided data on:

Accidents must be reported where they result in an employee or self-employed person being away from work, or unable to perform their normal work duties, for more than seven consecutive days as the result of their injury.”

 

Fractures, other than to fingers, thumbs and toes

Amputation of an arm, hand, finger, thumb, leg, foot or toe

Any injury likely to lead to permanent loss of sight or reduction in sight in one or both eyes

Any crush injury to the head or torso, causing damage to the brain or internal organs

Any burn injury (including scalding)

 

But no data was provided on deaths. I will pursue this.

The full spreadsheet of raw data disclosed by HSE can be found here.

The data was analysed after removing a few instances of data from acute NHS trusts which had been wrongly included.

Since 1 April 2015, there have been a total of 3,992 ‘over 7 day’ absences and 761 specified injuries sustained by NHS mental health staff that have been reported to HSE.

The summary RIDDOR injury statistics for mental health trusts can be found here.

This is the distribution of non-fatal RIDDOR injuries in NHS mental health services over time:

YEAR Number of over 7 day sickness absences Number of specified injuries
2015/16 1,055 168
2016/17 989 209
2017/18 1,114 209
2018/19 year to date 834 175
Total 3,992 761

Unsurprisingly, HSE advises that there is under-reporting of RIDDOR incidents, so the real figures are higher

Over the period 2015/16 to 2017/18, NHS Mental health trusts accounted for 15.4% (3744 of 24212) non-fatal RIDDOR injuries to employees in Human Health Activities.

There was considerable variation between different NHS mental health trusts.

The number of significant, specified injuries in the period varied between 47 at Lancashire Care NHS Foundation Trust, and zero.

Below are the 20 mental health NHS trusts which had the most RIDDOR non-fatal injuries. These trusts accounted for 67% (3182 of 4753) of RIDDOR non-fatal injuries to staff since April 2015.

Screenshot 2019-03-20 at 13.00.18

The variation may be explained partly but not wholly by size of trust. ‘Outstanding’ East London NHS Foundation had a total of 233 RIDDOR injuries, but South London and Maudsley NHS Foundation trust which is the same size had 130 RIDDOR injuries.

Mersey Care NHS Foundation Trust is equivalent in size to Leicester Partnership NHS Foundation Trust, but had three times as many absences over 7 days.

Mersey Care NHS Foundation Trust runs Ashworth Hospital, which has high secure 228 beds. Nottinghamshire Healthcare NHS Foundation Trust runs Rampton Hospital, which has 357 high secure beds and West London NHS Trust runs Broadmoor Hospital, which has 240 high secure beds.

However, it is unclear to what extent specialist secure services account for higher numbers of absences over 7 days.

For example, Hertfordshire Partnership is a smaller trust and has  30 medium secure beds  but racked up 133 non-fatal RIDDOR injuries compared to 84 at Greater Manchester Mental Health NHS Foundation Trust, which has 118 medium secure beds.

Neither do the RIDDOR injuries seem to be consistently associated with rates of physical restraint.

Examination of FOI data from 2016 on physical restraint of patients in mental health trusts, obtained by Norman Lamb’s office, shows very inconsistent recording of information on use of restraint and restraint-related injuries to staff and patients in the above 20 trusts. Anomalies in the data raise questions about the quality of data provided.

Where data was provided by any of the above 20 trusts, this broadly showed high use of physical restraint compared against the mean (3926 episodes of restraint) for mental health trusts in that period (based on 48 trusts who provided information). The exceptions were Barnet, Enfield and Haringey Mental Health NHS Trust and North East London NHS Foundation Trust, so it is interesting that these trusts were amongst the 20 that generated high numbers of RIDDOR injuries despite reportedly lower levels of physical restraint.

 

There was marked variation in the proportion of restraint episodes that resulted in recorded injury to staff or patients. If the figures are to be believed, the chances of injury to a member of staff taking part in physical restraint at Nottingham Healthcare NHS Foundation Trust and Mersey Care NHS Foundation Trust was an eye watering 41% and 32.5% respectively.

This purportedly fell to only 2% of restraint episodes resulting in staff injury at Lancashire Care NHS Foundation Trust. But a question arises about this because Lancashire Care racked up the highest number nationally of significant, RIDDOR specified injuries to staff.

Other dubious statistics are Lancashire Care’s claim that zero patient injuries resulted from 7,371 episodes of restraint, and Southern Health NHS Foundation’s claim that only two patient injuries resulted from 10,398 restraint episodes.

The poor and incomplete data on restraint and its consequences and marked apparent variation in rates of resultant injuries suggest that this is a poorly governed and regulated area. But the level of variation does raise questions on whether some of the injuries might be avoidable.

Current CQC inspection reports on the 20 trusts with the most non-fatal RIDDOR injuries do not consistently mention violence against staff and give little hard data about assaults.

The CQC reports also do not refer to staff injuries, (from a search under ‘injury’, ‘injuries’ and ‘RIDDOR’), except in three instances.

At Mersey Care NHS Foundation Trust the CQC observed:

“At core service level, we saw that managers had access to monthly ‘dashboards’ that illustrated their team’s performance in a number of areas. These areas (or key performance indicators) included mandatory training, patient experience scores, staff sickness, staff injuries, patient harm and other incidents.”

At Coventry and Warwickshire Partnership NHS Trust  the CQC observed:

“The trust had not addressed the issue of access in to the seclusion room through an area which was too narrow for staff and patients to enter without the potential for injury.”

“The trust must ensure that changes are made to the seclusion room to prevent the risk of injury to patients and staff.”

At North East London NHS Foundation Trust the CQC observed:

“However, the majority of incidents involving patients physically attacking staff were recorded as ‘no harm’ despite many staff receiving injuries.”

At South London and Maudsley NHS Foundation Trust the CQC commented on injuries to patients due to restraint, but not staff injuries:

“The trust should ensure staff record incidents of restraint accurately including the type of restraint, position of restraint, members of staff involved, length of time the restraint took place and whether the patient received a physical health check for any injuries post restraint.”

In an inspection report of 1 March 2019  on Kent and Medway NHS and Social Care Partnership Trust, published after the Secretary of State promised that CQC would target violence against NHS staff, CQC made no mention of such matters.

It would seem that CQC is either not consistently examining and or reporting on violence and injuries to staff in NHS mental health services.

So much for the government’s promise that CQC would help enforce violence reduction. But it is not surprising because the government has form for waving the CQC about tokenistically, to defuse political pressure.

This data will be submitted to parliament and I will draw CQC’s attention to the RIDDOR data for mental health trusts.

 

CORRESPONDENCE TO PARLIAMENT & CQC 21 MARCH 2019

Joint Committee on Human Rights

21 March 2019

Dear Ms Harman and colleagues,
HSE RIDDOR staff injury data for NHS mental health trusts 2015/16- 2018/19 YTD
With respect to the Committee’s recent work on the detention of children and young people in Learning Disability Units and conditions in inpatient learning disability units, I write to forward some data on reportable injuries to mental health NHS trust staff. The data shows substantial variation and adds to questions about whether there could be better staffing and conflict management in some mental health services, which might reduce the need for physical restraint and other restrictive interventions.
This is raw data from the Health and Safety Executive:
This is the cleaned data which has been analysed by NHS mental health trust:
This is a write up summarising the data:
I copy this to Health and Social Care Committee in view of some questions raised about how effectively the Care Quality Commission is implementing the government’s recently announced NHS violence reduction strategy.
I have passed the HSE data to CQC’s Chief Inspector of Hospitals, as per the correspondence below.
With best wishes,
Dr Minh Alexander
Cc Health Committee
     Baroness Lawrence
     Baroness Nicholson
     Lord Trimble
     Lord Woolf

 

From: Minh Alexander <REDACTED>

Subject: HSE RIDDOR staff injury data for NHS mental health trusts 2015/16- 2018/19 YTD

Date: 21 March 2019 at 08:24:58 GMT

To: Edward Baker <REDACTED>

Dear Ted,

HSE RIDDOR staff injury data for NHS mental health trusts 2015/16- 2018/19 YTD

I forward this FOI raw data from HSE on RIDDOR injuries to the staff of NHS mental health trusts for CQC’s information, in the event that CQC does not track this data:

https://minhalexander.files.wordpress.com/2019/03/hse-foi-disclosure-15.03.2019-nhs-trusts-data-foi-201902233.xlsx

I assume that CQC does not track it, as HSE itself does not track it.

This is the analysed data, cleaned of some data on NHS acute trusts which was wrongly included, and broken down by individual mental health trusts:

https://minhalexander.files.wordpress.com/2019/03/riddor-reports-april-2015-to-march-2019-by-nhs-mental-health-trusts-pub.xlsx

You will see that there is great variation.

With best wishes,

Minh

Dr Minh Alexander

 

 

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Public sector gags: The wilfully blind Treasury

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 12 March 2019

 

 

Summary: HM Treasury is responsible for scrutinising special, non-contractual severance payments and related gags in the public sector. Parliament asked the Treasury in 2014 to track the pattern of severance payments across the wider public sector. However, the government has resisted this. It gave the job to individual government Departments, which have a conflict of interest in reporting such data. A most cursory inspection of Department of Health and Social Care data on severance payments and minimal cross checking against other sources raises questions about its accuracy. The Treasury was asked if it kept its own data on special payments and gags, but in an FOI reply the Treasury frostily maintained that it does not track the settlement agreements and gags that it signs off. Plus ça change.

 

 

HM Treasury talks a tough game. The relevant Treasury guidance ‘Managing Public Money’ makes robust statements about the use of special severance payments. For example:

It is good practice to consider routinely whether particular cases reveal concerns about the soundness of the control systems”

“Any proposal to keep a special payment confidential must be justified especially carefully since confidentiality could appear to mask underhand dealing.”

“Departments should not treat special severance as a soft option, eg to avoid management action, disciplinary processes, unwelcome publicity or reputational damage.”

“The Treasury adopts a sceptical approach to proposals for special severance settlements, in particular:

  • precedents from other parts of the public sector may not be a reliable guide in any given case;
  • legal advice that a particular severance payment appears to offer good value for the employer may not be conclusive since such advice may not take account of the wider public interest;
  • even if the cost of defeating an apparently frivolous or vexatious appeal will exceed the likely cost of that particular settlement to the employer, it may still be desirable to take the case to formal proceeding;
  • winning such cases demonstrates that the government does not reward failure and should enhance the employer’s reputation for prudent use of public funds.”

 

In reality, the Treasury has nodded by all sorts, as reported by the National Audit Office in two linked reports:

Confidentiality clauses and special severance payments June 2013

Confidentiality clauses and special severance payments – follow up October 2013

In its follow up October 2013 report, NAO commented:

“The Treasury has approved some severance payments, where business cases refer to failure or inappropriate behaviour. The Treasury’s guidance states that payments that reward failure, inappropriate behaviour or dishonesty should not be approved. Yet we found business cases referring to elements of alleged gross misconduct or staff harassment. These alleged behaviours do not meet the standards of the Civil Service Code. Severance terms were approved because legal advice set out that the individual would be likely to win an award in an employment tribunal and settlements would probably be cheaper and quicker and therefore a better use of resources. This may be valid for individual cases, but it may not be true for the wider public sector. For example, alternative options (such as performance management or employment tribunals) may act as a deterrent or set a precedent to reduce future claims and costs”

In a report of January 2014, the Public Accounts Committee advised that public sector settlement agreements should be tracked, because unusually high numbers of agreements “might provide an early warning of management failure”.

The Committee recommended:

The Cabinet Office guidance should set out how lessons are going to be learnt across government to prevent reoccurrence where a failure of process has occurred within an organisation.

 The Treasury should be responsible for monitoring activity across the wider public sector, and for defining what action will be taken where significant patterns or trends are identified.”

The Government broadly agreed to the above, but it rejected the proposed Treasury surveillance of pay offs and gagging. Instead, it arranged for individual government departments to monitor settlement agreements and severance payments in the wider public sector.

This seemed odd when the Treasury is the central handler and was better placed to maintain an overview. But that would assume clarity is desired.

Taking the Department of Health and Social Care (DHSC) as an example, the DHSC gives only broad figures in its annual reports for special exit packages across its departmental group (which includes central NHS bodies, CCGs and NHS trusts and NHS foundation trusts).

Across the DHSC departmental group, special severance payments have been reported as follows:

YEAR Number of departures where special payments have been made’

 

2014/15 51 payments, £2,025,270

 

2015/16  

 

41 payments, £1,222,998

 

2016/17 28 payments, £ 479,778
2017/18 30 payments, £ 653,735

 

 

These figures seem low. It is already known that there are hundreds of settlement agreements and gags applied by the NHS every year. For example, the notorious Liverpool Community Health NHS Trust  alone accounted for 157 super-gags between 2011 and 2016.

A recent BBC Four FOI reportedly found that £70million had been paid to NHS staff through settlement agreements over a five year period.

Not all settlements will be special severance payments that require Treasury approval. Some will relate to voluntary resignation schemes. But even so, the Department of Health and Social Care’s figures for special severance payments are likely to be wrong, and an underestimate.

NHS Improvement’s consolidated 2017/18 accounts for all NHS providers  (NHS foundation trusts and non-foundation trusts) shows equally low figures.

NHSI admitted to only 18 special, non-contractual payments by NHS service providers, of unspecified value:

Screenshot 2019-03-12 at 10.19.01

 

Public bodies are supposed to report special severance payments in their annual reports. A quick check of NHS bodies’ 2017/18 annual reports reveals that the Department of Health and Social Care’s special payments data cannot be fully cross checked against the data in these annual reports. The annual reports give data on exit packages in variable format, a few do not mention exit packages at all and many bodies do not specify how many special severance payments were made.

But here are some of the listed special, non-contractual severance payments in 2017/18:

Royal Wolverhampton NHS Trust – one special payment of £5,000

Cambridgeshire and Peterborough NHS Foundation trust – one special payment of £38,000

Cambridge University Hospitals NHS Foundation Trust – one special payment of £13,000

James Paget University Hospital NHS Foundation Trust – one special payment of £48,000

Essex Partnership University NHS Foundation Trust –one special payment of £10,000

Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust – 11 special payments of £50,000 total value

University Hospital Bristol NHS Foundation Trust – three special payments, of £13,000 total value

Nottinghamshire Healthcare NHS Foundation Trust – One special payment of £12,000

Oxford University Hospitals NHS Foundation Trust – One special payment of £15,000

 

So my non-comprehensive flick through NHS trust annual reports has already produced a total of 21 special payments for 2017/18, which exceeds the number of 18 admitted to by NHS Improvement. This raises questions about the validity of published government data.

The Department of Health will be asked to clarify how it comes by its data on special severance payments, but it is likely that it depends on reporting by bodies such as NHS Improvement.

To see if the vagaries of Departmental reporting could be circumvented, the Treasury was asked what data it had collated on public sector settlement agreements, severance payments and confidentiality clauses since 2013, and to disclose any such data if it was held. The Treasury was also asked if it had reviewed its approval of settlement agreements and severance payments.

The Treasury’s initial response was to claim that it would exceed the cost limits under FOIA to answer these questions.

A request was re-submitted, focusing only what data was held by the Treasury.

The Treasury has responded claiming that it has no policy of keeping data on the settlement agreements and gags that it signs off:

Screenshot 2019-03-12 at 10.21.23

So there we have it, dodgy Departmental data and a refusenik, central controller who signs off gags blindfold.

Whatever propaganda gushes forth from the government and the National Guardian about commitment to greater transparency, you can be confident that the real secrets will remain locked down.

We need overhaul of UK whistleblowing law.

 

RELATED ITEMS

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STFU not FTSU

 

 

Spinning death at Gosport: The Department of Health and the National Guardian

Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 11 March 2019

 Summary: The NHS’ obsession with reputation management is well known and very unhealthy. It is rare to get a glimpse of its inner workings. The online Gosport Independent Panel archives of thousands documents, many of which were not cited by the Panel’s report, reveal some unsavoury secrets. For example, the intense spin by the NHS in the months prior to the 2009 inquest hearings into ten Gosport deaths. Although some officials expected a finding of unlawful killing, the inquests determined that all ten deaths were from natural  causes, albeit with medication contributing to some. The instructions for spinning Gosport originated from the Department of Health, which asked to be kept informed of the NHS comms campaign: “….in the run up to, during and after the inquest”. The spin continues. The National Guardian ran a PR campaign about the (illusory) success of the Freedom To Speak Up project just before the government’s response to the Gosport inquiry was published last autumn. She is about to be deployed again this month, to lay good news about purported good practice before parliament. This is just before the police announce their decision on whether to pursue prosecutions over the Gosport deaths. The Department of Health has confirmed that it holds records of communications with the National Guardian about this good news plan, but it is trying to find a way not to disclose the data under FOIA. The institutional resistance to transparency only serves to underline that safe handling of the most serious whistleblowing matters needs to be overseen by a properly independent, statutory body that is not managed by any government department. It also raises questions about the usefulness of a new network of medical examiners that will be controlled by the NHS itself.

 

Recent spin by the Department of Health

Part of the Department of Health and Social Care’s strategy in responding to the Gosport scandal is to claim that whistleblowers will be better treated from now on. This is a typical headline generated by the government spin machine:

Gosport hospital deaths: Whistleblowers promised support

When the Gosport Panel report was published last June, the National Guardian reprehensibly claimed in a letter to the Times that: If our new system of “freedom to speak up” guardians had been in place when the nurses at Gosport spoke up they would have been listened to and the right actions would have been taken.”

Last autumn just before the Department of Health was due to publish its response to the Gosport Independent Panel’s inquiry report, the National Guardian launched a distasteful, intensive PR drive, the so-called ‘Speak Up Month”. This spun copious good news about the Freedom To Speak Up project.

The police decision on whether to pursue prosecutions for the Gosport deaths will be announced this April. By sheer coincidence, the National Guardian has been asked to lay a report before parliament on more good news about purported good practice in NHS whistleblowing.

The National Guardian’s January 2019 newsletter stated:

AHH Newsletter extract

Who asked her to lay this report before parliament?

Parliament initially denied any contact with the National Guardian. When I pointed out that the National Guardian has had meetings with Sarah Wollaston MP Chair of the Health and Social Care Committee, parliament conceded that Henrietta Hughes and Sarah had met on three occasions: 14 September 2016, 13 March 2017 and 6 November 2018.

The House of Commons has made these comments about whether Select Committees and their members are subject to FOIA:

The Committee Office, made up of clerks, committee assistants, committee specialists etc., is part of the House of Commons, and it is the information held by the Committee Office that we check when a request under the Freedom of Information Act 2000 (FOIA) is made.

 The Committees themselves are made up of individual Members of Parliament, who are NOT public authorities in accordance with the FOIA. Any information that Members hold ‘personally’ – for example, their own personal notes or diary arrangements – is out of scope for the purpose of the FOIA.

 Finally, Committee Chairs sit somewhere in the middle. The work they do in the Committee with other Members falls within the scope of what the House holds. However, they may also choose to carry out work, attend meetings or conduct research in their capacity as the Chair but not on behalf of, or under instructions from, the Committee. Some of this work may be supported by the Committee Office, in which case the Committee Office may hold information about it. When working independently in this manner, Committee Chairs may also choose to share details with the Committee Office, but they are not obliged to do so.”

I asked Sarah Wollaston on 2 March 2019 if she would be willing to disclose the records of her three meetings with the National Guardian, and await an answer.

The Department of Health and Social Care was also asked for records of any communications with the National Guardian about the proposed report for parliament. The Department is overdue in its response. It has so far confirmed that it holds the data requested, but is currently considering whether an exemption applies under Section 35(1)(a) FOIA – formulation of government policy. Or in other words, the government is likely to be embarrassed if the PR manufacturing process is revealed.

 

The Department of Health and spin about the 2009 Gosport inquests

In 2009, inquests into ten suspicious deaths at Gosport War Memorial Hospital resulted in findings that all ten were deaths from natural causes, and that where medication was considered to have contributed more than minimally or negligibly to five of the deaths, it had been given for therapeutic purposes in all five cases. In three cases – Elsie Devine, Robert Wilson and Geoffrey Packman, the inquest concluded that although medication had been given for therapeutic purposes, it had not been appropriate to the symptoms or conditions which the deceased had been suffering. See archive document CPS000047 for the inquest jury verdicts.

This must have astonished some, including the Chief Medical Officer’s team, who assumed that the coroner would find unlawful killing:

AUnlawful Killing

The Gosport Independent Panel investigation led by Bishop James Jones has since concluded that there were hundreds of deaths due to deliberate, inappropriate and clinically unjustified use of lethal levels of opiates:

 12.10 The Panel’s analysis therefore demonstrates that the lives of over 450 people were shortened as a direct result of the pattern of prescribing and administering opioids that had become the norm at the hospital, and that probably at least another 200 patients were similarly affected.”

Many staff at Gosport had expressed concern about these practices to their managers and or to the police, about what the Gosport Independent panel inquiry euphemistically termed as “shortening lives”. Some staff voiced concerns to the police about  euthanasia or deliberate killing to keep waiting lists down.

Alarmingly, there was intense news management by the NHS authorities in the months before the 2009 inquest hearings. Documents in the Gosport Independent Panel’s archives reveal considerable resources were marshalled to limit reputational damage. Trimedia, a PR firm, was hired to help manage the news about the 2009 inquest. Trimedia had been hired by the Department of Health in preceding years, as revealed by a parliamentary question in November 2008.

This news management was barely reported by the Gosport Independent Panel, although the Panel’s report devoted a chapter to “The local and National media”. The Panel’s chapter about the media largely covers what was reported by the media, and not how the authorities tried to manipulate the media.

A search of the Panel’s inquiry report produces zero hits for

“public relations”

“media relations”

or “Trimedia”

The Department of Health had previously guided and dog whistled spin about the Gosport deaths.

For example, internal 2002 DH correspondence  shows deliberations by DH comms after the Strategic Health Authority contacted the Department for advice, in relation to an enquiry from a Sunday Times journalist.

Archive document DOH000398 showed that the Strategic Health Authority had a standard form for reporting media alerts to the Department of Health, which included a box entitled: ‘Information about lines to take’.

A 2003 Strategic Health Authority document on “lines to take” on the Gosport deaths showed that the SHA was reporting back to the Department of Health on detailed planning around a File on Four broadcast.

A related, “strictly confidential” SHA email  discusses further action in response to the File on Four broadcast. This includes the comment: “…no plans to dripfeed at present”.

2006 internal Department of Health correspondence revealed an instruction to the Strategic Health Authority (SHA) to construct a comms strategy on Gosport:

“Is the SHA on top of this?”

“Push them for a comms strategy please”

In 2009, the Department of Health wanted to be kept abreast “in the run up to, during and after the inquest”.

I collate below some of the archive documents which reveal the collusion and news management by NHS bodies regarding the 2009 Gosport inquest hearings.

 

Document DOH700711 (supplied by the Department of Health):

This was correspondence by Richard Samuels Hampshire PCT Director of Corporate affairs, which reveals the confidential, key aims of a multiagency steering group to handle the inquests. It includes an intention to “preserve the reputation of local NHS services”:

APreseve the reputation of the local nhs services

Importantly, this document notes that the steering group was to report regularly to the Strategic Health Authority:

ASteering group will report to SHA

 

Document CCG100024: 

A media management ‘action plan’ of January 2009, which reveals the scale of planning and multiagency coordination, complete with plans for photo opportunities:

APhotoopportunity

 

Document SOH100588 (supplied by Southern Health NHS Foundation Trust): 

This lists 32 individuals who were part of the “GWMH inquest project group”, including personnel from the law firm Mills and Reeve, Hampshire PCT comms team, Trimedia PR consultants, Portsmouth Hospitals NHS Trust staff and its comms team, Portsmouth City Teaching PCT and Hampshire Partnership Trust.

 

Document CCG100018: 

This was a “GWMH inquests – Communications Protocol Pack”. This document states that a “proactive approach” to the media would be coordinated.

 

Document DOH700738 (supplied by the Department of Health):

This records that Trimedia (represented by Julie Dean and Caroline Searle) and Mills and Reeve solicitors set to work on the inquest in October 2008, some six months before the inquest hearings were held.

A trade union, the RCN, was represented in the process. According to this document, Betty Woodland (BW) RCN Lead Steward brought along disclosure papers from one of the original Gosport whistleblowers, Sylvia Giffin.

Another related archive document, MRE000701,listed the RCN members who would be giving evidence to the inquests.

 

Document PHO103758 (supplied by Portsmouth Hospitals NHS Trust): 

This documents sets out the following strategic aims for the multiagency comms plan:

APublic Confidence

 

 

Document DOH700718 (supplied by the Department of Health):

This was a briefing by Trimedia for NHS managers on a meeting with BBC journalists on 2 March 2009. The action plan generated includes a pre-recorded interview in advance of the inquest verdicts:

APrerecorded inteview ahead of verdict

 

 

Document MRE000782 (supplied by Mills and Reeve): 

This document revealed some tactical considerations regarding the inquests and it discussed methods for bringing the media ‘onside’:

AOnside

Document DOH101771 (supplied by the Department of Health):

This document noted that a media tour of the hospital had been arranged as planned, for three BBC journalists, with support from Trimedia:

ABBC Tour

The same document revealed steering group discussions about ‘vulnerable areas’ at inquest, and the need for additional cover from Trimedia on days when Dr Jane Barton and Gill Hamblin were giving evidence:

AVulnerable areas

 

Document SOH001158 (supplied by Southern Health NHS Foundation):

Minutes of an inquest steering group meeting noted that “positive stories” were being fed to the media.

APositive Stories

 

Document MRE000244 (supplied by Mills and Reeve solicitors):

This showed how the different organisations worked together to get a single story which could be presented to the coroner:

ASingle document for coroner

The inquest steering group sought to defend events at Gosport by advancing an argument that what happened was ‘common practice’:

ACommon Practice

The document also showed that a witness statement by Lesley Humphreys, formerly Quality Manager and later Operations Manager was crafted by committee:

ALesley Humphreys statement by committee

 

Document PHO000072:

This document additionally shows how Lesley Humphreys’ statement was developed, and that the Strategic Health Authority was involved.

 

Document DOH700721 (supplied by the Department of Health):

This was the confidential media spokesperson pack generated by the steering group, which included a list of “key words” that were important in crafting the right messages:

AKey words.png

Parts of this document are redacted, so who knows what other objectionable material lurked within.

 

Document MRE001669 (supplied by Mills and Reeve solicitors):

This was a briefing pack for NHS staff who were scheduled to give evidence at the inquests. It included a media statement, showing the direction of organisational spin:

AMedia statement for staff giving evidence

 

Document PHO000070: 

This included discussion of whether, in the context of the comms strategy, there was any conflict between the interests of NHS bodies and the doctors or the NMC.

AMPS NMC

 

 

Document MRE000233 (supplied by Mills and Reeve solicitors):

This refers to preparation of a coordinated approach, to ‘counter’ police expert witness evidence:

ACounter police expert evidence

This document also reveals an intent to coordinate what media line Dr Jane Barton’s lawyers and the NHS authorities would take on her management:

ABarton's management

Last but not least, there is an email trail in the archives that appears to show Dr Jane Barton’s direct involvement in the inquest preparations, and communications between her medical practice and the Trimedia public relations firm:

Document FMC000058, supplied by Forton Medical Practice:

ABarton suggests Trimedia

So there you have it, a continuous thread running from Jane Barton all the way up to the Department of Health.

A later document showed that Trimedia staff were still involved in August 2009, regarding briefing about Dr Jane Barton’s Fitness to Practice proceedings at the GMC.

One wonders if given these industrial levels of official manipulation, the forthcoming network of medical examiners which will be under the control of the NHS has much of a chance.

The Bishop hardly commented in his Panel report on the news management by the NHS.

The only sections of the Panel’s report I could find which cited the above documents were these:

 

8.119 Despite hoping that the Coroner would not issue a Rule 43 letter, the Trust was keen to ensure that, pursuant to Rule 43, some evidence was heard during the course of the inquests about the present state of the hospital and how things had improved. In July 2008, an inquest ‘steering group’ was set up with the aim of managing the “Coroner’s inquests effectively in order to maintain the continuity, quality and confidence of local people in health services in Gosport” (MRE000260, p1). The steering group met on a number of occasions and received input from the solicitor for the Trust. The topics discussed at meetings included the approach of the Coroner to the inquests (MRE000647, p2), the communication strategy (MRE000244, pp1–2) and the best approach to addressing, through evidence, any potential Rule 43 issues (MRE000244).”

4.90 Correspondence in the period between 2008 and March 2009 shows that Portsmouth Hospitals NHS Trust and Hampshire PCT were focused largely on preparations for relevant inquests (DOH602073, DOH602082, MRE000782, MRE000780, DOH603144, MRE000211, MRE001459, MRE001646, MRE001678, MRE001638, MRE001615, MRE001600). Although the correspondence refers to some relevant matters in passing, there is no evidence that consideration was given to any further investigation of previous clinical failures at the hospital or the mishandling of the nurses’ concerns. The GMC and the Coroner continued to take action, and this is covered in later chapters.”

 

 

Neither did Tom Kark address the toxic role of the Department of Health in driving poor culture in his recent FPPR report. This was despite his acknowledgment of the Department’s role in his previous capacity as Counsel to the MidStaffs Public Inquiry.

But their reticence does emphasise that reviews and investigations under the umbrella of conflicted government departments are hardly likely to reveal everything.

For effective whistleblowing governance and public protection, nothing less than a fully independent statutory body that reports to parliament and not governments, will do.

 

RELATED ITEMS

Southern Health Foundation NHS Trust was one of the successor bodies of Hampshire PCT, and took over Gosport War Memorial Hospital. Southern Health carried on the tradition of neglect by failing to investigate hundreds of deaths of mental health patients.

Katrina Percy, the much criticised chief executive of Southern Health NHS Foundation Trust was involved in the aftermath of the Gosport deaths. For example, this is a letter by Percy to the NMC, which traces the subsequent movements of the nurses involved in the Gosport affair: Document NMC100113

Gosport archive document FMC000051: the business card of Julie Dean Trimedia senior consultant, supplied to the Gosport Independent Panel by Dr Jane Barton’s medical practice:

ATrimedia business card

 

Letter to parliament 29 September 2018: UK government doesn’t track whether whistleblowers’ concerns are addressed

Questions about coaching of staff who gave evidence to the Gosport inquests and the Department of Health and Social Care’s role in promoting spin

Gosport deaths, UK government pork pies about whistleblower protection and failure to investigate concerns

Evidence to parliament about the Kark FPPR Review

What could a new whistleblowing law look like? A discussion document

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

There’s still club culture at the heart of CQC

Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 9 March 2019

 

In advance of the Health and Social Care Committee hearing on the Kark FPPR review report, on what should be done about poor NHS managers, I have written to the Committee about the CQC’s incestuous mechanism for assessing the Well Led domain.

The Kark FPPR review team observed a CQC ‘Well Led’ inspection and that part of the Kark report is well worth reading (see from 4.45 onwards).

Kark remarked witheringly at 4.24:

This is not intended as criticism of the CQC, but it underlines the issue which is that the assurances given by the CQC via their ‘Well-Led’ rating, if based (as in part they are) upon the Trust’s application of the FPPT, may be optimistic and in this respect at least not well-founded.”

However, Kark did not comment on who conducted CQC’s ‘Well-Led’ inspections, but it is often the directors of other NHS trusts. I found this through a formal analysis in 2016. A brief glance at CQC’s recent inspection reports shows little change.

The awkwardness that this introduces into executive peer relationships and the potential for bias and backscratching are plain. The issues are summarised below in the letter to Health and Social Care Committee.

 

LETTER TO HEALTH AND SOCIAL CARE COMMITTEE 9 MARCH 2019

Dear Dr Wollaston and colleagues,

FPPR and potential conflicts of interest due to NHS Trust directors inspecting each other’s ‘Well Led’ domains

I omitted in my evidence to the Committee for the hearing on the Kark FPPR Review report to make this point.

An analysis that I previously conducted on this was kindly published by Open Democracy in September 2016:

Is there a ‘club culture’ at the heart of the NHS’s quality regulator?

In addition to NHS trust directors chairing CQC inspections of each other’s trusts, there was also an issue of managers from the private sector chairing inspections on the NHS and thus gaining access to market intelligence.

I have not repeated a formal analysis but my impression is that not much has changed, and that CQC inspections remain incestuous. There is a development in that CQC now sometimes fields so-called ‘executive reviewers’, instead of inspection Chairs, who are also drawn from other trusts’ boards.  Some CQC reports hide the identity of these ‘executive reviewers’.

I provide some specific examples below if needed.

Yours sincerely,

Dr Minh Alexander

Cc Tom Kark QC

Jane Russell

 

 

EXAMPLES

The Royal Wolverhampton NHS Trust

The latest CQC inspection report  on Royal Wolverhampton hid the identity of the ‘executive reviewer’ for the Well Led domain:

ARoyal Wolverhamton

This CQC inspection concluded that the Royal Wolverhampton NHS Trust was “Good” on the Well Led domain.

There has been significant controversy surrounding the chief executive of this trust in respect to a string of whistleblowing cases. For example the case of Prof David Ferry who gave an account of his ordeal to BBC File on Four in 2017:

Somebody entered my office and wrote racist graffiti on the wall, smashed my precious family photographs.”

 “It is very worrying and my eldest daughter was doing her GCSEs at the time and my wife is black, of course, and you have to consider carefully what you do. I think that some people were hoping I would react to that and say perhaps some inappropriate things, which would give them an excuse to suspend me or exclude me, but I think I managed that difficult episode with more control and dignity than I thought I might in the first days after it occurred.”

“Things were deteriorating, and after a particularly difficult day in the department, there was a lot of upset and that night, when I went to my car, there was a sticker on my car that said ‘Death to the bastard Geordie whistle-blower.’ You think, this is getting very difficult. And shortly after that, it was decided there was going to be an external inquiry into rectal radiotherapy treatments in the Trust. Ultimately, that inquiry by national level experts in rectal cancer supported my perspective.”

Prof Ferry was referred to the GMC, as Raj Mattu had been before him, and also exonerated:

Wolverhampton’s New Cross Hospital cancer scandal: Cleared after four-year fight! Victory for NHS whistle-blower

It is also worth noting that CQC previously misrepresented a critical finding in an inspection report that was related to Prof Ferry’s whistleblowing case. When Prof Ferry questioned this, Mike Richards the then CQC Chief Inspector reportedly maintained that the misrepresentation was due to a typo:

When the report came out, the CQC report, I read it and it said in the report, the first version of the report, that the chemotherapy the patients had received had been standard. In other words, there was no error made. Now when I raised this issue, there was a lot of fuss, the report had to be rewritten and Sir Mike Richards, who heads the hospital inspection process, stepped in and said there had been a typographical error, so that was very interesting.”

 

University Hospitals Bristol NHS Foundation Trust

 UHBT was rated ‘Outstanding’ by the CQC in 2017 despite renewed controversy in recent years about baby heart deaths and calls for another Bristol heart public inquiry.

The 2017 CQC inspection (which is the most recent) was chaired by Dr Andrew Welch, Medical Director of Newcastle Upon Tyne Hospitals NHS Foundation Trust:

Screenshot 2019-03-09 at 07.57.57 

Colchester University Hospital NHS Foundation Trust (now known as East Suffolk and North Essex NHS Foundation Trust)

The most recent CQC inspection report  shows that the ‘executive reviewer’ Dr Sean O’Kelly who was at that point the Medical Director of University Hospitals Bristol NHS Foundation (UHBT).

ASean OKelly

As above, UHBT has been at the centre of controversy about more baby deaths.

Dr O’Kelly moved to NHS Improvement last summer:

“We’ve appointed Dr Sean O’Kelly as our Medical Director for Professional Leadership to work alongside clinical leaders and improve the way we engage with clinicians.

In his new role, Dr O’Kelly will help ensure effective engagement between NHS Improvement and front-line clinicians. He’ll work as part of a team to provide clinical and professional guidance across NHS Improvement and the sector to help support the continued professional development of clinicians. He will also be working closely with commissioners, patient groups and providers to encourage innovation and support the development of new service and care models.”

 Birmingham Women and Children’s NHS Foundation Trust

The most recent CQC inspection was chaired by Dr Michael Anderson, the Medical Director of the Chelsea and Westminster Hospital NHS Foundation Trust:

AMichael Anderson

Brighton and Sussex University Hospitals NHS Trust

 BSUH has had stricken governance for years now and the flow of coroners’ warning PFDs has not stopped.

However, it was unexpectedly upgraded to “Good”  by CQC recently, and in this inspection the ‘executive reviewer’ who looked at the Well Led domain was David Melbourne the Finance Director of Birmingham Women and Children’s NHS Foundation Trust

ADavid Melbourne

 

East London NHS Foundation Trust

During the most recent CQC inspection, ELFT’s ‘Well Led’ domain was reviewed by Angela Dragone, the Finance Director of Newcastle Upon Tyne Hospitals NHS Foundation Trust:

AAngela Dragone

Northumberland Tyne and Wear NHS Foundation Trust

 During the most recent inspection,  the ‘executive reviewers’ were Neil Carr Chief Executive of Midlands Partnership NHS Foundation Trust  and Dr Olubukola Adeyemo Medical Director of  North Staffordshire Combined Healthcare NHS Trust.

ANeil Carr

Norfolk and Suffolk NHS Foundation Trust

The most recent inspection of NSFT was chaired by Paul Devlin Chair of Lincolnshire Partnership NHS Foundation Trust:

APaul Devlin

 

Salford Royal NHS Foundation Trust

The ‘executive reviewer’ for the most recent CQC inspection was Siobhan Harrington, thechief executive of Whittington Health NHS Trust:

ASiobhan Harrington

Barking Havering and Redbridge University Hospitals NHS Trust

The ‘executive reviewer’ for the most recent CQC inspection was Trish Armstrong-Child, Director of Nursing at Bolton NHS Foundation Trust:

ATrish Armstrong

Hull Teaching Hospitals NHS Foundation Trust

The ‘executive reviewer’ for the latest CQC inspection was Martin Earwicker, Chair of Berkshire Healthcare NHS Foundation Trust.

AMartin Earwicker

 

RELATED ITEMS:

Is there a ‘club culture’ at the heart of the NHS’s quality regulator?

The unfair sacking of Andrew Smith, NHS whistleblower and trade union representative. A heady cocktail of tainted ingredients. Or how CQC, NHS Improvement & Mid Essex Hospital Services NHS Trust worked together on FPPR.

Sorry is the hardest word: CQC, Paula Vasco-Knight and Regulation 5 Fit and Proper Persons

Clare Sardari’s evidence to the Health and Social Care Committee for the hearing on 12 March 2019 about the Kark FPPR Review report

Number of NHS whistleblowing cases: A disagreement with Tom Kark QC

Whistleblowers in Their Own Words: What’s wrong with UK whistleblowing law and how it needs to change

Vasco-Knight and Steve Field NHS England EDCSteve Field well done PVK

Steve Field former CQC Chief Inspector was recently appointed Chair of the Royal Wolverhampton NHS Trust:

Screenshot 2019-03-09 at 08.08.15

 

 

 

Another turn of the Magic Roundabout: Jo Williams’ referees

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 8 March 2019

The spectacle of the Health and Social Care Committee’s hearing on the Kark Fit and Proper Person Review approaches. It will be interesting, but surprising if it results in real change.

The reality is there is one rule for workers and another for the executive classes. NHS Providers is unsurprisingly, batting hard for the powerful and resisting the creation of a disbarring body along those lines:

 

NHS Providers’s evidence to Health and Social Care Committee

“3 22. The cost of setting up a new body is likely to be significant and there is a danger of setting up a bureaucratic and cumbersome process. Evidence also shows there is a considerable financial and human cost of fitness to practice investigations.

 3 23. In reality, it would be very difficult to ‘strike off’ a director. This would require proving criminal levels of behaviour and individuals would most likely appeal in the courts, as is often the case with General Medical Council (GMC) rulings. Given the profound impact on people’s livelihoods and futures, the evidence would have to meet a very high bar”

 

 

Despite the faux lamentation by senior officials when cover ups and whistleblower reprisal are exposed. The truth is, many privately support such behaviour and or protect fellow club members.

Jo Williams controversial former CQC Chair was recycled to the NHS as a non executive director of Alder Hey Children’s NHS Foundation Trust, and was recently appointed as its Chair:

The Times 2 February 2019 Disgraced CQC chief Dame Jo Williams given top job at children’s hospital

She replaces David Henshaw, another controversial figure:

Liverpool Echo 15 November 2010 Alder Hey Children’s Hospital boss Richard Glenn quits over David Henshaw appointment

An FOI response by Alder Hey of 21 February 2019  about William’s recycling has disclosed that the great and the good provided her with references as follows:

 

• “Reference from past Department of Health official/current chair of a health Think Tank

 

• Letter from past Minister

 

• Reference from University Vice Chancellor

 

• Reference from current NHS Board chair”

 

 

I do not know who these individuals are but have looked for possible candidates.

 

Who could be the “current chair of a health Think Tank”?

I asked three prominent health Think Tanks if their Chairs, all of whom are former Department of Health civil servants, had provided a reference for Jo Williams.

The Health Foundation did not think it came from them.

The Nuffield Trust has not yet replied.

The Kings Fund staff advised that they had forwarded my query to their Chair, Sir Christopher Kelly KCB former Permanent Secretary of the Department of Health, who has not yet replied.

However, according to a CQC announcement of 7 September 2012,  Kelly said nice things about Williams upon her resignation from the CQC after scandal:

 

“Sir Christopher Kelly, former Permanent Secretary of the Department of Health, said:

“Over a number of years of devoted public service, Jo Williams has shown tireless commitment to improving care for people, in particular people who rely on mental health and learning disabilities and their families and carers.

‘She has provided strong leadership to the CQC over the last three years, and leaves the organisation in an excellent position to deliver its crucial role as quality and safety regulator of the health and social care system.””

 

I wonder if the victims of the Winterbourne View care scandal and their families would agree with Kelly.

The Serious Case Review on Winterbourne View gave a disturbing account of CQC’s failure to listen to whistleblowers who raised the alarm on gross abuse. It concluded bluntly: “…the apparatus of oversight across sectors was unequal to the task of uncovering the fact and extent of abuses and crimes at the hospital.”

Of note, Kelly was appointed by Gordon Brown in 2007 as the Chair of the Committee on Standards in Public Life (CSPL). In 2009, as CSPL Chair he gave evidence to the Public Administration Select Committee for its inquiry on leaks and whistleblowing in Whitehall:

 

Examination of Witnesses (Questions 175-179)

SIR CHRISTOPHER KELLY KCB AND DR BRIAN WOODS-SCAWEN

10 FEBRUARY 2009

Q175 Chairman: Perhaps we could turn our attention to Leaks and Whistleblowing. Are there any introductory remarks you would like to make?

Sir Christopher Kelly: Whistleblowing was clearly a very important issue for the Committee in its early years. We set down a number of principles in a number of reports which were, on the whole, widely accepted. We returned to the subject in 2005, when the main recommendations were that regulators should take a particular interest in the whistleblowing arrangements in the bodies which they were responsible for regulating, and that departments and public bodies should make sure that the whistleblowing procedures they had, not only formed part of a general culture of openness and so on, but also were widely understood when that failed. In that respect, it is disappointing that the Public Concern at Work survey, which they did I think in 2007, suggests as far as departments are concerned—and I do not think anyone received full marks in their survey—that while some departments were better than others, there were still very large numbers of departments which had not seriously begun to address that issue.

 

Kelly also produced this 2013 report on standards on public life, to which Williams was a contributor:

Standards matter A review of best practice in promoting good behaviour in public life

 

Who could be the past Department of Health Minister who gave Jo Williams a reference?

Could it be Lord Norman Warner?

Community Care 20 July 2010 Government launches adult care funding commission

Screenshot 2019-03-08 at 07.44.36

According to FOI data, Norman Warner has provided a reference for another NHS trust director in recent years.

 

Who could be the university Vice Chancellor who provided a reference?

Could it be Professor Trevor McMillan, the Vice Chancellor of Keele University, where Jo Williams was appointed as Pro-chancellor last autumn?

Screenshot 2019-03-08 at 07.43.32

 

Who was the current NHS trust chair who provided a reference?

Can anyone think of a current NHS chair who has worked closely enough with Williams to provide a reference?

Joint strategic agreement between CQC and NHS Commissioning Board (NHS England)

Screenshot 2019-03-08 at 07.44.21

 

The Department of Health and Social Care’s masterly inertia

Whoever Williams’ referees were, it does not change the fact that under her leadership, the CQC was repeatedly and very seriously criticised by parliament for poor performance and ill-advised, unsafe management decisions:

Health Committee Annual accountability hearing with the Care Quality Commission 2011

Health Committee Annual accountability hearing with the Care Quality Commission 2012

Public Accounts Committee Inquiry on Care Quality Commission: Regulating the quality and safety of health and adult social care 2012

 

Nor does it change the fact that this is what the Mid Staffordshire Public Inquiry concluded about the senior leadership of the CQC, when Williams was CQC chair:

 

“The CQC has an unhealthy culture, in which senior managers are more concerned about public image than delivery, which is hostile to internal and external criticism, and in which staff feel under pressure and unsupported.”

See: Jo Williams’ letter of 25 November 2011 to all CQC staff, about two CQC whistleblowers who were about to give evidence at the Mid Staffordshire Public Inquiry

 

 

Stephen Hammond Minister for Health, who inherited the Kark FPPR Review from his predecessor Steve Barclay, was asked if he would permit the conflict of interest arising from CQC’s handling FPPR referrals on Williams.

The DHSC naturally washes its hands:

 

DHSC response 7 March 2019

As the CQC is an independent arm’s length body, the Department cannot and does not get involved in its investigations.”

 

 

But do your best to keep a straight face when you tune into the Committee hearing next week on the Kark report.

 

RELATED ITEM

1)Evidence from myself and two other NHS whistleblowers to the Health and Social Care Committee for the Kark hearing, which includes a critique of the Kark FPPR Review report:

Submission 1

Submission 2

2) Kark got his sums very wrong on numbers of whistleblowing cases and what is much more important, the Department of Health and Social Care allowed it to be published:

Number of NHS whistleblowing cases: A disagreement with Tom Kark QC

3) An account of how NHS Improvement recently employed a trust director who had been found to have seriously harmed a whistleblower:

The unfair sacking of Andrew Smith, NHS whistleblower and trade union representative. A heady cocktail of tainted ingredients. Or how CQC, NHS Improvement & Mid Essex Hospital Services NHS Trust worked together on FPPR

There has been no response on this matter so far from Dido Harding, NHS Improvement’s Chair, who will be giving evidence to the Committee on 12 March, and is in charge of deciding whether Kark’s recommendations will be accepted.

4) Whistleblowers in Their Own Words: What’s wrong with UK whistleblowing law and how it needs to change

5) What could a new whistleblowing law look like? A discussion document

Mafia NHS

 

 

Gosport deaths, UK government pork pies about whistleblower protection and failure to investigate concerns

 By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 6 March 2019

 

 Summary: The central issue in whistleblowing governance is whether concerns are properly investigated and addressed. The government is resisting the EU directive on whistleblowing, which seeks to compel proper handling of disclosures. The  government falsely claimed to parliament that UK whistleblowing provision is “advanced” and maintained that it does not need to be replaced. It produced a misleading report to the European Scrutiny Committee. This sowed confusion by conflating the investigation of whistleblowers’ concerns with the production of activity statistics by Prescribed Persons. BEIS has disclosed that it has no plans to scrap the useless system of toothless, often unhelpful and even hostile Prescribed Persons, to whom UK whistleblowers are supposed to disclose under the Public Interest Disclosure Act.

Caroline Dinenage Department of Health and Social Care Minister and MP for Gosport, has written to a bereaved relative of a victim of Gosport War Memorial Hospital. She claimed that since the Gosport inquiry report was published, the National Guardian has stepped up activity on ensuring that the NHS deals better with staff‘s concerns. This is surprising because recent FOI data showed that the National Guardian does not bother to track whether NHS whistleblowers’ concerns are addressed. Caroline Dinenage has been asked to expand on her claims and for supporting evidence of increased National Guardian activity on whistleblowers’ concerns.

 

The one key thing that the British establishment tries to avoid when dealing with whistleblowers is the investigation of their concerns.

Investigation may force other undesirable consequences, such as transparency and accountability.

The vital thing that the new EU whistleblowing directive offers is the compulsion of follow up and proper handling of whistleblowers’ concerns.

The EU whistleblowing directive passed an important stage in January.

The Greens were the prime movers in pushing for the directive. They have produced a digestible assessment of the directive’s strengths and areas that need further work.

However in June 2018, Andrew Griffiths MP then BEIS minister submitted this explanatory memorandum by his department to the parliamentary European Scrutiny Committee. It  poured cold water on the EU directive:

EXPLANATORY MEMORANDUM ON A EUROPEAN UNION DOCUMENT

The memorandum laughably claimed that UK whistleblowing arrangements are advanced:

The UK has one of the most advanced systems of whistleblowing protection in the EU.”

 and that there was no need to adopt the EU directive.

There was a crucial dishonesty underpinning the BEIS memorandum.

It tried to argue that the labyrinthine and ineffective system of UK ‘Prescribed Persons’, under the Public Interest Disclosure Act (PIDA), represented a satisfactory equivalent to the EU directive proposals for investigation of whistleblowers’ concerns:

BEIS explanatory memorandum to the European Scrutiny Committee June 2018

“Report handling requirements

62. The proposal also prescribes procedures for the way that those receiving reports need to deal with them. lt sets requirements on ensuring confidentiality, diligent follow up within reasonable timeframes not exceeding three months, and clear and accessible information regarding procedures.  

63. In addition to the requirement to give feedback to a reporting person within a reasonable timeframe, competent authorities must also keep a record of reports and review procedures every two years. Member States must ensure competent authorities follow up on reports by taking necessary measures to investigate reports and communicate the final outcome of investigations to the reporting person. Competent authorities must also have staff members dedicated to handling reports, who must receive specific training for these purposes.

64.The UK framework already requires prescribed persons (with some exceptions)to report in writing annually on whistleblowing disclosures made to them as a prescribed person over the previous 12 months. Each report must cover the number of disclosures made by workers in a 12 month period and the number of disclosures where the prescribed person decided to take further action. lt must also include a summary of the type of action taken as well as how disclosures have impacted on the prescribed person’s ability to perform its functions and meet its objectives (for example, to improve services in a sector). ln this regard, requirements for Member States to report on whistleblowing disclosures available at a central level may be able to be gathered from collated reports.”

 

 

BEIS sneakily tried to conflate whistleblowers’ “reports” – that is whistleblowing disclosures – with statistical activity reports by Prescribed Persons, when they are entirely separate things.

As the government department in charge of PIDA, BEIS would know that Prescribed Persons are not compelled by PIDA to investigate whistleblowers’ concerns.

There are many hundreds of Prescribed Persons and they are a very mixed bag. Some are not even regulators and have no powers at all.

The only legal duty place upon Prescribed Persons is to receive, record and annually produce very superficial statistics on whistleblowing disclosures:

BEIS guidance for PIDA Prescribed Persons

There has been insufficient training for Prescribed Persons. Some do not even appear aware that they have that role. FOI data last year showed that many do not understand or fulfil their basic duties:

Prescribed Persons or the Pretence of PIDA. How UK whistleblowers are ignored

In short, the Prescribed Persons system is a Sir Humphrey Special, a master work in convoluted obfuscation.

Nonetheless, BEIS remains defiant. Despite government spin about possible changes to UK whistleblowing law following the huge scandal of hundreds of unnatural deaths at Gosport War Memorial Hospital after whistleblowers were silenced, BEIS advised in an FOI disclosure of 18 February 2019, Reference FOI2019/01024, that it had no plans to change the Prescribed Persons system. BEIS pointed to some very tokenistic twiddling at the edges as the justification for its continued inaction:

“…you asked about work regarding the Prescribed Person system. We do not have any plans to change the operation of the Prescribed Person system. The Government has already made a number of improvements in this area. Firstly, the Prescribed Persons list is updated annually to ensure the right contacts and the matters they investigate stay up to date. The Government has also published comprehensive guidance for prescribed persons regarding how they handle disclosures. This guidance is intended to help them understand their role as a prescribed person.”

In addition to BEIS’ sleight of hand, the Department of Health and Social Care is also misleading the bereaved families of the Gosport victims.

At a townhall type event in January, the families were handed an information pack consisting of ‘good news’ documents from various agencies about lessons learnt.

This included material claiming improvement in NHS whistleblowing governance, which cited the lamentable Freedom To Speak Up project  as evidence of progress.

I have also been sent a copy of a letter by Caroline Dinenage Minister of State for Care and Gosport MP to a bereaved family member, which also makes dubious claims about progress:

 

Email from Caroline Dinenage MP, 27 February 2019:

“Dear [Redacted],


Thank you for your email. 

I agree that the whistleblowers of Gosport War Memorial were failed both by the hospital and the Government. In response to the Report the Government committed to considering how best to strengthen protection for whistleblowers in the NHS to support patients, families and staff and encourage them that they can raise their concerns in a safe, and heard, space. 

One of the key actions that the Government promised to undertake after the Report was to develop and reform measures to support whistleblowers and ‘freedom to speak up,’ as well as making it more transparent in the way individual NHS Trusts manage these cases.  

More generally, the National Guardian’s Office is an independent, non-statutory body that holds the Government and the system to account and advocates for change. The National Guardian, Dr Henrietta Hughes, will continue to champion for those who speak up through her Network of Freedom to Speak Up Guardians and will publish an annual report to showcase best practice and Government activity. Since the publication of the report the National Guardian has started to take a more active role and approach into how the NHS deals with concerns raised by staff. 

In regards to prosecution, as you know this is a matter for the police and it would be inappropriate for me to comment on the ongoing assessment. 

I will however write to the relevant Minister looking at whistleblowing to provide you with further assurances. 

Thank you again for taking the time to contact me.

Kind regards, 


Caroline 

Caroline Dinenage MP

Member of Parliament for Gosport”

 

 

A key claim by Dinenage is that the National Guardian has stepped up activity on how concerns are dealt with:

Since the publication of the report the National Guardian has started to take a more active role and approach into how the NHS deals with concerns raised by staff”

This is unexpected because recent FOI data showed that the National Guardian does NOT bother to track whether NHS whistleblowers’ concerns are addressed:

How can National Guardian’s Office say workers ‘know that the right actions will be taken’ if they speak up? Another health check on quality of the National Guardian’s data

I wrote to parliament about this in September 2018:

Letter to parliament: UK government does not track whether whistleblowers’ concerns are addressed

I have now asked Caroline Dinenage for information regarding her claims that the National Guardian has taken a more active role.

 

 

BY EMAIL

Caroline Dinenage

Minister of State for Care and MP for Gosport

Department of Health and Social Care

6 March 2019

 

Dear Ms Dinenage,

Your email to [REDACTED] of 27 February 2019 and comments about increased National Guardian activity

In the above email you advised [REDACTED] that:

“…the National Guardian has started to take a more active role and approach into how the NHS deals with concerns raised by staff”.

 Please could you kindly give more details of when this increased activity started, and what it comprises.

In what way is the National Guardian taking a more active role, and what is her revised strategy and new procedure in this area?

What activity measurements are planned or applied?

Is it possible to see the results of any activity monitoring?

I ask as recent FOI showed that the National Guardian was not tracking whether NHS whistleblowers’ concerns are being addressed. This is a letter to parliament on the matter:

Letter to parliament: UK government does not track whether whistleblowers’ concerns are addressed

As Gosport MP, I am sure you appreciate the paramount importance of acting on whistleblowers’ concerns and of ensuring proper, unbiased investigation.

A poor system response to whistleblowers, such as failure to investigate concerns, can be part of the covert intimidation.

Research by Greenwich University on helpline cases revealed from this particular sample that 44% of the whistleblowers raised a concern only once.

As at Gosport,  the window of opportunity for acting on whistleblowers’ concerns can be very limited. Once whistleblowers have been intimidated and silenced, the door may be closed forever, with grave resultant harm to the public.

I provide below some more links to additional evidence about the ineffectiveness and unhelpfulness of the National Guardian’s Office.

As you will be aware, there are many concerns that UK whistleblowing is fundamentally flawed. The reform that is needed is an overhaul of the law, not minor adjustments or ineffectual ventures like the Freedom To Speak Up project.

With best wishes,

Dr Minh Alexander

The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project

No evidence base for Freedom To Speak Up project. SSOTP: Robert Francis’ exemplar trust has feet of clay, and Jeremy Hunt’s safety claims are un-evidenced

Mission Drift by the National Guardian: Further, proposed dilution of NHS whistleblower case reviews

 

 

 

RELATED ITEMS

Witness statements about concerns at Gosport War Memorial Hospital

See website under construction Victimsofgosport.com by the family of Elsie Devine who died at Gosport War Memorial Hospital.

Spinning death at Gosport: The Department of Health and the National Guardian

Replacing the Public Interest Disclosure Act (PIDA)

 

Freedom To Speak Up Guardians bullied

Questions about coaching of staff who gave evidence to the Gosport inquests and the Department of Health and Social Care’s role in promoting spin

Dr Minh Alexander NHS whistleblower and former consultant psychiatrist

The Health and Social Care Select Committee is holding a hearing on 12 March 2019 on the Kark FPPR Review, on how unfit senior managers should be dealt with.

Tom Kark’s Review report is silent on the role of the Department of Health and Care in perpetuating poor NHS culture.

Below is a letter to Caroline Dinenage Gosport MP and DHSC Minister about documents from the archives of the Gosport Inquiry, which raise questions on whether NHS staff giving evidence were unduly influenced by their employer. The documents also show the DHSC’s role in managing the news.

 

BY EMAIL

Caroline Dinenage

Minister of State for Care and MP for Gosport

Department of Health and Social Care

5 March 2019

 

Dear Ms Dinenage,

Coaching of staff who gave evidence to the Gosport inquests and the Department of Health and Social Care’s role in promoting spin

Please see the following documents from the Gosport Independent Panel’s inquiry archives about the Gosport War Memorial Hospital deaths disaster:

 

  1. Archive document MRE001669 A confidential 2008 briefing pack by NHS Hampshire PCT prepared for staff who were to give evidence at the inquests on ten suspicious deaths

https://www.gosportpanel.independent.gov.uk/document-library/documents/MRE001669/

This document was supplied to the Gosport Independent Panel by Mills and Reeves solicitors, who defended the NHS in the Gosport affair.

It contains a media statement claiming that the PCT had cooperated fully with all investigations and that it provided safe care:

“We are very confident that the hospital provides safe, high quality care to all its patients, and will continue to play and important role in local healthcare services for years to come.”

 

2. Minutes by NHS Hampshire of a meeting on 10 November 2008 which was held to prepare for the above inquests. In attendance was a solicitor from the RCN, Chris Green, and also the staff of a firm of PR consultants.

https://www.gosportpanel.independent.gov.uk/document-library/documents/SOH001158/

This document was supplied to the Gosport Independent Panel by Southern Health NHS Foundation Trust.

The PCT’s purpose was clearly to spin the inquests:

“…positive stories about the GWMH are being given to the press already”

These minutes refer to the briefing pack for staff, so it is reasonable to imagine that the staff briefing pack was intended by the PCT and other parties to form part of the news handling.

In terms of the RCN’s involvement, this is a document disclosed by Mills and Reeves to the Panel, which lists the RCN members who were scheduled to give evidence:

https://www.gosportpanel.independent.gov.uk/document-library/documents/MRE000701/

 

3. Archive document DOH70021 A confidential, restricted briefing pack by NHS Hampshire PCT for managers who might have contact with the press.

This document was supplied to the Gosport Independent Panel by the Department of Health.

It again shows the PCT’s intention to spin the inquests and includes at the end of the document a list of “key words” to be used for crafting the desired messages. This included an emphasis on claiming that the problems were historical, that the organisation had been exonerated and that there was no evidence of criminality.

https://www.gosportpanel.independent.gov.uk/document-library/documents/DOH700721/

Chris Green RCN solicitor is again listed as an involved party. So was Graeme Zaki Medical Director of Portsmouth Hospital Trust and other managers from that trust.

I am very concerned that the above trail of documents raises questions about the extent to which NHS staff, including some of the original Gosport hospital whistleblowers, were coached to give evidence to the inquests that was more favourable about the hospital than was merited by the facts.

It must surely have been very intimidating for any member of staff giving evidence to see the media statement in the so-called briefing pack which was given to them by the PCT. This seems tantamount to an instruction to take the lines being spun by the trust.

It is especially troubling that whilst on the one hand the Chief Medical Officer’s team assumed that the inquest would find unlawful killing:

CMO's team assumed unlawful killing Gosport inquests DOH000264

https://www.gosportpanel.independent.gov.uk/document-library/documents/DOH000264/

the PCT and others were at the same time spinning the opposite, and taking actions that were an abuse of power and could unduly influence witnesses to an inquest.

Indeed, there is concern about the Department of Health’s actions in 2006 in response to BBC coverage of GosportIs, which arises from document DOH013796,  disclosed by your department to the Gosport Independent panel:

https://www.gosportpanel.independent.gov.uk/document-library/documents/DOH013796/

In internal departmental correspondence, Phill Shields from the DH Ministerial Briefing Unit asked:

“Is the SHA on top of this?”

And he added:

“Push them for a comms strategy please.”

I wonder if the Department of Health and Social Care could advise on what steps it can take to ensure that such behaviour is discouraged in future and that NHS staff witnesses to inquests are not in any way pressured to spin a line.

Yours sincerely,

Dr Minh Alexander

Cc Tom Kark QC and Health and Social Care Committee for information in advance of the Committee hearing on 12 March about the Kark FPPR Review

Matt Hancock

Stephen Hammond

Donna Kinnair RCN Chief Executive and General Secretary

 

RELATED ITEMS

(1) Witness statements about concerns at Gosport War Memorial Hospital

(2) This is a summary of evidence that I have submitted to the Health and Social Care Committee for the Kark FPPR Review hearing on 12 March 2019:

Summary of evidence submitted 3 March 2019 to Health and Social Care Committee for the hearing 12.03.2019 on Kark FPPR Review

(3) From the Gosport Independent Panel inquiry archives – document FMC000051, the business card of a senior consultant from the firm Trimedia UK, which the NHS hired to help handle the news about Gosport:

Trimedia UK Julie Dean Senior Consultant business card from Gosport Independent Panel archives

Number of NHS whistleblowing cases: A disagreement with Tom Kark QC

Dr Minh Alexander NHS whistleblower and former consultant psychiatrist

 

 

Letter 1 March 2019 to Tom Kark QC who has undertaken a review of CQC Regulation 5, Fit and Proper Persons on behalf of the Department of Health and Social Care:

Dear Tom,

Number of NHS whistleblowing cases

I write to ask about a matter of fact concerning your report from the FPPR Review, which states that there are low levels of whistleblowing cases in the NHS.

I found much of your report very interesting but on this point I need to disagree.

The passage in question is on page 113 of the report:

“10.14 The relatively low levels of whistleblowing cases in the NHS suggests either that there is very good management practice in dealing with whistleblowing issues or that employees are, for some reason, reluctant to raise them. The NHS only received 39 whistleblowing cases about Foundation Trusts in 2013/2014, 28 in 2014/2015 and 60 in 2015/2016. Nationally, the figure for numbers of whistleblowing cases received by Employment Tribunals ranges between 1,395 and 2,754 (in the period between 2007/2008 and 2016/2017). Whilst the national figure for numbers of whistleblowing cases is not particularly high, the number of whistleblowing cases in the NHS is surprisingly low for such a large employer.”

For clarity, the numbers cited in the above, linked FOI disclosure related to whistleblowing disclosures made to Monitor by the workers of NHS Foundation Trusts, and not to claims made to the Employment Tribunal against Foundation Trusts.

Whilst Monitor received disclosures from a small number of whistleblowers, many more NHS staff whistleblew to the CQC.

The CQC’s submission to Robert Francis’ 2014 Freedom To Speak Up Review revealed that approximately nine thousand workers a year from regulated providers raised concerns with the CQC. This figure represents staff from health and social care.

A more recent FOI disclosure by the CQC revealed that, according to the CQC, there were a total of 1535 whistleblowing contacts to the CQC by workers from NHS trusts (Foundation and non-Foundation) over 2015/16 and 2016/17.

For the thousands of NHS staff who get to the stage of making an external disclosure to a regulator such as NHS Improvement or the CQC, there will be more who raised concerns internally, and who possibly gave up and or were silenced.

Some supporting evidence for this comes from a study by Greenwich University, sifting data from Public Concern at Work’s (now known as Protect) helpline data, ‘Whistleblowing: The Inside Story’. 

The study reported:

Within our sample of 1,000 cases, concerns were raised 1,514 times, 82% of which was internal, 15% external, and 3% to a union.

 The majority of whistleblowers (44%) raise a concern only once, and a further 39% will go on to raise a concern a second time.”

In terms of the number of whistleblowing Employment Tribunal claims against the NHS, ACAS kindly advised that it handled 324 whistleblowing claims from Health and Social Care in 2017/18. As you will see from the tables provided, this represents one of the highest numbers of cases compared to other sectors.

So in short NHS whistleblowing is widespread, but most likely under-reported for a range of reasons, and out of view. The above type of data has to be privately collated, when the government should actually have ensured active tracking and transparent publication.

The invisibility of NHS whistleblowers is to a degree a matter of design. Some are hidden by super-gags which the Department of Health and Social Care, NHS Improvement and CQC all continue to collude with, despite what they told you in evidence about being ‘uncomfortable’ about gagging.

Indeed, NHS Improvement vets NHS trusts’ applications for special severance payments and related settlements agreements, before they go to the Treasury for final approval.

Also, the NHS National Guardian has just jointly produced a guide with NHS Employers on settlement agreements, which still contains a template agreement with a super-gag.

The flat line graph below, generated from the just published annual NHS staff survey, which shows no change in the NHS workforce’s confidence that employers will act on concerns, confirms little has changed since the publication of the MidStaffs Public Inquiry.

NHS Staff Survey 2018 Five year trend on the question: “I am confident that my organisation would address my concern”

Screenshot 2019-03-01 at 03.25.20

 

I hope the whistleblowing case numbers provide some additional perspective in advance of your evidence session with the Health and Social Care Committee.

I also wonder if it is possible to amend the FPPR Review report or to issue an advisory postscript about the real level of NHS whistleblowing, based on the additional data sources.

With best wishes,

Minh

Dr Minh Alexander

cc Jane Russell Essex Court Chambers

Whistleblowing, The National Guardian and Defence Medical Services

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 27 February 2019

 

 

Summary: The NHS Freedom To Speak Up project defines waste. It has committed millions in public money across the NHS to an un-evidenced vanity project. Not content with that, the government is trying to spread and embed the dubious model. Once embedded, it will be a bulwark against real whistleblowing reform. The National Guardian expends much energy on glad-handing and self-promotion instead of the day job of actually protecting patients and whistleblowers. The Defence Medical Forces have fallen to the Speak Up charm offensive, and has now adopted the model. Disclosed documents are provided.

 

 

The NHS National Guardian has a small annual budget of one million pounds for protecting NHS trust whistleblowers. NHS England recently gave her office an additional bung for expanding into primary care as well: “NHS England will triple their contribution for my office”.

She does not make best use of this precious resource, and does not conduct enough whistleblowing case reviews. Too many whistleblowers are turned down on spurious grounds. For example:

The Greasy Freedom To Speak Up Review is Stuck. More Tales of Silence about Silence.

A Study in Delay: The National Guardian & Brighton and Sussex University Hospitals NHS Trust

Even when Freedom To Speak Up Guardians repeatedly escalate case issues to her Office, this does not always result in a case review. For example, FOI data has shown that she has not reviewed a troubled NHS trust not long out of special measures, despite the local Speak Up Guardians escalating case issues to her on five occasions.

Whistleblowers whose cases are reviewed by her Office are not adequately protected. They are merely substrate for the production of reports. I have been contacted by several whistleblowers who have had concerns about their experiences of case review.

The National Guardian’s case reviews do not threaten employers or erring regulators. They defuse and reduce serious corruption and managerial misconduct to a bureaucratic paper chase.

NHS regulators are not taking the case review process seriously and cannot produce any evidence that real action has been taken. Poor leaders who are responsible for serious failures are allowed to stagger on.

The annual NHS Staff Survey was released yesterday. It showed that despite a massive and most distasteful PR push by the National Guardian’s Office last October, the wet and windy “Speak Up Month” just before data collection for the NHS staff survey, the dial has barely flickered on staff confidence in speaking up:

 

NHS STAFF SURVEY OVER THE PERIOD IN WHICH THE NATIONAL GUARDIAN’S OFFICE HAS BEEN ESTABLISHED:

YEAR NATIONAL AVERAGE SCORE ON “I WOULD FEEL SECURE RAISING CONCERNS ABOUT UNSAFE CLINICAL PRACTICE”

 

2016 70%
2017 70%
2018 70.5%

Source: NHS Annual Staff Survey reports

More on the NHS staff survey next month, when the full question level data is published.

 

Inversely related to the energy that the National Guardian has expended on her day job of protecting patients and whistleblowers, she has noticeably hit the selfie and self-promotion trail.

She established the embarrassing ‘Pan Sector Network’ early in her tenure. She has courted corporate whistleblower slayers:

Corporate schmoozing at the National Guardian’s Office: National Guardian’s Pan Sector Party Planning

`

The Ministry of Defence was an early invitee to the National Guardian’s Pan Sector Party:

Screenshot 2019-02-27 at 09.41.50

A reciprocal invitation was made, with the obligatory mutual admiration:

Screenshot 2019-02-27 at 09.42.07

Notably, the MoD has had terrible whistleblowing governance, and attracted savage criticism from even the very conservative Civil Service Commission, which investigates whistleblowing disclosures about breaches of the Civil Service Code.

In a case of suspected criminality over contracts handling at the MoD, the Civil Service Commission’s decision notice had this to say on the MoD’s repeated Code breaches:

 

 

Decision Notice: MoD March 2015, Ref. AP000122

–       Specialist police investigation by MoD CID into the concerns concluded that the complainant had raised his concerns reasonably, and that there was “flagrant disregard for competition which could possibly indicate criminality”.

–       MoD policy was incompatible with the Code, because prevented MoD staff from making public interest disclosures unless it concerned their area of work

–       There was “…a lack of appetite within the Department to either consider the concern against the framework of the Code or to take account of the evidence that their own internal investigation had uncovered” and a lack of objectivity in the Department’s handling of the concern – which was an additional Code breach.

–       “there is clear evidence of a culture which discourages dissent and does not take allegations of breaches the code seriously”

–        The Commission concluded that overall, the MoD’s behaviour in this matter was so poor that it went to “the heart of whether from the top to the bottom of the organisation there is an unwavering commitment to the values of integrity and honesty which are fundamental to the Civil Service.”

 

 

A tweet last month revealed that the National Guardian, had a day out with the Defence Medical Services (DMS). It also revealed that Freedom to Speak Up Guardians have now been established in the DMS.

It should be noted that the Armed Forces are not covered by the Public Interest Disclosure Act, but civilian personnel in the DMS are.

However, the Service Authorities have at least given an undertaking to: “honour the spirit of the Act in that they will recognise and adhere to the criteria for protected disclosures for military personnel and follow the prescribed procedures whether dealing with or making a qualifying disclosure.”

Doctors and other registered clinicians who are Armed Forces personnel also remain bound by the requirements of their professional codes to protect patients and raise concerns as needed as part of this. This seems a rough deal given that they do not have the same legal cover under whistleblowing law.

 

The DMS reminds such staff:

The GMC states that you should contact a regulatory body where you cannot raise a concern with a responsible person or body locally because you believe them to be part of the problem; or you have raised concerns through local channels but are not satisfied that the concern has been addressed seriously; or that there is an immediate serious risk to patients, and a regulator or external body has a responsibility to act or intervene. Regulated healthcare workers have professional responsibilities to raise concerns regarding patient safety to their regulator.”

 

 

An FOI enquiry to the DMS produced the following documents yesterday:

Defence Medical Services FOI reply letter 26.02.2019

Air Vice Marshal Alastair Reid letter to Henrietta Hughes 7.02.2019

Email between Henrietta Hughes and the Defence Medical Services November 2018

Whistleblowing policy ‘Raising concerns including by Defence Medical Services personnel’

The above whistleblowing policy document gives sparse information about the DMS Freedom To Speak Up Guardians. It merely signposts DMS staff to the woeful government propaganda material on the NHS Employers’ website:

 

Freedom To Speak Up Guardian 30.

 Freedom To Speak Up (FTSU) Guardians have a role to promote the profile of raising concerns in their organisation and provide confidential advice and support to staff in relation to concerns they have about patient safety or the way their concern is being handled. Further information on FTSU Guardians can be found at the following reference9

9 http://www.nhsemployers.org/your-workforce/retain-and-improve/raising-concerns-at-work-and-whistleblowing/freedom-to-speakup-guardian-hub Accessed 18 Mar 16

 

 

The DMS disclosed that it appointed two Freedom To Speak Up Guardians “in the last six months”, and that there are also FTSU “champions”.

According to the DMS, their Guardians may escalate concerns to:

One of the DMS FTSU Guardians works in Defence Primary Healthcare (DPHC) and reports to the DPHC Command Board. Both FTSU Guardians have direct access to the Medical Regulator within the Defence Safety Authority and can, within their remit, report concerns directly to Professional Bodies, the Care Quality Commission and the National Guardian’s Office.”

And wouldn’t you know it, but there is no ringfenced time for these Guardian roles.

Enough to make you wonder if this isn’t just more managerial tokenism.

Excellent empire building and nice selfies though.

Screenshot 2019-02-27 at 09.21.29

 

RELATED ITEMS:

Part of the evidence of the UK government’s resistance to reform of totally ineffective whistleblowing law – an explanatory memorandum by BEIS Minister Andrew Griffiths to the parliamentary European Scrutiny Committee last summer, pouring cold water on the new EU Whistleblowing Directive:

BEIS Explanatory Memorandum June 2018 – Advice to the parliamentary European Scrutiny Committee on not adopting the EU Whistleblowing Directive

The EU Directive proposes ludicrously unreasonable measures, such as ensuring the investigation of whistleblowers’ s concerns. Why would any self-serving club culture wish to adopt this?

Fakery such as the Freedom To Speak Up project is much more conducive to preserving the status quo.

Whistleblowers in Their Own Words: What’s wrong with UK whistleblowing law and how it needs to change

What could a new whistleblowing law look like? A discussion document

The Disinterested National Guardian & Robert Francis’ Unworkable Freedom To Speak Up Project

Whistleblowing in Whitehall: Civil Servants’ Complaints about Breaches of the Civil Service Code since 2014

Spinning death at Gosport: The Department of Health and the National Guardian

 

STFU not FTSU

 

 

 

 

 

 

 

 

An example of the investigation industry: Conflict Management Plus Limited (CMP Resolutions)

By Dr Minh Alexander NHS whistleblower and consultant psychiatrist 24 February 2019

 

Summary: Whistleblowers are always interested in private companies that employers may hire to undertake whistleblowing investigations. An example is CMP Resolutions, a company whose Business Development Manager wrote an article in the Health Service Journal on 21 February 2019 about how internal whistleblowing investigations come to “comfortable outcomes”. Some information about CMP Resolutions is collated here.

 

Introduction

Whistleblowers need a truly independent investigation mechanism when local investigation fails. There are examples in other jurisdictions of statutory whistleblowing bodies which have powers and which carry out this function.  Such a body is required in the UK to protect the public. It needs to have robust arrangements for parliamentary scrutiny, constant refreshment and safeguarding against capture. To achieve this, real legislative reform and replacement of the current  ineffective UK whistleblowing law.

Robert Francis fudged in his Freedom To Speak Up report and instead gave NHS whistleblowers:

  1. A powerless National Guardian’s Office which explicitly has no remit to investigate whistleblowers’ concerns
 

Page 169 of the report of the Freedom To Speak Up Review:

7.6.13 I want to emphasise that I am not proposing an office to take over the investigation of concerns. As I have already said, this needs to remain the responsibility of the local organisations.”

 

 

  1. An insincere assurance that there could still be ‘independent’ investigation of whistleblowers’ concerns if employers outsourced investigations.
 

Page 129 of the report of the Freedom To Speak Up Review:

Action 8.1 All NHS organisations should devise and implement systems which enable such investigations to be undertaken, where appropriate by external investigators, and have regard to the good practice suggested in this report.”

 

 

In relation to this, Robert Francis made a vague proposal that:

The trust has access to a panel of trained investigators, who can respond quickly and with the necessary level of expertise.”

Action on Francis’ Recommendation 8.1 was recorded in the annex of the Freedom To Speak Up Review report as an action for: “All orgs incl. providers”.

However, four years on, there is no evidence that the government and senior NHS officials have taken any action to put in place a panel of properly trained investigators. Neither have I heard Francis raise concerns about the failure to implement his recommendation or ensure a properly managed external investigation system for NHS whistleblowing.

Instead, NHS regulators have called in private companies like Deloitte to review governance in some high profile whistleblowing cases, such as at the Royal Wolverhampton NHS Trust.

They have also outsourced investigations to niche private investigators, many of whom are former NHS managers. An example of this is the investigation that NHS Improvement commissioned into an executive whistleblowing scandal at Wirral Teaching Hospital NHS Foundation Trust.

What’s up at Wirral? NHS Improvement’s investigation of executive whistleblowing at Wirral University Teaching Hospitals NHS Foundation Trust

Investigations commissioned and paid for by employers can go badly wrong for whistleblowers. In the case of Hayley Dare West London Mental Health Trust whistleblower, her chief executive offered her an independent investigation into her concerns, but it turned out that he intended that this be carried out by Capsticks the trust’s solicitors:

Hayley Dare Capsticks investigator

In the above context of the NHS’ approach to whistleblowing investigations, I provide below some information about the company CMP Resolutions and the recent HSJ article by its Business Development Manager.

 

CMP Resolutions or Conflict Management Plus Limited, Companies House 3880628

On 21 February 2019 the Health Service Journal, whose editor said it was a privilege to “serve healthcare leaders”, published an article by Richard Peachey, the Head of Business Development at CMP Resolutions:

“In-house whistleblowing investigations rush to comfortable outcomes”

According to CMP Resolutions’ website, the company sells amongst other services, expert investigations into whistleblowing cases:

AExpert investigations

 

But Peachey’s HSJ article seems somewhat ambivalent about the value of whistleblowing:

We’re in a new age of speaking up, when taking on authority feels right and proper. Employees in all kinds of organisations now have the models, precedents and language they need for going public.

But in the singular NHS context of extreme public scrutiny and emotional pressures, encouraging more whistleblowing isn’t necessarily going to do anything for the working environment or stress levels. Whistleblowing is a dangerous weapon when it’s used for malicious purposes, as a means of escalating grievances against management. 

NHS employers quickly need to find a smart, grown-up balance between buttoned-up secrecy and a whistleblower’s charter. The difficulty of finding this balance may well be the reason why it’s four years since the “Freedom to Speak Up” review and yet the topic is more fraught than ever.”

The above comments do not frame whistleblowing in the public interest as a prosocial behaviour and an expression of fundamental democratic values and human rights to free speech. Instead, they imply that whistleblowing is a matter for bosses to manage, and they give prominence to the employer-centric narrative about ‘malicious’ whistleblowing in bad faith.

Is this the right approach in a safety-critical sector?

Who is Richard Peachey? According to his LinkedIn pages, he has had varied jobs. None of them obviously relate to the NHS or to whistleblowing.

There are also LinkedIn pages for other CMP Resolutions officers:

Katherine Graham CMP Resolutions Chair

Arran Heal Managing Director CMP Resolutions

Rebecca Foreman Director of Operations CMP Resolutions

Tim Kingsbury Head of Investigations CMP Resolutions

Rukshana Horwood Head of Management Training and Coaching CMP Resolutions

Patrick Moulsdale  Head of People Development and Mediation at CMP Resolutions

Liz McCaw Non Executive Director CMP Resolutions

Leanne Holt Head of Operations and Client Delivery CMP Resolutions

Tom Humphrey Finance Officer CMP Resolutions

There seems to be little link generally between CMP Resolution’s officers and the NHS.

Its Chair according to her LinkedIn page, was a publications manager at the Kings Fund for three years:

AKingsFund

Arran Heal, CMP Resolution’s Managing Director’s LinkedIn page states that he is a proven visionary who has worked for Coca-Cola and then set up a business selling drinks to hospitals:

AVisionary

Liz McCaw CMP Resolutions NED according to her LinkedIn page is a coach for the Faculty of Medical Leadership and Management:

AFMLM

Perhaps of greatest potential interest to whistleblowers is CMP Resolution’s Head of Investigations, Tim Kingsbury.

AKingsbury

According to his LinkedIn page, he served mainly in the Royal Navy:

ANavy

Overall, the background of CMP Resolutions’ officers is essentially corporate and administrative.

CMP Resolutions’ website describes the company as “the UK’s leading workplace investigation company”.

 CMP’s Chair’s LinkedIn page also states that the company is the UK’s foremost provider of dispute resolution services:

AForemost

According to papers filed at Companies House, this is the (unaudited) balance sheet for the company in the year ending 31 March 2017:

ABalance Sheet

 

These are publications by CMP Resolutions:

When Employees Speak Up

How the best employers create a clear air workspace

How the best managers always have good conversations. The CMP Guide to handling difficult conversations and defusing conflict

The content about whistleblowing in these reports is generic and broad.

According to CMP Resolutions’ website, the Department of Health and at least two NHS trusts (South East Coast Ambulance Services and Wrightington, Wigan and Leigh NHS Foundation Trust) have been clients:

AClients

ASECAMB

AWigan

I leave it with readers to make their own minds up about how organisations such as this would handle very complex and fraught NHS whistleblowing cases. For example, those of the CQC whistleblowers who raised concerns about their senior leadership team, or others.

UPDATE 25 FEBRUARY 2019

Underlining the problems with outsourcing governance reviews and whistleblowing investigations, and the control exerted by the purchasing organisations, the Health Service Journal today reported that NHS England has tried to bury an external review that it commissioned on governance issues at Sheffield CCG. This included alleged bullying, cover ups and whistleblowing at the “toxic” CCG.

“The review was carried out by a former Primary Care Trust chief executive Denise McLellan, who questioned 87 people.”

The CCG’s Medical Director Dr Zak McMurray has reportedly been on “special leave” for a year, after whistleblowing:

 

Crisis at top CCG amid claims of bullying and ‘toxic’ culture, by Annabelle Collins, 25 February 2019

“During a later public meeting on an unrelated topic, Dr McMurray, who was one of those who raised a concern, spoke out about plans to cut back on Procedures of Limited Clinical Value. Following this, he was put on so-called special leave in February 2018.

The CCG would neither confirm nor deny Dr McMurray’s absence on full pay.

But Dr McMurray told HSJ in a statement: “I can confirm that I have been on special leave for just over a year now. I wish to reassure my patients that my absence is not due to a disciplinary process and is not conduct or ability related. I am unable to comment further at this time.”

Key findings from the NHS England review into Sheffield CCG include:

·       Poor decision-making processes which resulted in frustration and poor behaviours by senior staff;

·       Disagreements between executive team members which were not addressed effectively or handled properly in line with NHS values;

·       Widespread dissatisfaction about how bullying and harassment cases were handled;

·       A leadership team which lacked a clear strategy, while stakeholders were not confident the executive team had the right skills to lead the CCG;

·       An ongoing investigation involving governing body members putting the organisation under strain and communication had been poor;

·       Stakeholders panels for senior appointments which felt their views were ignored without feedback; and

·       Internal career progression opportunities which were not fairly offered.

The review acknowledged Sheffield CCG, which was rated “good” by NHS England in 2018, has a number of strengths, with committed staff and plans to further transform services.

HSJ asked NHS England a number of questions about whether it was aware of the whistleblowing incidents, the concerns about the CCG and Dr McMurray’s “special leave” but it declined to provide a response.”

 

RELATED ITEMS:

The toothlessness of the National Guardian’s Office: Why it cannot be a model for protecting whistleblowers

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