Jeremy Hunt’s Secret Whistleblower (Non-Employment) Scheme

Dr Minh Alexander, NHS whistleblower and former consultant 14 October 2017

On 21 January 2015 the parliamentary Health Committee advised Jeremy Hunt to ensure that harmed NHS whistleblowers should receive an ‘apology and practical redress’. 1

On 11 February 2015 Robert Francis recommended in his report of the Freedom To Speak Up Review that as a minimum, sacked and exiled NHS whistleblowers should be urgently provided with support to return to NHS employment, including trial employment. 2

 

“7.3.8 Beyond that, I believe that there is an urgent need for an employment support scheme for NHS staff and former staff who are having difficulty finding employment in the NHS who can demonstrate that this is related to having made protected disclosures and that there are no outstanding issues of justifiable and significant concern relating to their performance. This should be devised and run jointly by NHS England, the NHS Trust Development Authority and Monitor. As a minimum, it should provide:

• remedial training or work experience for registered healthcare professionals who have been away from the workplace for long periods of time

• advice and assistance in relation to applications for appropriate employment in the NHS

• the development of a ‘pool’ of NHS employers prepared to offer trial employment to persons being supported through the scheme

• guidance to employers to encourage them to consider a history of having raised concerns as a positive characteristic in a potential employee.” 2

 

 

Over two years later, the Department of Health and its organs are still leading harmed whistleblowers a not so merry dance, making whistleblowers jump through bureaucratic hoops for the privilege of little more than employment coaching services, with profits going to an outsourced supplier. 3 4 5

There is no trial employment on offer, despite the DH’s attempts to spin otherwise through willing helpers. 6

Screen Shot 2017-10-14 at 10.10.18

Yet it has emerged that behind the scenes, NHS Improvement made a special arrangement months ago to help secure a sacked NHS whistleblower a job, no red tape involved whatsoever.

Jim Mackey has been asked to account for this blatant inconsistency and to ensure that other whistleblowers receive equal access:

Letter to Jim Mackey re-employment 8 October 2017

In the meantime, NHS England’s pilot Employment Support Scheme, which attracted only eight applicants, is coming up for evaluation.

A request led to this update from NHS England on 8 September, about a proposed evaluation by Liverpool John Moores University:

NHS England High Level Plan

NHS England WBSS briefing for workshop attendees

NHS England did not give full details of the proposed evaluation methodology, I therefore asked Liverpool John Moores University for more information.

Correspondence with Liverpool John Moore University

Limited detail was provided, but this draft list of proposed interview questions was shared:

interview questions-1

I asked for all of my request to be processed. The university then closed its doors:

Liverpool John Moore’s University FOIResponse17_179

Screen Shot 2017-10-14 at 09.02.01

It did not make any specific technical case for secrecy but simply claimed that disclosure would prejudice the outcome of the evaluation.

NHS England purports to promote co-production:

1.3 Co-production: What this looks like for people   

  • People with lived experience have an equal status with practitioners to influence key decisions.” 7

It specifically promised on 8 September to involve whistleblowers in designing its evaluation:

The evaluation will engage directly with stakeholders to explore both the process of developing the pilot and the utility of the support to clients. Because of the involvement of stakeholders it is particularly important that they feel valued as partners. The evaluation will therefore be done with participants (not imposed ‘on’ them) ensuring they have a say in determining the aims and objectives of the pilot and its evaluation.”

It is important that whistleblowers can see exactly what the university proposes to do, including its ethical controls, as this is sensitive work. There were already concerns arising from a presentation by the lead researcher at an event by NHS Improvement on 22 September. This is because there was an implication that whistleblowers’ personal data might be sought from confidential coaching services purchased for whistleblowers, and it had to be clarified by whistleblowers and the service supplier that such data was off limits.

I have therefore asked NHS England to keep its word and to intervene:

REQUEST 14 OCTOBER 2017 TO NEIL CHURCHILL

It would be ironic if research aimed at delivering Mr Hunt’s Plans to end cover up culture in the NHS 8 is beyond scrutiny.

Almost as ironic as this recent refusal by Jim Mackey to provide much of the data sought by an FOI request about NHS Improvement’s scheme, and his decision to withhold an NCAS paper relating to the scheme.

FOI_Employment_Support_Scheme_development

Laughably, both NHS Improvement and NHS England have also surreptitiously tweaked the names of their programmes from ‘Whistleblower Employment Support Service’ to just ‘Whistleblower Support Service’:

Screen Shot 2017-10-14 at 00.43.10

 

That’s a big clue.

It is irresponsible of the DH et al to mistreat whistleblowers who have been through so much, many of whom still bear the serious health consequences of their ordeals.

As Health Committee acknowledged, this spectacle of un-rectified injustice damages patient safety culture: 

 

“114. The failure to deal appropriately with the consequences of cases where staff have sought protection as whistleblowers has caused people to suffer detriment, such as losing their job and in some cases being unable to find similar employment. This has undermined trust in the system’s ability to treat whistleblowers with fairness. This lack of confidence about the consequences of raising concerns has implications for patient safety”

 Health Committee, Complaints and Raising Concerns, 21 January 2015

 

But perhaps that’s the idea.

apology-redress

 

RELATED ITEMS

At the NHS Improvement Soup Kitchen

https://minhalexander.com/2017/03/26/at-the-nhs-improvement-soup-kitchen/

 

REFERENCES

1 Complaints and Raising Concerns. Health Committee 21 January 2015

https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/350/350.pdf

2 Report of the Freedom to Speak Up Review

http://webarchive.nationalarchives.gov.uk/20150218150953/https://freedomtospeakup.org.uk/wp-content/uploads/2014/07/F2SU_web.pdf

3 At the NHS Improvement Soup Kitchen

https://minhalexander.com/2017/03/26/at-the-nhs-improvement-soup-kitchen/

4 NHS failing whistleblowers with return-to-work plan, Kat Lay, The Times, 21 August 2017

https://minhalexander.files.wordpress.com/2016/09/nhs-e28098failing-whistleblowers_-with-return-to-work-plan-times-21-aug-2017.pdf

5 NHS Improvement whistleblowers’ support scheme launch September 2017

https://improvement.nhs.uk/events/whistleblowers-support-scheme-launch/

6 NHS trusts to offer whistleblowers trial employment, Shaun Lintern, Health Service Journal 26 September 2017

https://www.hsj.co.uk/workforce/nhs-trusts-to-offer-whistleblowers-trial-employment/7020644.article

7 Co-production. NHS England June 2017

https://www.england.nhs.uk/wp-content/uploads/2017/06/516_Co-production-for-personal-health-budgets-and-Integrated-Personal-Commissioning_S7.pdf

8 Plans to end the cover up culture in the NHS, Department of Health 9 March 2016

https://www.gov.uk/government/news/plans-to-end-the-cover-up-culture-in-the-nhs

 

Will Simon Stevens uncork ALL the NHS Race data?

The poor, discriminatory treatment of BME staff in the NHS has been a long recognised stain upon the NHS’ reputation.

A landmark event in NHS Race history was Joe Collier and his colleagues’ whistleblowing about a racist computer programme at St Georges which weeded out foreign medical student applicants.

Screen Shot 2017-10-11 at 07.37.58

The classic book Racism in Medicine: An Agenda for Change,  Naaz Coker et al 2001, is a very good, gripping read and still highly relevant.

NHS England commendably launched the Workforce Race Equality Standard programme (WRES) but its implementation has been a disappointment to many, with no focus on enforcement and a number of significant omissions in the parameters measured.

Whistleblowing and NHS racism are interlinked. Research done on behalf of the Speak Up Review showed that BME whistleblowers are more likely to be ignored and victimised.

I have asked Simon Stevens to prioritise the proper measurement of BME staff’s experience of whistleblowing through the NHS staff survey.

I have also asked him to uncork data that already exists at trust level on Race differentials for all domains of the national NHS staff survey.

I have been advised by the Picker Institute which administrates the survey for NHS England that the cost of analysing this trust level Race data is reportedly very modest:

“£1200-£1600 (excl. VAT)”

I find it perplexing that such analyses have not already been requested and published.

The letter to Simon Stevens, with supporting references, background correspondence and data,  is provided below.

Dr Minh Alexander

NHS whistleblower and former consultant psychiatrist

11 October 2017

 

LETTER TO SIMON STEVENS

BY EMAIL

Simon Stevens

Chief Executive

NHS England

 

11 October 2017

Dear Mr Stevens,

 

Re: NHS Englands approach to Race Equality & Race analysis of NHS Staff Survey Data

I write about the rigour of NHS England’s approach and to make a request about better use of national staff survey data.

As you may be aware from correspondence to the NHS England WRES team into which I have copied you, I have concerns that the WRES programme is at this late juncture not measuring important matters such as Race Employment Claims against the NHS. Neither is it measuring Race pay inequality.

Since WRES was established, challenges to how WRES is administrated have sometimes been ignored, resisted or deflected to varying degrees. It has been indicated and or implied more than once that after any year’s WRES programme has been approved by you, no deviation is possible, whether or not this is correct. It may be that the recent shake up in WRES personnel will speed progress up.

But to give a recent example of inflexible system response:

Gross bias and Race discrimination was evident from analysis of NHS Employers’ data on the appointment of Speak Up Guardians earlier this year 1 and confirmed by the National Guardian’s office subsequent analysis of its data. 2 I asked that further measures be taken, including addition of whistleblowing questions to the WRES metrics of the annual staff survey. I was told that WRES will not even consider possible changes until April 2018 at the earliest – see correspondence below. 3

This lack of urgency is a concern given the findings by Middlesex University, published in the Speak Up Review report, that BME whistleblowers are much more likely to be ignored and to suffer considerably more detriment. 4

After the last response from NHS England 3, I established for myself that the current generic whistleblowing questions in the NHS staff survey are not good at distinguishing between White and BME staff groups 5, despite the known differences in how these groups are treated. It may be that they rely too much on expectation and not on actual experience.

I do think NHS England should prioritise the better measurement of whistleblowing experience of staff in the national survey, and also include effective whistleblowing questions in the WRES metrics as soon as possible.

Most importantly, I have established that Race data is held at trust level for all questions in the national NHS staff survey and not just whistleblowing questions, and that it would reportedly cost £1200 – £1600 plus VAT to analyse the 2016 national data by white v BME scores. 6

Given this seemingly modest cost, I am surprised that this data has not already been requested and published by NHS England. This is especially as I understand the budget of millions allocated to WRES to date has not been fully spent.

Such an analysis would clearly help shine a powerful light on the shameful and still unmitigated Race inequality in the NHS. 7

I would be very grateful to know if you would authorise:

  • Urgent action on ensuring that Race differences in whistleblowing are measured as part of the WRES programme

 

  • The above Race analysis of all 2016 NHS staff survey data at trust level, similar analysis of all future annual NHS staff surveys, and the publication of such analyses.

 

Many thanks.

Yours sincerely,

Dr Minh Alexander

 

Cc

Philip Dunne Minister of State for Health

Yvonne Coghill Director of WRES Programme

Professor David Lewis Professor of Employment Law Middlesex University

Lord Adebowale NHS England NED

Prof Mala Rao NHS England WRESAG

Marie Gabriel NHS England WRESAG

Dr Henrietta Hughes National Freedom To Speak Up Guardian

Dame Moira Gibb NHS England NED and member of National Guardian’s Accountability & Liaison Committee

 

REFERENCES

1 https://minhalexander.com/2017/05/16/speak-up-guardians-a-whiter-shade-of-corporate-pale/

2http://www.cqc.org.uk/sites/default/files/20170915_Freedom_to_Speak_Up_Guardian_Survey_2017.pdf

3 Correspondence about Race discrimination in the appointment of Speak Up Guardians & tracking whistleblowing Race metrics:

From: “COGHILL, Yvonne (NHS ENGLAND)” <**************>

Subject: RE: Concerns about Freedom to Speak Up Guardian appointments – Race

Date: 1 October 2017 at 18:18:38 BST

To: Minh Alexander <********************>

Cc: “CE, England (NHS ENGLAND)” <****************>, mala rao <***************************>, Victor Adebowale <*****************>, *******************>, Marie Gabriel <**********************>, “NAQVI, Habib (NHS ENGLAND)” <*********************>, “WILHELM, Reg (NHS ENGLAND)” <************************>

Dear Minh,

Thank you for you e mail.

We are in the process of arranging a meeting with the National Guardian and will let you know when it will be. I will of course need to inform Dr Hughes of your request to have the meeting minuted.

With regards to the inclusion of new metrics in the WRES, we are in the process of evaluating phase 1 of the initiative and will not prior to the outcomes and recommendations of the evaluation be considering the inclusion of additional metrics in the WRES. We are hoping the evaluation to be completed by the end of April 2018.

In addition,  you will be aware that Professor Dr Mala Rao is arranging a meeting to which you and other clinicians/academics will be invited, the purpose of the meeting is  to discuss the WRES, research and together decide what more needs to be done in this arena.

On a final note, NHS England, the WRES team and SAG are fully committed to helping to make demonstrable, sustainable  change within the system for BME staff and will continue to work towards that aim.

Kind Regards

Yvonne

Yvonne Coghill OBE

Director -WRES Implementation

NHS England

Skipton House

London SE1 6LJ

From: Minh Alexander [********************]

Sent: 29 September 2017 11:30

To: COGHILL, Yvonne (NHS ENGLAND)

Cc: CE, England (NHS ENGLAND); mala rao; Victor Adebowale; Hughes, Henrietta; Marie Gabriel

Subject: Concerns about Freedom to Speak Up Guardian appointments – Race

BY EMAIL

Yvonne Coghill

Director of WRES Programme

NHS England

29 September 2017

Dear Yvonne,

Re: Bias and Race Discrimination in the appointment of Freedom to Speak Up Guardians

Further to my letter of 19 September to the Minister of State for Health below, the Minister has informed me the WRES team will be meeting with the National Guardian’s office to

“…consider the identification of interventions that may help to improve the diversity of Freedom to Speak Up Guardians”

I wonder if it would be possible to share the minute of this meeting and any associated action plan with whistleblowers.

Also, please can you advise if NHS England is willing to include whistleblowing measures in the WRES metrics of the annual NHS staff survey, as per my request of 19 September?

Many thanks.

Yours sincerely,

Minh

Dr Minh Alexander

Cc Simon Stevens Chief Executive NHS England

     Lord Adebowale NHS England NED

     Prof Mala Rao NHS England WRESAG

     Marie Gabriel NHS England WRESAG

     Dr Henrietta Hughes National Freedom To Speak Up Guardian

From: Minh Alexander <minhalexander@aol.com>

Subject: Concerns about Freedom to Speak Up Guardian appointments – Race

Date: 19 September 2017 at 07:52:26 BST

To: philip.dunne.mp@parliament.uk

Cc: ****************, edward Jones <*****************>, Contactus England <*******************>, CE England <******************>, kate Moore <*********************>, Robert Francis, “Hughes, Henrietta” <*****************>, Dave Lewis <******************>, Yvonne Coghill <****************>, mala rao <**********************>

BY EMAIL

Rt Hon Philip Dunne

Minister of State

Department of Health

19 September 2017

Dear Mr Dunne,

Concerns about Freedom to Speak Up Guardian appointments – Race

I see that the National Guardian’s survey of Speak Up Guardians, released yesterday, has confirmed a low percentage (8.5%) of Speak Up Guardians from visible ethnic minorities. This is in accordance with my findings when I reviewed NHS Employer’s data and other sources earlier this year – see attached and previous correspondence below with Sir Robert.

This is a gross under-representation of BME staff in the NHS (at last count there were 17% non-white NHS staff and 38% non-white NHS doctors and dentists).

It is very disappointing given that research on behalf of the Freedom To Speak Up Review showed that BME whistleblowers are known to suffer greater reprisal.

This failure to appoint enough BME SpeakUp Guardians is another demonstration of the laissez-faire attitude towards and poor administration of the Freedom To Speak Up Project.

Sir Robert Francis stated in his report of the Freedom to Speak Up Review:

“I do not think it necessary to set out specific additional actions related to the raising of concerns by BME staff”

Given the latest demonstration of system bias in the form of gross under-representation of BME amongst Speak Up Guardians, I wonder if the Department of Health could review this policy and reconsider whether more specific action is needed beyond encouragement.

For example, addition of specific Speaking Up measures to the WRES metrics in the annual NHS Staff Survey.

I additionally copy this to Prof David Lewis, Middlesex University and to the NHS WRES team.

Yours sincerely,

Dr Minh Alexander

cc

Secretary of State for Health

Dame Moira Gibb NHS England NED and member of National Guardian’s Accountability and Liaison Board

Kate Moore, NHS Improvement General Counsel and member of National Guardian’s Accountability and Liaison Board

Sir Robert Francis, CQC NED and member of National Guardian’s Accountability and Liaison Board

Dr Henrietta Hughes National Freedom to Speak Up Guardian

Prof David Lewis, Professor of Employment Law, Middlesex University

Simon Stevens CEO NHS England

Yvonne Cognill, WRES Programme Director, NHS England

Prof Mala Rao, WRES Advisory Group and lead for WRES medical programme

https://minhalexander.files.wordpress.com/2017/04/20170915_freedom_to_speak_up_guardian_survey2017.pdf

4 Page 66 of the report of the Freedom to Speak Up Review:

Francis BME page 66

http://webarchive.nationalarchives.gov.uk/20150218150953/https://freedomtospeakup.org.uk/wp-content/uploads/2014/07/F2SU_web.pdf

5 https://minhalexander.files.wordpress.com/2016/09/race-breakdown-of-q13-whistleblowing-nhs-staff-survey-2015-20161.pdf

6 Correspondence with the Picker Institute about NHS staff survey data:

From: Rory Corbett <***********************************>

Subject: RE: Race breakdown for question 13

Date: 10 October 2017 at 11:28:10 BST

To: Minh Alexander <**************************************>

Cc: nhsstaffsurvey <nhsstaffsurvey@surveycoordination.com>

 Hi Minh,

For those analyses it would cost approximately:

1)    £500-£700 (excl. VAT)

2)    £1200-£1600 (excl. VAT)

The exact cost will depend on exactly what is required for each question – are you after ‘top box’ data (e.g. for q13a –  the % responding ‘yes’) or data for each individual response option (e.g. for q13a – the % responding ‘yes’, the % responding ‘no’, the % responding ‘don’t know’)?

I’d also need to run this request past NHS England for approval – but I would expect there wouldn’t be a problem as no case level data is being shared.

Regards,

Rory

Rory Corbett

Senior Research Associate

Survey Coordination Centre

Picker Institute Europe

Buxton Court

3 West Way

Oxford OX2 0JB

Web:   www.nhsstaffsurveys.com

           www.nhssurveys.org

           www.picker.org

From: Minh Alexander [*******************]

Sent: 04 October 2017 16:16

To: Rory Corbett <******************>

Subject: Race breakdown for question 13

Again, very helpful Rory, thank you.

Is it possible to say roughly how much ‘BME v White’ analyses of

1) Question 13, at trust level

2) All Questions, at trust level

for the 2016 data would cost, respectively?

BW

Minh

Minh Alexander

From: Rory Corbett <*******************>

Subject: RE: Race breakdown for question 13

Date: 4 October 2017 at 16:11:16 BST

To: Minh Alexander <*************************>

Hi Minh,

We haven’t broken down the data at trust level by white/BME for all questions – but this would be possible with the data we hold.

We do conduct additional analysis on the staff survey data for individuals & organisations but we do have to charge for our staff time in such cases.

Regards,

Rory

Rory Corbett

Senior Research Associate

Survey Coordination Centre

Picker Institute Europe

Buxton Court

3 West Way

Oxford OX2 0JB

Web:   www.nhsstaffsurveys.com

           www.nhssurveys.org

           www.picker.org

Charity registered in England and Wales: 1081688

Charity registered in Scotland: SC045048

From: Minh Alexander [*********************]

Sent: 03 October 2017 22:19

To: Rory Corbett <*******************>

Subject: Race breakdown for question 13

Hi,

Thanks. That’s very helpful.

May I check one more thing – do you hold the trust level data, even if you don’t publish it?

Thanks,

Minh

Minh Alexander

From: Rory Corbett <**************************>

Subject: RE: Race breakdown for question 13

Date: 2 October 2017 at 15:12:15 BST

To: Minh Alexander <***************************>

Cc: nhsstaffsurvey <nhsstaffsurvey@surveycoordination.com>

Hi Minh,

If you look at this spreadsheet you will find the 2016 results for q13 for both white staff and BME staff – this is located on row 391 and 392.

The same data is available in this spreadsheet for 2015 on row 370 and 371.

Please note this is the score for staff from all organisations (including CCGs, CSUs and other small organisations that conduct the survey voluntarily).

We don’t publish this data at trust level unfortunately.

Regards,

Rory

Rory Corbett

Senior Research Associate

Survey Coordination Centre

Picker Institute Europe

Buxton Court

3 West Way

Oxford OX2 0JB

Web:   www.nhsstaffsurveys.com

           www.nhssurveys.org

           www.picker.org

Charity registered in England and Wales: 1081688

Charity registered in Scotland: SC045048

This email and any attachments to it may be confidential and are intended solely for the use of the individual to whom it is addressed. 
Any views or opinions expressed are solely those of the author and do not necessarily represent those of Picker Institute Europe.
If you are not the intended recipient of this email, you must neither take any action based upon its contents, nor copy or show it to anyone.

From: Minh Alexander [******************]

Sent: 01 October 2017 21:37

To: nhsstaffsurvey <nhsstaffsurvey@surveycoordination.com>

Subject: Race breakdown for question 13

Dear Sir,

Race breakdown for question 13

Can you advise me if you can provide a national overview as regards the scores for white v BME staff on the following 2016 and 2015 NHS staff survey questions?

Question 13

a)    If you were concerned about unsafe clinical practice, would you know how to report it?

b)     b) I would feel secure raising concerns about unsafe clinical practice.

c)     I am confident that my organisation would address my concern.

Also, do you hold trust level data on white vs BME for these questions, for 2015 and 2016?

Thanks,

Dr Minh Alexander

Picker Institute Europe is a charity registered in England and Wales, registered number 1081688 and in Scotland, registered number SC045048.
Registered Company number 3908160. Registered office: Picker Institute Europe, Buxton Court, 3 West Way, Oxford OX2 0JB.
This email and any attachments to it may be confidential and are intended solely for the use of the individual to whom it is addressed.
Any views or opinions expressed are solely those of the author and do not necessarily represent those of Picker Institute Europe.
If you are not the intended recipient of this email, you must neither take any action based upon its contents, nor copy or show it to anyone.

 

Postscripts on Paula. NHS England’s apologia & regulatory reticence

By Dr Minh Alexander and Clare Sardari, NHS whistleblowers, 10 October 2017

The Vasco-Knight affair is emblematic of a self serving managerialism that has crept into the NHS in latter years:  Those with sharp elbows climbing over other people’s rights, corporate back slapping, gala events to puff up egos, endless hot air and empty lip service to service by those who primarily help themselves.

Paula Vasco-Knight was a much feted NHS chief executive before her final fall due to the emergence of a criminal fraud. She was a BME poster girl for NHS England’s rhetoric about Equality. 1

 

One of Vasco-Knight’s colleagues at NHS England was Steve Field, who became CQC’s  Chief Inspector of General Practice in 2013:

Screen Shot 2017-10-10 at 00.19.02

 

She was awarded a honorary doctorate by Exeter University 2 and took dubiously to calling herself ‘Doctor’. She was also favoured with a CBE.

 

CBE

 

NHS England Chair’s comments about Vasco-Knight’s CBE:

Professor Sir Malcolm Grant, Chair of NHS England, said: “We are very proud of Dr Vasco-Knight for her achievement. She has done a fantastic job at NHS England representing the needs of all staff and promoting the call for diversity to be further up the NHS agenda across the UK. This honour is testament to the 25 years of hard work Dr Vasco-Knight has given to the NHS and is continuing to give.

Healthwatch Devon on PVK’s CBE Dec 2013

 

 

The great and the good were reluctant to believe ill of her even after an Employment Tribunal criticised Vasco-Knight and South Devon her former trust for victimising whistleblowers.

Some were solicitous about the length of her suspension in February 2014 after the ET, which was relatively brief compared to those typically imposed on whistleblowers:

Screen Shot 2017-10-10 at 02.39.26

Vasco-Knight resigned in May 2014 as South Devon’s chief executive. But she was quickly recycled on the locum circuit, where she was still handsomely paid by the NHS. 3 Monitor accepted her into its interim pool. 4 4b When Vasco-Knight returned to a Board position at St Georges, there were raised eyebrows but some were quick to opine that she deserved a second chance. 5

The CQC determined that a history of whistleblower reprisal was not a sufficiently serious obstacle to her recycling. The CQC’s then chief inspector Mike Richards personally shut down an FPPR referral and this allowed Vasco-Knight to be promoted to acting Chief Executive at Georges:


https://minhalexander.com/2017/01/27/cqc-a-chief-inspector-doesnt-call/

 

It was only the news of her misappropriation of NHS funds that finally led to her sacking by the NHS.

It is ironic that Vasco-Knight’s end was brought about by a paltry £11K swindle. Her nepotism and persecution of whistleblowers had previously cost the NHS hundreds of thousands, but was just shrugged off by the powers that be.

Exeter University’s bosses tried their best to ignore a complaint about her honorary doctorate on the basis of her victimisation of whistleblowers and conviction for fraud. 6

Screen Shot 2017-10-10 at 01.31.05.png

The university still did not respond to a reminder after she was sentenced. 7

But further enquiries now reveal that Vasco-Knight was stripped of the degree in April in this year, after her sentencing for fraud.

Screen Shot 2017-10-09 at 16.47.25

 

NHS Protect had advised that its fraud investigation commenced in March 2014 and was triggered by a joint referral from Vasco-Knight’s former trust and NHS England:

Screen Shot 2017-10-09 at 22.48.25From FOI response by NHS Protect 21 February 2017

 

Enquiries to NHS England about its role in the fiasco by Clare Sardari @SardariClare , one of the South Devon whistleblowers, were met with predictable circumlocution.

Initially, Simon Stevens’ office claimed that NHS England had been innocent of Vasco-Knight’s fraud until informed about it in April 2016 by NHS Protect:

“Paula Vasco-Knight worked for NHS England on a part-time basis up to January 2014. On 28 April 2016, we were informed by NHS Protect that a member of our staff was being charged with fraud, together with Paula Vasco-Knight and her husband. I informed NHS Improvement the following day as I was aware that Paula Vasco-Knight had recently been appointed to an interim role at Georges Foundation NHS Trust.

As far as I can establish, NHS England was not aware that Paula Vasco-Knight was under investigation prior to 28 April 2016. I understand that she was referred to NHS Protect by South Devon Healthcare NHS Trust, and I can’t find any record of NHS England being involved in the referral. I can confirm that we haven’t disclosed an further material on this matter to NHS Improvement (i.e. in addition to the notification I shared with them in April last year).”

When this was queried with opposing facts, Simon Stevens’ office revised its account:

Dear Clare

I can now confirm that NHS England did indeed make a formal referral to NHS Protect in April 2014. I was not aware of this when I wrote to you on 11 July.

Referrals to NHS Protect are confidential and it would not be appropriate for us to inform other bodies when such referrals are made. This is for two reasons: first, there has to be a presumption of innocence while investigations are taking place and second, NHS Protect’s investigations could be undermined if the individual being referred should become aware of the referral.

As I previously explained, I did alert NHS Improvement at the point I became aware that Paula Vasco-Knight was to be charged with fraud.

Yours sincerely 

Tom

Tom Easterling

Director of the Chair and Chief Executive’s Office

NHS England

Health and high quality care for all, now and for future generations”

When it was pointed out that NHS England’s date did not tally with the information from NHS Protect, Simon Stevens’ office again revised its position. It specifically admitted that it did not warn NHS Improvement about Vasco-Knight’s fraud:

“Dear Clare

Thank you for your email. To respond to your questions:

  1. I am told that an informal referral was initially made to NHS Protect by South Devon Healthcare NHS Foundation Trust and this was then followed by a formal referral by South Devon Healthcare NHS Foundation Trust and NHS England in April 2014.
  2. No disclosure was made to NHS Improvement so there is no further correspondence to share.
  3. As I previously explained, referrals to NHS Protect are confidential and it would not have been appropriate for us to inform other bodies that we had made a referral to NHS Protect.  It is the responsibility of employers to assure themselves that potential employees are fit and proper persons.

Yours sincerely

Tom

Tom Easterling

Director of the Chair and Chief Executive’s Office

NHS England

Health and high quality care for all, now and for future generations”

This is the full correspondence with NHS England:

NHS England correspondence

 CQC was evasive about when it learned of Vasco-Knight’s fraud, but disclosed that there was also an internal meeting of senior CQC managers on 28 April 2016 about Vasco-Knight’s fraud:

“We do not hold a record of the exact date when CQC first became aware of the fraud allegations.

 We can however confirm that a meeting took place on 28 April 2016 between David Behan, Chief Executive of CQC, Professor Sir Mike Richards, Chief Inspector of Hospitals, Ellen Armistead, Deputy Chief Inspector of Hospitals and Rebecca Lloyd-Jones, Director of Legal Services and Information Rights, where the fraud allegations were discussed.” 

20170324 Final Response FOIA CQC IAT 1617 0746

 

This is a redacted email chain between Jim Mackey, Mike Richards and others in early May 2016 when Vasco-Knight’s fraud hit the headlines:

Screen Shot 2017-10-09 at 15.39.58

20160518 Email from NHS Improvement to CQC WITH SCANNED REDACTIONS

20160517 Email correspondence St George’s Fit and Proper Person Test CQC IAT 1617 0746 WITH SCANNED REDACTIONS

 

NHSI has also revealed that irregularly, an un-minuted meeting took place between Mike Richards and NHSI’s Head of Private Office about Vasco-Knight and FPPR on 26 May 2016. 8

But the full details of what passed between the regulators and NHS England are not available as both CQC and NHSI have drawn a veil over it all on grounds that it might prejudice the conduct of public affairs. That usually just means that important people do not wish to be embarrassed:

“Section 36(2)(b)(ii) free and frank exchange of views 

The correspondence in question represents senior executives exchanging views about the investigations against Paula Vasco-Knight and the fit and proper person test. The correspondence was intended to prompt discussion and learning from the case of Ms Vasco-Knight, and how this situation could be avoided in the future. Sharing information between bodies ensures that we are able to respond to situations effectively and efficiently. In order to carry out their functions, the officials of NHS Improvement, NHS England and the CQC must be able to exchange information freely, without concern that the detail of that information exchange will be disclosed inappropriately. If the information were published, it would be likely to restrict the organisations’ willingness to share and discuss information, due to the possibility that this information may be made public. That would have an adverse impact on the ability of NHS Improvement, NHS England and the CQC to liaise effectively on leadership and operational issues at NHS trusts and foundation trusts and would inhibit the free flow of information.”

 NHS Improvement 19 July 2017 

NHSI FOI response to Clare Sardari 19 July 017

 Mr Behan has reviewed the information and expressed the opinion that disclosure of the information would inhibit the free and frank exchange of views for the purposes of deliberation; would be likely to prejudice the effective conduct of public affairs, and that the public interest to be served by withholding the information outweighs the public interest that would be served by disclosure

 CQC 24 March 2017

 “No other person’s opinion can be substituted for that of the qualified person but, where we receive a request for internal review, a non-executive member of our board is asked to perform the review and consider whether the opinion of the qualified person is a reasonable one, and whether the public interest in withholding the information outweighs the public interest in disclosure. In this case, Mr Paul Corrigan performed this review. Mr Corrigan’s decision is that the exemption was correctly applied, therefore we will not release the content of the email.

 CQC 13 July 2017

Intriguingly, NHSI also considered that full disclosure of all relevant correspondence might damage its relationships with NHS England and CQC:

“This exemption is engaged as disclosure of correspondence on how to prevent similar conduct in the NHS as that in the Vasco-Knight case may damage the relationship of trust and confidence between NHS Improvement and other national bodies involved, as well as inhibit the free flow of information.” 8

One wonders if recriminations lurk in the undisclosed correspondence.

But whatever words were exchanged, it seems clear that NHS England simply stood by and kept shtum when Vasco-Knight was recycled to board positions at St Georges, despite knowing that there were serious questions about whether she was a Fit and Proper Person.

So much for Safeguarding principles.

NHS England defends keeping its hands in pockets on grounds that Vasco-Knight was innocent until proven guilty.

No such latitude was given to the whistleblowers who were persecuted on her watch.

NHS whistleblowers are still suspended at the drop of a hat and shown the door quicker than you can say ‘interim executive pool’.

CQC’s and NHSI’s approach to assuring that NHS executives are Fit and Proper Persons looks unchanged. A few deck chairs have been re-arranged but the process continues to rely on self assessment by regulated bodies:

“NHSI have no direct involvement in the completion of the fit and proper person test for executive staff by NHS Trusts. Owing to the confidential nature of the content within the FPPT, we rely on a self-assessment by the NHS Trusts that this process has been completed. NHS Trusts are asked to complete a template notifying NHSI of the outcome of the selection process and within this template includes a box for the trust to confirm the FPPT has been completed.” 8

Indeed, when NHS England was asked if it would do things differently in future it retorted:

It is the responsibility of employers to assure themselves that potential employees are fit and proper persons.”

NHS England email 9 August 2017

So despite the recent jailing of Jon Andrewes trust chair who falsified a CV 9, and Paula Knight’s conviction for fraud after ineffective vetting by St Georges with collusion from the CQC, we are simply back at square one.

Any old patter may pass.

 

Comments by Vasco-Knight in a blog she wrote for the NHS Leadership Academy after receiving her honorary doctorate from Exeter University in 2013:

The most important thing you can bring to work with you is your common humanity – your kindness and compassion. Think of your patients or your customers or your colleagues as if they might be members of your own family. What would you want for them and how would you wish them to be treated?

I live these values in my everyday life and so far they have served me well.

Vasco-Knight NHS Leadership Academy blog 2013

 

Mike Richards claimed at the outset of implementing Regulation 5 in 2014 that it would be too difficult to remove too many managers.  To our knowledge, CQC has not triggered the removal any NHS managers under FPPR yet.

Shortages of management staff are of course a challenge, but tolerating a solid contingent of poor quality appointments seems unlikely to make the NHS attractive to better managers.

And as for Clare Sardari, a robustly and repeatedly vindicated whistleblower, the NHS still not made any meaningful amends.

 

Screen Shot 2017-10-09 at 23.39.31

 

Screen Shot 2017-10-10 at 02.47.43

Screen Shot 2017-10-10 at 02.29.55

 

OTHER ITEMS

Open letter by Clare Sardari to St George’s governors

clare-sardari-open-letter-st-georges

NHS Gagging: How CQC sits on its hands

https://minhalexander.com/2016/09/23/nhs-gagging-how-cqc-sits-on-its-hands-2/

Engineered failure to investigate whistleblowers’ concerns

https://minhalexander.com/2017/04/08/engineered-failure-to-investigate-nhs-whistleblowers-concerns/

 

REFERENCES

1 Paula Vasco-Knight was appointed as NHS England’s National Lead for Equality in 2013, under David Nicholson’s reign

Screen Shot 2017-10-10 at 00.21.43

https://www.england.nhs.uk/2013/11/equality-toolkit/

https://www.england.nhs.uk/wp-content/uploads/2014/01/edc-meet-min-jan14.pdf

Vasco-Knight NHS Leadership Academy blog 2013

3 Management consultant’s £1,000 a day slap in face for Lancashire NHS Staff Peter Magill, Lancashire Telegraph, 5 August 2015

http://www.lancashiretelegraph.co.uk/news/13573334.Management_consultant___s___1_000_a_day____slap_in_face____for_Lancashire_NHS_staff/

https://twitter.com/IanLex2/status/741201394355560448

4 FOI disclosure by St Georges 24 March 2016

  • Mrs Vasco-Knight was interviewed for the post of Interim COO on 28th September 2105.
  • The interview included questions about the reason for Mrs VascoKnight leaving South Devon Healthcare Trust.
  • References were taken up from Hunter Healthcare on appointment
  • Verbal approval to the interim appointment had been given by Monitor and Mrs Vasco-Knight was confirmed to be on the Monitor interims approved list
  • When concerns were raised by staff and governors, the trust obtained a copy of the ET findings and took advice from Capsticks Solicitors.
  • A member of the executive team interviewed Mrs Vasco-Knight.
  • Further references were taken from Monitor, which had provided support for the Monitor FPPT process.

The findings were considered by Christopher Smallwood, Chairman on 27th October 2016.

St Georges FOI response FPPR assessment of Ms VascoKnight 24.03.2017

4b FOI disclosure by Monitor 23 December 2015

Ms Vasco-Knight submitted her application for the Monitor interim pool on 16 April 2015. Monitor subsequently undertook its validation process to obtain references and verified case studies, and accepted and confirmed Ms Vasco-Knight’s membership, over the course of May 2015.

Monitor VascoKnight FPP FOI response 23.12.2015

5

Vasco-Knight HSJ Editor &amp; MBI recyle

6 Letter to Chancellor Exeter University 27 Feb 2017

7 Letter to Exeter University 10 Mar 2017

8 NHS Improvement FOI response 19 July 2017

NHSI FOI response to Clare Sardari 19 July 017

9 http://www.bbc.co.uk/news/uk-england-39183882

http://www.somersetcountygazette.co.uk/news/15137343.Builder_who_conned_his_way_into_top_NHS_jobs_jailed/

 

Ivy Atkin’s death & more CQC evasion

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 5 October 2017

Summary

The CQC catastrophically failed Ivy Atkin and other vulnerable residents at Autumn Grange care home in Nottingham, where patients were horrendously neglected and suffered unexplained injuries.

Ivy Atkin died on 22 November 2012 as a result of severe neglect. Inexplicably, it seems that on the final inspection of Autumn Grange when CQC inspectors found her gravely ill, she was not taken to hospital. Instead, she was transferred to another care home where she died after three weeks.

CQC did not carry out any internal review of its failures for four years, and it has still not properly accounted for its omissions in the Autumn Grange affair.

It has not answered a question about why Ivy Atkin was not taken to hospital.

The local authority has published only an executive summary of the Serious Case Review into Autumn Grange.

Remarkably, despite the fact that David Behan gave an undertaking last year that an internal review of the matter would be published, CQC has had a change of heart and is now trying to conceal the full contents of this document.

I have made a formal complaint about this extraordinary secrecy and arbitrariness.

Moreover, as CQC has now admitted under FOIA that it has asked for some of its responses to coroners’ Section 28 reports not to be published, I have asked CQC if it asked for its response on Ivy Atkin’s death to be withheld.

I hope Sir Robert Francis is re-thinking his comments to me of 19 January 2017:

“Of course nothing is perfect and the organisation recognises this:…under the leadership of David Behan, it is constantly – and openly –  striving to improve the way it regulates the sector”

 

Complaint to CQC Chair cc CQC Board, Philip Dunne Minister of State for Health and others:

BY EMAIL

Peter Wyman

Care Quality Commission Chair

5 October 2017

 

Dear Mr Wyman,

CQC’s handling of Ivy Atkin’s death, matters at Autumn Grange and issues of transparency and accountability

I write to raise a complaint about CQC’s handling of its failures concerning Ivy Atkin’s death and the related matters at Autumn Grange.

This is separate to a request for general internal review of CQC’s response to FOIA request IAT 1718 0390 which I will address under separate cover.

Ivy Atkin died a horrific death on 22 November 2012, weighing only 3st 13lb, having lost half her body weight over 48 days stay at Autumn Grange care home. Her body mass index was 10.7, which is at the outermost limit of survival. She was found close to death at Autumn Grange. She had pneumonia and an infected grade 4 pressure ulcer, contaminated with faeces. Her bed was soaked with urine. 1

When Ivy Atkin was discovered in extremis by CQC inspectors and the police she was reportedly not taken to hospital, but transferred to another care home where she later died three weeks later. 2

Other residents at the home were also found in a most neglected state:

“…mattresses were sodden with urine, there was no hot water or incontinence pads and residents were wearing each other’s clothing and even underwear” 1 

A spokesperson for the CQC reportedly stated:

 “The level of care at Autumn Grange was unacceptable and our inspectors were truly shocked by what they found.” 1

Private Eye reported in February 2016:

 

“Ivy who had dementia, wasn’t the only resident suffering gross neglect. After an anonymous carer blew the whistle, at least two residents were found to have pressure sores which were not treated properly; others were found lying in their own urine or waste; another had long, filthy nails digging into the skin, and yet another was found dehydrated with cracked and bleeding lips. Others had “unexplained injuries and bruising”, including head wounds, bruised and swollen hands and cuts to the knees and eyes of people who were immobile. Painting a horrific picture of staff “care”, one resident complained to inspectors about noisy nights. “Depends on which gang is on. They shout at the barmy ones,” he said. There was no hot water to wash those who were in a filthy state, and call bells were either not working or deactivated.” 2

 

 

The care home owner was subsequently convicted of manslaughter for the criminal negligence that resulted in Ivy Atkin’s death. 1 3 It was reported that expert evidence drew a causal link between the poor care and Ms Atkin’s physical decline and death. 1

Yet CQC had determined that Autumn Grange was largely compliant in the weeks prior to her death in 2012:

 

Screen Shot 2017-10-05 at 12.33.52

http://www.cqc.org.uk/sites/default/files/old_reports/1-101618554_sherwood_rise_limited_1-126202251_autumn_grange_residential_home_20121102.pdf

 

In February 2016 the CQC told Private Eye “..if there are further lessons to learn as a result we will ensure we do so”.

In relation to this, I asked David Behan on 18 February 2016 if CQC had conducted any internal review of its regulatory failure:

Dear Mr Behan,

Re Autumn Grange, the death of Ivy Atkin and CQC’s role

I see that the latest Private Eye reports concerns that CQC did not detect (or act upon) very serious failings at Autumn Grange care home, and concerns that the death of Ivy Atkin, 86 in 2012 was related to this.

I copy below the salient extracts from the Private Eye article. 

As the CQC has undertaken an internal review into why it gave Homerton maternity services a “good” rating in 2014, when this followed by at least Rive subsequent maternal deaths and findings of service failings at inspection a year later, may I ask if CQC has undertaken a similar internal review of the matters at Autumn Grange?

If such an internal review has been undertaken, please could a copy of this be made available and published.

Whilst I understand that a serious case review regarding Autumn Grange is now underway, may I also ask if there has been any previous examination of why Ivy Atkin was reportedly not admitted to hospital in October 2012 when she was found to be in such serious medical condition, but reportedly only transferred to another care home where she died three weeks later, despite CQC and all agencies presumably being aware of the serious medical condition in which she had been found?

Yours sincerely,

Dr Minh Alexander

I received an unfortunate response to this enquiry from the CQC Head of Inspection for the Central Region. He told me that although CQC had not undertaken an internal review, it was his view that CQC regulatory processes were “better than ever before”. 4

The CQC Head of Inspection did not address my question about why Ivy Atkin was not taken to hospital despite CQC inspectors finding her in extremis.

The executive summary of a Serious Case Review report produced for Nottingham City Council later stated that CQC accepted their inspection in September 2012 should have been more rigorous”. 5

But it was only after damning coroner’s findings on Ivy Atkin’s death and a related Section 28 Report on Action to Prevent Future Deaths issued on 25 October 2016 that CQC gave any public indication of internal review regarding Autumn Grange. 6

 

The coroner’s Section 28 report of 25 October 2016 on Ivy Atkin’s death, sent to CQC as a named respondent:

https://www.judiciary.gov.uk/wp-content/uploads/2016/12/Atkin-2016-0379.pdf

CQC’s did not respond to the coroner within the statutory deadline and its response was not published by the Chief Coroner until August 2017, after I queried its absence:

https://www.judiciary.gov.uk/wp-content/uploads/2016/10/2016-0379-Response-by-Care-Quality-Commission.pdf

 

 

CQC informs me that the internal review took place in August 2016.

However when I recently asked for a copy of the internal review, CQC resisted disclosure on grounds that it would infringe CQC staff privacy:

 

 

We consider CQC’s full Internal Review into this matter to be exempt from disclosure as the reports contains personal information and identifies individual inspectors and disclosure could severely impact their privacy if they were identified. This exemption is explained in full in the ‘Exemptions on disclosure’ section below.

 From a CQC response received 4 October 2017

 

 

This is an extraordinary FOIA exemption to rely upon in a case of unlawful killing where the regulator has admitted that its actions were wanting.

CQC’s attempt to protect itself in this manner also seems all the more questionable given that David Behan CQC CEO previously assured the CQC Board on 16 November 2016 that this internal review would be published:

 

 

We expect to publish our internal review into our regulation of Autumn Grange Residential Home alongside the summary of the Council’s Safeguarding Adults Review.”

https://minhalexander.files.wordpress.com/2017/09/david-behan-report-to-cqc-board-16-nov-2016-cm111604_item4_chiefexecutivereport.pdf

  

 

CQC has gone to trouble of producing a manicured summary of its withheld internal review on Autumn Grange, which emphasises that the coroner was satisfied by CQC’s assurances that things had ‘moved on’:

https://minhalexander.files.wordpress.com/2016/09/cqc-internal-review-summary-20170902-autumn-grange.pdf

There is ample evidence that things have not ‘moved on’ and that CQC continues to fail very vulnerable care home residents. 7 8 9

CQC’s failure to act on the appalling, similar death of Barbara Cooke in 2014 despite receiving a coroner’s Section 28 report is a case in point. 10 I should point out that there is still no published CQC response to the Section 28 report issued on 12 September 2014 about Barbara Cooke’s death.

It is inappropriate of CQC to suggest that the public should settle for a summary of its withheld internal review report on Autumn Grange.

Given that CQC has now just been exposed for covering up the likely rape of a highly vulnerable man in another care home 11, I think this filtering of information by CQC is especially unwelcome and that the negligent, horrific death of a vulnerable person requires full transparency.

CQC conceded only four weeks ago that external review was required in the case of the above covered up rape. It is simply not credible for CQC to assert that a filtered version of an internal review is adequate accountability for Ivy Atkin’s terrible death.

Under even the much criticised old CQC regime, Cynthia Bower and Jo Williams arranged an internal review of CQC’s notorious failures at Winterbourne View that was published. 12 And nobody died in that episode.

CQC’s summary of its internal review on Autumn Grange raises more questions than it answers.

Unsurprisingly, CQC admits fleetingly in its summary of the internal review that it failed to listen to whistleblowers:

 

 

The review identified a number of areas where improvements were required. There was too much focus on the evidence collected the day of the inspection in September 2012 rather than ensuring that our methods for assessing the provider’s regulatory risk was based on all the information available including past regulatory history, whistleblowing and safeguarding referrals and concerns from other agencies. The review also identified that record keeping, storage of information and inspection planning was poor.

 Undated CQC summary of its internal review on Autumn Grange and Ivy Atkin’s death

 

 

I believe it is incumbent on CQC to explain in greater detail exactly what whistleblower intelligence it received about Autumn Grange prior to Ivy Atkin’s death and why it failed to act upon this intelligence.

This is because these matters remain relevant and CQC continues to fail whistleblowers by not listening to them or even being complicit in reprisal against them. 13

A recent FOI disclosure by CQC relating to HC-One, one of the largest care providers, suggests that CQC still gives insufficient weight to whistleblower intelligence. 14

I think given the gravity of the matters in question CQC should publish its internal review on Autumn Grange in its entirety, and provide the public some assurance regarding the competence of inspection staff involved and whether they remain employed by CQC.

If CQC is not willing to provide such assurance, I feel the very least that CQC should do is disclose and publish the internal review with redaction of individual CQC staff details.

I should point out of course that the CQC may not rely on a privacy exemption under the FOIA where information is already in the public domain.

Your inspector for Autumn Grange is already named on the public record and reported to have stated that she found “chaos and screaming” upon the final Autumn Grange inspection, but that she maintained that “A home can go downhill quickly”. 15

It was also reported:

“Under questioning from Nottinghamshire Assistant Coroner Stephanie Haskey, Mrs W said she had not “missed anything” in an earlier inspection in September.”

 

To summarise, I am concerned that:

  • CQC did not see fit to undertake an internal review until four years after Ivy Atkins death.

 

  • CQCs Head of Inspection appeared in his letter to me of 2 March 2016 to be dismissive of the need for internal review and despite the absence of review, claimed that things were better.

 

  • CQC has refused to disclose a copy of its internal review and it has not published its internal review despite this being originally promised by David Behan.

 

  • CQC has given inadequate and frankly spurious reasons for not making the full contents of its internal review public. CQC has failed to act appropriately on the most serious public interest issues possible.

 

  • CQC has still not addressed my original question of why Ivy Atkin was not taken to hospital when CQC inspectors found her gravely ill.

 

Moreover, now that CQC has admitted that it has asked that some of its responses to Section 28 reports should not be published by the Chief Coroner, I would be grateful if CQC would clarify whether it initially asked for its response to the Section 28 report on Ivy Atkin’s death not to be published by the Chief Coroner.

In short, CQC cannot have the moral authority to demand transparency of regulated bodies if it is not willing to model the same behaviour and values.

Yours sincerely,

Dr Minh Alexander

Cc

Sir Robert Jay Queen’s Bench Division, High Court

Ms Stephanie Haskey Ass Coroner Nottinghamshire

Ms Mairin Casey Coroner Nottinghamshire

Judge Mark Lucraft Chief Coroner

Elizabeth Denham UK Information Commissioner

Lord Bew CSPL

Sir Amyas Morse NAO

Public Administration and Constitutional Affairs Committee

Public Accounts Committee

Health Committee

Philip Dunne MP Minister of State for Health

Dr Philippa Whitford MP

Norman Lamb MP

Jon Ashworth MP Shadow Secretary of State for Health

Barbara Keeley MP Shadow Minister for Mental Health and Social Care

Sir Paul Jenkins, Matrix Chambers

Sir Robert Francis QC CQC NED

Prof Louis Appleby CQC NED

Paul Corrigan CQC NED

Paul Rew CQC NED

Jora Gill CQC NED

Ted Baker CQC Chief Inspector of Hospitals

Andrea Sutcliffe CQC Chief Inspector of Adult Social Care

Steve Field CQC Chief Inspector of General Practice

Mike Mire CQC NED and Chair of CQC Regulatory Governance Committee

Malte Gerhold CQC Executive Director of Strategy and Intelligence

Jane Mordue CQC NED and Chair Healthwatch England

 

RELATED ITEMS

CQC’s “better than ever”…or didn’t you know?

https://minhalexander.com/2016/10/14/cqcs-better-than-ever-or-didnt-you-know/

CQC an ongoing concern

http://www.compassionincare.com/node/229

Care home deaths and more broken CQC promises

https://minhalexander.com/2016/10/08/care-home-deaths-and-more-broken-cqc-promised/

 

REFERENCES

1 http://www.nottinghampost.com/news/nottingham-news/ivy-atkin-death-care-home-138551

2 Autumn’s Fall. Private Eye February 2016, Issue 1412

3  http://www.bbc.co.uk/news/uk-england-nottinghamshire-35499865

4 https://minhalexander.files.wordpress.com/2016/10/cqc-no-internal-review-of-autumn-grange-death.pdf

5 https://minhalexander.files.wordpress.com/2016/09/safeguarding-adults-review-executive-summary-autumn-grange.pdf

6 CQC Chief Executive report to the CQC Board 16 November 2016

https://minhalexander.files.wordpress.com/2017/09/david-behan-report-to-cqc-board-16-nov-2016-cm111604_item4_chiefexecutivereport.pdf

7 Elderly people put at risk as watchdog fails to act on warnings of fatally negligent care homes, Melanie Newman and Oliver Wright, Independent 2 September 2015

http://www.independent.co.uk/life-style/health-and-families/health-news/elderly-people-put-at-risk-as-watchdog-fails-to-act-on-warnings-of-fatally-negligent-care-homes-10483573.html

8 Public Accounts Committee, report of Inquiry on CQC, 11 December 2015 https://publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/501/501.pdf

9 Care home deaths and more broken CQC promises, Minh Alexander 8 October 2016

https://minhalexander.com/2016/10/08/care-home-deaths-and-more-broken-cqc-promised/

CQC an ongoing concern, Compassion in Care December 2015

http://www.compassionincare.com/node/229

10 Death of Isle of Wight care home resident at centre of national investigation

https://onthewight.com/death-of-isle-of-wight-care-home-resident-at-centre-of-national-investigation/

Section 28 report on Barbara Cooke (for which there is still no published CQC response)

https://www.judiciary.gov.uk/publications/barbara-cooke/

11 Three Times articles published on 27 July 2017, related to CQC cover up of a suspected rape and other incidents at care homes run by Hill Green Care

https://minhalexander.files.wordpress.com/2017/09/cqc-covered-up-suspected-rape-in-care-home.pdf

https://minhalexander.files.wordpress.com/2017/09/leading-article-silent-witness.pdf

https://minhalexander.files.wordpress.com/2017/09/cqc-is-no-stranger-to-claims-of-cover-up.pdf

12 CQC internal management review of the Winterbourne View affair 2011

https://minhalexander.files.wordpress.com/2016/09/cqc-internal-management-review-on-winterbourne-view-20120730_wv_imr_final_report.pdf

13 CQC breach of whistleblower confidentiality and complicity in reprisal

https://minhalexander.com/2017/06/22/cqc-involved-in-a-whistleblowers-referral-to-the-disclosure-barring-service/

Letter to Public Accounts Committee 11 September 2017

https://minhalexander.files.wordpress.com/2017/09/letter-to-public-accounts-committee-11-sep-2017-re-review-of-whistleblowing.pdf

CQC denies denial

https://minhalexander.com/2017/09/16/newsflash-cqc-denies-denial/

14 The FOI data on HC-One disclosed by CQC, regarding information of concern received by CQC on all HC-One providers:

https://minhalexander.files.wordpress.com/2016/09/cqc-foi-hc-one-info-of-concern-20160728-what-do-they-know-jan13-to-jun16-ir7993-v3-cqc-iat-1617-0235.xlsx

Screen Shot 2017-10-05 at 22.54.21

Source: FOI disclosure CQC IAT 1617 0235 via the ‘What Do They Know’ site

https://www.whatdotheyknow.com/request/hc_one_care_home_operator#incoming-848034

 

Five out of the top eight HC-One care homes with the highest number of whistleblowing contacts recorded by CQC, between Jan 2013 to June 2016, are currently rated ‘Good’ overall by CQC:

Screen Shot 2017-10-05 at 23.08.10

Source: FOI disclosure CQC IAT 1617 0235 via the ‘What Do They Know’ site

https://www.whatdotheyknow.com/request/hc_one_care_home_operator#incoming-848034 and published CQC inspection reports as of 17 September 2017

15 http://www.bbc.co.uk/news/uk-england-nottinghamshire-37621522

CQC, coroners’ warnings & the neglect of older people in hospital

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist, 2 October 2017

On 29 September 2017 Professor Ted Baker the new CQC Chief Inspector reportedly made highly politicised comments stating that the NHS was not fit for the 21st Century. He said that the NHS had failed under Labour’s government to adapt to an ageing society with more complex needs. 1

Unsurprisingly he did not refer to the current Conservative government’s policy of aggressively defunding and destabilising the NHS over the last seven years.

Unhelpfully, Baker added to the corporate hectoring against beleaguered managers doing their best in increasingly intolerable conditions with this admonition:

Prof Ted Baker said it was “not acceptable” to keep “piling patients into corridors” as he urged hospital leaders to act swiftly to guard the safety of those in their care.

In his first interview as chief inspector, he said too many hospitals had normalised “wholly unsatisfactory” arrangements which endangered patients, as well as denying basic privacy and dignity.

Prof Baker has written to all hospital chief executives, calling for immediate action to improve safety in A&E, amid fears the NHS will struggle to cope with overcrowding this winter.

This follows surreal revelations that NHS England senior managers made NHS chief executives chant ‘We can do this’ in relation to forthcoming winter A&E performance. 2

The fact is, the economically unviable, frail older people, the seriously mentally ill and learning disabled and the severely physically disabled have rarely been treated by politicians with the care and respect that they deserve. There aren’t enough votes in it.

The list of NHS scandals involving the care of older people is long.

Beech House 3

I whistle blew on some neglected dementia back wards, early in my career but was intimidated and ignored by the local psychogeriatric consultants. Matters might have been worse for me if I had not been protected by other senior staff. A few years later, serious physical and mental abuse of the elders was uncovered and reported in the Beech House Inquiry by Camden and Islington.

Abuse at Beech House:

Screen Shot 2017-10-02 at 14.15.19

Shipman murders 4

The infamous and numerous murders by Harold Shipman flew under the radar for years, partly as his victims were mostly elderly.

 

Gosport Memorial Hospital deaths 5

The controversial deaths are now subject to yet another inquiry after years of unsatisfactory investigations.

 

North Lakelands scandal 6

This related to the mistreatment of psychogeriatric patients and was reported by CHI, one of CQC’s more effective predecessors:

“A culture developed within the Trust that allowed ‘unprofessional, countertherapeutic and degrading – even cruel – practices’ to take place. These practices went unchecked and were even condoned or excused when brought to the attention of the Trust.” 6

 CHI is deeply disturbed by the consultant’s lack of awareness and passive acceptance of being treated like a visitor on the ward where the abuse occurred.6

 

Liverpool care pathway 7

The discredited Liverpool death pathway was a significant stain on the NHS’ reputation, with reports abroad such as:

“UK to scrap notorious Liverpool care pathway, criticized as gateway to euthanasia” 8

And then there are the common or garden intermittent headlines that recur periodically about the neglect of older people in hospitals. For example, failures to ensure nutrition and help with other basic daily functions. 9

Politicians know full well that there is serious unmet need, but typically resist funding decent care for the most vulnerable. The real scale of harm is hidden by ageist assumptions, the fact that older people are expected to die, and that fewer questions are asked when they do. Cases that should be reported to coroners are not. I give an example below.

Moreover, the current government continues to delay the establishment of medical examiners, despite having accepted that they are needed. 10

It has also made a religion out of prizing profit above people, actively persecuting the vulnerable to the extent that it has attracted United Nations censure for breaching Human Rights. 11

 

 

See the Disability News Service website for in depth coverage of the UK government’s violations of the rights of disabled people:

https://www.disabilitynewsservice.com/

@johnpringdns 

 

 

This bell tolling the death of decency has been ringing for years now. CQC with its birds-eye view of both health and social services knows exactly what has been happening. Baker has worked for the CQC since 2014 11 so had three years to say something.

Baker’s intervention this weekend was a perfect sample from the Hunt public relations play book: Tough-new-shiny-independent-regulation…. by the Health Secretary who cares. The truth however is the CQC is just another arm of government, dressed up as a regulator but moving to invisible strings.

 

Coroners’ warnings

Coroners regularly issue Section 28 warning reports on ‘Action to Prevent Future Deaths’ (PFDs) about the poor care of older people in NHS hospitals, which since 2014 have been automatically copied to the CQC based on a memorandum of understanding with the Coroners’ Society.

Based on data published by the Chief Coroner, there is roughly at least one Section 28 report issued every week that relates to harm or risk associated with the care of older people in NHS hospitals.

Screen Shot 2017-10-02 at 17.05.41.png

Section 28 reports on the inpatient care of older people have accounted for at least 19.7% (195 of 987) of all published Section 28 reports relating to the NHS in the last four years.

This is a spreadsheet with reference details of the 195 cases:

https://minhalexander.files.wordpress.com/2016/09/nhs-inpatient-care-of-older-people-section-28-reports-published-up-to-31-july-2017-pub.xlsx

There were 101 women and 94 men.

171 deaths related to the English NHS and 24 deaths related to the Welsh NHS.

The figure of 195 is conservative because the data in Section 28 reports is not standardised, and age is not always stated. I did not include some reports that probably related to older people because there was insufficient indication of age. I have also used an age threshold of 70 and not 65 years. 12

Eleven of the 195 (5.6%) cases attracted a formal finding of neglect. Neglect was described or implied in a number of other cases where a formal finding of neglect was not reported. 13

5.6% is a slightly higher proportion than the proportion of neglect cases amongst all published Section 28 reports relating to NHS care in the same period –  49 cases of neglect out of a total 987 (4.9%). 14

This set in the context that 24 of a total of 60 (40%) published Section 28 reports from all sectors with a finding of a neglect related to people over the age of 65.

It is also important to stress that coroners’ Section 28 reports represent only the tip of the safety iceberg.

Of the 195 NHS cases of harm or risk to older people receiving NHS hospital care, some of the coroners’ concerns related to factors that applied to all patients regardless of age.

However, a number raise questions about low expectations, ageist attitudes and possible cover ups:

 

  1. The coroner for South Manchester felt that Elsie Mallalieu was “written off”:

https://www.judiciary.gov.uk/publications/elsie-mallalieu/

  1. There were two cases featuring the Liverpool care pathway, the deaths of Alva Jullien and Agnes Hannan:

https://www.judiciary.gov.uk/publications/agnes-hannan/

https://www.judiciary.gov.uk/publications/jullien-2013-0232/

  1. The coroner for Brighton and Hove considered that Herta Woods had been “abandoned” in hospital:

https://www.judiciary.gov.uk/publications/herta-woods/

  1. The same coroner reported that Evelyn Kennedy had been so severely neglected that one ward at Brighton and Sussex raised a Safeguarding about another ward’s practice:

https://www.judiciary.gov.uk/publications/evelyn-kennedy/

  1. The same coroner noted that Jack Molyneux was so neglected by Brighton and Sussex that a care home immediately made a Safeguarding referral when he was discharged to their care:

https://www.judiciary.gov.uk/publications/jack-molyneux/

  1. The coroner noted that Alwyn Head’s MRSA related death at Medway occurred in the context of poor care, including a 12 day period in which there was no evidence that a wound was checked and in which effectively “meaningless” nursing entries were made.

https://www.judiciary.gov.uk/publications/alwyn-head/

  1. Susanna Geraty was a fit 75 year old who died after staff failed to give her enough fluids after surgery for a fracture, and she sustained acute renal failure in consequence:

https://www.judiciary.gov.uk/publications/susanna-geraty/

  1. Mrs Care died with a large unexplained bruise:

https://www.judiciary.gov.uk/publications/mrs-care/

  1. Doreen England died of a grade 4 pressure sore which developed in hospital

https://www.judiciary.gov.uk/publications/doreen-england/

  1. Devindar Seth suffered opiate poisoning under Barts’ care and this was not detected by staff but pointed out by the family.

https://www.judiciary.gov.uk/publications/devindar-seth/

  1. In the death of Barbara Cooke with contributory neglect from serious care failures, the coroner for the Isle of Wight noted that the doctors treating her completed a death certificate instead of reporting the death. The coroner was only alerted to the death by chance:

https://www.judiciary.gov.uk/publications/barbara-cooke/

  1. In the death of Leslie Pates at Tameside hospital, the coroner was concerned that the consultant had submitted a report stating that Mr Pates was discharged from hospital without a temperature and a clean pressure sore, when the discharge quickly failed and another doctor from the trust gave the cause of death as ‘sepsis’:

https://www.judiciary.gov.uk/publications/leslie-pates/

  1. 91 year old William Beckwith died after being discharged home by the Royal Chesterfield in the small hours of the morning with an undetected cervical fracture. Eight months after his death, the coroner noted:

The Department, at that time, did not have in place any formal policy or procedure for risk assessing the safety of discharging a frail, elderly patient to home in the early hours of the morning.

https://www.judiciary.gov.uk/publications/william-beckwith/

Widespread unsafe discharges of older people, resulting in emergency re-admissions were flagged by a 2015 Healthwatch England briefing:

https://minhalexander.files.wordpress.com/2016/09/healthwatch-eng-older-people-briefing-2015-10090.pdf

 

No doubt the current bullying of trusts by NHS England and CQC to pull their socks up on A&E performance targets will do little to stem unsafe discharges.

Trusts are not expected to answer back or to highlight glaring unmet need. Indeed, the centre’s behaviour is more likely to result in cover ups.

Several coroners’ Section 28 reports referred to very unsatisfactory internal investigations into the deaths of older people. For example:

“…investigative procedures were demonstrably inadequate”

“The SI report failed to consider or acknowledge lack of fluids as a cause of her acute renal failure despite expert evidence that it was the only credible cause” 

“The report contained serious factual inaccuracies”

Staffing issues were explicitly flagged by coroners in 19 of the 195 cases of care failures involving older people, whether in terms of numbers, skill mix or lack of specialist staff. For example, a lack of physiotherapy at weekends was flagged as a risk to some frail older patients.

In the death of Leslie Murray under St George’s care, the coroner noted that he was assessed as needing 1:1 care but suffered a fall which led to his death because this care was not put in place:

Screen Shot 2017-10-02 at 15.32.45

Of great concern, the coroner also noted that this situation occurred ‘frequently’:

Screen Shot 2017-10-02 at 12.38.30

https://www.judiciary.gov.uk/publications/leslie-murray/

Preventing falls requires safe levels of nursing staffing, sufficient to provide attentive and responsive care for frail older people with sensorimotor handicaps.

Of recurring clinical errors flagged by coroners, failures of falls prevention were very prominent. Thirty five of the 195 cases featured poor falls management, with either inpatient falls (the majority) or falls related to unsafe discharges.

This is unsurprising given repeated reports from nursing staff that they do not have enough time to give all the care that patients need. 15

The latest Royal College of Nursing report based on 30,000 survey responses about nurses’ last shifts, advised that over half of respondents said that care had been compromised on their last shift due to understaffing:

https://www.rcn.org.uk/professional-development/publications/pub-006415

A 2012 Royal College of Nursing survey of nurses revealed these gaps in older people’s care due to inadequate staffing, which includes the vital task of preventing falls:

Screen Shot 2017-10-02 at 14.54.34

https://my.rcn.org.uk/__data/assets/pdf_file/0009/476379/004280.pdf

When there is serious, systemic and recurrent failure to meet foreseeable need this is classed as institutional abuse. To quote the DH’s own words:

 

Neglect and poor professional practice also need to be taken into account. This may take the form of isolated incidents of poor or unsatisfactory professional practice, at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems and this is sometimes referred to as institutional abuse.

Department of Health 2000

https://www.gov.uk/government/publications/no-secrets-guidance-on-protecting-vulnerable-adults-in-care

 

But I suspect that many of the 195 cases of poor care of older people flagged by coroners were never even formally referred as Safeguarding cases to the relevant local authorities. It would be useful to clarify this.

But who would one refer – the service providers or the government that is ultimately responsible through its policies?

I have now written to the newly created Healthcare Safety Investigation Branch, to submit the coroners’ evidence on poor care of the elderly in general, and to raise the specific issue of preventable falls and also the NHS’ compliance with Safeguarding procedures where the harm in question was caused by the NHS itself.

 

RELATED ITEMS

CQC an ongoing concern

http://www.compassionincare.com/sites/default/files/breakingsilence/AN%20ONGOING%20CONCERN%20PUBLISHED%20.pdf

4 years of published coroners’ Section 28 reports in England and Wales

https://minhalexander.com/2017/08/24/four-years-of-published-coroners-section-28-reports-in-england-and-wales/

Covering up cover ups: CQC revisionism

https://minhalexander.com/2016/12/15/covering-up-the-cover-ups-cqcs-revisionism/

 

REFERENCES

1 NHS is not fit for the 21st century hospital Chief Inspector warns, Laura Donnelly, Telegraph 29 September 2017

http://www.telegraph.co.uk/news/2017/09/29/nhs-not-fit-21st-century-hospital-chief-inspector-warns/

2 ‘Humiliated’ NHS hospital bosses forced to chant ‘we can do this’ over A&E targets, Jon Sharman, Independent,  26 September 2017

http://www.independent.co.uk/news/uk/home-news/nhs-england-hospital-bosses-we-can-do-this-a-e-targets-london-meeting-accident-emergency-a7968556.html

3

Report of the internal Inquiry Relating to the Mistreatment of Patients Residing at Beech House, St Pancras Hospital During the Period March 1993 – 1996, Camden and Islington NHS Foundation Trust 1999

Elderly patients punched and abused, BBC January 1999

http://news.bbc.co.uk/1/hi/health/260422.stm

4 The Shipman inquiry reports 2002-2005:

http://webarchive.nationalarchives.gov.uk/20090808155110/http://www.the-shipman-inquiry.org.uk/reports.asp

5 Portsmouth Healthcare NHS Trust at Gosport War Memorial Hospital, CHI 2002

http://webarchive.nationalarchives.gov.uk/20080930083325/http://www.healthcarecommission.org.uk/_db/_documents/04005353.pdf

Gosport hospital deaths inquiry looks into 800 certificates signed by Dr Opiate, Lois Rogers,  Times, 20 August 2017

https://www.thetimes.co.uk/article/hospital-deaths-inquiry-looks-into-800-certificates-signed-by-dr-opiate-jane-barton-p508dnh56

6 The North Lakeland NHS Trust, CHI report to Secretary of State for Health 2000

https://minhalexander.files.wordpress.com/2016/09/chi-investigation-into-north-lakeland-healthcare-nhs-trust-2000.pdf

7 DH review of Liverpool Care Pathway 2013

https://www.gov.uk/government/publications/review-of-liverpool-care-pathway-for-dying-patients

8 UK to scrap notorious Liverpool care pathway, criticized as gateway to euthanasia

https://www.lifesitenews.com/news/uk-to-scrap-notorious-liverpool-care-pathway-criticized-as-gateway-to-eutha

9 Hospitals discriminate against the elderly, BBC 2 November 1998

http://news.bbc.co.uk/1/hi/health/206270.stm

Malnutrition in the community and hospital, Patients Association 2011

http://www.patients-association.org.uk/wp-content/uploads/2014/07/Malnutrition-in-the-community-and-hospital-setting.pdf

Half of hospitals failing to feed elderly patients properly, Guardian 8 October 2011

https://www.theguardian.com/society/2011/oct/08/half-hospitals-not-feeding-elderly

Hospitals show ‘shocking’ lack of care discharging vulnerable patients, James Meikle, Guardian 21 July 2015

https://www.theguardian.com/society/2015/jul/21/healthwatch-hospitals-discharging-vulnerable-patients-lack-of-care-

Healthwatch England special inquiry: Older People briefing 2015

https://minhalexander.files.wordpress.com/2016/09/healthwatch-eng-older-people-briefing-2015-10090.pdf

10 Medical Examiner delay. Statement by Royal College of Pathologists March 2017

https://www.rcpath.org/discover-pathology/news/medical-examiner-delay.html

11 Government accused of breaching UN convention in its treatment of disabled people, May Bulman, Independent 20August 2017

http://www.independent.co.uk/news/uk/home-news/government-disabled-people-un-convention-treatment-breach-a7900176.html

11 CQC information about Ted Baker

http://www.cqc.org.uk/about-us/meet-our-team/professor-ted-baker

12 There is no defined age threshold for services older people. Some services operate a threshold of 65 years but others also assess functional level and frailty. The definition of ‘adults of working age’ has also changed with government policy on retirement age. I have used a threshold of 70 years to be more certain of identifying patients who are clearly older people’s services users.

 

13 The eleven cases with findings of neglect, in the NHS inpatient care of older people:

https://www.judiciary.gov.uk/publications/barbara-cooke/

https://www.judiciary.gov.uk/publications/kathleen-cooper/

https://www.judiciary.gov.uk/publications/audrey-daws/

https://www.judiciary.gov.uk/publications/beryl-farmer/

https://www.judiciary.gov.uk/publications/frederick-hall/

https://www.judiciary.gov.uk/publications/jean-james-2/

https://www.judiciary.gov.uk/publications/sheila-johnson/

https://www.judiciary.gov.uk/publications/david-little/

https://www.judiciary.gov.uk/publications/george-marks/

https://www.judiciary.gov.uk/publications/jack-molyneux/

https://www.judiciary.gov.uk/publications/milly-zemmel/

14 This is the list of 60 Section 28 reports with formal findings of neglect, published up to 31 July 2017:

https://minhalexander.files.wordpress.com/2016/09/section-28-reports-with-findings-of-neglect-published-up-to-31-july-2017-pub2.xlsx

This is a prior analysis which found a total of 987 Section 28 reports relating to the NHS, published up to 31 July 2017:

https://minhalexander.com/2017/08/24/four-years-of-published-coroners-section-28-reports-in-england-and-wales/

15 NHS staff shortages ‘mean patients dying alone’ in hospitals, Nick Triggle, BBC 29 September 2017

http://www.bbc.co.uk/news/health-41433159

Letter to BMA Chair of Council, President & Past Presidents

 

BY EMAIL

Dr Chaand Nagpaul

BMA Chair of Council

27 September 2017

 

Dear Dr Nagpaul,

Re: Transparency about BMA member services and whistleblowing

I write to ask if the BMA will publish data that it assured me in March 2015 that it would start collating on its decisions to support – or not – members’ whistleblowing claims to the Employment Tribunal.

I copy below the most recent correspondence from the BMA of 29 November 2016, in which a BMA senior policy advisor declined to release any BMA case decision data on the basis of small numbers and possible identifiability.

I would be grateful if you could review this given the time elapsed and the likelihood that more cases have accrued. This may have obviated any ‘small numbers’ objections.

I do think that as a matter of good governance and accountability to its members, the BMA should publish data on its support for all cases, and not just whistleblowing claims.

The context of the correspondence with the BMA about these matters is summarised in this article:

https://minhalexander.com/2016/09/29/is-the-bma-worth-163-are-new-socks-better/

You will note that I published an addendum today which relates to a document that the BMA sent to a member of the public, who kindly passed it to me knowing my interest in whistleblowing matters.

https://minhalexander.files.wordpress.com/2016/09/bma-whistleblowing-faqs-21-09-2017-issued-to-a-member-of-the-public-by-bma-on-26-sep-2017.pdf

I was concerned by the tone of this BMA document and its comments about the case of Dr Chris Day, NHS whistleblower.

Dr Day still has serious travails ahead of him, and a young family to support.

http://www.dailymail.co.uk/news/article-4503734/The-dedicated-NHS-doctor-tried-gag-destroy.html

I imagine Dr Day will respond formally in due course to the BMA’s document.

I think the BMA has much to learn and ground to cover as regards whistleblowing governance.

Although the government agreed in July 2015 to honour Sir Robert Francis’ recommendations to provide sacked NHS whistleblowers with trial employment and other help to re-enter NHS employment 1, I have seen little sign of related BMA activity on this matter.

May I ask whether the BMA will take a position on this issue, support and work with whistleblowers.

Also, will the BMA set a good practice example and consider some resource neutral options such allowing unwaged medical whistleblowers free access to the BMA’s online library and online journals to help them stay up to date professionally.

I would also be grateful to know if the BMA will help lobby for replacement of the Public Interest Disclosure Act. This is in the light of the BMA’s acknowledgment three years ago in its submission to the Freedom to Speak Up Review that this legislation is inadequate for protecting whistleblowers, and therefore patients:

“Many BMA members – and indeed their legal representatives – believe, however, that the Public Interest Disclosure Act does not give them adequate protection. The main difficulty in practice lies in showing that the detriment or dismissal is linked to 2 the disclosure. Legally there will be grounds to take action only where it can be shown that the protected disclosure has ‘materially’ influenced the employer’s treatment of the whistleblower. In many cases this will not be clear. For example, if the concern is raised in the context of a dispute with a colleague, a forthcoming reorganisation or a threat of disciplinary action, this may create doubts as to whether the employer’s subsequent actions have been influenced by the disclosure. The Freedom to Speak Up Review might wish to devise ways of strengthening the legislation.”

https://minhalexander.files.wordpress.com/2016/09/bma-freedomtospeakup-10-09-2014.pdf

 

Many thanks.

Yours sincerely,

Dr Minh Alexander

Cc

Dr Hamish Meldrum BMA Deputy Chair

Sir John Temple BMA President c/o London Medicine & Healthcare

Professor Pali Hungin Past BMA President

Professor Sir Albert Aynsley-Green BMA Past President

Baronness Ilora Finlay BMA Past President

Baronness Sheila Hollins BMA Past President

Professor Sir Michael Marmot BMA Past President

Professor Averil Mansfield BMA Past President

The Princess Royal BMA Past President

Professor Dame Parveen Kumar BMA Past President

Professor David Haslam BMA Past President

Sir Charles George c/o The Academy of Medical Science

Professor Sir Brian Jarman BMA Past President

Professor Allyson Pollock

Professor Mary Dixon Woods

Bcc Dr Chris Day

1 Sir Robert Francis’ Freedom To Speak Up Review recommendations February 2015 (accepted by the government in July 2015):

Page 153

“7.3.8

Beyond that, I believe that there is an urgent need for an employment support scheme for NHS staff and former staff who are having difficulty finding employment in the NHS who can demonstrate that this is related to having made protected disclosures and that there are no outstanding issues of justifiable and significant concern relating to their performance. This should be devised and run jointly by NHS England, the NHS Trust Development Authority and Monitor. As a minimum, it should provide:

 

  • remedial training or work experience for registered healthcare professionals who have been away from the workplace for long periods of time

 

  • advice and assistance in relation to applications for appropriate employment in the NHS

 

  • the development of a ‘pool’ of NHS employers prepared to offer trial employment to persons being supported through the scheme

 

  • guidance to employers to encourage them to consider a history of having raised concerns as a positive characteristic in a potential employee.

 

7.3.9 All NHS organisations should support such a scheme. Doing so would send a clear signal to their staff, and to staff across the NHS that they are willing to value people who are brave enough to raise concerns. Organisations that do should be given appropriate recognition”

 

RELATED ITEMS

Letter to the Health Service Journal Patient Safety Correspondent

https://minhalexander.com/2017/07/10/letter-to-the-health-service-journals-patient-safety-correspondent/

The NHS in the Employment Tribunal

https://minhalexander.com/2017/07/06/the-nhs-in-the-employment-tribunal-a-five-month-sample/

Ian Paterson and failure by oversight bodies

https://minhalexander.com/2017/06/01/ian-paterson-and-failure-by-oversight-bodies/

Engineered failure to investigate NHS whistleblowers’ concerns

https://minhalexander.com/2017/04/08/engineered-failure-to-investigate-nhs-whistleblowers-concerns/

National Guardian: Measuring Up?

By Dr Minh Alexander NHS whistleblower and former NHS consultant psychiatrist, 25 September 2017

 

The National Guardian has published her first tranche of data from NHS trusts on staff contacts with Freedom to Speak Up Guardians, for the period 1 April to 30 June 2017:

National Guardian data 20170831 FINAL Q1 PUBLISHED TABLE- v2

There is little discussion in her accompanying report about data quality:

National Guardian report on whistleblowing data Q1 2017:18

This is despite a past admission by the National Guardian that there was great variability between trusts in how data was being gathered:

https://minhalexander.files.wordpress.com/2017/02/hh-meeting-records-23-01-2017-and-2-02-2017.pdf

The lack of discussion of data quality is all the more significant given that fact that a whopping one third of trusts  (n=88) failed to return any data at all.

Four trusts rated as ‘Outstanding’ by the CQC were amongst the 88 trust that failed to return any data:

Birmingham Women’s and Children’s NHS Foundation Trust

East London NHS Foundation Trust

Salford Royal NHS Foundation Trust

Newcastle upon Tyne Hospitals NHS Foundation Trust

 

This is the full list of the 88 trusts that failed to return any data:

88 Trusts that returned no data to the National Guardian Q1 2017:18

The National Guardian does not account in her report for why such a large number of trusts failed to return data nor does she make proposals for improving future response rates.

Another key issue is that the system rests entirely on self reporting by trusts.

There is no indication that the National Guardian intends to pursue any form of verification.

Indeed, she was reluctant in a past discussion to consider external quality control:

From records of a telephone meeting with the National Guardian 23 January 2017:

MA What data are local guardians collating and has it been agreed with your office? Is it standardised?

HH “What” has been agreed with us and is standardised “How” – no. “How” is very much what works for the organisation. So long as information held separately from main databases. We haven’t been prescriptive.

MA How do you know data from local Guardians isn’t fiddled or flawed in some other way?

HH Ultimately it will reflect in the staff survey.

MA Have you got a means of quality control to check quality of local guardians’ data?

HH We’re working on trust….

MA So no checks?

HH We don’t have access to their information systems. Are you suggesting we do so? Is that appropriate?

MA You have the remit for picking up local failures including by local guardians, and safeguarding against local failure.

HH We haven’t received any information about problems with local guardians

 

The National Guardian has now admitted that 17 trusts reported that no staff made any contact with Freedom To Speak Up Guardians:

17 Trusts reported that there were no contacts with their Speak Up Guardians
 

Birmingham and Solihull Mental Health NHS FT

Blackpool Teaching Hospitals NHS FT

Calderdale and Huddersfield NHS FT

Cambridgeshire Community Services NHS Trust

Central Manchester University Hospitals NHS FT

East Kent Hospitals University NHS FT

Homerton University Hospital NHS FT

London Ambulance Service NHS Trust

Norfolk and Norwich University Hospitals NHS FT

North Staffordshire Combined Healthcare NHS Trust

Royal Free London NHS FT

Royal Surrey County Hospital NHS FT

Royal United Hospitals Bath NHS FT

Somerset Partnership NHS FT

Southend University Hospital NHS FT

The Queen Elizabeth Hospital King’s Lynn NHS FT

Wrightington, Wigan and Leigh NHS FT

 

 

This is a tad awkward as the National Guardian herself previously maintained that numbers of contacts were an indication of staff confidence:

From records of a meeting  with the National Guardian on 2 February 2017

MA But how will you measure and prove that it’s working well?

HH 1) Numbers of staff going to the Speak Up Guardians – that’s a measure of confidence”

 

Notably, Blackpool Teaching Hospitals NHS Foundation Trust was amongst the trusts that reported zero contacts with their Speak Up Guardians.

The Speak Up Guardian for this trust, a deputy medical director, was much feted and featured in the National Guardian’s recent publicity material, including a particularly embarassing promotional video.

Conversely, troubled Colchester Hospital University NHS Trust reported a high number of contacts (30), but it also had the highest number of reports of detriment (14).

Colchester has latterly been run by the former of CEO of Croydon Health NHS Trust, which recently lost against NHS whistleblower Dr Kevin Beatt in the Court of Appeal.

Other trusts which reported high numbers of contacts with Speak Up Guardians included the following:

Screen Shot 2017-09-25 at 01.27.37

East Lancashire and Mid Yorkshire Hospitals are notorious amongst whistleblowers.

Out of a total of 1,124 cases were raised in 144 trusts, 192 (17%) were raised anonymously.

It is unclear how cases were raised anonymously. But anonymous reporting is not an unequivocal vote of confidence in the Speak Up Guardians.

It is also alarming that there were concerns about lack of places where Guardians could meet staff confidentially. This is a basic issue that should have been sorted out by now, and reveals a lack of sensitivity and insight into the huge risks that staff take when whistleblowing.

Lastly, the National Guardian maintains that there was “an overwhelmingly positive response” from staff who had made disclosures to Speak Up Guardians, and she states that 87% said they would speak up again.

No details are given in her report about how this staff feedback data was gathered or the completeness of the data that she cites.

In any case, one third of trusts are missing from the National Guardian’s statistics and this is a potential source of bias. For example, Trusts with poorer results may have been less willing to return data.

As a doctor, the National Guardian should appreciate the importance of properly caveating any limitations in data.

Previously, she informed me that Speak Up Guardians would seek staff feedback at 3 months post contact. However, it seems unlikely that the staff experience data she cites was subsequently gathered on this basis because her report was published on or before 5 September. This would not have allowed for  a full 3 month follow up of all contacts for the relevant period.

She also previously admitted that there was no uniformity in how Speak Up Guardians were measuring staff experience of their services:

 

From records of a meeting with the National Guardian 2 February 2017:

“MA How are Speak Up Guardians measuring staff experience?

HH It varies, Different trusts need different things

MA What are the different ways in which Speak Up Guardians are measuring staff experience?

HH Working in partnership at local level. Pulse surveys as well as the annual staff survey.

MA What are the pulse survey questions?

HH We haven’t received the outputs of those yet.

MA But what questions are being asked?

HH We haven’t asked specifically”

 

However, this lack of standardisation is not acknowledged in her latest report, other than by implication in a comment that the numbers of staff contacts cannot be used to compare between trusts.

Some staff reported worries about repercussions.

Staff in 85 of the 1,124 (7.5%) cases raised by Speak Up Guardians reported detriment.

The period of follow up so far is not long enough to fully assess whether all the staff who raised concerns will suffer reprisal. Reprisal can occur long after disclosure behind closed doors, once no one is looking.

The National Guardian should also have acknowledged this limitation in her data.

In short, the National Guardian’s claim of overwhelming positive staff feedback is presently not clearly substantiated.

For transparency and accountability, the National Guardian should:

  • Clearly describe the methodology by which staff feedback is obtained
  • Provide trust level data on staff feedback, including response rates
  • Publish the surveys used by Speak Up Guardians to gather staff feedback.

I have written to ask if she will do so.

 

 

Email 24 September 2017 to the National Guardian:

BY EMAIL

Dr Henrietta Hughes

National Freedom To Speak Up Guardian

Care Quality Commission

24 September 2017

Dear Dr Hughes,

 

Re: Speak Up data for all trusts April – July 2017

I see that you have published broad findings on staff feedback as part of this data:

http://www.cqc.org.uk/national-guardians-office/content/speaking-data

Is it possible in future data releases to provide the following data:

– The methodology by which staff feedback is obtained by Speak Up Guardians

– Trust level data on staff feedback, including response rates

– Copies of the surveys used by local Speak Up Guardians to measure staff feedback ?

Many thanks,

Minh

Dr Minh Alexander

 

STFU not FTSU

 

RELATED ITEMS

Letter to PAC

Letter to Public Accounts Committee 11 Sep 2017 Re-Review of whistleblowing

CQC denies denial

https://minhalexander.com/2017/09/16/newsflash-cqc-denies-denial/

SSOTP: Robert Francis’ exemplar trust has feet of clay and Jeremy Hunt’s safety claims are unevidenced

https://minhalexander.com/2017/05/28/ssotp-robert-francis-exemplar-trust-has-feet-of-clay-and-jeremy-hunts-safety-claims-are-un-evidenced/

 

 

NEWSFLASH: CQC denies denial

Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 16 September 2017

 

I raised a concern with the CQC Chair Peter Wyman about a Chief Inspector’s written denial of allegations, by the campaigning charity Compassion in Care, that CQC had breached the confidentiality of 47 whistleblowers.

“we do not recognise this statement”

Letter by Andrea Sutcliffe CQC Chief Inspector to Compassion in Care 14 July 2017

This was in the light of a subsequent admission by CQC that it had not audited its policy of whistleblower confidentiality since 2013, when David Behan its chief executive promised that CQC would keep whistleblowers’ identities secret. The factual basis of Andrea Sutcliffe’s denial was therefore not apparent:

Letter to Peter Wyman Andrea Sutcliffe denial 13.09.2017

Peter Wyman Chair responded within two days to deny that Ms Sutcliffe had denied anything:

Wyman response re Sutcliffe denial 15.09.2017 POCU 1516 0181

Notwithstanding the tensions between plain English and the CQC’s linguistic acrobatics, I have asked Peter Wyman if the CQC will audit whether it has kept Behan’s promise of confidentiality, and if it will involve whistleblowers in the design of any audit.

 

BY EMAIL

Peter Wyman

CQC Chair

15 September 2017

Dear Mr Wyman,

Basis of denial by a CQC Chief Inspector

Thank you for your swift response.

Whilst some might accept that one interpretation of Ms Sutcliffe’s words might be that they are not an outright denial, I doubt that the average reasonable person would take her words to mean anything but a denial.

I would suggest that it would be helpful if CQC does not use such language, particularly where it knows that there is no proper basis for any denial.

Now that CQC implicitly concedes that there was no proper basis for any denial, may I ask if it will systematically audit whether it has complied with its policy of whistleblower confidentiality.

Whistleblowers would be happy to help co-produce any such audit if CQC is willing to examine its practices in this way.

Yours sincerely,

Dr Minh Alexander

Cc

PACAC, PAC and Health Committee Chairs

Sir Robert Francis CQC

Dr Henrietta Hughes National Freedom To Speak Up Guardian, CQC

 

delay-deny

 

UPDATE 19 SEPTEMBER 2017

Peter Wyman CQC Chair has today replied but omitted to answer whether CQC will audit its compliance with its policy of whistleblower confidentiality:

Screen Shot 2017-09-19 at 11.42.37

 

I have pointed to CQC’s own past admissions that it has breached whistleblower confidentiality and the case for audit, and put the question again to Peter Wyman:

BY EMAIL

Peter Wyman

Chair, Care Quality Commission

19 September 2017

Dear Mr Wyman,

Audit of CQC compliance with CQC’s policy of whistleblower confidentiality

Thank you for another swift response.

I do not recognise your response as an answer to my question about whether CQC will audit its compliance with its policy of whistleblower confidentiality.

It is difficult to have confidence in the CQC’s claims of progress if they are not based on evidence.

General audit is separate to any specific investigation that you may wish to undertake, or not, into the allegations by Compassion in Care of breached confidentiality.

To be clear, I have made no request that you investigate the allegations by Compassion in Care.

Notwithstanding the fact that it is good practice to conduct routine audit (which CQC admits it has not done), CQC has admitted on several occasions that it has breached whistleblowers’ confidentiality.*  This additionally makes the case for audit.

Therefore, I would be grateful for an answer on whether CQC will audit and I remain available to help co-produce any audit, as do other whistleblowers.

Yours sincerely,

Dr Minh Alexander

The occasions on which CQC has admitted breaching whistleblower confidentiality:

1) David Behan publicly admitted in 2013 that CQC had breached a whistleblower’s confidentiality

2) CQC apologised to Helen Rochester for breaching her confidentiality when she previously whistleblew in 2013

3) CQC admitted in 2014 that it breached NHS surgeon and whistleblower Shiban Ahmed’s confidentiality

cc PACAC, PAC and Health Committee Chairs

Sir Robert Francis CQC

Dr Henrietta Hughes National Freedom To Speak Up Guardian, CQC

 

UPDATE 21 SEPTEMBER 2017

The CQC Chair has today replied as follows:

Screen Shot 2017-09-21 at 15.39.29

 

Accordingly, I have referred this matter to the parliamentary Public Accounts Committee:

BY EMAIL

Public Accounts Committee

21 September 2017

Dear Ms Hillier and colleagues,

CQC refusal to audit its compliance with its policy of whistleblower confidentiality

Further to my letter of 11 September asking PAC to consider a re-review of whistleblowing 1, I write to submit additional evidence in support of my request.

Please find attached a letter of today’s date from Peter Wyman CQC Chair in which he declines to audit CQC’s compliance with its policy of whistleblower confidentiality.

Although CQC disclosed via FOI on 3 August 2 that it had not undertaken any such audit since 2013 when David Behan promised to respect whistleblowers’ confidentiality, Mr Wyman now states that CQC routinely ‘monitors’ its compliance with policies. I am not clear what this means, but I am unable to clarify it as Mr Wyman advises that he will not correspond any further on this subject.

I remain unconvinced that CQC has acted responsibly as regards its duty of care towards whistleblowers and therefore towards service users.

Yours sincerely,

Dr Minh Alexander

Cc

Chairs of PACAC and Health Committee

Sir Robert Francis CQC NED

Dr Henrietta Hughes National Freedom To Speak Up Guardian

Sir Amyas Morse NAO

Lord Bew CSPL

Margaret Hodge MP

1 https://minhalexander.files.wordpress.com/2017/09/letter-to-public-accounts-committee-11-sep-2017-re-review-of-whistleblowing.pdf

2 https://minhalexander.files.wordpress.com/2016/09/cqc-foi-disclosure-whistleblower-confidentiality-3-august-2017-foi-final-decision-notice-cqc-iat-1718-0210.pdf

 

RELATED ITEMS

Helen Rochester v CQC, Act II: Wherein a whistleblower Sueth a Prescribed Person

https://minhalexander.com/2017/09/09/helen-rochester-v-cqc-act-ii-wherein-a-whistleblower-sueth-a-prescribed-person/

National Guardian ‘Expects’

https://minhalexander.com/2017/09/03/national-guardian-expects/

Breach of confidentiality by CQC and complicity in referring a whistleblower to the Disclosure and Barring Service

https://minhalexander.com/2017/06/22/cqc-involved-in-a-whistleblowers-referral-to-the-disclosure-barring-service/

The CQC denies…

https://minhalexander.com/2017/01/08/the-cqc-denies/

National Guardian independent: The CQC denies some more…

https://minhalexander.com/2017/01/19/national-guardian-independence-the-cqc-denies-some-more/

 

 

 

Helen Rochester v CQC, Act II: Wherein a Whistleblower Sueth a Prescribed Person

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 9 September 2017

 Screen Shot 2017-09-09 at 17.07.21.png

Helen Rochester a care home whistleblower has made a claim in the Employment Tribunal against the Care Quality Commission (CQC).

Background

On 20 June 2017 Helen Rochester confronted the CQC board about CQC’s behaviour towards her as a whistleblower on two separate occasions in 2013 and 2017. CQC first breached her confidentiality. It was then later complicit in reprisal, being party to Rochester’s inappropriate referral to the Disclosure and Barring Service by her employer.

These matters were summarised previously:

https://minhalexander.com/2017/06/22/cqc-involved-in-a-whistleblowers-referral-to-the-disclosure-barring-service/

Rochester’s 2013 whistleblowing was previously reported by Private Eye in March 2015, which was not complimentary about the CQC:

Private Eye Go Whistle Article on Helen Rochester March 2015

 

In a letter of 30 June, after an internal investigation, CQC still maintained to Rochester that it had acted appropriately in suggesting that her former employer should consider referring her to the Disclosure and Barring Service. CQC said that its Chair and Chief Executive both saw this letter before it was sent to Rochester.

On 24 June I informed the National Freedom to Speak Up Guardian of Rochester’s case. I asked her to hold the CQC to account and to establish how many other cases had been mishandled, as this could have not only life changing implications for whistleblowers, but potentially posed serious risk to patients.

The National Guardian, who has an annual budget of £1 million, took over two months to respond and did not actually indicate whether she had established if CQC had breached other whistleblowers’ confidentiality.

https://minhalexander.com/2017/09/03/national-guardian-expects/

Whistleblowers – with zero budget – have in fact established that CQC has conducted no audit of its performance on whistleblower confidentiality since David Behan its CEO promised categorically in 2013 that CQC would not breach whistleblowers’ confidentiality:

CQC FOI disclosure 3 August 2017

CQC FOI disclosure whistleblower confidentiality 3 August 2017 FOI FINAL Decision Notice CQC IAT 1718 0210

 

At the very least, this shows complacency by the regulator.

The CQC has refuted recent allegations by the campaigning charity Compassion in Care that the CQC has breached the confidentiality of 47 whistleblowers to their employers. 1

On 14 July 2017 Andrea Sutcliffe the CQC’s chief inspector of Adult Social Care wrote “we do not recognise this statement” and insisted on proof before CQC could act. 2

One wonders upon what evidence this denial was founded, if CQC has never actually audited its performance.

On 11 August 2017 Sutcliffe repeated a claim that the CQC could not look into the alleged breaches of whistleblower confidentiality unless it was first provided with proof. 3 This seems a questionable position for the CQC to take when it has obvious recourse to audit as a means of proactively answering the question for itself.

 

Rochester’s claim against the CQC

Rochester has now made a claim against the CQC in the Employment Tribunal.

The claim has been made on the basis that Rochester alleges CQC is jointly liable for detriment in respect of its actions in causing her unwarranted referral to the Disclosure and Barring service (DBS), and contends there is an indirect employment relationship. Rochester argues that CQC acted detrimentally and unreasonably upon information from her former employer without verifying it, despite being aware that she was a whistleblower.

Whether or not the Public Interest Disclosure Act (PIDA) 4 and Employment Rights Act 5 are the correct legal tools for dealing with CQC’s behaviour is for the Court to decide. The man on the Clapham Omnibus will very likely see CQC as being at fault, and think that a challenge in law is reasonable.

However, Rochester is an unrepresented, unemployed care worker.  CQC is resisting the claim. It is a multimillion pound corporation. Its annual income regularly exceeds £200 million. 6

An FOI enquiry by NHS whistleblower Clare Sardari @SardariClare  last year revealed that CQC spends millions annually on legal services:

Screen Shot 2017-09-09 at 16.38.48

https://minhalexander.files.wordpress.com/2016/09/cqc-foi-disclosure-legal-spending-12-sept-2016.pdf

This stark inequality of arms speaks for itself.

Whatever the legal merits of Rochester’s ET claim, it is most unusual for a whistleblower to sue a PIDA Prescribed Person 7. A search has not so far revealed any precedents.

Rochester’s claim follows NHS whistleblower Dr Chris Day’s legal action against Health Education England 8 and Dr Eva Michalak’s action against the General Medical Council 9. These cases posed interesting questions  about the definition of the employment relationship under the Public Interest Disclosure Act and or what cases may be heard in the Employment Tribunal.

 

 CQC’s mishandling of Rochester’s safety concerns

 It is worth giving this some attention as the case is very typical of how CQC treats whistleblowers from all sectors.

As Private Eye noted of Rochester’s previous whistleblowing experience:

Ms Rochester complained to the health and social care watchdog immediately after leaving Manor Gardens in April 2013 but it was nine months before inspectors arrived.”

This time, CQC excelled itself by suggesting that Rochester – the whistleblower –  should be referred to the DBS before it acted upon her disclosures by making a Safeguarding referral.  Within 24 hours of learning of her whistleblower case on 20 April, the CQC advised her employer of its duty to refer Rochester to the DBS. Yet CQC took until 24 April to make a Safeguarding referral to the local authority: “…the first safeguarding referral we made on 24 April 2017”.

Morevover, CQC has now given Rochester’s former employer a clean bill of health despite her serious patient safety disclosures.

The CQC’s re-inspection report dated 30 August 2017  rates the care home a ‘Good’ overall, and ‘Good’ on the ‘Safe’ and ‘Well Led’ domains.

This is despite Rochester raising serious safety concerns with CQC in April, that threw doubts on the leadership of the care home.

The CQC report shows that CQC did not re-inspect the home until 13 July 2017, but claims that it acted in response to concerns:

“We carried out a comprehensive inspection of ********************** on 7 and 8 February 2017. After that inspection we received new information of concerns in relation to people’s safety and the leadership of the service. As a result we undertook a focused inspection on 13 July 2017 to look at these concerns.”

Rochester is concerned that CQC did not act upon her concerns when she first raised them, but re-inspected only after she attended the public CQC board on 20 June 2017 and because she caused the regulator severe embarrassment by exposing its inaction and its dereliction of duty both to her and service users.

Rochester raised concerns with CQC in April about numerous safety issues. Key details from her meticulous disclosure correspondence are provided below in the reference section. This audit trail puts a very human face on the dangers faced by helpless elderly people in care and the serious dilemmas that whistleblowers face everyday.

 

The broad areas of Rochester’s disclosure to CQC were as follows:

 

Unsafe staffing, especially at night 10

This is in fact an important national care home quality issue, about which the CQC has been issued with a coroners’s Section 28 warning.

The coroner considered that there should be clear standards set for night time staffing levels:

“I know that many hospitals are looking carefully at their staffing levels at night particularly in the wards where patients suffer from dementia and may be at a risk of falls through wandering and I am drawing this case to your attention so that you and your inspectors can look carefully at whether staffing levels for night time are adequate to meet the various needs of all the residents/patients in residential, nursing and hospital environments. It seems to me that only two members of staff caring for over twenty four residents, some of whom suffer from dementia and are restless, is not enough to meet all the complex needs, especially with their other duties over a long shift of almost twelve hours.”

 Coroner’s Section 28 warning report about death of John Gwyfryn Morris

https://www.judiciary.gov.uk/publications/morris-2013-0295/

This coroner’s challenge not only posed a potential threat to the care industry’s profits but to government austerity plans for health and social care. There is currently no published CQC response to this key coroner’s Section 28 report. David Behan has been asked to disclose CQC’s response to this Section 28 report.

CQC’s latest inspection report on Rochester’s former employer determined that staffing levels were safe, despite the CQC raising and not answering its own question about emergency response:

“However it was not clear how two care staff working at night would ensure emergency situations would be responded to quickly and effectively”

 This inconclusiveness by CQC is especially poor given that Rochester had told CQC in an email of 20 April 2017 that the care home falsified records to hide understaffing:

“I also worked with two people who will falsify documentation to say care given when it is not.”

 

 A call bell system which was not fit for purpose and unsafe 11

 CQC previously inspected the care home in February and did not detect this problem. It was not mentioned at all in the related CQC inspection report of 25 April 2017.

CQC’s latest report of 30 August 2017 mentions the problem only to say that the care home has promised to address the issue. Rochester is concerned that CQC glosses over the fact that her employer failed to act promptly upon her concerns about this issue.

 

Poor infection control and lack of staff training 12

In April Rochester told her former employer and the CQC of several examples of serious infection control risks:

*********’s infection control procedures are appalling. I have never seen her wash her hands and she does not change her gloves between patients. She will throw or drop soiled pads onto the floor and pile dirty linen outside of doors until she picks it all up and carries it against her uniform to the laundry. When ********* had diarrhoea she did not have a clue re universal precautions..” 12

CQC’s previous inspection of the care home in February did not detect this serious problem, and CQC’s related inspection report of 25 April 2017 does not mention infection control. Rochester has concerns about the rigour of CQC’s latest claims that the care home is compliant.

 

Unsafe manual handling, including pulling drag lifting and pulling patients by the neck, staff not properly trained 13

This is one of the relevant excerpts from Helen Rochester’s resignation letter of 17 April 2017 to her former employer, which she submitted to the CQC as evidence when raising her concerns about the care home’s safety:

*********‘s moving and handling is dangerous both to the residents and her. Until told by me she was not using slide sheets when indicated and was not raising beds when the facility was available to her. I have caught her pulling residents by the wrists and neck when moving them on her own and she will do it in front of me so clearly thinks this is acceptable practice. She has never been corrected.” 13

 Rochester informed the CQC that the care home had residents who were unable to weight bear even though it had no hoist equipment to safely move them.

Even though Rochester told CQC the care home had no hoists, CQC seemed to uncritically accept the care home’s practice of locating immobile residents on the first floor:

“…immobile people were cared for on the first floor”

despite clear recognition in its inspection report that this presented an additional challenge in the event of a fire.

Rochester also informed the CQC that care home staff were falsifying records to pretend that patients were being moved with two staff, when they were being unsafely moved with just one member of staff. 14

However, CQC’s latest report is blandly positive about manual handling at the home and relies in part on what the care home reported, despite Rochester’s warning that the care home falsified evidence:

“Due to the facilities and lay out of the service the mobility of people was reviewed regularly and taken into account within the care provision to ensure people’s safety. We were told that those people who needed assistance in moving used a stand aid as they could hold their weight when standing. Staff received training on moving and handling people safely and we observed them using the stand aid appropriately and safely.”

 

Poor care of patients with pressure sores and poor related Safeguarding practice 15

CQC’s latest inspection report gives a superficially positive account of the care home’s handling of skin care with focus on documentation, but does not address Rochester’s concerns that the care home did not purchase the appropriate – if costly – alternating air mattress equipment for nursing patients with open pressure sores.

 

Institutional abuse because patients were taken out of their beds very early in the morning to suit the care home’s regime and staff convenience 16

Rochester told CQC that the care home got residents out of their beds in the small hours of the morning for its own convenience, a very bad practice that marks out the worst homes. The CQC did not re-inspect early enough in the morning to detect this practice.

Despite Rochester’s serious disclosures of numerous examples of poor standards amounting to institutional abuse and the specific example of getting people out of their beds in the small hours, CQC inexplicably only spoke to three residents during its latest re-inspection:

“At the time of the inspection there were 33 people living at ****************. During the inspection we talked with three people who use the service and five relatives.”

 

Unsafe lack of training for staff and unsafe staff clearance 17

Rochester told the CQC that she was particularly concerned that staff lacked training in safety practices around medicines management, infection control and manual handling.

According to Rochester, staff training at the care home consists of filling in questionnaires whilst provided with the answers. CQC’s inspection regime  ticked off the paperwork generated from this ‘training’.

Rochester told the CQC that the care home put her to work unsupervised before her DBS clearance came through.

There is no issue with my DBS check but that is hardly the point. I could have been anyone with a criminal record and I was left unsupervised in charge of 34 vulnerable adults many of which have dementia purely for the sake of convenience and to avoid them having to employ expensive agency staff over the Easter weekend.”

The latest CQC inspection found no fault with the care home’s clearance procedures.

Nationally, it has emerged that the CQC has resisted the coroner’s criticism and recommendations following the unlawful killing of Ivy Atkin, in which CQC failings regarding DBS scrutiny were considered to present a risk to the public.

The neglect of Ivy Atkin a care home resident was so gross that an inquest made a finding of unlawful killing. She reportedly lost almost half her body weight in 48 days and was discovered close to death with an infected pressure sore. There was an accompanying criminal conviction of manslaughter against the care home owner. regulator, CQC was criticised for not checking DBS compliance itself and allowing smaller homes to effectively mark their own homework, because of a purported loophole in regulations. The coroner issued a Section 28 warning report on 25 October 2016 and asked CQC to rectify this. CQC did not respond until 21 March 2017. CQC’s response was not published until last month by the Chief Coroner after the lack of a published response was questioned. The response revealed that CQC had resisted the coroner’s recommendation that it should change its practices on DBS:

Screen Shot 2017-09-09 at 15.39.28

https://www.judiciary.gov.uk/publications/ivy-atkin/

 

Poor whistleblowing governance 18

Rochester told CQC in April that staff with whom she worked were too frightened to raise concerns. 18

On the ‘Well-Led’ domain, CQC’s latest inspection report has not mentioned that Rochester’s former employer has made factually inaccurate claims about a whistleblower, falsified a dismissal that has been rejected by the Tribunal and made a referral to the Disclosure and Barring Scheme that has also been rejected.

Instead, CQC provides this alternative vision of reality:

“Staff told us they had the opportunity to raise any concern internally and knew there were other agencies to contact if concerns were not addressed. Staff were confident any concern would be dealt with effectively and quickly by the registered manager. Staff told us they felt they were listened to and their views were taken into account. For example, one staff member told us “If anything is needed like any equipment all you have to do is ask and it is provided.”

One effect of regulators giving poor employers good reports is that they can help to undermine a whistleblower’s position.

Quis custodiet ipsos custodies?

 

I asked the CQC to comment on Rochester’s legal action and it said:

“The individual who has submitted an employment tribunal claim against CQC, is not and has never been an employee of CQC.  The individual has raised a complaint with the CQC and this was not upheld. However, as this is subject to ongoing tribunal proceedings, we will not comment further until these proceedings have been completed.”

 

CALL FOR HELP

If there are any lawyers interested in the matters raised by the Rochester case who would like to get in touch or may be able to contribute any information or help of any sort, please get in touch via the contact page of this site.

 

UPDATE 11 SEPTEMBER 2017

Letter to Public Accounts Committee submitting evidence about Helen Rochester’s case and requesting re-review of whistleblowing:

Letter to Public Accounts Committee 11 Sep 2017 Re-Review of whistleblowing

 

RELATED ITEMS

Watch Helen Rochester at the CQC public board meeting on June 20 2017 (1.15):

https://cqc.public-i.tv/core/portal/webcast_interactive/291254

FPPR: CQC has lost all moral authority but what will the National Guardian do?

https://minhalexander.com/2017/05/23/fppr-cqc-has-lost-all-moral-authority-but-what-will-the-national-guardian-do/

The CQC denies…

https://minhalexander.com/2017/01/08/the-cqc-denies/

Letter to the Health Service Journal’s Patient Safety Correspondent

https://minhalexander.com/2017/07/10/letter-to-the-health-service-journals-patient-safety-correspondent/

Ian Paterson and failure by oversight bodies

https://minhalexander.com/2017/06/01/ian-paterson-and-failure-by-oversight-bodies/

NHS gagging: How the CQC sits on its hands

https://minhalexander.com/2016/09/23/nhs-gagging-how-cqc-sits-on-its-hands-2/

Homerton maternity whistleblowers: FOI disclosure of the London Clinical Senate on four maternal deaths and the National Guardian

https://minhalexander.com/2016/09/28/homerton-maternity-whistleblowers-foi-disclosure-of-the-london-clinical-senate-report-on-four-maternal-deaths-and-the-national-guardian/

Care home deaths and more broken CQC promises

https://minhalexander.com/2016/10/08/care-home-deaths-and-more-broken-cqc-promised/

Screen Shot 2017-09-09 at 17.44.34

 

 

REFERENCES

1 Several networks reported Compassion in Care’s concern’s disclosure about CQC breaches of whistleblowers’ confidentiality

Screen Shot 2017-09-03 at 00.58.40

2 From letter 14 July 2017 by Andrea Sutcliffe CQC Chief Inspector Adult Social Care to Compassion In Care

Screen Shot 2017-09-03 at 01.28.48

 

3 From letter 11 August 2017 by Andrea Sutcliffe CQC Chief Inspector Adult Social Care to Compassion In Care:

Screen Shot 2017-09-08 at 16.15.21

4 Public Interest Disclosure Act 1998

http://www.legislation.gov.uk/ukpga/1998/23/contents

5 Employment Rights Act 1996 Section 47B

https://www.legislation.gov.uk/ukpga/1996/18/section/47B

CQC annual report 2016/17

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/631942/CQC_annual_report_accounts_2016_17_web_version.pdf

7 Under PIDA, Prescribed Persons should in theory provide a safe haven where whistleblowers can make confidential, legally ‘protected’ disclosures, but in reality they have poorly defined roles and powers, and a poor reputation.

https://www.gov.uk/government/publications/whistleblowing-guidance-for-prescribed-persons

https://www.gov.uk/government/publications/blowing-the-whistle-list-of-prescribed-people-and-bodies–2/whistleblowing-list-of-prescribed-people-and-bodies

8 Dr Chris Day’s website:

http://www.54000doctors.org/thecase/1-intro-and-how-this-case-affects-you.html

The Court of Appeal judgment in Dr Chris Day’s case:

http://www.54000doctors.org/judgments/court-of-appeal-judgment.html

9 The Supreme Court judgment in Dr Eva Michalak’s case:

http://www.bailii.org/ew/cases/EWCA/Civ/2016/172.html

https://ukhumanrightsblog.com/2016/04/11/equality-claims-and-health-regulators-availability-of-jr-does-not-oust-jurisdiction-of-et/

10 Examples from Helen Rochester’s resignation letter to her employer, which was sent to CQC on 17 April 2017 as part of raising concerns about the care home’s safety:

I also suggested if you want real quality care on nights you need an extra member of staff  particularly at times when the dependency levels are high.”

“I have come away on all four of my shifts feeling that I have given care that is rushed and barely adequate within the resources I have which have been to the poor standard contained in this letter”

“Over the course of the night I observed both ********** and ********* adapting documentation timings to show things happening when they were not.”

Email 20 April from Rochester to CQC:

“I also worked with two people who will falsify documentation to say care given when it is not.”

11 Email 22 April 2017 by Helen Rochester to CQC:

Furthermore unless you are by the office or the kitchen you cannot hear any call bells or sensor mats activating so he could have been left unattended for some time.”

12 An example from Helen Rochester’s resignation letter to her employer, which was sent to CQC on 17 April 2017 as part of raising concerns about the care home’s safety:

********* infection control procedures are appalling. I have never seen her wash her hands and she does not change her gloves between patients. She will throw or drop soiled pads onto the floor and pile dirty linen outside of doors until she picks it all up and carries it against her uniform to the laundry. When ********* had diarrhoea she did not have a clue re universal precautions and I discussed this with ********** on Sunday.”

Rochester reports that there were no liquid handwash dispensers or paper towels in most of the residents’ rooms in April, which meant that staff had to wash and dry their hands using a used bar of soap and a used towel, or leave residents’ rooms to wash their hands.

13 An example from Helen Rochester’s resignation letter to her employer, which was sent to CQC on 17 April 2017 as part of raising concerns about the care home’s safety:

********‘s moving and handling is dangerous both to the residents and her. Until told by me she was not using slide sheets when indicated and was not raising beds when the facility was available to her. I have caught her pulling residents by the wrists and neck when moving them on her own and she will do it in front of me so clearly thinks this is acceptable practice. She has never been corrected.”

“On the Friday night I worked with her I caught her handling ******* by the ankles in an effort to drag him towards the end of the bed so he could get round the cot side. When I challenged her as to why she was doing this and put the side down she told me she had never been shown this. She also was quick to point out she had asked ********** for advice on this and said he did not know either.”

“I asked ******** what practical moving and handling training she has had. She says nothing but has apparently asked for some and it has not been given. She is reliant on other people supervising her and she is not getting this.”

14 Examples from email 22 April 2017 by Helen Rochester to CQC:

“********* needs hoist to transfer and is/was being drag lifted out of bed by night staff. Multiple skin tears due to poor handing”

“….violent and aggressive and lashes out at staff. Handed over to me needs two to put to bed. Has stand aid to transfer and also has a paralysed left arm. Agency carer (under other team leader instructions)  had put her to bed on her own putting both at risk of injury and then team leader falsifies documentation to show two people. At night when there are only two on duty the rest of the home is then left unattended whilst dealing with this challenging lady”

15 An example from an email by Helen Rochester to CQC on 20 April 2017:

There are serious issues in this home on night duty which i have outlined below. I cannot speak for what happens on days but in the case of resident ********** (cannot recall surname but in room 45) she has pressure sores and it would appear, to the best of my knowledge, nobody (days or nights) has raised this as a safeguarding issue or have they dealt with her inadequate bed. This lady needs an air mattress that alternates pressure before her hips break down as well. At present she is on a foam mattress with some other aids put in. they are not working on her hips or are they designed to.”

16 An example from an email by Helen Rochester to CQC on 20 April 2017:

I am also aware of institutional abuse happening on nights with the blessing of management. There is a list of 11 residents that have to be got up for the day staff and on Monday – Thursday carer’s start at around 04.15 to do this. I refused to do this at the weekend and when I questioned this I was told “they can sleep in their chairs”. I was also told all 11 have “other needs” that make them eligible for this treatment by the deputy. If that is the case then the home needs to be staffed accordingly so they can be got up unrushed at a sensible time.”

17 Email from Helen Rochester to CQC 22 April 2017:

“I walked out of this home on the morning of the 16th April 2017 I was so disgusted at what I was seeing and being expected to manage. I lasted four nights.

During those four nights I worked unsupervised without a valid DBS check. At the time of writing this email it is still not through. I brought this to the attention of the registered manager on Wednesday 19th April who then lied to me saying it was. As I had not received it I phoned the DBS to check. It was still at stage 4 and not complete. 

There is no issue with my DBS check but that is hardly the point. I could have been anyone with a criminal record and I was left unsupervised in charge of 34 vulnerable adults many of which have dementia purely for the sake of convenience and to avoid them having to employ expensive agency staff over the Easter weekend.”

18 An example from Helen Rochester’s resignation letter to her employer, which was sent to CQC on 17 April 2017 as part of raising concerns about the care home’s safety:

I cannot work like this and I am very uncomfortable with some of the things I have witnessed in only four nights. The problems you have on nights are overwhelming for one person to deal with when they are new. Furthermore ***********’s approach seems to be tackling this through having people into the office for a telling off whereas mine would have been through training and support .

It would then be known it was me who reported all this given I have spoken out at the time of seeing things happening and I will not be able to build working relationships with the people I have to work with for twelve hours.

I also suggested if you want real quality care on nights you need an extra member of staff  particularly at times when the dependency levels are high. According to *********** you are legal on paper and “nobody else has had a problem” indicating that I am a problem for raising this. If this is the reaction that is standard then it’s not surprising people do not say anything.”

“However because of ***********’s reaction to me I would feel uncomfortable ever raising a concern again.”

 

National Guardian ‘Expects’

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist,  3 September 2017

 

The Care Quality Commission (CQC) has been mired in even more scandal of late.

On 27 July 2017 the Times exposed and severely censured the regulator for covering up the suspected rape of a vulnerable man at an Enfield care home run by Hillgreen Care, with three blistering articles on the same day. 1

The Times accused CQC of ducking its duty, betraying its mission to protect the most vulnerable and thereby failing to deliver the values of a civilised society.

As ever, only under the strain of such a critical press attack did CQC bend and announce that an investigation would be held into its failings. 2

The campaigning charity Compassion in Care had reported on 6 July 2017 that it was aware of 47 whistleblowing cases in which CQC passed whistleblowers’ identities  to their employers. 3

Terse correspondence was exchanged between CQC and the charity. CQC was loftily dismissive of Compassion in Care’s concerns – “we do not recognise this statement” – and demanded proof.  4

But such is the level of concern about care home abuses and whistleblower suppression that Compassion in Care held two recent protests, outside of CQC headquarters and the Department of Health respectively. 5

paperwork

Screen Shot 2017-09-03 at 06.00.22.png

Indeed, as an indictment of government policy and CQC performance, nine out of ten MPs do not think that our care system is “suitable for the UK’s ageing population”:

https://www.independentage.org/sites/default/files/2017-08/Independent%20Age_MPs_Parliamentary_Audit_Social_Care.pdf

Results of a survey of MPs by the charity Independent Age, reported on 31 August 2017:

Screen Shot 2017-09-03 at 06.33.22.png

On 20 June 2017 Helen Rochester a care home whistleblower confronted the CQC board about the fact that CQC had breached her confidentiality and on a later occasion, had been complicit in reprisal.

These are the salient details of the extraordinary Rochester case:

https://minhalexander.com/2017/06/22/cqc-involved-in-a-whistleblowers-referral-to-the-disclosure-barring-service/

On 24 June 2017 I wrote to the National Freedom To Speak Up Guardian about the Rochester case and CQC’s approach to whistleblower confidentiality. 6

I asked the National Guardian to hold CQC to account and to establish how many other whistleblower cases had been similarly mishandled by the CQC.

She clearly appreciated the urgency of the situation and got straight back to me…on the 31 August 2017.

The National Guardian stated that she expected CQC to maintain whistleblowers’ confidentiality, but made no comment whatsover on CQC’s performance:

EMAIL FROM HENRIETTA HUGHES NATIONAL GUARDIAN 31 AUGUST 2017

“Dear Dr Alexander

Thank you for your email of 24 June (below) setting out your concerns about CQC’s handling of whistleblowers.  You particularly mention the case of Helen Rochester.

I understand that Helen Rochester’s case is the subject of a separate complaint so we do not wish to comment on that, however, I have sought assurance from CQC about aspects of their whistleblowing procedures.  In particular, I have enquired about the preservation of confidentiality. 

The CQC’s policy on maintaining the confidentiality of whistleblowers is quite clear.  Their publication ‘A quick guide to raising a concern about your workplace’ states ‘We will not disclose your identity without your consent unless there are legal reasons that require us to do so’. I would expect that anyone handling issues raised by Whistleblowers is aware of this policy, appropriately trained, and that there are assurance processes in place to ensure that the policy is consistently applied in practice. 

I understand that CQC intends to widen the scope of their safeguarding committee to include whistleblowing more specifically, and thus provide a more transparent oversight mechanism.  I will ask that the topic of confidentiality is considered as part of the work of this group 

Thank you again for your correspondence.  I want to ensure that people who speak up are treated fairly, respectfully, and that the issues they raise are acted on appropriately.

 Kind regards

Henrietta

If all the National Guardian ever does is ‘expect’, the CQC will be very happy.

But then CQC is the National Guardian’s employer and part funder. There is little reason to imagine that she will robustly insist that CQC does its job or provide meaningful transparency.

It is a mere six years since whistleblowers who tried to raise concerns about serious abuse at Winterbourne View were notoriously ignored by the CQC, and the government in consequence promised us reform.

The serious case review into the Winterbourne View scandal concluded with icy restraint:

“The review has demonstrated that the apparatus of oversight was unequal to the task of uncovering the fact and extent of institutional abuse at Winterbourne View Hospital.”

 South Glos Serious Case Review Winterbourne View

 

In 2012, on the heels of Winterbourne View the Department of Health cynically appointed Behan, one of its director generals to the CQC. It spun him as CQC’s saviour but we’ve just had more of the same.

Screen Shot 2017-09-03 at 05.31.08

However, this has not stopped Jeremy Hunt from recommending Behan for a knighthood, as confirmed by Compassion in Care.

Cabinet Office Letter Behan Knighthood 7 August 2017

Nevertheless, I have asked the National Guardian if she satisfied herself that CQC has actually audited its protection of whistleblowers’ confidentiality. 7

Don’t expect too much.

But more to come about the CQC shortly.

 

RESPONSE FROM NATIONAL GUARDIAN 9 OCTOBER 2017

The National Guardian replied after a reminder to her office, but failed to give a straight answer. This is a core mission failure given the promises by Robert Francis, CQC and the Department of Health that the office would hold CQC, its employer and paymaster, to account.

Screen Shot 2017-10-17 at 19.04.30

 

chateau-cqc

 

RELATED ITEMS

CQC an ongoing concern, a revelatory report by Compassion in Care which reveals the very longstanding extent and repetitive nature of CQC’s care home failures:

http://www.compassionincare.com/node/229

National Guardian and CQC defend Fortress DH This is an explanation of how the National Guardian’s office is designed – and operated – to be ineffective

https://minhalexander.com/2017/05/06/cqc-and-national-guardian-defend-fortress-dh/

Letter to the Health Service Journal’s Patient Safety Correspondent This provides a digest of overall government policy shortcomings on whistleblowing and reforms that are needed

https://minhalexander.com/2017/07/10/letter-to-the-health-service-journals-patient-safety-correspondent/

 

REFERENCES

1 Three Times articles published on 27 July 2017, related to CQC cover up of a suspected rape and other incidents at care homes run by Hill Green Care

i. CQC covered up suspected rape in care home

ii. LEADING ARTICLE Silent Witness

iii.CQC is no stranger to claims of cover-up

CQC inspection reports:

http://www.cqc.org.uk/sites/default/files/new_reports/INS2-2434774843.pdf

http://www.cqc.org.uk/sites/default/files/new_reports/INS2-2508593360.pdf

http://www.cqc.org.uk/sites/default/files/new_reports/AAAC9941.pdf

http://www.cqc.org.uk/sites/default/files/old_reports/1-215264645_Hillgreen_Care_Limited_-_14_Colne_Road_INS1-991372541_Responsive_-_Follow_Up_08-03-2014.pdf

2 Statement by David Behan on investigation into Hillgreen Care rape

CQC statement Hillgreen Care rape

 

 

3 Compassion in Care’s concerns about CQC’s breaches of whistleblower confidentiality were widely reported by networks on 6 July 2017:

Screen Shot 2017-09-03 at 00.58.40

4 From letter 14 July 2017 by Andrea Sutcliffe CQC Chief Inspector of  Adult Social Care Services to Compassion In Care

Screen Shot 2017-09-03 at 01.28.48

5 Protest by Compassion in Care and supporters at CQC headquarters, Buckingham Palace Road 22 March 2017

https://minhalexander.com/2017/03/23/protest-by-compassion-in-care-and-supporters-at-cqc-headquarters-buckingham-palace-road-22-march-2017/

6 Letter to Henrietta Hughes National Guardian 24 June 2017 about CQC breach of whistleblower confidentiality and contribution to detriment

Letter to National Guardian whistleblower confidentiality 24 June 2017

 

7 Letter to Henrietta Hughes 31 August 2017

BY EMAIL

Dr Henrietta Hughes

National Freedom To Speak Up Guardian

Care Quality Commission

31 August 2017

Dear Dr Hughes,

CQC breaches of whistleblower confidentiality and contribution to whistleblower detriment

Thank you for your response on this important matter of CQC regulatory probity.

You say that you expect

a. CQC staff to follow CQC’s policy on maintaining whistleblower confidentiality

b. CQC to have assurance processes in place to ensure that its policy is consistently applied in practice.

May I ask if you actually satisfied yourself that CQC has audited its adherence to its policy?

If you have not done so, may I ask if you will do so, or if it is not your intention to do so, what are the reasons for this?

Many thanks,

Minh

Dr Minh Alexander

cc Sir Robert Francis CQC NED and Chair of National Guardian’s Accountability and

Liaison Committee

Dame Moira Gibb NHS England NED and member of the National Guardian’s

Accountability and Liaison Committee

Kate Moore General Counsel NHS Improvement and member of the National

Guardian’s Accountability and Liaison Committee

Lord Bew CSPL

Sir Amyas Morse NAO