Author: minhalexander

By Dr Minh Alexander retired consultant psychiatrist 21 June 2023

The parliamentary Health and Social Care Committee sat on 20 June 2023 and took evidence from Steve Barclay Secretary of State.

Mr Barclay appeared to start waffling when asked about failure of the Freedom To Speak Up project.

In his verbal perambulations he wondered out loud if bad NHS managers are recycled.

He knows the answer to this, of course, having commissioned the Kark review on this topic in 2018.

But to provide cognitive support, I have reminded him of his previous commission, of two recent unanswered letters on the topic and of a topical example of an NHS exec who resigned after being criticised for poor governance, who then sold governance services to the NHS and is now back in the NHS as a Director of – you guessed it – Governance.

But it is positive that MPs are now starting to speak openly about the failure of the Freedom To Speak Up project.

The danger is that it will be replaced with something equally ineffective that will be again be used for another eight to ten years for PR and to block real change.

Actors new to the whistleblowing landscape, who are not whistleblowers, have recently been clamouring for a central route of NHS disclosure, such as at DHSC or NHS England. I have advised against that notion but it has popped up again through a Committee member. I have warned the Committee against it.

These are the relevant exchanges at Committee on 20 June 2023:

Rachael Maskell MP: If I may Chair. I’d just like to turn to the complaints system. I’m really concerned about the reports coming out of University Hospitals Birmingham. We’ve seen the reports that have come out of a number of mental health trusts. These trusts are clearly not safe for patients as the data is showing, but also not safe for many of the staff who are raising concerns.

After the Robert Francis report we thought that this would come to an end. Duty of Candour very much [inaudible] the front, whistleblowing being accepted as part of the NHS culture, however we haven’t seen the culture move on, and risk still prevails. Even looking at the PHSO insufficiency in being able to have leverage over what’s happening and in their reporting, back of what’s happening at many of these trusts, I’m really concerned that we do not have a robust complaint system.

What steps are you taking to look into that and what measures have you taken to date to move that forward?

Steve Barclay MP and Secretary of State for Health and Social Care: I think it’s a hugely important issue and I think colleagues across the house when I was on the Public Accounts Committee as a member for four years, one of the things I particularly focussed on, which is on record, was gagging of whistleblowers, particularly in the NHS. And how we have more transparency and a culture of learning where things go wrong, you know. In a Department which is allocating over £180 billion and employing as many people as the NHS does, there will be issues that go wrong. The key is how we identify them quickly and how we learn from that.

And so I know the Committee will share my concern when we heard the reports of some of the sexual abuse data that was coming out. And that was something I very urgently met with NHS leaders to discuss to ensure that was being gripped. You allude to the issues of mental health and I hope to have more to say very shortly on that specifically, particularly in the context of the Essex issues. And I know that a number of members of parliament [inaudible] have discussions with them on that, not just in Essex, but there’s been concerns more widely so I think the point you raise is a very valid one. It’s one I take extremely seriously. It’s one that colleagues can see throughout my time as an elected representative I’ve taken very seriously and it is something that I have discussed with Amanda Pritchard the chief executive of the NHS and with senior leaders such as Ruth May the lead nurse, and others, to ensure that we are learning the lessons from these issues and ensuring that where an issue is raised whether that’s by patients, whether it’s by members of staff, whether it’s by others in the community, that we’re addressing it.

Rachael Maskell MP: Just my final question. Because of what has been described as quite a bullying culture in many of these organisations and bullying being very prevalent across the whole economy (27% of workers experience bullying) but when it comes into the Health context it clearly puts the system at risk and patients at risk as well. Not to mention the impact on staff and staff retention.

Will you look at a central place where people can raise concern independently, in order to be able to whistleblow safely and to be able to raise those those concerns so that they are properly investigated? And a top down approach can be put on trusts to deal with these issues, because without it, as hard as the Robert Francis report tried to address these issues, it hasn’t delivered.

Steve Barclay MP and Steve Barclay Secretary of State for Health and Social Care: I’m keen to understand where, if there are areas where the complaints system are not working, why that is and how we learn from it. I think it is an area that has already had lots of focus so one of the issues we’ve got to understand, we have a Patient Safety Commissioner, we have er Guardians, we’ve had a number of other initiatives over many years, in this space. You touched on cases such as Birmingham which still generates significant concern. So for me it’s about understanding why when issues are known about locally, too often they’re not addressed. And how where, we’re learning from that. So that includes things like the trust Board and what visibility, what line of sight does the Board have? What accountability is there for senior managers when wrong doing is established? Are they just rotated  through the system? Or are people held to account? So I think there are a number of issues. It’s an issue sadly that’s been with us for quite a while, because I’ve spent a fair bit of time on it in a previous role. But I share your absolute desire to tackle it. I think you touched on it in the context of the wider duty we have to NHS staff and things like staff absence which is why these things then often manifest themselves in falling retention, because people vote with their feet and leave. It’s a hugely important issue. It’s one that we have a number of people involved in the NHS to tackle.  It is also a role for the Royal Colleges and others in the wider NHS family and I’m extremely keen to work with them on it.

This is my letter to Steve Barclay which includes a formal request for information about the DHSC’s approach to the Kark review on Fit and Proper Persons in the NHS:

“BY EMAIL

Steve Barclay

Secretary of State for Health and Social Care

21 June 2023

Dear Mr Barclay,

Kark review implementation and disbarring unfit NHS senior managers

I watched your oral evidence to Health and Social Care Committee yesterday, and in particular your answers to concerns that the government’s Freedom To Speak Up model has failed to deliver.

Your response on being asked about the failure of the DHSC’s and Robert Francis’ 2015 Freedom To Speak Up project was thus:

“Steve Barclay MP and Steve Barclay Secretary of State for Health and Social Care: I’m keen to understand where, if there are areas where the complaints system are not working, why that is and how we learn from it. I think it is an area that has already had lots of focus so one of the issues we’ve got to understand. We have a Patient Safety Commissioner, we have er Guardians, we’ve had a number of other initiatives over many years, in this space. You touched on cases such as Birmingham which still generates significant concern. So for me it’s about understanding why when issues are known about locally, too often they’re not addressed. And how where, we’re learning from that. So that includes things like the trust Board and what visibility, what line of sight does the Board have? What accountability is there for senior managers when wrong doing is established? Are they just rotated  through the system? Or are people held to account? So I think there are a number of issues. It’s an issue sadly that’s been with us for quite a while, because I’ve spent a fair bit of time on it in a previous role. But I share your absolute desire to tackle it. I think you touched on it in the context of the wider duty we have to NHS staff and things like staff absence which is why these things then often manifest themselves in falling retention, because people vote with their feet and leave. It’s a hugely important issue. It’s one that we have a number of people involved in the NHS to tackle.  It is also a role for the Royal Colleges and others in the wider NHS family and I’m extremely keen to work with them on it.” 

A number of points arise from your comments to Committee:

1.      The Patient Safety Commissioner’s role

The Patient Safety Commissioner’s remit is restricted to medicines and medical devices.

She is not currently listed as a Prescribed Person to whom whistleblowers can make protected disclosures.

But if she is to be a Prescribed Person under UK whistleblowing law, within these narrow confines, I would be grateful if you could confirm that this is so. 

2.      Local NHS Freedom To Speak Up Guardians 

Local FTSU guardians are toothless and importantly, defenceless. They themselves may become victims of abusive NHS organisations which employ them, and that has happened in some cases. Alternatively, some Guardians are appointed because they are willing to abuse whistleblowers. The model is a logically flawed and wasteful. It contributes very little. Testimony from two whistleblowers who have been failed by NHS trust Guardians can be found here:

CQC allows National Guardian to make unsubstantiated claims, and ignores harmful behaviour by Freedom To Speak Up Guardians

3.      Oversight by NHS boards

Oversight by NHS Boards is not the issue. It is abusive NHS Boards that are the issue, whether by actively and directly abusing whistleblowers or knowingly soliciting and/or permitting abuse. 

4.      Accountability for senior management wrongdoing

In your evidence to Committee you wondered out loud about whether there is accountability for erring senior NHS managers, or whether such individuals are recycled.

You personally commissioned the Kark review in 2018 on identifying unfit NHS managers and preventing their recirculation. 

You will recall the immediate catalyst was the debacle in which failed trust managers were protected by NHS regulators after Mid Staffs style failures at Liverpool Community Health NHS Trust.

See Hansard: Capsticks Report and NHS Whistleblowing 13 July 2016

Upon reviewing the Fit and Proper Persons test in the NHS, Mr Kark KC found current systems wanting and made recommendations for improvement. 

However, the implementation of the Kark review recommendations was entrusted to NHS England, an NHS regulator which has been responsible for much of the executive recycling and setting a culture of impunity.

There has been no sign yet of implementation of the Kark review. 

Indeed, NHS England has claimed to me that there is no ministerial support for Tom Kark’s crucial recommendation of a disbarring mechanism for the worst and most unfit NHS managers. 

I have written to you twice about this (7 February and 29 May 2023, forwarded below), asking you to reconsider this reported decision, but I received no reply. 

A current example of NHS executive recycling

But to answer your question on whether erring senior managers are rotated through the system, the answer is ‘yes’. This is a current and topical example:

Darren Grayson resigned from a post as NHS trust CEO in 2015 after an extremely critical CQC report and allegations of management bullying and other governance failures. Mr Grayson went on to sell consultancy services to the NHS through a private company, the Good Governance Institute. This included work for a predecessor body of University Hospitals Sussex NHS Foundation trust, during Marianne Griffiths’ tenure as CEO. Partly on the basis of material produced by the Good Governance Institute, the CQC took the trust out of special measures and rated it “Good” in 2019. Last year Mr Grayson took up a substantive post at this same trust as Director of Governance. Staff whistleblowing to the CQC continued and the police are now making enquiries into concerns about patient deaths 2015-2020 that may amount to gross negligence manslaughter.

The longer the implementation of the Kark review is delayed, the more examples of such recycling will accumulate. 

The Kark review stopped short of recommending managerial regulation, but reserved it as an option for the future. Please note that the delay in regulating NHS managers now spans decades.

The 2002 Bristol Heart inquiry recommended regulation for NHS managers:

I would be very grateful if under FOIA the DHSC could advise me of the following:

1.      As of now, which of the Kark review recommendations does the DHSC accept and which does the DHSC reject?

2.      Is it correct that there is no ministerial support for Tom Kark’s recommendation of a disbarring mechanism for unfit NHS managers? 

3. Why did the DHSC decide not to pursue a disbarring mechanism? What directions/ instructions has the DHSC given to NHS England on this matter?

4.      What is the DHSC’s timetable, if any, for implementating any of the Kark review recommendations that it has accepted?

Many thanks and best wishes,

Minh

Dr Minh Alexander”

This is my letter to the Health and Social Care Committee to register concern about the proposal for another NHS and government controlled whistleblowing body, and to ask that the Committee instead focuses on implementation of the Kark review.

Letter to Rachael Maskell MP and Health and Social Care Committee 21 June 2023, Kark review and concern about another central NHS whistleblowing body

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NHS musical chairs: Darren Grayson, the Good Governance Institute & University Hospitals Sussex NHS Foundation Trust

Mr Tristan Reuser’s whistleblowing case: Scandalous employer and regulatory behaviour on FPPR

By Dr Minh Alexander retired consultant psychiatrist 13 June 2023

Background

The private company the Good Governance Institute (GGI) sells consultancy services and has many links with the NHS. It lists a large group of current and former NHS managers and NHS regulatory staff amongst what it calls its “people”.

What this designation signifies seems vague.

Jacqui Smith the controversial former Home Secretary, former Chair of University Hospitals Birmingham NHS Foundation Trust (UHB) and current chair of Barts Healthcare NHS Trust and Barking Havering and Redbridge University Hospitals NHS Trust is listed amongst the Institute’s “people”.

Upon a FOI request to Barts, Smith denied that this amounted to any specific role: “Rt Hon Jacqui Smith has no formal board or management title or any ongoing role with GGI” but nonetheless Smith is listed as one of the GGI’s “people”.

Several other UHB managers are listed as GGI “people”.

The GGI carried out a “Well Led” review on UHB in 2019, but more on that another time.

Moreover, the GGI is known for the fact that it hired Mason Fitzgerald former NHS trust director despite his sacking by the NHS after a false claim about his qualifications.

The Good Governance Institute at Sussex

What I cover here is a link between the GGI and University Hospitals Sussex NHS Foundation Trust, where it was revealed at the Employment Tribunal on 5 June 2023 that the police are investigating allegations that may amount to gross negligence manslaughter.

The Guardian reported that Mr Krish Singh, surgeon, one of the Sussex whistleblowers had raised concerns about corporate actions which resulted in deaths:

“Singh claimed the trust had promoted insufficiently competent surgeons and overused insufficiently skilled locums.”

“…he claimed that cost-saving changes at the hospital “were driven through that were grossly unsafe and ultimately drove up complication rates and patient mortality”. 

Another senior trust whistleblower Mr Mansoor Foroughi, surgeon, raised similar concerns.

University Hospitals Sussex NHS Foundation Trust was formed by the 2021 merger of Western Sussex Hospitals NHS Foundation Trust, a regulatory and political favourite run by Marianne Griffiths CEO and George Findlay Medical Director, with the struggling trust Brighton and Sussex University Hospitals NHS Trust.

But the board of Western Sussex took over the running of Brighton and Sussex University Hospitals NHS Trust (BSUH).

From April 2017 onwards Marianne Griffiths became CEO for BSUH as well.

BSUH remained a PR thorn in Griffith’s side for the next two years, with BSUH stuck in special measures until 2019. when it was taken out of special measures by the Care Quality Commission and jumped from a rating of “inadequate” to “good”.

In the CQC’s evidence appendix for the related inspection report, CQC stated that the trust had hired the Good Governance Institute and ensured a “golden thread” of quality throughout its improvement strategy:

“Governance

The chief medical officer explained that when the current executive management team had taken over the management contract for the trust, they felt concerned about the governance and assurance arrangements in place and felt they did not have assurance about the quality of treatment and care being provided for patients. They found examples of good clinical governance and reporting in place at a service level, but this information was not being reported up to the board. The trust had therefore commissioned an external review of the governance arrangements from the Good Governance Institute.

Because of this review, a structure of five divisions was put in place where previously there had been 13 directorates. The divisional structure led by a triumvirate of a clinical director, general manager and head of nursing had provided the building blocks for the revised governance arrangements. The Good Governance Institute provided training in governance for these leaders. the non-executive directors and executive directors described the journey for the triumvirate leaders moving from a concern that more reporting was going to be required of them, to understanding governance and how the data and reporting would enable them to drive quality improvement.

The board invited the Good Governance Institute to carry out a review of the trust’s quality governance structures, which resulted in 31 separate recommendations being made. The trust acted to address these issues and the Good Governance institute carried out a further review reporting on progress against these actions. A focus of this work has been to strengthen quality governance arrangements at divisional level.

The trust had effective structures, systems and processes in place to support the delivery of its strategy including sub-board committees, divisional committees, team meetings and senior managers. Leaders regularly reviewed these structures. The trust reported regularly through its governance arrangements on progress against delivery of its strategy to the board, trust executive committee and to other relevant committees. However, the structure needed more time to become fully embedded.

In interviews with the chair of the Quality Assurance Committee, the chair of audit and the chief medical officer (the executive officer responsible for governance), all non-executive and executive directors were able to describe the governance structure and how it functioned.

The effectiveness of the governance arrangements was observed on inspection at Strategy Deployment Review meetings. Each of the three leaders of each division owned and presented the data for their breakthrough objectives. They had interrogated the data to find root causes where the objectives were behind plan and had devised action plans based on this knowledge to bring the objective back on track.

The Chair of the Audit Committee explained that under the previous administration, assurance was not provided through reporting and they were not getting the information they needed. The new structures provided a joined-up approach that provided assurance on quality and delivery against the Patient First Strategy and breakthrough objectives and delivered quality improvement.

Quality was a ‘golden thread’ running through the trust Patient First Strategy. In all the interviews undertaken on inspection the golden thread of quality was evident in the use of data both quantitative and qualitative and how this was triangulated and reported through the Quality Steering Group to the Quality Assurance Committee and the trust board.

Non-executive and executive directors were clear about their areas of responsibility. Performance against the trust’s patient first strategy, true north and breakthrough objectives was focused and reinforced through the trust’s strategic deployment review approach. There was clear ward to board line of sight through daily performance huddles, weekly driver meetings, Divisional Strategy Deployment Review, executive level Strategy Deployment Review and the board.

The Chair of the Quality Assurance Committee gave an example of challenge and holding the executive directors to account when an action plan did not evidence sufficient learning to drive improvement and required further work to be undertaken.

The quality dashboard was aligned to the quality priorities along with the quality improvement plan with actions being taken and monitored at divisional, corporate and board level through the quality governance system, Quality Assurance Committee and board. The Audit Committee evaluated the effectiveness of the trust’s structures and processes in relation to the management of risk, the management of performance and financial management and the management of quality and quality improvement.”

Well, if your quality dashboard looks good, what could possibly go wrong?

And who led the CQC inspection team that concluded BSUH should be taken out of special measures? The inspection team was led by Cath Campbell now CQC Deputy Director of Operations and a David Melbourne.

Would that be the David Melbourne who was then deputy chief executive of
Deputy Chief Executive of Birmingham Women’s and Children’s NHS Foundation Trust and is now the much-criticised CEO of Birmingham and Solihull ICB, a body that has helped to protect failing UHB executives and to obfuscate the reality at UHB?

Just fourteen months after the remarkable January 2019 CQC inspection report praising Griffiths et al, Health Education England noted horrendous governance and serious patient safety failings at the trust.

Darren Grayson formerly of the Good Governance Institute, now a University Hospitals Sussex NHS Foundation Trust director

I am informed that the Good Governance Institute’s review of BSUH in 2018 was led by Darren Grayson, executive director and partner at the Good Governance Institute 2016-2022.

The Good Governance Institute later celebrated its work at Sussex with a little blog:

Brighton and Sussex University Hospitals NHS Trust – supporting the implementation of a new quality governance structure 13 April 2021.

And then what happened next?

In March 2022 Griffiths appointed Darren Grayson, executive director and partner of the Good Governance Institute, on to the board of the newly formed University Hospitals Sussex NHS Foundation Trust as Chief Governance Officer.

This is Grayson’s LinkedIn entry, which gives some of his CV in terms of past NHS posts prior to becoming an executive partner at the GGI. He was a local NHS executive, previously working as CEO of NHS Brighton and Hove, and then CEO of East Sussex Healthcare NHS Trust.

Notably, Grayson stood down from his post as CEO at East Sussex Healthcare NHS trust in 2015, after a CQC inspection of the trust rated it as “Inadequate” both overall and on the “Well Led” domain.

The CQC found evidence of managerial bullying and other signs of poor culture. For example:

“The themes identified related to the quality of staff engagement, low morale, and a bullying and harassment culture from senior management.”

“The trust board continues to state they recognise that staff engagement is an area of concern but the evidence we found suggests there is a void between the Board perception and the reality of working at the trust. At senior management and executive level the trust managers spoke entirely positively and said the majority of staff were ‘on board’, blaming just a few dissenters for the negative comments that we received.

We found the widespread disconnect between the trust board and its staff persisted. This is reflected in the national NHS Staff survey.

….The trust told us they were disappointed by the results; but we saw no direct programme to address this or to change the position. There remained a poor relationship between the board and some key community stakeholders. We found the board lacked a credible strategy for effective engagement to improve relationships.

….Within the trust, we did not see a cycle of improvement and learning based on the outcome of either risk or incidents.

• Staff remained unconvinced of the benefit of incident reporting, and were therefore not reporting incidents or near misses to the trust. the trust was not able to benefit from any learning from these. this position had not improved.

• The risk register was not capturing risks in a robust way.

• We saw a redesign of the governance structure, but were unable to yet see any significant benefits or improvements from this.”

A special meeting of the local Joint Health Scrutiny and Overview committee reached a unanimous vote of no confidence in him:

No confidence in NHS Trust bosses

The Chair of the Committee commented: “You are the captain of the ship which has hit rocks, and it is starting to sink and I think the biggest morale boost you can give to staff is to say sorry and then offer your resignation.”

Grayson reportedly refused to resign initially but later stepped down:

Controversial NHS boss to stand down – but chairman to remain in position

Local MPs called for Grayson’s resignation.

The unions also called for his resignation and warned against any golden handshake.

“The CEO did not listen to his own staff, public opinion or GMB. Instead he openly criticised and blamed those, including GMB, for challenging him and his management style.”

This is Grayson’s biography from the University Hospitals Sussex NHS Foundation Trust’s website, which adds political detail in terms of his work at the New Labour hub, the No 10 delivery unit which ran 2001-2005.

Importantly, Darren Grayson’s partner is Jenny Procter, another director at University Hospitals Sussex NHS Foundation Trust, as revealed by trust declarations of interest:

According to her LinkedIn entry, Procter has been the trust’s Director of Improvement & Delivery since April 2021, and before that she was Director of Efficiency & Delivery from 2017 to 2021 for both its predecessor trusts.

Matters arising

So, what does it say about Marianne Griffiths’ leadership of University Hospitals Sussex NHS Foundation Trust that she hired someone like Darren Grayson to review trust governance and then later gave him an executive job, after such a disaster at East Sussex Healthcare NHS Trust?

Ironically for Griffiths et al, their enterprise with the Good Governance Institute may well tip the balance in any consideration of corporate failures in the deaths scandal. In the

BSUH quality accounts of 2017/18,  Griffiths claimed:

“At a corporate level, we are working with Good Governance Institute to ensure clear lines of sight from the front line of service delivery through to board level on quality and safety. This means that we can identify – and resolve – issues much earlier, contributing to the improvements in patient care.”

As above, the CQC later reported that the “clear line of sight” by the trust board was in place in its January 2019 inspection report. This appears to be additional evidence supporting staff disclosures to Health Education England that the board, through Griffiths, knew about the deaths, staff concerns and lack of governance in the surgical division.

I am requesting copies of all Good Governance Institute reports undertaken for the trust under FOIA.

I will also ask CQC to confirm that David Melbourne was an employee of the CQC as an inspection chair/ executive reviewer, to disclose whether this continues and to disclose whether any other executives from UHB and Birmingham and Solihull ICB are CQC executive reviewers.

CQC’s unseemly habit of employing part time/ bank staff from regulated bodies, especially at director level, has long been a source of conflicted interests and incestuousness which has undermined the authority and legitimacy of its inspections.

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

UPDATE 23 SEPTEMBER 2023

The Times has picked up the story about Darren Grayson’s recycling to the Sussex board as Chief Governance Officer:

Surgery deaths continued after repeated warnings by coroners

Importantly, it has now been made public that shockingly, Grayson is the trust’s police liaison for Sussex police with respect to the polic investigation into police deaths.

This is despite the fact that there are questions of conflict of interest from his review of trust services in his previous capacity as a consultant for the so-called Good Governance Institute. The GGI was investigated by BBC Newsnight.

RELATED ITEMS

This is a published CIPFA profile of David Melbourne in question and answer format, from when he was CFO at Birmingham Women and Childrens, in which Melbourne sympathises with the poor and emphasises the importance of staying true to your values.

David Melbourne, Chief Finance Officer

This is Birmingham and Solihull ICB’s biography of Melbourne:

Melbourne took part in a charade in which the ICB and UHB misled the public and partner agencies by claiming that David Rosser the former CEO of UHB stepped down, when he in fact remained employed by UHB:

NHSE, ICB and UHB’s three-ring circus and Rosser’s digital assignment

The neglected Kark review on unfit NHS managers

The Kark review, commissioned by Steve Barclay five years ago made a string of recommendations for preventing the recycling of unfit managers in the NHS. The task of implementation was given to NHS England, which is notorious for running the so-called “donkey sanctuary” for failed senior NHS managers. There has been no sign yet of any implementation, and NHS England claims that Steve Barclay himself dropped Kark’s recommendation for a disbarring mechanism. Correspondence to Mr Barclay about the failure to implement Kark’s recommendations has so far gone unanswered.

I leave readers with this comment below The Brighton Argus report on Grayson’s fall in 2015, by a perspicacious member of the public:

The NHS National Freedom To Speak Up Guardian helped Griffiths and co by disadvantaging trust whistleblowers in 2018, when she delayed a review of whistleblowing governance. This aspect of the saga can be found here:

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

A Study in Delay II : The National Guardian, maternity safety & University Hospitals Sussex NHS Foundation Trust

I have asked the CQC to investigate the National Guardian’s Office’s handling of whistleblowing matters at Sussex.

Letter to Ian Trenholm CQC CEO requesting an investigation of the National Guardian’s handling of whistleblowing matters at University Hospitals Sussex NHS Foundation Trust 11 June 2023

A prime example of the fate of whistleblowers at UHB, another NHS trust which favoured the GGI, can be found here:

Mr Tristan Reuser’s whistleblowing case: Scandalous employer and regulatory behaviour on FPPR

The twists and turns at Sussex illustrate very well what an insurmountable and well constructed wall NHS whistleblowers often face.

Dr Minh Alexander retired consultant psychiatrist 8 June 2023

This is a brief post to share and unpack claims made by University Hospitals Birmingham NHS Foundation Trust, via an FOI disclosure, about its appointment of the private consultancy TheValueCircle to review its “toxic” culture.

So far, other enquiries about TheValueCircle’s past work in the NHS have revealed steep fees, little evident tangible work product and much secrecy by the NHS bodies which purchased the consultancy’s services. Well Led and governance reviews etc undertaken by TheValueCircle are kept under lock and key by NHS execs:

  UHB controls its culture review, NHS executive secrecy and what value from the “TheValueCircle”? 

This does little to foster a culture of transparency and accountability.

Perhaps it is not surprising that the much-criticised board of UHB might opt to hire such services.

UHB has now disclosed information on the panel which hired TheValueCircle and its criteria for selection.

FOI disclosure by UHB on the panel selection process to appoint TheValueCircle

The panel of seven included four UHB directors, including significantly Fiona Alexander the UHB Director of Comms and former editor of the Birmingham Post. Why would you want the chief spin doctor vetting a contractor for a governance exercise, unless perhaps it was more of a PR exercise?

UHB feel no shame it seems in stating that Fiona Alexander’s role is one of reputational management:

So what is she doing inside an exercise that is purportedly supposed to uncover and reveal the embarrassing truth? A silly question, no doubt.

The disclosed selection panel members: “Dame Yve Buckland, Chair of University Hospitals Birmingham NHS FT Roger Kline, Independent Chair of UHB Culture Review Reference Group Mehrunnisa Lalani, Non-Executive Director and Chair of People and Culture Committee UHB Professor Mike Bewick, Patient Safety Review Lead and report author – identified culture themes to be carried through in to culture review Giles Peel, Patient Safety Reviewer and report contributor – identified culture themes to be carried through in to culture review Cathi Shovlin, Chief People Officer Fiona Alexander, Director of Communications“

There was no staffside representation on the selection panel, so arguably no one with a real interest and commitment was there to ask penetrating questions.

Mike Bewick who was hired by Birmingham and Solihull Integrated Care Board to oversee all of the UHB reviews, and Giles Peel one of his longstanding business associates and regular report co-authors were on the panel.

Interestingly, Bewick and Peel were appointed to the panel a month after all the others.

They were not paid by UHB so the implication is that the ICB was paying for their input.

The trust denied that NHS England was involved in the selection of panel members and maintained that it was solely directed by the trust chair Yve Buckland who both appointed and sat on the panel.

But the appearance of Bewick and his associate Peel on someone else’s tab suggests there was coordination with other bodies and external influence on this process.

Buckland also hired Roger Kline to act as “independent” chair of the panel.

Kline had prior links with UHB.

In response to a question about panel members’ credentials for the task, UHB answered merely:

“Their credentials are evident from the relevance of their role to the culture review.”

A great start to a review of culture when the accused is so arrogant that it cannot even affect a small show of humility.

As for the criteria by which Buckland’s panel selected the contractor to conduct the culture review, these are the disclosed criteria:

The panel’s disclosed selection criteria for the contractor: “1. Experience and credibility in undertaking a high quality culture review of this scale and in our current context 2.     Experience in undertaking culture reviews both within the NHS and wider – important that they understand the NHS but also seek added value in what can be gained from wider sectoral experience 3.     Demonstration of understanding of culture, our organisation, our values and the different stakeholder groups 4.     Demonstration of understanding of equality, diversity and inclusion, and their approach to embedding this through culture review 5.     Approach to the culture review – how they will maximise opportunities to hear all voices and how they will approach engagement and trust-building in our current context 6.     The team – their diversity and ability to reflect our staff, and the gravitas with which they can engender trust and credibility 7.     Scale – their ability to undertake the review in all its complexity and in the depth required within the timeframe 8.     Value for money – price, timescale and any additional services they would include”

So how exactly did Kline et al establish that TheValueCircle had “credibility”, “gravitas” and be “value for money” when there is no work product by the company in the public domain and other organisations jealously guard it with such secrecy?

Does the hiring of TheValueCircle whiff a little of a predetermined decision because of a recommendation/ instruction from on high?

Was a selection criteria missed off the disclosed list: “favoured and tipped by other executives”?

Finally, let us remember that TheValueCircle has friends in high places. Andrew Morris a member of the NHS England board acts as a consultant for them.

Dr Minh Alexander retired consultant psychiatrist 7 June 2023

NHS England has purchased services from a private company, the Good Governance Institute, despite the fact that the Institute hired former NHS director Mason Fitzgerald. Fitzgerald was sacked after false qualification claims, including on his LinkedIn entry:

NHS boss Mason Fitzgerald sacked over false qualification claim

NHS England has failed to respond to concerns since last autumn and initially ignored a complaint about this. It also ignored a related FOI request until it recently received a direction from the ICO to respond.

It now refuses to confirm or deny that it has employed Mason Fitzgerald since his sacking by East London NHS Foundation Trust.

Curiously, NHS England admitted that the Good Governance Institute carried out pro bono research for it this year on “systems”. This sounds as if it could be the work on ICS governance that the GGI and Mason Fitzgerald were possibly involved with, as suggested by GGI material in the public domain.

I have asked for further information  about this pro bono research and for an internal review of NHS England’s refusal to answer on whether it has employed Mason Fitzgerald since his sacking.

I have also pointed out recent evidence that the GGI’s normalisation of his behaviour and his dismissal by the NHS is leading to his re-entry into the NHS.

The FOI response and further correspondence to NHS England is provided below.

From: REDACTED

Subject: Sensitive NHS England’s relationship with the “Good Governance Institute” and possible employment of sacked former NHS director Mason Fitzgerald

Date: 7 June 2023 at 07:14:11 BST

To: REDACTED

Cc: REDACTED

BY EMAIL

Amanda Pritchard 

Chief Executive

NHS England 

7 June 2023

Dear Amanda,

NHS England’s relationship with the “Good Governance Institute” and possible employment of sacked former NHS director Mason Fitzgerald

I have finally received NHS England’s response to my FOI request about whether or not NHS England employed Mason Fitzgerald after he was sacked by East London NHS Foundation Trust (ELFT) in 2021, following concerns about false claims about a legal qualification which appeared in several documents and on his LinkedIn entry.

NHS boss Mason Fitzgerald sacked over false qualification claim

As you may recall, I was concerned that the so called “Good Governance Institute”, a private company with many links to the NHS and which lists many former and current senior NHS managers amongst its “people”, had hired Mr Fitzgerald as a senior consultant despite his sacking by the NHS. It has since promoted him to Director of Consultancy.

I became even more concerned when I saw that Ruth May NHSE England Chief Nursing Officer had engaged the Good Governance Institute late last year. I became even more concerned when I saw material by the GGI which raised questions about whether the GGI was working with NHS England on ICS governance and that Mr Fitzgerald taking part in this work.

Hence I raised concerns with Ruth and then with you about whether NHS England should have links with the GGI and whether NHS England was employing Mr Fitzgerald to work on of all things, ICS governance.

NHS England has stonewalled. The response to my eventual FOI enquiry, made in the absence of any response from you or Ruth, only came after direction by the ICO to NHS England to respond. The FOI reply is forwarded below.

NHS England has now refused to confirm or deny whether it has employed Mason Fitzgerald on grounds that this is non-disclosable personal information. It considers my request for this information “intrusive”.

But it has confirmed that it did indeed purchase services from the GGI AFTER Mr Fitzgerald was sacked by the NHS, including a purchase by Ruth May’s directorate in autumn 2022, by which time Mr Fitzgerald was working for the GGI.

Curiously, NHS England states that it received an offer of pro bono work from the GGI this year: “an offer of pro bono work with a nominal payment of £100”.

This work was vaguely described as: “consultancy services for conducting research with systems to inform the development of set of principles regarding system risk management”

1)         As a fresh FOI request, I would be grateful if NHS England

–           could confirm whether this research by the GGI related to ICS governance

–           could disclose all documents relating to the offer and acceptance of this “pro bono” consultancy work

–           could disclose whether the former CEO of ELFT who is now an NHSE director was involved in setting up this “pro bono” arrangement

–           could disclose what access to NHS systems was given to the GGI in order to undertake this research, including any financial data

–           could disclose the research report(s) produced as a result of this “pro bono” consultancy work

–           With respect to NHSE’s advice that “We are able to generally advise that NHS England scrutinises the suppliers financial standing and capability to deliver the required services and can withhold contracts from organisations where directors have been convicted of fraud or similar offences but that power does not extend to the investigation of employees of the organisation”, please disclose the policy document(s) which sets out what due diligence NHSE should undertake regarding contractors’ governance and the circumstances in which contracts may be refused.

2)         I would also be grateful if NHS England could internally review its assertion that information about whether it employed Mason Fitzgerald is personal data, that is not disclosable.

Mr Fitzgerald was a senior NHS director who was appointed as an NHS trust Chief Executive but did not take up the position at the last minute, causing a scandal and serious reputational harm and disruption to two NHS trusts because of the false claims about his qualifications. 

The reasons for his eventual dismissal by East London NHS Foundation Trust have a serious impact on public trust in the NHS. 

It is of great public interest whether NHS England as the body which oversees the rest of the NHS and is a regulator of NHS trusts and NHS Foundation Trusts, takes issues of probity seriously and does not employ those who have been dismissed following acts of dishonesty. It is a matter of basic Safeguarding that senior individuals whose actions impact on many, many lives should be trustworthy. 

Moreover, it is important that NHS England as the body charged with implementing the Kark review recommendations on preventing unfit NHS managers from recirculating in the NHS is seen to model good practice, to live by the principles set out by the Kark review and not to actively undermine the goals of the Kark review.

NHS England maintains that it cannot investigate contractors’ employees. But the NHS has already investigated and sacked Mr Fitzgerald.

It is therefore essential that NHS England accounts for whether it has employed Mr Fitzgerald following his sacking by East London NHS Foundation Trust, and if it has done so, to explain how it will move on from this.

I should point out that the GGI’s normalisation of Mr Fitzgerald’s behaviour and dismissal is leading to his re-entry to the NHS in other contexts. According to a tweet by the Head of Risk Management of Nottingham University Hospitals, where maternity deaths are currently being investigated by Donna Ockenden, M Fitzgerald was due to speak there last month as a GGI representative, on “risk appetite”.

If NHS England is also seen to normalise the situation, and fails to account in full regarding its relationship with the GGI or to answer questions about whether it has employed Mason Fitzgerald after his sacking, this effect would be greatly amplified.

With best wishes,

Minh

Dr Minh Alexander

Cc Tom Kark KC

     BBC Newsnight

     Health and Social Care Committee

     Steve Barclay Secretary of State

From: REDACTED

Subject: Freedom of Information Request (Our Ref: FOI-2305-1971470) NHSE:0176254

Date: 6 June 2023 at 15:10:01 BST

To: REDACTED

Freedom of Information Request (Our Ref: FOI-2305-1971470)

Dear Minh Alexander,  

Thank you for your Freedom of Information (FOI) request dated 15 March 2023. Please accept our apologies for the delay in responding.

Your request

You requested the following information [numbering inserted by NHS England]:

“As an FOI request, 
 

1. please disclose if since July 2021 when Mason Fitzgerald was sacked by East London NHS Foundation Trust, NHS England has purchased Mason Fitzgerald’s services in any capacity, whether directly or via another party such as the Good Governance Institute.

 
Please disclose 
 

1. the number of occasions on which his services were purchased,
2. the total number of days work purchased,
3. the type of services purchased and
4. the total amount spent.
5. As part of this, please clarify if Mason Fitzgerald did indeed work on ICS governance, and if he did, on which ICS did he work.

• Please also disclose
• which NHSE senior managers signed off these expenses, and
• under which NHSE directorate these expenses fell.

• Please also disclose the total amount that NHS England has spent on the Good Governance Institute’s services since July 2021, irrespective of which directorate purchased these services.”

Decision

In respect of questions 1 and 2, NHS England is neither confirming nor denying whether the requested information is held.

In respect of question 3, NHS England holds some information in scope of your request and has disclosed all of the information that it holds.

Questions 1 and 2

Please note, from the information that NHS England would routinely hold or collect, we would be unable to breakdown this information as per parts 1(b), 1(c) and 1(e) of your request. Therefore for those parts, we confirm NHS England does not hold the information being requested.

In relation to the other parts under questions 1 and 2, NHS England neither confirms nor denies whether it holds the requested information and considers section 40(5)(b)(i) is engaged.

To determine whether section 40(5) applies, NHS England needs to demonstrate:
 

1. that confirming or denying whether the requested information is held would constitute the disclosure of a third party’s personal data; and
2. that providing this confirmation or denial would contravene one of the data protection principles.

Section 3(2) of the Data Protection Act 2018 (DPA) defines personal data as: “any information relating to an identified or identifiable living individual”.

In response to part a), whether NHS England has contracted or employed services from a specific individual, or did not employ a specific individual, meets the definition of personal data under the DPA. We consider that if we were to either confirm or deny we hold this information, this would in itself disclose personal data.

NHS England are required to be consistent when considering the application of section 40(5) when processing FOI requests. Therefore, it is important to apply this exemption on a consistent basis when considering requests for information under the FOI Act. The application of this exemption should not be taken as an indication as to whether the information is held or not.

In response to part b),NHS England can only confirm whether or not it holds the requested information if to do so would be lawful (i.e. it would meet one of the condition of lawful processing listed in Article 6(1) GDPR), be fair and be transparent.

The most applicable would be Article 6(1)(f) which provides that “processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject…”

Disclosure under FOI Act is considered to be a disclosure to the world at large, and not just to the individual applicant. Confirming or denying whether this information is held would, in our view, be unfairly disclosing information that is an individual’s personal data. 

Prior to services being contracted, NHS England would scrutinise suppliers’ financial standing and capability to deliver the required services and can withhold contracts from organisations where directors have been convicted of fraud or similar offences. Therefore, we consider there are other ways in which the legitimate aim in question for this FOI can be satisfied and there are less intrusive ways of meeting this legitimate aim. We therefore consider, it would be unfair in this particular instance to disclose an individual’s personal data and we do not have a lawful basis for processing this personal data (i.e. disclosing it under the FOI Act).


Question 3

Since July 2021, NHS England can confirm that it has contracted services from the Good Governance Institute on three occasions:
 

1. Between July and October 2021, a contract was signed by Health Education England for £47,982 for consultancy services for a review of executive governance to support the Accountable Officer.
2. Between October and December 2022, NHS England paid £74,650 for consultancy services for an engagement exercise to support the development of the next CNO for England Professional Strategy for nursing and midwifery.
3. In February 2023, NHS England paid £100 for consultancy services for conducting research with systems to inform the development of set of principles regarding system risk management.

Each of these contracts were contracted through specifying the service required rather than the number of days worked. Therefore, even if a certain individual had worked on behalf of this organisation whilst the contract was in place, NHS England would be unable to breakdown the information we hold as per parts 1(b), 1(c) and 1(e) of your request.

Contract A was arranged when Health Education England (HEE) was a separate organisation to NHS England. In accordance with the former HEE’s Standing Financial Instructions, this was approved by the budget holder, Director of Corporate Accountability and Engagement (the directorate it fell within) and the Director of Finance.

Contract B was approved by NHS England’s Nursing directorate and was approved by the budget holder, finance account manager for the budget it was raised from, and NHS England’s Commercial Panel in accordance with our Standing Financial Instructions.  The Commercial Panel includes representation from the Commercial, Financial and Legal teams.  In addition, due to the value and type (consultancy services) these procurements were referred to, and approved by, the Department of Health and Social Care’s (DHSC) Procurement team.

The procurement was below the PCR (2015) threshold and as such subject to the light touch procurement process. This does not require the use of the Standard Selection Questionnaire (SQ) mandated under PPN 8/16 for above threshold work.

We are able to generally advise that NHS England scrutinises the suppliers financial standing and capability to deliver the required services and can withhold contracts from organisations where directors have been convicted of fraud or similar offences but that power does not extend to the investigation of employees of the organisation.

Contract C was approved by NHS England’s directorate for the Chief Delivery Officer and was approved by the budget holder and constituted an offer of pro bono work with a nominal payment of £100.

The total amount that NHS England has spent on the Good Governance Institute since July 2021 is £122,732 (contracts detailed above).

Copyright

NHS England operates under the terms of the Open Government Licence (OGL). Terms and conditions can be found on the following link:

http://www.england.nhs.uk/terms-and-conditions/

Review Rights

We hope this information is helpful. However, if you are dissatisfied, you have the right to ask for an internal review. This should be requested in writing within two months of the date of this letter. Your correspondence should be labelled “Internal Review” and should outline your concerns and/or the area(s) you would like the review to consider. Internal Review requests should be sent to:

NHS England
PO Box 16738
REDDITCH
B97 9PT

Email: england.contactus@nhs.net

Please quote the reference number FOI-2305-1971470in any future communications.

If you are not content with the outcome of the internal review, you have the right to apply directly to the Information Commissioner for a decision. The Information Commissioner’s Office (ICO) can be contacted at the following weblink:

https://ico.org.uk/global/contact-us/


Please note there is no charge for making an appeal.

Please do not reply to this email. This message has been sent from a central mailbox. To communicate with NHS England regarding Freedom of Information (FOI) requests, enquiries or complaints we ask these are sent directly to NHS England’s customer contact centre. This is to ensure all communications are progressed correctly. Their postal address, telephone number and email details are as follows: PO Box 16738, Redditch, B97 9PT; 0300 3 11 22 33, england.contactus@nhs.net.

Yours sincerely,

Freedom of Information
NHS England

By Dr Minh Alexander retired consultant psychiatrist 5 June 2023

Today Croydon Employment Tribunal is scheduled to hear a whistleblowing doctor’s claim against University Hospitals Sussex NHS Foundation Trust. The hearing is set to run until 16 June 2023.

This is a post to share a relevant report from a 2020 Health Education England review of core and higher surgical trainees’ experience at the trust, carried out after trainees raised concerns:

Urgent Concern Review (On-site visit) Core and Higher General Surgery, March 2020

Trainees valued the supervision of some consultants but otherwise raised many safety and governance issues with the HEE reviewers. These included:

• An “unpleasant”, “toxic” atmosphere

• Poor behaviour by some consultants

• “Trainees informed the review team of examples of bullying and undermining by a named consultant, towards both other consultants and trainees.”

• “The review team heard that some consultants frequently demonstrated undermining behaviour at the morning handover for the upper and lower gastrointestinal (GI) team, for example criticism of the registrars’ management of patients and arguments between themselves.”

• “Trainees described a recent incident where the named consultant had undermined a consultant colleague in a large meeting by repeatedly accusing them of being incapable of performing a basic surgical procedure.”

• High complication rates and poor recording of clinical outcomes“

• “The review team heard of a case in which a patient had received surgery on the wrong part of their bowel, resulting in recurrent readmissions.”

• Trainees expressed concern at the apparent increase in death rates over a period of years, to levels which they felt were unexpected considering the demographics of the local population. Trainees reported they had requested this was investigated by the Chief Medical Officer. When asked, trainees confirmed that the Medical Director and Chief Executive had been made aware of these concerns.” [my emphasis] At the time of the review, the trust Chief Executive was Marianne Griffiths.

• Lack of leadership in the department

• “….a lack of ownership of emergency surgery patients.”

• “The review team heard that some consultants frequently refused to review patients who were not going to theatre that day, resulting in trainees feeling unsupported when asking for senior advice on managing patients. The review team were informed that core trainees were often expected to act at a registrar level in terms of decision- making.”

• Poor quality clinical work by locum doctors which was not well supervised

• “Trainees reported a lack of confidence in the supervision provided by some locum consultants and provided examples related to clinical decision-making and dismissal of core trainees’ concerns about an unwell patient.”

• “The review team were informed there were three gaps (two non-training and one training) on the registrar rota which are currently unfilled. Trainees reported consultants were aware of concerns about the capability of some locum registrars who had covered the rota but had responded that they were required to fill the gaps.”

• “…..the review team were informed of a review of the last 100 elective colorectal resections performed (taking place between September 2019 and 3 February 2020), which indicated that the anastomotic leak rate was between 10.5-11.5% depending on the definition used to classify as a leak. The review team also noted of the cases reviewed: 14% returned to theatre, 12% experienced wound infections and 15% required readmission. Trainees reported they would not want a family member operated on by some of the consultants in the department.” [my emphasis]

• “Trainees reported complications were inadequately discussed at morbidity and mortality (M&M) meetings due to the volume of complications.”

• “The review team heard an example of a serious incident being closed down without sufficient review.”

• “The review team heard that results of an audit showing that M&M does not meet Royal College of Surgeons guidelines had been shared with the Clinical Lead for General Surgery. Trainees reported they had also raised concern at the Local Faculty Group (LFG) around the accuracy of M&M data and received the response that all departments were struggling with this. The review team were concerned to hear of the lack of systematic governance of M&M data collection. Furthermore, the review team were informed that M&M meetings were not well attended by consultants and until recently minutes of the meetings had not been recorded.”

• Trainees’ hours were not appropriately controlled and in some cases exception reporting had been discouraged.

• “The review team heard that trainees regularly worked additional hours. When asked, trainees reported they did not submit exception reports because some consultants had discouraged F1 doctors from doing so. The review team were informed that the Guardian of Safe Working Hours had recognised a drop in exception reporting and approached a higher trainee regarding this. Trainees reported a lack of leadership and responsibility around exception reporting.”

Of great concern, the HEE reviewers were told that trainees were discouraged from raising concerns, including with HEE.

A senior manager was reportedly one of the individuals who had discouraged the raising of concerns:

“The review team were particularly concerned to hear of behaviours apparently intended to discourage trainees from raising concerns. The review team were informed that a consultant had sent an email to trainees ahead of the review, appearing to put pressure on trainees to provide positive feedback. Furthermore, the review team heard that a trainee had been told by a senior manager that those who raised concerns needed to appreciate the consequences of their actions in terms of the impact on service provision.”

The HEE reviewers clearly believed and took what the trainees reported seriously, as reflected in their list of mandatory requirements to the trust.

These included requirements for improved governance and resolution of the cultural issues:

“HEE require the Trust to develop robust clinical governance processes, in line with NHS England and NHS Improvement (NHSE/I) requirements, in relation to patient safety, complication rates and record keeping with regards to patient outcomes.”

“HEE require the Trust to carry out work to improve the culture and reduce the number of bullying and undermining incidents within the general surgical department.”

As part of the action plan on bullying, HEE required: “the Trust to consider an external review of the department from the Royal College of Surgeons.”

I understand that this RCS external review took place only last month, three years on from the original recommendation. I am asking the trust to confirm that this is so, and about progress in general on HEE’s requirements.

The National Guardian and CQC at Sussex

So in summary, HEE found very serious dysfunction in a major trust department, with substantial patient safety implications and reports of actual care failings.

Concerns about the death rates had been raised with Marianne Griffiths.

HEE also found evidence of suppression, including by a senior manager.

And guess who carried out a review of trust whistleblowing governance in July 2019, eight months before the damning findings by HEE in March 2020?

The former NHS National Freedom To Speak Up Guardian, Henrietta Hughes.

Hughes received concerns from trust staff in December 2017, but ignored her own policy and procedure, and astonishingly postponed a review until 2019 to give the trust time to improve.

Her July 2019 review predictably praised the trust leadership for making improvements, and reflected none of the dysfunction found by HEE the following Spring.

CQC would have been informed of the Spring 2020 HEE review findings as part of multi-agency protocols. There is no record of a CQC inspection of trust surgical services in response to the concerns.

An unannounced Care Quality Commission inspection of several trust sites in September/October 2021 took place after staff whistleblew. CQC found care failings and poor whistleblowing governance.

Yet Griffiths and co were still protected and CQC let them keep their “Outstanding” overall rating.

But the CQC continued to hear from trust whistleblowers:

“CQC then received concerns about the UGI surgical service from staff and other stakeholders. We carried out an inspection of the elective UGI surgical service in August 2022 and found serious safety and leadership concerns.”

“We have continued to receive concerns from staff about the safety of the surgical services at the Royal Sussex County Hospital.”

Finally, last month, even the CQC conceded that the trust was failing and downgraded it from “Outstanding” to “Requires Improvement” overall, and “Inadequate” on the Well Led domain.  In its inspection report, CQC noted:

“Some staff feared reprisal for raising concerns and others had simply given up because of ‘concern fatigue.’ This group of staff felt there was little point raising concerns because no action was taken when they did. When we asked staff to describe the culture of the trust, the feedback was mostly negative. Staff also felt the trust was a ‘hierarchical’ organisation which made it hard to get their voice heard.’

CQC also admitted in its briefing, upon release of its report:

“We continue to have repeated contact from staff who tell us feel unable to raise concerns through the trust’s own internal escalation processes.”

How many Sussex staff and patients suffered because Henrietta Hughes gave Marianne Griffiths et al a free pass in 2018?

Or because the CQC failed to act quickly enough on concerns, including those raised by HEE in 2020?

What is Hughes doing as the Patient Safety Commissioner?

And importantly, what do HEE’s findings of serious governance failings and suppression, CQC’s similar findings, and Sussex’s apparent failure to organise a timely external review of surgical services as advised by HEE – despite Griffiths having already been informed of rising death rates – say about Marianne Griffiths’ current investigation of North East Ambulance Service for NHS England?

UPDATE 10 JUNE 2023

Matters took a dramatic turn at the opening of the Sussex whistleblowing ET case on 5 June 2023 when the police asked to sit on evidence, because it was relevant to a criminal investigation of gross negligence manslaughter at Sussex. The trust subsequently asked for an adjournment on grounds of prejudice to their witnesses. But it means that the skeletons in Griffiths’ (and her former medical director now successor CEO) cupboard have tumbled out:

Police investigate dozens of deaths at hospital in Brighton

Alongside this, NHS England continues to resist questions, raised over the last year, regarding the legitimacy of the investigation of NEAS headed by Marianne Griffiths. In its most recent letter, NHSE took the bizarre and desperate step of pretending that it had no jurisdiction over NHS Foundation trust governance, in order to avoid addressing the issue:

Correspondence to Amanda Pritchard regarding Marianne Griffith’s suitability to head the investigation of the deaths scandal at North East Ambulance Service

UPDATE 11 JUNE 2023

I have asked the CQC, which employs the National Guardian, to investigate its handling of the whistleblowing matters at Sussex:

Letter to Ian Trenholm CQC CEO requesting an investigation of the National Guardian’s handling of whistleblowing matters at University Hospitals Sussex NHS Foundation Trust 11 June 2023

A little more on the dramatis personae

Henrietta Hughes got an OBE, and here is Marianne Griffiths congratulating her about it:

Griffiths was made a dame in the 2018 New Year’s honours list, eight months after Hughes gave her the free pass.

George Findlay the former Sussex medical director, promoted to trust CEO, has opined on how much things have improved since the last CQC inspection:

NHS boss sets out how hospital trust has improved after damning report.

Findlay told the media the improvements included:

“Trust-wide focus on making it easier for people to speak up and raise concerns, including stronger support for the Freedom To Speak Up service. Results from the anonymous monthly “Pulse” staff survey show more people now feel confident that the trust would act upon concerns that were raised, up from 49 per cent in September 2022 to 58 per cent in March 2023, closing in on the best-performing trusts nationally.”

Having 42% staff who do not believe concerns will be acted upon is not great cause for celebration. And that is if one accepts that the trust’s report / its pulse surveys are reliable. It is hard to imagine that any patients with botched surgery, leaky bowels, post operative infections and readmissions, or bereaved families, would be uncorking any champagne.

In April 2021, shortly before he was promoted to CEO, Findlay had these commendable aspirations on quality for patients and staff, as expressed in a video posted on Facebook by the trust:

“Welcome to University Hospitals of Sussex. My name is Dr George Findlay. I am Chief Medical Officer and Deputy Chief Executive. We’re absolutely passionate about providing the highest quality care for patients every time and the best environment for our staff to work in. We’re really clear about the continued investment in services and we’ll continue to provide accident and emergency services, maternity services, trauma services and special services in all the locations we currently do. We’re absolutely passionate about research and innovation and working with our partner universities. We’ll make sure that we adopt best practice, our best roles and make the best value of evidence for our patients for the future.”

RELATED ITEMS

University Hospitals Sussex NHS Foundation Trust resisted FOI requests about their current whistleblowing claims:

There are currently FOURTEEN Employment Tribunals against Marianne Griffiths’ former NHS trust, University Hospitals Sussex NHSFT. The trust refuses to say how many include whistleblowing claims

Dr Minh Alexander retired consultant psychiatrist 4 June 2023

WhistleblowersUK the much criticised external secretariat of the also dubious Whistleblowing All Party Parliamentary Group (which has no official standing or powers), has publicly suggested that Boris Johnson might be a whistleblower for stating that he will cooperate with the UK COVID inquiry.

As might be expected, this has provoked strong reactions from genuine whistleblowers.

A hopefully self-explanatory enquiry to the Whistleblowing APPG is shared below.

From: REDACTED

Subject: WhistleblowersUK’s suggestion that Boris Johnson is a whistleblower, financial transparency and handling of whistleblowers’ personal data

Date: 4 June 2023 at 11:04:04 BST

To: REDACTED

BY EMAIL 

All Party Parliamentary Group on Whistleblowing

4 June 2023

Dear Ms Robinson and colleagues,

WhistleblowersUK’s suggestion that Boris Johnson is a whistleblower, financial transparency and handling of whistleblowers’ personal data

I write to raise further serious concerns about your external secretariat, WhistleblowersUK.

On 3 June 2023 WhistleblowersUK tweeted to suggest that Boris Johnson was a whistleblower in respect to his claimed plans to disclose pandemic related documents to the COVID inquiry.

“Is former PM @BorisJohnson #BlowingTheWhistle?”

Mr Johnson is known for the opposite of telling truth. He was fined for a criminal breach of COVID lockdown laws, committed as prime minister. He currently faces further allegations about other breaches of the COVID lockdown.

He has been criticised for abrogation of responsibility during the pandemic. The many COVID policy failures under his premiership, such as the forced discharge of COVID positive patients into care homes, unnecessarily killed and injured thousands. The misconduct in public office that killed so many has been chronicled by Keep Our NHS Public.

Billions that could have been spent on public services, and on protecting the population from the clinical and economic effects of COVID, made their way into private pockets during his tenure.

He brought disgrace many times to his Office as prime minister.

Genuine whistleblowers find it appalling that WhistleblowersUK could suggest that Mr Johnson is any way a “whistleblower”.

It is a fundamental misapplication of the concept to apply it to the individual who was the controlling mind in our country’s tragic COVID misadventures. The many, many families whose lives have been changed forever by COVID losses deserve much better.

Moreover, it is most unfortunate to associate the term “whistleblower” with someone of Mr Johson’s character.

I acknowledge however, that under the US style bounty hunting model of financial rewards/ incentives that key members of the Whistleblowing APPG and WhistleblowersUK have sought to establish, that a criminal ratting out another criminal could be accepted as “whistleblowing” and rewarded. As in the case of Bradley Birkenfeld and other examples. If however, the APPG does not intend to replicate this aspect of the US model, please let me know.

I should add that the Chair of WhistleblowersUK has ignored a letter asking for clarification about WhistleblowersUK’s financial charges to whistleblowers seeking help, and the handling of whistleblowers’ data. Please see the correspondence forwarded below of 4 May 2023.

1.   I would appreciate your comment on the tweet by WhistleblowersUK which equates purported compliance by a controlling mind with a public inquiry into gross failures with mass loss of life, to whistleblowing. Does the Whistleblowing APPG stand by the suggestion that Boris Johnson is a whistleblower?

2.   I wonder also if the APPG would be kind enough to ensure that I receive a response from Tessa Munt on the outstanding questions on transparency about WhistleblowersUK’s financial charges to whistleblowers and WhistleblowersUK’s handling of whistleblowers’ highly sensitive data. 

I previously raised questions of finances and conflict of interest with respect to WhistleblowersUK’s role as APPG secretariat in 2019. But this only led to Sir Norman Lamb’s resignation from the APPG because WhistleblowersUK refused to answer. The other APPG members were happy to continue with WhistleblowersUK as secretariat despite the lack of accountability and transparency. For the newer APPG members, my unanswered questions to the APPG in 2019 are documented here: Norman Lamb MP has resigned from the Whistleblowing All Party Parliamentary Group

A key issue arising from information on WhistleblowersUK’s website is: Does WhistleblowersUK share whistleblowers’ highly sensitive personal data with third parties such as NAVEX Global, and without disclosing that it does so?

Many thanks and best wishes.

Dr Minh Alexander

Cc 

The Earl of Minto, Minister of State, Department for Business and Trade

Baroness Heather Hallet

Dr Philippa Whitford MP

Keep Our NHS Public

Lord Wills Whistleblowing APPG member

Lord Sikka Whistleblowing APPG member

Baroness Neville-Jones Whistleblowing APPG member

From: REDACTED
Date: On Thursday, May 4th, 2023 at 4:08 PM
Subject: Data processing by WhistleblowersUK
To: REDACTED

BY EMAIL & Twitter

Tessa Munt

Chair of WhistleblowersUK

4 May 2023

Dear Ms Munt,

I am directing this to your council email address as I did not wish to sign into your private website, having noted the message displayed about data collected by the LibDems.

The current  “Help me” section of the WhistleblowersUK website tells whistleblowers seeking help that their data is processed under the “WhistleB” process and overseen by WhistleblowersUK’s data controller. Could you kindly advise who is WhistleblowersUK’s data controller and whether any third parties have any role in processing the data of whistleblowers who contact WhistleblowersUK? For example, does WhistleblowersUK use dropboxes or digital platforms by third parties such as Navex Global? Please can WhistleblowersUk provide details of all third party involvement and also make such third party involvement clear on its website so that whistleblowers seeking help are fully informed? Also can WhistleblowersUK explain what the WhistleB process is?

Also, under“Our Purpose”, WhistleblowersUK now states that it provides “affordable” help. Can this be made be more transparent, and any financial charges for services to whistleblowers be explicitly published upfront? Also can any WhistleblowersUK’s requests for a share of financial settlements and awards be made explicit upfront? I ask as a document making indicating such charges and levies has never been published by WhistleblowersUK as far as I am aware.

Many thanks,

Dr Minh Alexander

Dr Minh Alexander retired consultant psychiatrist 1 June 2023

This is a brief post to share information about a disturbing failure by the Care Quality Commission to prosecute a private provider for egregious care failures. These failures led to an exquisitely vulnerable patient’s death, in a governance context of a regulatory revolving door.

Sally Lewis had a learning disability and lived in sheltered accommodation run by the company Dimensions UK.

Sally Lewis died avoidably from constipation on 27 October 2017, a known risk in her case, because of a failure to follow a care plan to monitor her bowel function and to administer vital laxative medication. It was a very painful death, with sections of her bowel found to be necrotic (dead) at post mortem.

There were many opportunities to stop this deterioration, as her family repeatedly raised concerns with staff about a deterioration in Sally’s overall wellbeing and distension of her abdomen, but this did not prompt appropriate action.

The details of Sally’s inquest this week and reactions  to it can be found via tweets by her family, a supporting inquest blog,  an INQUEST briefing and media accounts such as this: Inquest finds neglect contributed to constipation death.

I concentrate here on serious questions arising from CQC’s conduct.

CQC inspection background  

Sally Lewis died at a Dimensions UK facility called The Dock.  

A 2014 CQC inspection report gives the usual cursory, superficial account of the care one expects from CQC social care reports.  

Laughably, as evidence of user choice, the CQC report produces the example:  

“We heard a person being offered choice at mealtime. One staff said: “Would you like cheese or ham?””

As evidence of respect, CQC quoted what staff claimed they did:

“Staff told us how they demonstrated respect for people they were caring for. Staff said: “I knock on the doors”  

CQC connection at Dimensions UK

Unattractive aspects of the CQC in recent years include the way in which some of its most senior officers have walked through the revolving door to highly lucrative jobs in the private sector, and links between the regulator and the regulated.

Months after retiring from CQC, David Behan CQC’s former CEO took up a job at the care home giant HCOne, and started arguing in parliament that people should pay a tax for their future care home care:

Workers ‘should be forced to have pay docked to pay for care in old age’  November 2018

Even more outrageously, he was appointed by Dido Harding onto NHS England’s board despite his position on HCOne’s board, which one would have imagined created direct conflicts of interest. He also became Chair of Health Education England, raising similar concerns about conflicts.

Mike Richards former CQC Chief Inspector of Hospitals shortly after retirement walked into similar posts in the private sector but was also welcomed as a NED onto the board of the Department of Health.

At Dimensions UK, CQC’s former Head of Adult Social Care Policy until 2015, Rachael Dodgson became the company’s Managing Director in 2019 and then its Chief Executive last year.

Dimension UK’s annual report 2021/22 shows a turnover of over £200 million and places Dodgson’s remuneration in the pay band £180,000 to £189,999.

Was there any regulatory capture in the period following Sally Lewis’ death that affected CQC’s objectivity?

The CQC failure to prosecute for Sally Lewis death

CQC has the following legal time limits for bringing a prosecution for serious care failures:

“The CQC may bring a prosecution within a period of 12 months from the date on which sufficient evidence to warrant the prosecution came to their knowledge. However, this is limited to no more than 3 years after the commission of the relevant offence.”

From the MoU between the CQC and the NPCC:

“Under section 90(2) HSCA 2008 where CQC are investigating criminal offences into
specific incidents under Regulation 22(2), 12, 13 or 14 RAR 2014, the statutory time-limits require that CQC prosecutions must be commenced within twelve months of the date at which sufficient evidence in the opinion of the prosecutor to justify a prosecution came to the prosecutor’s knowledge. Additionally, no prosecution can be brought where information is laid more than 3 years after the commission of the offence.”

CQC informed the BBC that it attempted to prosecute but the case was thrown out because the judge concluded that the CQC had erred in calculating dates.

“The CQC said following proceedings at magistrates’ court in March 2022, the district judge concluded it “had made an error in relation to the timing of the decision to prosecute”.

CQC did not seek to prosecute Dimensions UK until 2020.

Why did it take almost three years to prosecute such obvious and serious care failings, and where the link between the care failings and death were so clear?

Surely the risk to a prosecution of delaying until 2020 should have been obvious?

Rachael Dodgson’s apology

The coroner found neglect, a very serious outcome for Dimensions UK.

The company, via Counsel, reportedly tried to argue even at inquest that constipation was not a well known side effect of Sally’s medication regime of anti-psychotics (it was).

After the coroner ruled, Dodgson issued a most objectionable apology, woven with mulitple threads of organisational self-justification.

She failed to properly apologise for the fact that a vulnerable person died slowly in front of her organisation’s eyes despite frantic warnings by the family, by adding qualifications, casting blame on Sally’s behaviour, not fully acknowledging the scale of failure and importantly, not showing enough empathy or even reportedly making a personal apology to the family.

The apology was insensitively illustrated with this smiling image:

It was reportedly not even made personally to the family:

“As for suggesting you’d like to apologise to Sally’s family, if you really wanted to do that, you need to do it in person, to them, if they want to hear from you, not to the media. This is an almost carbon copy of how Southern Health behaved at the end of Connor Sparrowhawk’s inquest…”

But cutting through the distasteful corporatisation of an apology, there was some tacit if reluctant admission of the enormity of the failure: Dimensions UK admitted that serious harm from constipation is a Never Event. Although one would need to see their operationalised details to be sure that this is translated into future action.

This is the regrettable apology by Dodgson, which only makes the questions about the CQC reverberate even more loudly:

“Our response following the inquest into the death of Sally Lewis

“The way we supported Sally Lewis in respect of her constipation simply wasn’t good enough. We could and should have done better. For that I am truly sorry and would like to apologise again to Sally’s family.

Our last CEO previously set out what had gone wrong, based upon our understanding at the time. The inquest has undertaken a deeper examination of the circumstances surrounding Sally’s death; it is clear that our processes, systems, management oversight and day-to-day support for Sally’s bowel management were not what they should have been.

That was almost six years ago and, in that time, a huge amount of organisational energy has gone into making things better. In the second half of this blog I am going to talk about what is different at Dimensions now and, just possibly, what others can learn from our experiences. But first, I want to talk about Sally, who is the most important person in all of this:

We supported Sally for 20 years. Sally was known to be at risk of constipation. Her medical records and prescriptions made that clear. And yet bowel monitoring was not done consistently and robustly.  Yes, there were some ticks put into some boxes but not routinely, and whilst our colleagues verbally discussed Sally’s bowel movements between them, that wasn’t enough to make sure they, or Dimensions’ management, understood what was happening.  We did not make our expectations to colleagues sufficiently clear in terms of recording.  Furthermore, our systems and processes to check the quality of records and support weren’t delivered effectively.  And this meant that nobody put all the pieces together. When Sally died, no-one around her realised she was constipated. And as a result, she hadn’t been receiving her PRN (“as needed”) medicine.

From the start we have said that one of the key issues here is how to balance individual dignity, privacy and rights with safety.  Sally found it difficult for people to accompany her to the bathroom and this could trigger significant behaviours of distress for her.  This meant that we couldn’t monitor how often she opened her bowels and the consistency, size and shape of her faeces. That issue stands but the key issue here was our acceptance of this. We should have raised this as a risk with her GP, the care manager, her family and with all those around her so we could work together to identify a way forward. I don’t think we did enough to help Sally herself understand why it was so important to be accompanied to the loo. And I don’t think we did enough to ensure our colleagues supporting her understood clearly the risks associated with long term constipation. I would like to turn to what is different at Dimensions now. Sally’s death has had a profound effect upon our organisation, and we didn’t wait for the inquest to identify the lessons we needed to learn, although following the Coroner’s findings we will reflect and consider carefully if there is any more we can do. We acted swiftly to make the necessary changes. We now have mandatory training for everyone supporting a person at known risk of constipation. We have a Bowel Toolkit which includes bowel management plans, improved bowel recording charts, a constipation screening and referral tool, guidance on how to prepare for a constipation appointment and more.  It is an organisational requirement that all people we support are regularly screened for constipation and bowel health. Specialist advice is available from our Health and Wellbeing Lead.

Our electronic daily records system which is now fully embedded means it is much easier for managers to scrutinise all records relating to the people we support.  And families also have access to these electronic records at any time from their own homes.  There are, simply, many more pairs of eyes able to see what is going on.  And we know that partnership working with families and loved ones results in better outcomes for the people we support.

Constipation is now one of seven ‘Never Events’ at Dimensions. Never events are a well-known concept in the NHS. Quite simply it means that, with the right training, behaviours, systems and processes, an incident that carries a potential risk of harm, injury or death should never happen. Specifically, at Dimensions, we say that “No one should suffer any harm as a result of a failure to administer or monitor the medication prescribed, or to follow established processes, for the relief or avoidance of constipation.”  And we work to provide the right training and processes, and ensure the right behaviours, accordingly.

Our CQC registrations, previously held at Operations Director level, are now held by Locality Managers across our organisation to ensure that those directly responsible for the oversight of delivery of individual care and support are closer to the people we support. That’s a critical change; if any providers reading this have yet to make a similar change, I urge them to do so.

We have also undertaken a great deal of work externally to raise awareness of the risks and issues surrounding constipation for people with learning disabilities, to enable us and others to do everything possible to keep people at risk of constipation safe and well:

We produced an animation for our colleagues which has been used by the NHS, and this accessible book, funded by Dimensions and co-produced with Beyond Words.

Many colleagues have also devised extraordinarily creative ways of delivering what we continue to believe is a very important message, and one that we will continue to deliver. Sally’s inquest is an incredibly sad but important and timely reminder that we must always make sure support plans are clear, followed by our colleagues in how they support people, and that checks take place to ensure all those things are happening, whether that’s in relation to people’s bowels or any other areas of support.

I will end this by simply saying, to Sally’s family, I’m truly sorry.  Nothing can bring Sally back but I’m determined that we will continue to do all we can to minimise the risk of this ever happening to anyone else.”

Rachael Dodgson, Chief Executive, Dimensions”

Sally Lewis’ family had no highly paid corporate lawyers or publicists.

They fought for an inquest and the truth of a loved one’s death on private means, and also endured the extra years of limbo caused by CQC’s scandalously late and unsuccessful prosecution.

They have a crowdfunding appeal for help with inquest costs:

Justice For Sally

UPDATE 6 JUNE 2023

I have asked the CQC for information under FOIA regarding its response to Sally Lewis’ death, multi-agency warnings about Safeguarding failure and its failure to mount a time prosecution. I have also asked whether in the light of Sally Lewis’ case and others, CQC should audit its application of Regulation 12 and I have sent a copy of the questions to the parliamentary Health and Social Care Committee, with a request that the committee consider CQC’s application of its responsibilities under CQC Regulation 12 at the next CQC accountability hearing.

FOI correspondence to CQC and letter to Health and Social Care Committee 1 June 2023

UPDATE 8 JUNE 2023

Dimensions UK have removed the grinning photograph of Rachael Dodgson from their “apology” webpage.

By Dr Minh Alexander 29 May 2023

The painful spectacle of the NHS denial machine grinding on at University Hospitals Birmingham NHS Foundation Trust (UHB) continues to embarrass us all.

Instead of an effective and genuine response to staff and patient concerns about maladministration, under-resourcing and related safety matters, the upper echelons of the NHS are wasting thousands in public cash on reputation management. Literally, because the relevant commissioner, Birmingham and Solihull ICB has hired the well known professional reputation managers, Freshwater.

Part of the prestidigitation is the performative exercise of allowing UHB to control a culture review on itself. This is akin to the useless models of internal Freedom To Speak Up arrangements for NHS whistleblowing and internal NHS arrangements for conducting Fit and Proper Persons investigations under CQC Regulation 5.

UHB, through a panel chaired by Roger Kline, has appointed a private company called “TheValueCircle” to carry out the culture review. TheValueCircle was set up by a former employee of the Good Governance Institute, another private company, which has many links with UHB managers and former managers, including Jacqui Smith former UHB Chair.

Roger Kline   Roger Kline was previously a Co-director of the now defunct organisation Patients First.   I have written previously about Patients First.   Roger Kline has links with the organisation B-RAP and has done joint work with this organisation. B-RAP was until 10 January 2023 chaired by Karen Kneller, a UHB non executive director.   Naledi Kline is a trustee of B-RAP.     Roger Kline interacted with UHB prior to the announcement that he would chair a panel to select the organisation to conduct the UHB culture review.   A local media report confirmed in April that he had prior links with the trust:   “He confirmed he has prior links to UHB, having worked with some of the existing leadership in the past on a ‘fairness taskforce’ looking at staffing issues, but insisted he had ‘no interest’ in positioning the trust chiefs in a positive light if that was not what he found.”   It is remarkable that the UHB trust board, and ultimately NHS England where Kline was previously a director, even at this late stage, appear unconcerned about any appearance of potential conflict of interests.

TheValueCircle is notable in that one of its consultants is a CURRENT member of the NHS England board, Andrew Morris, as declared in the NHSE register of interests.

Several of its other consultants are former NHS trust directors, regulators and commissioners, some very recently stepped through the revolving door, such as Ian Hall who according to his LinkedIn entry was until June 2022 Regional Director of System Improvement, for NHS England Midlands.

This is the very NHS England region responsible for UHB and which is controlling the conduct of the UHB reviews behind the scenes, as revealed by PHSO correspondence, which is another topic for another day.

Unhealthy proximity, did I hear you say?

To understand TheValueCircle’s past work for the NHS, I looked for examples of other reviews and consultancy work. Strikingly, I found no past work product by TheValueCircle in the public domain. But I did find a comment on the company’s website about the fact that it did not produce much in the way of reports:

To find out more I requested, under FOIA, information from ten NHS bodies which appeared to have used TheValueCircle’s services in the past. They were mostly located in the West Midlands and North West regions. The results are provided below.

1) Walsall Healthcare NHS Trust

In an FOI response, Walsall reported it spent £119,232 on TheValueCircle for “Acute Partnership Development Support” and “Board Development Programme 2021/22”.

Astonishingly, the trust claimed that it held no data on which consultants from TheValueCircle carried out this work, any reports by TheValueCircle or whether NHS England had recommended the TheValueCircle.

This is the Walsall Healthcare FOI disclosure.

2) Sandwell and West Birmingham NHS Trust (and false claims)

This trust and Walsall Healthcare NHS Trust are both chaired by David Nicholson, the former CEO of NHS England who was forced to resign after the scandal of the MidStaffs Public Inquiry.

He is now a major influence again in the West Midlands region, where it all started, as the chair of multiple NHS trusts.

Although Sandwell and Birmingham NHS Trust board papers recorded that Nicholson commissioned a review by TheValueCircle as one of his first acts as trust chair in, the trust FOI department bizarrely claimed to me that the trust had NEVER hired TheValueCircle.

“We have never commissioned this company for any consultancy work, advice or any services.”

When I pointed out that this was incorrect and supplied the evidence to prove this, the trust FOI department simply ignored me. Alongside this, I actually wrote to Nicholson to ask him if he had prior experience of TheValueCircle. He responded via a message from his office confirming that a review report had been produced but with a new narrative that it was not he but his CEO who had commissioned the review. He denied that NHS England had recommended TheValueCircle.

“From: REDACTED

Subject: RE: The Value Circle

Date: 18 April 2023 at 16:51:45 BST

To: REDACTED

Dear Dr Alexander

Many thanks for your email below.

Sir David has confirmed that he has not used The Value Circle previously.  Sandwell and West Birmingham used them and I understand that they produced a good report which focussed heavily on the culture and behaviour elements of governance.  This was requested by Richard Beeken the CEO.  There is no connection with NHSE.

I hope the above is helpful.

Kind Regards

REDACTED”

Sandwell and West Birmingham did not respond properly to my FOI request until I complained to the ICO and I published my letter of complaint.

The day after, a response finally arrived indicating that the trust spent £28,200.00 on TheValueCircle’s services for a “Governance Review”.

The trust refused to disclose which consultants from TheValueCircle did the work claiming it was exempt as personal data.

Despite paying for and owning the review report on behalf of the public, the trust claimed it needed TheValueCircle’s permission to disclose it to the public:

“The report was prepared solely for the use of Sandwell and West Birmingham Hospitals NHS Trust. There is a disclaimer that the details may be made available to specified external agencies, but otherwise the report should not be quoted or referred to in whole or in part without prior consent. No responsibility to any third party is accepted as the report has not been prepared and is not intended for any other purpose. We have requested permission from The Value Circle as to what can be shared. We will respond once they have confirmed.”

The trust denied that NHS England recommended TheValueCircle and stated: “…they were chosen through a competitive bidding tender process.”

This is the Sandwell and West Birmingham FOI disclosure.

3) Dudley Integrated Health and Care NHS Trust 

No response.

I will be complaining to the ICO.

UPDATE 20 JUNE 2023

After a complaint to the ICO, Dudley Integrated Health and Care NHS Trust revealed it has spent £468K on TheValueCircle’s services since 1 April 2021. But it refuses to disclose any reports by the same, on grounds of personal privacy (Section 40).

FOI response 20 June 2023 by Dudley Integrated Health and Care NHS Trust, spending on purchases from TheValueCircle

4) Gloucestershire Health and Care NHS Trust

This trust hired TheValueCircle to provide “training to our Board including a Well Led training session so that Board members would be further prepared for the then upcoming CQC inspection and also a Board Development programme.”

This cost £43,316.49 ex VAT.

The trust refused to disclose which consultants from TheValueCircle supplied the purchased services on grounds that disclosure would prejudice the conduct of public affairs. Really? Were the consultants current public servants?

The trust dubiously claimed that it could not disclose reports by TheValueCircle on grounds of commercial sensitivity.

It implied that NHS England had not recommended TheValueCircle:

“The Trust was made aware of TVC and other potential suppliers of Well Led reviews via a Trust Secretary network. TVC were appointed through a procurement exercise/tender by the Trust.”

This is the Gloucestershire Health and Care FOI disclosure.

I have asked for an internal review.

5) Shropshire Telford and Wrekin ICB (and false claims)

ICB records clearly showed that TheValueCircle was hired to work on transformation of musculoskeletal services:

“To help shape the future ambition for MSK services, ICS organisations jointly commissioned The Value Circle to undertake a review of the current MSK transformation programme and make recommendations on next steps. The initial feedback which remains in draft form is attached in Appendix 1.”

This is the the relevant section of Appendix 1.

However, the ICB claimed to me that it had never conducted any business with TheValueCircle.

This has been questioned and await a response.

6) Harrogate and District NHS Foundation Trust

No response.

I will be complaining to the ICO.

7) Liverpool University Hospitals NHS Foundation Trust

This trust spent £83,160.00 (inc VAT) by hiring TheValueCircle “work in partnership to develop a new risk management framework”.

The main man from TheValueCircle, David Cockayne, was the main consultant supplied, as is the case at UHB:

“David Cockayne, Chief Executive (The Value Circle LLP) was the senior sponsor supplied to co- ordinate the work undertaken with the Trust.”

Astonishingly, for £83,160.00 of public money spent, there is purportedly no tangible product to show for it:

“In accordance with Section 1 of the FOIA, we can confirm that the Trust does not record/collate the above information. We do not hold a final written report in order to answer Q4 of your request.”

The trust denied that NHS England recommended TheValueCircle in an interestingly worded reply:

“No external body recommended TheValueCircle to the Trust”.

8) East Lancashire Hospitals NHS Trust

This trust hired TheValueCircle to provide “Support to the development of the Provider Collaborative Strategy” and paid £193,065.90 inc VAT for this service.

The trust was reluctant to disclose which consultants from TheValueCircle provided the service, copies of their reports or whether NHS England had recommended TheValueCircle to the trust. It repeatedly gave the answer:

“The Trust does not hold this information centrally.”

This is the East Lancashire FOI disclosure.

I am requesting an internal review of this given reason for non-disclosure.

Until July 2021, the CEO of this trust was Kevin Mc Gee.

An apparent testimonial by Mr Mc Gee appears on TheValueCircle’s website:

I have asked Kevin McGee to kindly confirm that this comment was correctly attributed to him.

9) Blackpool Teaching Hospitals NHS Foundation Trust

This is another trust under Kevin McGee’s oversight as CEO.

The trust disclosed that it had hired TheValueCircle for the following jobs:

“From 19/20 the Trust commissioned 3 pieces of work:-

• a review of our Wholly Owned Subsidiary – Atlas
• a review of our Divisional Structure and consideration of a Tertiary Division
• a support piece of work for the Development of the Provider Collaborative for L&SC – this was commissioned by BTH but was for the entire PCB across Lancashire and South Cumbria.”

This all cost £350K.

David Cockayne was the main consultant for this project, as he is at UHB currently.

“David Cockayne, Chief Executive of Value Circle, was the lead contact for the projects, deploying various other consultants dependent upon the work.”

The trust refused to disclose any reports by TheValueCircle on grounds of commercial sensitivity.

Most incredibly, the trust also refused to disclose whether or not NHS England had recommended TheValueCircle on grounds of commercial sensitivity.

Shurely shome mistake?!, I hear you cry.

Surely no one at NHS England has a commercial interest in TheValueCircle getting lucrative NHS contracts?

This is the Blackpool FOI disclosure.

I am requesting an internal review of these claimed exemptions.

The last but possibly the most important example:

10) North East Ambulance Service NHS Foundation Trust

As the NEAS deaths cover up and coronial misreporting scandal swirls on, compounded by the appointment of Marianne Griffiths as an investigator despite her controversial history with whistleblowers, who is found in the mix but TheValueCircle.

I discovered that TheValueCircle had been hired from NEAS financial transparency data , which showed that the trust CEO had authorised a payment to the company in December 2022 for “external consultancy”.

In response to FOI questions, the trust disclosed that it had hired TheValueCircle to undertake a  “Well Led Independent Review” at a cost of £79,253 ex VAT and a  “Full review of Trusts Governance and Assurance Framework” at a cost of £127,660 ex VAT.

TheValueCircle consultants who did the work were Sue Hillyard, Maggie Boyd a former NHS Improvement director in the Midlands and East Region and David Cockayne.

With desperation, and despite the massive and obvious public interest arguments, the trust claimed that it would be prejudicial to the conduct of public affairs if the reports produced by TheValueCircle were shared:

“Frankness and candour are essential for good decision-making. We believe that disclosure would be likely to prevent future reviews taking place with an honesty and candour needed to ensure that corrections can be made to improve our services.

We are therefore unable to release this information and apply section 36(2)(b)(i)&(ii) and section 36(2)(c) exemptions. This exemption states that information is exempt information if, in the reasonable opinion of a qualified person, disclosure of the information under the legislation:

(b) would, or would be likely to, inhibit –
(i) the free and frank provision of advice, or
(ii) the free and frank exchange of views for the purposes of deliberation, or
(c) would otherwise prejudice, or would be likely otherwise to prejudice, the effective conduct of public affairs.

The documents requested and subsequently withheld contain the findings and opinions from external reviews that, if made public, would likely inhibit the future frankness and candour that we require to ensure our decisions are robust and informed.

In my reasonable opinion, this would likely damage the quality of advice and deliberation and lead to poorer decision making in the future. It would also inhibit the necessary frankness and candour of our staff if their discussions were made public.”

It is striking how the NHS will argue that night is day and vice versa when it suits.

When it is inconvenient, as at NEAS, embarrassing findings are hidden behind the wall of Section 36 exemption.

When it is less inconvenient, they may be published in full.

Here is an example of a fully public Well Led Review report on another NHS trust, of which Maggie Boyd was also a co-author:

Well Led review report on North West Anglia NHS Foundation Trust

NEAS also denied that NHS England recommended TheValueCircle:

“The Value Circle was not recommended by another body. Procurement exercise completed for Well Led Independent Review and further work on Governance and Assurance Framework required rapid completion post CQC inspection.”

This is the NEAS FOI disclosure.

Conclusion

So there you have it dear reader, UHB which has been severely criticised for secrecy and marking its own homework, allowing cover ups of patient safety and staff abuse, is being allowed to mark its own homework again using a private company about which there is studiously little transparency despite large amounts of hard public cash changing hands.

So far, even with three of ten trusts failing to respond to the FOI requests, over a million pounds were spent on TheValueCircle with nothing tangible in the public domain to show for it, even with a major scandal and many lives lost at North East Ambulance.

Why should highly paid NHS trust executives pay others with our money to do their jobs for them?

In times of austerity, when the lowest paid NHS frontline have to rely on foodbanks and 7.3 million patients wait for treatment, is not an obscene sight that money is frittered away in this fashion?

If these highly paid executives are incapable of doing their jobs, they should be shown the door. But oh, wait, there is still no sign of any implementation of the Kark review which the current Secretary of State himself commissioned but reportedly has stifled. He has not replied to a letter of 7 February 2023 asking him to reconsider his decision to reject Tom Kark’s recommendation of a disbarring mechanism. I have written once more:

LETTER TO STEVE BARCLAY SECRETARY OF STATE ABOUT DISBARRING UNFIT NHS MANAGERS 29 MAY 2023

NEUROLINGUISTIC PROGRAMMING AT THEVALUECIRCLE

As a little bonus feature, I should draw attention to the fact that one of TheValueCircle’s featured consultants Margaret McCabe is advertised as a NLP practitioner.

Her arrival was announced by David Cockayne himself.

NLP has been described as “pseudo-scientific”, “folk magic”, a “quasi-religion” and a New Age “psycho-religion”.

The current NHS National Freedom To Speak Up Guardian is master practitioner of NLP, not to mention a fire walk trainer. Nuff said.

Neuro-linguistic-programming: a critical review of NLP research and the application of NLP in coaching

Thirty-Five Years of Research on Neuro-Linguistic Programming. NLP Research Data Base. State of the Art or Pseudoscientific Decoration?

RELATED ITEMS

Auditors concluded North East Ambulance Service failed to act on legal advice to ensure it complied with coronial legislation to disclose evidence, and vilified staff who followed the law

Mr Tristan Reuser’s whistleblowing case: Scandalous employer and regulatory behaviour on FPPR

After Reuser v UHB and Macanovic v Portsmouth: New rules to deter malicious referrals of whistleblowers to the Practitioner Performance Advice service

Death of a UHB patient following an unwitnessed fall: Coroner’s PFD report

Healthwatch Birmingham & Solihull has been receiving increasing concerns from the public about UHB and has held monthly meetings with the CQC

Cygnet Health Care has Fit and Proper leaders according to the CQC, despite gross whistleblower reprisal

By Dr Minh Alexander retired consultant psychiatrist 21 May 2023

University Hospitals Birmingham NHS Foundation Trust received a warning notice for under-staffing from the Care Quality Commission in December 2022 following an unannounced inspection of Good Hope Hospital over 7-14 December 2022.

The inspection took place just after BBC Newsnight broadcast about poor culture and mistreatment of staff at the trust. The CQC claimed it inspected “due to a number of concerns raised by patients and their families around the care and treatment they had received”.

The warning notice on under-staffing was served partly as the CQC found that patient falls, some with serious harm, occurred DURING the inspection:

“Staff knew about and dealt with many specific risk issues. However, in many ward areas staff told us about their concerns over the number of falls and patients with pressure damage due to staffing pressures preventing them from taking appropriate, preventative action. On the first day of our inspection, staff reported that they had unfortunately had 2 patients fall due to being unable to provide the supervision the patients were assessed as requiring.

“The service did not have enough nursing and support staff to keep patients safe. During our inspection we found most wards were operating below national guidance for safe staffing levels. The Royal College of Nursing recommend safe staffing levels of 1 qualified nurse to 6 patients. Staff told us shifts were regularly planned for 3 qualified members on staff each shift, however this regularly reduced to only 2 qualified staff members working on the shift. Even with 3 qualified nurses on each shift, this would still have been outside of the recommended safe staffing levels. On the 13 December 2022, we found Ward 16 which had medical outlier patients admitted at the time were reduced to 1 qualified member of staff for 26 patients, at the time of our visit. The registered nurse was supported by a trained nursing associate. On the 13 and 14 December 2022, we found Ward 9 had a ratio of 1 nurse to 17 patients on both days of our inspection. Staff told us the ward had a high acuity as they had a large number of patients with complex needs, many of whom required 1:1 supervision. At the time of our inspection, staff were unable to provide this due to the unsafe staffing levels. On the first day of our inspection, Ward 9 reported 2 falls as they were unable to provide the 1:1 support for them. One patient did not sustain serious harm, however, 1 patient was awaiting a head CT scan and undergoing neurological observations due to the fall. Staff told us this was not a rare occurrence due to the challenges they faced with staffing.

We raised our concerns about staffing during and after our inspection and issued the trust with a Section 29a Warning Notice advising them of timely improvements needed to be made due to serious safety concerns.”

UHB trust board papers show that inpatient falls with “severe” and “catastrophic” harm occur on a regular basis.

It raises a question of why the CQC only served a warning notice and is not actively investigating under Regulation 12.

Another UHB hospital has now been criticised in relation to a patient fall which resulted in death.

On 19 May 2023 the coroner issued a Prevention of Future Deaths report after the death of 77 year old Norma Bruton who had an unwitnessed fall at Heartlands Hospital, resulting in a fractured neck of femur and her death seven days later.

Norma Bruton Prevention of Future Deaths report 19 May 2023 Ref Ref: 2023-0165

The death occurred on 22 October 2022, shortly before the unannounced CQC inspection of Good Hope Hospital in December 2022.

“She had an unwitnessed fall on the morning of 15 October 2022 when trying to walk the short distance to her bathroom and sustained a right fractured neck of femur for which she underwent surgery on 20 October 2022. Mrs Bruton’s condition deteriorated after the surgery and she died in hospital on 22 October 2022.”

The coroner identified a concern about UHB’s falls risk assessment process and failure to take trailing attachments such as drains and drip lines into consideration as risk factors.

Bewick’s rapid review of clinical safety at UHB, published in March 2023 claimed that UHB was safe overall, despite Bewick’s awareness of the CQC warning at Good Hope Hospital. Bewick’s report maintained that mitigations were in place.

The issues of serious understaffing across all UHB sites, about which staff have been whistleblowing for years according to UNISON and others, supported by regulatory findings, long A&E waits and rates of avoidable harm from falls, are not consistent with a conclusion that clinical care at UHB is reliably safe.

Neither is the upsurge in concerns reported by the public to Healthwatch since 2021.

Will other care failings continue to emerge?

I am sending the PFD on Ms Norma Bruton’s death to the Care Quality Commission with respect to Regulation 12 issues. The Coroner has already sent it to NHS England.

NB I am occupied with a family matter at present so apologies if I am slow to respond to correspondence. Best wishes.

RELATED INFORMATION

A previous UHB FOI disclosure revealed that there were 30 fractured necks of femur resulting from inpatient falls in the period 2012/13

Another UHB FOI disclosure showed that the majority of inpatient falls at UHB are unobserved:

Dr Minh Alexander retired consultant psychiatrist 9 May 2023

This is a post to spell out the stark numbers behind the unethical and exploitative US bounty model of “whistleblowing” rewards that the whistleblowing APPG is trying to introduce.

All Party Parliamentary Groups have no official status whatsoever.

Some do good work.

Many are shady lobbying devices for wealthy and powerful private interests that subvert our democratic process.

They positively abuse parliament’s dignity, flinging the portcullis about as a branding and marketing tool.

The APPG sleaze story is a long running and ongoing scandal. These are the typical concerns about APPGs:

“We are concerned that if left unchecked, APPGs could represent the next great parliamentary scandal, with commercial entities effectively buying access to and influence of parliamentarians and decision-makers.”

‘Every lobbying company sees an All-Party Parliamentary Group as an ideal way of making a quick buck’

“….there remains a significant risk of improper access and influence by commercial entities or by hostile foreign actors, through APPGs”

“.External organisations providing support for APPGs are a corruption risk. It is possible that organisations are using this privileged access to MPs and the ability to book rooms within the parliamentary estate, as a way of impressing clients and at the very least appearing to influence the views of parliamentarians.”

In this context, the Whistleblowing APPG was established with money from US bounty hunting lawyers, and it has an external secretariat in the form of a private company, WhistleblowersUK.

WhistleblowersUK has advocated for whistleblower rewards, and latterly has euphemistically dressed this up as “compensation” but in contexts which indicate rewards are being posited. Members of the APPG have also advocated for whistleblower rewards and “incentives”.

The trouble with the US bounty model is that it is utterly ruthless. It is focussed on recovering money for the State, from the financial sector. It is not about other forms of whistleblowing in the public interest. It does not care about the welfare of all whistleblowers. It wishes only to identify those who will recover the most money for the State, be they genuine whistleblowers, or criminals who rat on other criminals.

Indeed, a lawyer from the US firm which funded the whistleblowing APPG publicly compared whistleblowing to the use of paid informants in law enforcement at a Bylines festival.

Bona fide whistleblowers who report wrongdoing, and suffer for it, are discarded by the US bounty system if their disclosures do not result in recovery of a sum beyond a target threshold, (a million dollars under the US Security and Exchange Commission rules). Some whistleblowers wait years under this system to receive nothing.

Then factor in secondary effects from perverse incentives: regulatory corruption, which has made an already heartless system even worse. In short, game keepers setting up a poaching monopoly for financial gain from the bounties. This is research from Kansas University which exposed the corruption.This is corroborating work by investigative journalists which supported that research. It is no surprise that monetising whistleblowing leads to unseemly consequences.

And what of the cold mathematics of SEC’s whistleblowing hunger games?

Since 2011, the US Securities and Exchange Commission (SEC) says its whistleblower programme has received a total of 64,755 whistleblowing tips about financial wrongdoing.

Source: SEC annual reports from SEC’s Dodd-Frank whistleblower programme

SEC says that from all of these tips, it has made 328 awards to individuals under its whistleblower programme:

“Since the beginning of the program, the SEC has paid more than $1.3 billion in 328 awards to individuals for providing information that led to the success of SEC and other agencies’ enforcement actions.”

Although there are complexities, that roughly gives a conversion rate of only 0.5%.

That is, 99.5% are junked. Some after many years of waiting.

And bear in mind that investigators have discovered that scandalously, SEC have given some of the awards to individuals who did not even meet SEC’s own definitions of a whistleblower.

Here is an example of a genuine whistleblower who failed to qualify under SEC’s Byzantine process:

GENE ROSS He Waited 17 Years to Be Denied an SEC Whistleblower Award Gene Ross discovered the theft of $175K from a client and reported it. He suffered serious detriment. After seventeen years, he was told that he would not qualify for a SEC award, although his report eventually led to SEC recovering more than $50 million from a fraud. “What has moved far more slowly is the story of Gene Ross, father of three, who, in the process of voluntarily cooperating with government prosecutors and regulatory agencies in the criminal and civil actions against Amerindo, lost his job at Bear Stearns, which strongly discouraged his participation in the legal reckoning that followed, cut his pay, took away his sales team, and subjected him to unchecked harassment and retaliation. After leaving Bear, Ross was forced to sell his home to cover mounting legal bills that eventually bankrupted him. Yet he continued to provide evidence, documents, and testimony as a star witness in the 2008 criminal case that put Vilar and Tanaka behind bars.” Ross commented of the SEC decision: “It kind of made me feel like a victim again.”

The real winners from the cruel SEC and other related US programmes are the lawyers and other middlemen.

And the obscene bounties that are paid out in the few, select cases are excessive set against losses suffered by victims who remain uncompensated.

Occasionally, some whistleblowers have refused SEC awards out of conscience:

Deutsche Bank whistleblower rejects award because SEC ‘went easy’ on execs.

“I request that my share of the award be given to Deutsche and its stakeholders,”

The whistleblowing APPG and its secretariat WhistleblowersUK have waged a clearly well-resourced and increasingly glossy media campaign about UK whistleblowing reform which camouflage their intentions and their vaguely and worryingly drafted law to replicate SEC’s much maligned Office of the Whistleblower.

One of the APPG’s MPs is now in power and has wasted no time in calling for a review of UK whistleblowing law:

Tory MP Kevin Hollinrake who called for whistleblower “incentives” is now in a ministerial role, launching a review of UK whistleblowing law

The Whistleblowing APPG have used poster boys and girls from health and social care in their campaigns, when whistleblowing about poor care is the last thing that would attract bounties. It is the financial sector that is the real prize. And even then only a few whistleblowers would benefit.

The great risk is that the APPG’s proposed vision would quickly descend into a racket, with the whole system trained on money making rather than public protection, with the great majority of whistleblowers discarded. The more lowly paid and disenfranchised, the more neglected. Nursing and care assistants have little enough voice already.

We have already seen quite enough degradation of our public life with greed, chumocracy and misconduct in public office.

We don’t need anymore.

No thank you to failed US policies or the bounty hunting sharks and their companions.

RELATED ITEMS

A much better US model is that of the Office of Special Counsel which looks after public sector whistleblowers – federal employees – it works on a lean model, seeks to apply redress during employment rather than after dismissal and works on the principle of restoring a whistleblower to the position they would have been in but for the whistleblowing. Most valuably, it can address non-financial detriment, such as restoring lost seniority and erasing unfair performance and disciplinary records. The principle is of more justice, not incentivising greed, stoking wasteful conflict or feeding a legal industry.

UK whistleblowing law, PIDA, is hopelessly weak, wasteful and was explicitly drafted to appease industry. It benefits the lawyers. It has caused no end of suffering to whistleblowers and contributed to countless public protection failures:

Replacing the Public Interest Disclosure Act (PIDA)

The law needs urgent replacement, but in that space, opportunists will exploit any chance they can to make money or build careers.

Those who have earned their daily bread from not rocking the boat and selling whistleblowing products from the last twenty years of PIDA’s jurisdiction will want to continue their business in a newly configured form. The bounty hunters will obviously want their taste. The academics will want to preserve their access to power and grants, and some may not be too discriminating about which tables they sit at. Some politicos will expect a berth in the Pullman carriage of the gravy grain.

It falls to un-captured and genuine whistleblowers with no personal agendas, seeking no personal gain, to speak up for the public interest and for future whistleblowers.

For any journos who want a quick primer on the legislative intentions of the whistleblowing APPG and the now Parliamentary Under Secretary of State at the Department for Business and Trade, here is a summary:

A Bounty Hunters’ Bill? A critique of the Whistleblowing APPG’s April 2022 Bill

UPDATE

WhistleblowersUK has now ended any pretence that it is pursuing the bounty model.

It recently co-authored a document with two major US bounty hunting law firms praising the model.

The document made an unsupported claim that the model worked well for centuries in England.

Historical studies show that there were serious abuses:

Qui Tam. A tale of malicious informants and corruption in ye Olde England. And its evolution to the modern bounty hunting model