West Suffolk NHS Foundation Trust’s whistleblower witch hunt, National Guardian’s visit and an object lesson in superficiality

Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 8 February 2020

For the last few months the Orwellian scandal of the NHS hunting down a whistleblower in the Health Secretary’s constituency, West Suffolk, has dripped out painfully.

We have heard of astonishing coercion against staff for fingerprints and handwriting samples.

And we are now approaching the heart of the grotesque heavy handedness – the cover up of widely held concerns about a trust doctor’s fitness to practice and an attempt to bury whistleblowers. 

There is very serious concern that behind the faux contrition after being rumbled, the trust continues to grind its whistleblowers into the dust, a classic scenario.

Under press scrutiny, Trust directors lost their head. They dared to claim that there was central approval for their witch hunt, and that the centre allegedly considered that the trust’s oppressive actions constituted “clear reasoning” and “good practice”.

The National Guardian lost her head and her Office fingered NHS Improvement by social media:

Screenshot 2020-02-04 at 07.37.13

NHS Improvement has been stony silent and appears to have enforced omerta, as the trust has now fallen silent too. The trust is well overdue on an FOI request about who at the centre approved the whistleblower witch hunt.

The CQC has dished out a punishment beating by stripping the trust of its ‘Outstanding’ rating and casting all manner of aspersions on the trust directors’ ability to engage staff and ensure quality. CQC also made findings about failure by the trust Freedom To Speak Up Guardian.

Winding back a bit, many had noted that the trust CEO Steve Dunn was fond of sporting a Freedom To Speak Up lanyard.

Steve Dunn selfie with Matt Hancock and Freedom To Speak Up lanyard

The National Guardian’s Office was moved to tweet thanks to him for “showing” his commitment to Freedom To Speak Up.

Steve Dunn National Guardian tweet thanks for commitment

 

An additional search now reveals that Henrietta Hughes the National Guardian in fact visited the trust in January 2018 and praised its culture.

The minutes of a trust board meeting 1 Dec 2017 noted the visit:

“Jan Bloomfield [then Director of HR] explained that the 5 o’clock club was where the organisation talked about leadership and quality improvement, and anyone with an interest was welcome to attend. The Trust was trying to cover a wide range of subjects and this was an opportunity for people across the organisation to connect. There were some excellent speakers for next year and the aim was to link the programme with what WSFT was trying to achieve as an organisation. Dr Henrietta Hughes would be speaking on 11 January”

Inevitable grinning selfies of Dunn and the trust Freedom To Speak Up Guardian with Henrietta Hughes were tweeted:

Screenshot 2020-02-08 at 04.09.19

 

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The trust capitalised on the visit with the following report in its local newsletter:

“Following her visit, Dr Hughes kindly wrote to the trust to thank us for hosting her. Here are some key comments from her letter:

“Your focus on staff engagement for the benefit of patient care comes through at every level of the trust”

“It is striking that you adopted the vision of speak up for the purposes of quality improvement well before it was mandated and everyone I spoke with told me the same, that they felt valued and that they were encouraged and supported to speak up”.

Screenshot 2020-02-08 at 04.12.13

Other similarly dismal good news output by the trust, exploiting the Freedom To Speak Up branding, can be found below.

And that campers, is exactly what the Freedom To Speak Up project was devised for by the government. It is but a paltry confidence trick.

Accept no substitute for real law reform and genuinely effective enforcement infrastructure, and certainly not the synthetic air kissing road show that is the National Guardian’s Office.

Screenshot 2020-02-08 at 04.13.38

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Robert Francis’ denial and a major failure of the government’s Freedom To Speak Up model at West Suffolk NHS Foundation Trust

By Dr Minh Alexander, NHS whistleblower and consultant psychiatrist, 4 February 2020

Summary: CQC has released detailed supporting evidence from its inspection of West Suffolk NHS Foundation trust which shows stark failure of the Freedom To Speak Up model, with some criticism of the trust’s internal Freedom To Speak Up Guardian as well as the trust senior managers. There are concerns about actual breaches of whistleblower confidentiality in addition to the witch hunt to identify a whistleblower. Alongside this, Robert Francis continues to insist that the Freedom To Speak Up project is progressing well. Having five years ago recommended the voluntary Freedom To Speak Up scheme over substantive whistleblowing law reform, because he claimed the former was a speedier solution, Francis now falls back on claiming that the project “needs time to develop”.  Under pressure, the National Guardian appears to be conceding a little ground on responsibility for remedy of detriment, but it is very early days. She has so far failed to act on the West Suffolk scandal by announcing a case review. The ICO has accepted intelligence about West Suffolk’s processing of biometric (fingerprint) data. 

 

A Good Samaritan recently forwarded me a copy of their correspondence with Robert Francis, in which they tried to engage him about the lack of real change for NHS whistleblowers, and the behaviour of lawyers on behalf of the NHS towards whistleblowers. As the person put it, exhorting NHS workers to whistleblow can be like asking someone to volunteer for a Forlorn Hope mission.

As has become his wont, Francis responded by defending his work. He continued to tie himself up in logical knots, stonewalling with counter claims very similar to the daily output by the National Guardian’s Office. Francis maintained that there was safety in numbers and that if many whistleblew, that would solve the problem.

From email by Robert Francis 14 January 2020:

“In my view the best way of ensuring that staff who raise concerns feel safe to do so is to encourage all those who have concerns to do so.  One of the reasons this has been perceived as being risky is the isolation many who have tried to raise issues have experienced.

I fear we are not going to agree about the value of the Freedom to Speak Up National Guardian.  Her office and the network she leads is making a great deal of progress on promoting the freedom to speak up without legislative or regulatory powers.  The concept of guardians in this context is a new one and needs time to develop.   I believe that progress in this field is evidenced in her report, published today showing a dramatic increase in the level of concerns raised with local guardians.”

This is particularly surreal juxtaposed against the months of highly publicised scandal about West Suffolk NHS Foundation’s whistleblower witch hunt, where staff have been pitted against the trust executive. There is no sign there that any whistleblower found safety in numbers or that persecuted staff have declared that all is magically well now.

Doctors at West Suffolk hospital ‘too scared’ to report safety issues

Staff say hospital bosses misled them in hunt for whistleblower

In fact, documents released by the CQC in the last week provided more evidence of the failure of Francis’ useless Freedom To Speak Up model at West Suffolk.

CQC appear to have punished West Suffolk NHS Foundation Trust managers for committing the cardinal sin of claiming that they were following orders from the centre when they hunted a whistleblower, by releasing humiliating details of board failure.

Along with this, CQC have also revealed purported failures by the trust Freedom To Speak Up Guardian.

 

Alleged central approval for West Suffolk’s whistleblower witch hunt

The trust claimed to the Guardian newspaper that its approach was backed by “the NHS national head of whistleblowing”.

The National Guardian broke ranks after criticism and denied that it was she. Via social media, her Office fingered NHS Improvement:

Screenshot 2020-02-04 at 07.37.13

Alongside this, correspondence with Steve Dunn the trust CEO requesting information about the central backing has been met with evasion. There has also been silence from NHS Improvement to a request for information.

Most recently, NHS England press office has issued a slippery denial to BBC journalist Nikki Fox that it did not back the witch hunt. This may be a misleading way to avoid admitting that NHS Improvement was responsible.

A complaint has been made to the ICO about West Suffolk’s flat failure to answer several FOI questions.

 

Notably, a detailed, 396 page CQC evidence appendix, which was the supporting document to the main CQC inspection report, criticised the local trust Freedom To Speak Up Guardian for not focussing on their role to support staff, and criticised the reports produced by the Guardian. CQC also questioned the accuracy of some information provided by the trust Freedom To Speak Up Guardian.

Importantly, the forensic nature of CQC’s dissection on West Suffolk’s whistleblowing governance shows that CQC is perfectly capable of rigour when it pleases.

CQC claimed:

“During interview the FTSU guardian was extremely positive of the support provided by the executive directors. As well as direct support from the executive and non-executive leads for FTSU, they stated they could speak at any time to the CEO and chair and were confident that issues would be dealt with. They were proud of the role and stated they saw it as important and a privilege. They had monthly one-to-one meetings with the interim director of human resources and stated they met the nominated non-executive director (NED) every six months. They recognised that contact out in the community services needed to improve and stated they planned to work with the staff governor in the community to address this.

 However, during interview we were not assured that the guardian had full understanding of the role. Their focus was on the support they were receiving from the executive team rather than support they were providing to staff across the organisation. They also stated they caught up fairly frequently with the guardian of safe working hours (GOSW), however this was not confirmed by the GOSW. The GOSW had been in post since March 2019 and informed us that the FTSU guardian had not responded to their initial contact. Despite initial thoughts that contact between the two roles would be important, as time had passed this had lessened, however they confirmed that they knew who the FTSU guardian was.”

“There was no evidence of triangulation to other patient /staff experience data to identify potential emerging issues. There was no trend analysis of numbers, issues, type of worker speaking up or analysis of wider context such as potential risks, barriers and opportunities. Neither FTSU reports mentioned any analysis of the 2018 NHS staff survey results.”

Certainly, a previous review of the data published by the National Guardian showed that the West Suffolk NHS Foundation Trust Freedom To Speak Up Guardian rarely considered that there was any detriment to staff for speaking up.

Given what we now know about the West Suffolk witch hunt and deep staff unhappiness, this raises questions of whether the trust Freedom To Speak Up Guardian was assessing effectively or reporting accurately, or whether staff trusted the Guardian enough to report detriment.

There is an indication in CQC’s evidence appendix about a lack of trust in the local Freedom To Speak Up Guardian due to apparent breaches of confidentiality:

“We heard examples from staff that information they had provided in confidence, to various individuals including the FTSU guardian, had become known”

This is not to say that the Freedom To Speak Up Guardian breached whistleblower confidentiality. Whilst that is clearly a possibility, an alternative is that the trust may have spied electronically on staff by interrogating whistleblower case files. If a trust board are willing to hunt down whistleblowers with fingerprint evidence, why would they stop at other intrusive measures?

 

These are some other CQC findings about poor culture and whistleblowing governance, as detailed in CQC’s evidence appendix:

“Six of the 10 whistle-blower contacts we received between September 2018 and September 2019 raised concerns that there was an apparent reluctance by the senior executive team to hear and accept feedback of a negative nature. Overarching themes included: the trust does not welcome feedback, a lack of robust investigation into employee relation matters and human resource (HR) process, poor support for staff with mental health concerns, poor culture, lack of engagement with FTSU guardian, poor communication, distrust of being able to raise concerns without breach of confidence or fear of repercussion.”

“Staff did not feel listened to and saw others that had raised concerns be penalised. There was a focus on the individual raising concerns and response to issues were on occasion disproportionate. The executive leadership team failed to fully recognise the impact that this had on the safety culture within the organisation.

“we found that some staff felt the culture did not encourage openness and honesty. Not all staff felt supported, respected or valued and some feared reprisals if they raised concerns. This impacted negatively on the ability of staff to challenge and discuss options for mitigating risk.”

“the executive team appeared focused on the who, rather than the why and whether there were effective systems for staff to raise concerns to ensure patient safety.”

“There was a level of acceptance, by the executive team, that there were simply two sides of the incident which was not helpful. In one meeting, the medical director described that certain staff were in “separate camps” and alluded to a “them and us” situation. There were wider ripples of impact in that disengagement of the consultant body was a real risk, yet following the concerns raised there had been no separate medical staff survey undertaken to explore the extent of concerns.”

“We saw evidence that when staff had raised concerns they were not always taken seriously, appropriately supported or treated with respect. In some cases, responses to those raising concerns, were defensive in nature, individually focused rather than actively collaborating to seek solutions.”

“Several of the whistleblowing concerns included factors around poor engagement, communication and leadership. There was a growing disconnect between the executive team and several clinical specialties which had impacted on consultant involvement with the running of services. Communication with some members of medical staff had broken down. We were not assured that the significance of this had been fully acknowledged by the executive directors, or board, or responded to in an effective, timely manner.”

“The Pathology team stated they felt the executives had stopped listening and believed the matter resolved.”

“During interview it was evident that the board were aware of the areas of concern and there were strong opinions as to the reasons that certain groups were unhappy, however actions to address and repair leadership relationships were less apparent. We discussed with the executive team during feedback, that certain staff felt the executives listened but did not hear.”

“There was recognition that the board were aware of a degree of unhappiness among the consultants, and a feeling that concerns were not being recognised. It was noted that the increasing distance felt between the consultant body and the executive team had begun to impact on individuals withdrawing involvement in the running of the trust.”

“We reviewed the board meeting minutes for April 2019 and whilst the agenda stated the FTSU report was submitted for the board to accept there was no documented comment in the minutes that this had taken place or evidence of any questions or challenge to the FTSU guardian. Therefore, we were not assured that there was sufficient data or content presented within the reports to provide any assurance to board.”

 

 

I have raised a concern with the Information Commissioner about West Suffolk NHS Foundation Trust processing staff biometric data without valid consent, and I am now passing on a concern about covert breaches of whistleblower confidentiality.

 

Biometric data and GDPR

The General Data Protection Regulation deems that biometric data used for the purposes of identification constitutes “Special category data”,  which requires more rigorous processing and safeguards.

One of the requirements is that employers need to gain explicit consent before processing special category data.

This raises issues of lawfulness if West Suffolk covertly processed any fingerprint data or processed fingerprint data through duress and coercion, which may negate valid consent.

The ICO has passed the matter to its intelligence team.

 

 

Breaches of whistleblower confidentiality by the NHS are nothing new. Even regulators have been implicated in such breaches. The CQC has in the past admitted breaching the confidentiality of at least three whistleblowers: Helen Rochester, Shiban Ahmed and a third unnamed person.

In the case of Shiban Ahmed, it very much appeared that CQC outed him to his employer in reprisal for criticising some of CQC’s regulatory failures of child protection.

Thus, CQC’s current scapegoating of the West Suffolk board, which it previously and dubiously elevated to a ‘Outstanding’ rating, looks more like politicised and hypocritical abuse of power than dedication to the public interest.

 

No honour amongst thieves

One particularly hypocritical attack by the CQC on West Suffolk’s leadership deserves special mention.

CQC previously told providers that they had to sell themselves as ‘Outstanding’:

“Professor Field responded that if a practice was outstanding ‘this is up to the practice to tell us’.”

Field: Presentation skills necessary to receive CQC outstanding rating

But in its evidence appendix, CQC insinuated that West Suffolk’s leadership should be censured for doing so:

“Some staff told us that they felt that the executive team were so focused on maintaining outstanding status this impacted on the response received when concerns were raised and they “only wanted to hear the good”. We explored during the inspection whether there was added pressure on staff internally that was arising from the rating of outstanding. We noted that the theme of outstanding was used in various communications and formats. For example, the summer leadership summit had taken place on 19 June 2019 with outlined objectives and sessions based on creating a more inclusive culture and quality. There was an intense focus on understanding, developing and maintaining outstanding care and 70 staff attended. Session one focused on addressing and responding to priorities for improvement agreed from the 2018 national staff survey results. Session two focused on quality “keep calm and carry on being outstanding.” Minutes from the trust executive group on 2 September 2019 included a section on the CQC inspection and included text “the CQC don’t know we are outstanding, so we need to ensure we tell them”. This message was reiterated by several staff throughout the core service and well led inspections”.

The theatrical thoroughness of CQC’s public flogging of West Suffolk’s leadership does emphasise that the centre probably has unsavoury truths from which it wishes to deflect.

 

 

One of the great concerns about the government’s Freedom To Speak Up scam has been that it spins a false line about progress. This encourages thousands more NHS staff to break cover and make themselves vulnerable to being picked off whenever it suits power. Not unlike Mao’s campaign to “Let a hundred flowers blossom”:

The Silence that Preceded China’s Great Leap into Famine. Mao Zedong encouraged critics of his government—and then betrayed them just when their advice might have prevented a calamity

At present, we wait to see how far up the West Suffolk whistleblower witch hunt went. West Suffolk NHS Foundation Trust staff had the misfortune of whistleblowing in a Secretary of State’s constituency, which increases jeopardy because of the increased political sensitivity.

Matt Hancock Health Secretary initially claimed to the Bury Free Press that he had been told by the NHS that whistleblowing matters at West Suffolk had been handled “entirely appropriately”.

It is essential that this claim is further clarified. I have asked Hancock to disclose from whom he received advice. I expect prolonged resistance by DHSC to my request.

In the meantime the National Guardian has reluctantly, in principle, agreed to stand by a 2017 promise to  help reinstate unfairly sacked NHS whistleblowers. Correspondence continues on whether she will logically help NHS whistleblowers with remedy of other forms of detriment, even though she has tried to date to avoid this. I will report on the outcome of the correspondence in due course.

The National Guardian has so far stood by passively on West Suffolk scandal. Her Office previously even congratulated the trust’s CEO for “commitment” to Freedom To Speak Up.

She should of course proactively review West Suffolk NHS Foundation Trust and help ensure that the detriment suffered by whistleblowers is rectified.

But just as the West Suffolk Freedom To Speak Up Guardian is beholden to their employer, she has no powers and is beholden to the CQC, NHSI/E and DHSC.

The main, damning sections of CQC’s evidence document about the lack of Freedom of To Speak Up at West Suffolk are provided in the appendix. I have formally brought them to Robert Francis’ attention. The letter to Francis is also provided.

 

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Real reform is needed with much better UK whistleblowing law and supporting structure:

Replacing the Public Interest Disclosure Act (PIDA)

In the meantime, we will be stuck for some time with the government’s charade of wholly flawed UK whistleblowing governance, which fails to protect the public.

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APPENDIX

(1) Letter to Robert Francis:

 

Sir Robert Francis

Chair of Healthwatch England

Care Quality Commission

4 February 2020

Dear Sir Robert,

Further evidence of serious failure of the Freedom To Speak Up model

I am aware from correspondence shared by others that you remain firm in your views that yours and the government’s Freedom To Speak Up model is sound.

I am also mindful that your disclosed correspondence to the National Guardian of 3 February 2017 revealed that you apparently decided not to meet with me as I requested, because you believed you could not change my mind on my concerns about the Freedom To Speak Up project:

“We can have no expectation that Dr A will agree with anything you do or say and I have little doubt that any meeting with me is not going to change that. I do not propose to accede to her request.”

May I posit that it is open to you to change your mind.

To that end, I copy below relevant excerpts from CQC’s evidence appendix for its latest inspection report on the scandal-hit West Suffolk NHS Foundation Trust, where the trust board tried to hunt down a whistleblower with biometric data.

As you will see, the Freedom To Speak Up Guardian is criticised, and staff concerns about the confidentiality of disclosures to the Freedom To Speak Up Guardian are noted.

From the outset, this type of risk to staff and patients was the central and very obvious flaw of the Freedom To Speak Up project.

I would be grateful if you could comment on whether you will act to put right this serious risk and call for better cross sector, UK whistleblowing law and enforcement structure, to drive genuine improvement in culture and practice.

With best wishes,

Minh

Dr Minh Alexander

 

(2) This is the supporting evidence document for CQC’s latest inspection report on West Suffolk NHS Foundation Trust:

West Suffolk NHS Foundation Trust Evidence appendix

Below is the section from this document on the trust’s culture and whistleblowing governance failures. For convenience, I have highlighted the section on the trust Freedom To Speak Up Guardian in bold.

Culture

Not all staff felt respected, supported and valued or felt that they could raise concerns without fear. Communication and collaboration to seek solutions had not always been effectively undertaken. An open culture was not always demonstrated. However, staff were focused on the needs of patients receiving care. Equality and diversity and opportunities for career development were promoted.

Throughout the core service inspections, we found that the culture was centred on the needs and experience of people who used the service. Staff across the services were proud of the care they provided. Within the divisions staff were positive about the culture and felt supported by their colleagues and immediate line managers.

The trust felt that they promoted an open culture and had policies, procedure and processes in place to support staff, patients and relatives to raise concerns. The trust took assurance from the following mechanisms incident reporting, PALS, freedom to speak up (FTSU) guardian, trusted partners (volunteer members of staff), and guardian of safe working hours. To support staff directly there was an employee assist programme in place and the chaplaincy department was available to all. However, this did not align to the inspection findings. Staff did not feel listened to and saw others that had raised concerns be penalised. There was a focus on the individual raising concerns and response to issues were on occasion disproportionate. The executive leadership team failed to fully recognise the impact that this had on the safety culture within the organisation.

The trust was clear that behaviour inconsistent with the vision and values would be addressed and there were processes in place to manage behaviour and performance. In October 2018 the trust outlined via the green sheet that the trust executive group (TEG) was actively sponsoring action to make sure that anyone who believed they were being / or had been bullied or harassed or discriminated against had the confidence to report it formally and knew how to do this and that access to confidential support was available.

Despite these identified processes we found that some staff felt the culture did not encourage openness and honesty. Not all staff felt supported, respected or valued and some feared reprisals if they raised concerns. This impacted negatively on the ability of staff to challenge and discuss options for mitigating risk. Detail in the provider information request (PIR) was that, between April 2018 and March 2019, the trust had recorded one whistle blowing incidence. Incidences of whistleblowing were recorded in three main categories; patient care and patient safety, fraud, and workforce issues (including bullying culture). Additional PIR narrative then stated there had been six workforce incidents raised, no incidents of fraud and two patient care / patient safety incidents, thus giving a total of eight whistleblowing incidences, not one, within the same timeframe. The trust’s own analysis of theses noted that allegations of bullying and harassment, including lack of consideration and kindness to colleagues were key factors in a number of incidents. Other issues were around professional registration and staffing issues. These correlated to some of the results in the 2018 NHS staff survey and to our findings during inspection.

Six of the 10 whistle-blower contacts we received between September 2018 and September 2019 raised concerns that there was an apparent reluctance by the senior executive team to hear and accept feedback of a negative nature. Overarching themes included: the trust does not welcome feedback, a lack of robust investigation into employee relation matters and human resource (HR) process, poor support for staff with mental health concerns, poor culture, lack of engagement with FTSU guardian, poor communication, distrust of being able to raise concerns without breach of confidence or fear of repercussion. We heard examples from staff that information they had provided in confidence, to various individuals including the FTSU guardian, had become known. Across a number of specialties, including paediatrics, pathology, anaesthetics and vascular services, genuine concerns relating to clinical risk and safety had been raised. Staff directly involved felt communication and collaboration to seek solutions had not been effectively undertaken. Some staff, during interview, stated they felt this had resulted in specific areas and groups of staff being seen, by the executive team, as dysfunctional rather than believing that issues needed to be addressed and worked through with staff to improve services for patients. Some senior staff we spoke with felt that they had not been personally supported by the executive team when they had sought help and advice.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 20 Duty of candour, is a regulatory duty that relates to openness and transparency and requires providers of health and social care services to notify patients (or other relevant persons) of certain ‘notifiable safety incidents’ and provide reasonable support to that person. When we requested information around a serious incident in the vascular services, we were informed that duty of candour had not been undertaken as the level of harm was still unknown.

Whilst the duty of candour component 20(2) refers to notifiable incidents (death of a service user, severe harm, moderate harm or prolonged psychological harm), component 20(1) states that registered persons must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users in carrying on a regulated activity. Providers must promote culture that encourages candour, openness and honesty at all levels. This should be an integral part of a culture of safety that supports organisational and personal learning. There should also be a commitment to being open and transparent at board level or its equivalent, such as a governing body. We reviewed the trust local policy “Being open – The Duty of Candour” January 2018 where it was stated in the summary that the board set out a commitment to transparency and being open.

We requested copies of communication that were sent to vascular patients that required follow up and received only a draft letter for duty of candour. We were not provided with evidence of what communication had been made with the patients that had been affected by the incident, to be assured that the trust was openly communicating that there had been a failing in internal systems. It was also evident that this had not been acted upon or communicated in a timely manner. Therefore, we were not assured that the trust had acted in line with its own policy or taken reasonable steps to ensure duty of candour had been appropriately applied by being fully open and transparent.

There was a complex serious incident investigation ongoing at the time of inspection that encompassed aspects of alleged patient safety, incident reporting, risk management, breach of confidentiality and both personal and professional conduct. We found that the process of this investigation had far reaching effects across a number of staff, and the executive team, impacting on health and wellbeing, culture and morale of those involved. Whilst internal HR processes were being adhered to, some staff felt that the actions undertaken by the trust were questionable in purpose. Communications sent during the investigation were corporately worded, with direct legal reference, which meant that they lacked any personal element, and were seen by some as quite threatening in nature with a focus for apportioning blame.

On the 10 September 2019 the medical staffing committee (MSC) wrote a collective statement of concern to the chair. This stated that concerns had been raised by multiple departments in regard to the culture and behaviours of the executive body, on multiple occasions, that had not endorsed the trust values of freedom to speak up. The CEO and the chair attended the next meeting of the MSC in October 2019 to discuss and listen to the concerns being raised and reassure the consultant body that the executive directors lived the values. Whilst the meeting itself had been an attempt to address some of the concerns raised, we found that the subsequent response letter to the MSC chair, dated 14 October 2019, could be considered intimidating, and confirmed to us the continued disconnect around communication. The letter outlined that discussions were held around how matters of speaking up were dealt with and how the board sought to ensure balance and objectivity in their decision making. However, it also included a schematic, developed by trust lawyers, to set out the process followed when concerns were made about a professional’s practice and stated that this was “assiduously followed”.

During the well led interviews, we found that the ongoing serious investigation was in the forefront of several of the executive directors’ minds. There was an understandable desire to bring the investigation to a closure as soon as possible however, we were concerned that the route the investigation had taken, and the commitment of the board of non-tolerance to poor behaviour, was potentially limiting their objectivity. CQC have no regulatory remit to investigate or intervene with individual complaints or incidents. Having looked at the process however, we were concerned that the incident focus had potentially impacted on the wider root cause analysis. Irrespective of the incident itself there was learning to be gained from understanding why established channels of raising concerns had not been taken, however the executive team appeared focused on the who, rather than the why and whether there were effective systems for staff to raise concerns to ensure patient safety. There was a level of acceptance, by the executive team, that there were simply two sides of the incident which was not helpful. In one meeting, the medical director described that certain staff were in “separate camps” and alluded to a “them and us” situation. There were wider ripples of impact in that disengagement of the consultant body was a real risk, yet following the concerns raised there had been no separate medical staff survey undertaken to explore the extent of concerns. We fed this back to the executive directors and there was an element of recognition that communication and engagement needed to improve.

The senior executive team did reflect and recognise that communication and handling of certain aspects of this incident, and others, could have been better. They also stressed that other incidents had been handled sensitively and had not been brought to the attention of others by those involved. They provided a separate example where wording around a question in relation to pay and annual leave for doctors had caused huge discontent and recognised that often language used can escalate an appropriate question out of proportion, that then takes a long time to repair. The trust had implemented a “lessons learned” process following a grievance or disciplinary to help to ensure any issues identified were not repeated going forward, but we were not provided with evidence that this had been implemented.

There was a better working lives group in place. We reviewed the minutes of the meeting on the 23 September 2019. Under agenda point 7, there was a discussion held in relation to improved support for staff in stressful situations such as coroner’s court, serious incident investigation, a never event, a complaint or after maternity or any long-term sickness absence. Included in this discussion were suggestions from the MSC. Options included ‘opt out’ rather than ‘opt in’ for support required. There was agreement that an exact process for support would be beneficial for all staff, not just doctors. It was noted that this would be a great quality improvement project but would be a huge piece of work. An action was identified that the deputy medical director would arrange a meeting with the head of patient safety and human resources to help take this forward.

Some staff told us that they felt that the executive team were so focused on maintaining outstanding status this impacted on the response received when concerns were raised and they “only wanted to hear the good”. We explored during the inspection whether there was added pressure on staff internally that was arising from the rating of outstanding. We noted that the theme of outstanding was used in various communications and formats. For example, the summer leadership summit had taken place on 19 June 2019 with outlined objectives and sessions based on creating a more inclusive culture and quality. There was an intense focus on understanding, developing and maintaining outstanding care and 70 staff attended. Session one focused on addressing and responding to priorities for improvement agreed from the 2018 national staff survey results. Session two focused on quality “keep calm and carry on being outstanding.” Minutes from the trust executive group on 2 September 2019 included a section on the CQC inspection and included text “the CQC don’t know we are outstanding, so we need to ensure we tell them”. This message was reiterated by several staff throughout the core service and well led inspections.

 

NHS Staff Survey 2018 results – Summary scores

The following illustration shows how this provider compares with other similar providers on ten key themes from the survey. Possible scores range from one to ten – a higher score indicates a better result.

Screenshot 2020-02-04 at 06.21.38

There were no themes where the trust’s scores were significantly higher (better) or significantly lower (worse) when compared to the 2017 staff survey. (Source: NHS Staff Survey 2018) The 2018 NHS staff survey was completed by staff during the period September 2018 to December 2018. A sample of 1250 staff was randomly selected, of which 601 responded. This meant a 48% response rate which was better than the average of 44%. The 2018 national staff survey results showed that staff felt more supported than in the previous year. Ratings improved for staff getting support from their immediate manager (up 2.5%); getting clear feedback on their work (up 2.1%); being asked for their opinion before changes are made (up 2.9%); and for feeling like their manager values their work (up 1.4%). The percentage of staff that felt their role made a difference to patients had decreased from

92.7% in 2017 to 91% but remained above the national average 89%. The percentage of staff satisfied with the quality of care they give was 84% against a national average of 80%, and 78% staff felt enthusiastic about their job (national average 74%). The overview theme results, scored out of 10, for health and wellbeing, morale, safe environment (bullying and harassment) and safe environment (violence) were all above average at 6.4, 6.4, 8.1 and 9.4 respectively. Whilst the trust had a fairly consistent result between 2015 and 2018 in relation to safe environment (bullying and harassment and violence) there had been decline in several of the detailed results: Q13b: In the last 12 months, how many times have you personally experienced bullying and harassment from managers: had increased from 9.1% in 2017 to 11.9% in 2018 (2.8% increase). Q13c: In the last 12 months, how many times have you personally bullying and harassment from other colleagues: had increased from 14.9% in 2017 to 19.3% in 2018 (4.4% increase). Q13d: The last time you experienced harassment, bullying or abuse at work, did you or a colleague report it: reporting had dropped significantly from 51.2% to 37.9% which was in line with the worst rate for acute trusts.

A summary paper on the staff survey results went to board on 1st March 2019 and highlighted reporting, creating a compassionate and inclusive culture, being kind to each other and visible leadership as the top three priorities. We reviewed the trust action plan in response to the 2018 staff survey. Actions to address these results included further analysis to identify any ‘hot spots’ and reasons why staff may not be reporting. Additional actions included communication of the reporting process and importance of reporting via several means (core brief, Green sheet, and medical directors bulletin) alongside the re-promotion of staff support available, alongside setting of agreed behavioural standards and staff training on positive performance management and dealing with unacceptable behaviour. The introduction of an anonymous telephone reporting line had seen two contacts, one of which was to explore what the line was for. The lack of any high immediate response was seen by the executive directors we spoke with is as a positive sign.

The freedom to speak up (FTSU) guardian had been in post since 2017 and was directly employed by the trust. Prior to the role they had been a staff governor for nine years and had been approached by the director of HR to consider the role as there had been no expressions of interest. The FTSU guardian stated that they averaged approximately four hours a week but would flex this dependent on need. They could be contacted either directly by telephone or via email. The guardian had received initial training from the National Guardian Office (NGO) and they were involved in the Eastern Counties freedom to speak up network. The trust had hosted the network meeting on site on 26 June 2019.

During interview the FTSU guardian was extremely positive of the support provided by the executive directors. As well as direct support from the executive and non-executive leads for FTSU, they stated they could speak at any time to the CEO and chair and were confident that issues would be dealt with. They were proud of the role and stated they saw it as important and a privilege. They had monthly one-to-one meetings with the interim director of human resources and stated they met the nominated non-executive director (NED) every six months. They recognised that contact out in the community services needed to improve and stated they planned to work with the staff governor in the community to address this.

However, during interview we were not assured that the guardian had full understanding of the role. Their focus was on the support they were receiving from the executive team rather than support they were providing to staff across the organisation. They also stated they caught up fairly frequently with the guardian of safe working hours (GOSW), however this was not confirmed by the GOSW. The GOSW had been in post since March 2019 and informed us that the FTSU guardian had not responded to their initial contact. Despite initial thoughts that contact between the two roles would be important, as time had passed this had lessened, however they confirmed that they knew who the FTSU guardian was.

The FTSU guardian produced two reports a year to board. We reviewed the FTSU reports to board, dated 26 April 2019 and 1 November 2019. We found that these reports lacked substance and were extremely limited in content. Both reports outlined the role of the guardian and ongoing engagement at staff events to promote role. There was no evidence of triangulation to other patient /staff experience data to identify potential emerging issues. There was no trend analysis of numbers, issues, type of worker speaking up or analysis of wider context such as potential risks, barriers and opportunities. Neither FTSU reports mentioned any analysis of the 2018 NHS staff survey results.

Data was submitted quarterly to the NGO as per the “Recording Cases and Reporting Data guidance”, July 2018. Data entry format was the total number of cases, number raised anonymously, number with a patient safety / quality element, number with a bullying or harassment element and number where people report they are suffering detriment. The FTSU report for board categorised the data into behaviour / attitude, trust procedure / practice, capacity / workload and miscellaneous. It was difficult to compare reported data to the NGO with the data reported to the trust board as timeframes and categories differed.

In the data submitted to the NGO for quarter four 2018/19 eight cases were reported, two under the patient safety element and six under bullying and harassment. The same total number overall was reported in the April 2019 board report, with time frame stated as “over the last six months”. Four were recorded under behaviour / attitude, with the status reported as zero resolved and four outstanding. We noted that the additional text did not correlate with the figures presented as it stated “these are two cases where I am either working with staff and HR or where I have been asked to support staff. To date one has been resolved and the other is outstanding with the member of staff awaiting closure”. One was recorded under trust procedure / practice (status outstanding), and three recorded as miscellaneous (all resolved). In the November 2019 report six concerns were documented as being reported in the five months prior to the report. Four as behaviour / attitude (status three resolved, one outstanding), and two as miscellaneous (both resolved). There was no update on any of the previous reports concerns that had remained outstanding in the November report. This limited the board’s ability to track and monitor progress. We reviewed the board meeting minutes for April 2019 and whilst the agenda stated the FTSU report was submitted for the board to accept there was no documented comment in the minutes that this had taken place or evidence of any questions or challenge to the FTSU guardian. Therefore, we were not assured that there was sufficient data or content presented within the reports to provide any assurance to board. We noted that in an additional report to board in November 2019, in response to national FTSU guidance in NHS trusts it was documented that the trust would review the FTSU guardian report to ensure that the board received assurance through this reporting mechanism. In the same document was the commitment to produce a FTSU strategy to be presented to the board in January 2020.”

 

“Is this organisation well-led?

Leadership

The trust had an established, stable executive leadership team. Whilst priorities and issues were known and understood these were not always managed in a consistent way. The style of executive leadership did not represent or demonstrate an open and empowering culture. There was an evident disconnect between the executive team and several consultant specialties. Poor communication and fractured engagement of some of the consultant body had begun to impact on medical managers playing a full and effective role within the organisation.

The trust has an established experienced executive leadership team with only one executive being an interim appointment. The trust board consisted of six executive directors, chair and five nonexecutive directors. The team had remained stable since the previous inspection in 2017, with the only substantive change being the appointment of a new chair on 01 January 2018.

At the time of the inspection, there was an interim executive director of human resources (HR). The previous substantive director of HR, had accepted the interim position on 01 May 2019, on a part time basis following their retirement, until the next appointed director took up the position. Recruitment, and appointment, had taken place and the new director of HR was due to take up position with the trust on 04 November 2019. The chief executive officer (CEO) had been in post since 03 November 2014. The longest established member of the executive team was the director of resources, and deputy CEO, who had been in post since 01 December 2011.

The five non-executive directors (NED) were appointed between September 2013 and September 2018. There had been two changes of NED since we last inspected in 2017 due to previous individuals reaching the end of their tenure. Of the two most recent appointments, one NED held the responsibility as the audit committee chair, link to director of resources and health and wellbeing programme. The other held responsibilities for safeguarding adults, security and emergency preparedness, resilience and response (EPRR).

We found that the executive leadership team did not always support the delivery of high-quality person-centred care. The style of leadership amongst the executive directors did not represent or demonstrate an open and empowering culture. There was a failure by the executive team to step back from specific clinical safety concerns and consider organisational impact. We saw evidence that when staff had raised concerns they were not always taken seriously, appropriately supported or treated with respect. In some cases, responses to those raising concerns, were defensive in nature, individually focused rather than actively collaborating to seek solutions.

CQC received 10 whistleblowing concerns between September 2018 and September 2019, five of which were received in the three months leading up to inspection. Several of the whistleblowing concerns included factors around poor engagement, communication and leadership. There was a growing disconnect between the executive team and several clinical specialties which had impacted on consultant involvement with the running of services. Communication with some members of medical staff had broken down. We were not assured that the significance of this had been fully acknowledged by the executive directors, or board, or responded to in an effective, timely manner.

The medical staffing committee had been reinvigorated in June 2019, by the consultants, as an opportunity for clinicians to increase engagement collectively with the executive directors. We reviewed the minutes of the first two meetings. In the initial meeting the structure, format and frequency of the MSC were outlined, with the CEO to have a regular 15 minute slot at each meeting. It was agreed that the medical director would attend but that the chair of the MSC could ask the medical director to leave should this be appropriate if discussions directly related to them. Matters arising were minuted, with actions, and it was agreed at that initial meeting the MSC would be held quarterly, with the next meeting set for September 2019.

The 10 September 2019 meeting minutes demonstrated that there had been discussion between the trust chair and the secretary of the MSC, around the morale and concerns of the consultant body. There was recognition that the board were aware of a degree of unhappiness among the consultants, and a feeling that concerns were not being recognised. It was noted that the increasing distance felt between the consultant body and the executive team had begun to impact on individuals withdrawing involvement in the running of the trust. As a result, it was agreed that one of the non-executive directors should be regularly invited to attend the MSC to update the consultants on the issues and concerns that the board was addressing and to gain an understanding of the consultants’ views and concerns. It was agreed at this meeting that the MSC would meet monthly rather than quarterly.

During interview it was evident that the board were aware of the areas of concern and there were strong opinions as to the reasons that certain groups were unhappy, however actions to address and repair leadership relationships were less apparent. We discussed with the executive team during feedback, that certain staff felt the executives listened but did not hear. One example was Paediatrics where the trust and the consultants shared similar concerns but the communication between parties had not identified they were on the same page. Another example was Pathology, where there was an apparent disconnect between the view of the executive team and that of the consultants. The executive view was that staff at the trust were reluctant to work within the North East Essex and Suffolk Pathology Services (NEESPS) network however, we were informed by the consultants, and operations manager, that this was not the case. Their frustrations came from a lack of ability to provide the service they wanted to, due to ageing equipment and no control over the day to day management of the service they provided. Whilst the board had met with the senior team at the lead acute trust that host the NEESPS and received a commitment to deliver the required improvements, the consultants felt that this focused on the longer term and did nothing to address immediate concerns. They remained sceptical about the timeframe for change as NEESPS had been in place for two years with no significant improvement or responses to continued concerns. The Pathology team stated they felt the executives had stopped listening and believed the matter resolved.

There was a process for individual contribution, check and challenge through the internal governance framework, HR processes and various committees. Whilst there was an appropriate level of challenge seen in the various committee meetings we reviewed, we found that there was a potential risk that the board had become so driven behind a united decision there was a reluctance, perceived or actual, to take on board other perspectives and alternatives. For example, there was an ongoing complex, serious incident investigation at the time of inspection. The way this had been managed had impacted on the leadership, governance and culture across the organisation. We reviewed the approach taken by the executive leaders in regard to the investigation process that had occurred, alongside relevant information provided. Actions undertaken were unprecedented and concerning, such as the requirement for fingerprinting and handwriting analysis. These actions had not been disclosed to us until after the trust had undertaken them. Whilst there had been attempts to ensure impartiality, such as external independent reviews and legal advice, we found that certain aspects of the process lent towards individual bias with potentially questionable conclusions and judgements made. We were not assured that, having made the decision to follow the course of action agreed by the board, that any subsequent information had been appropriately considered. We voiced this concern with the CEO and chair during the inspection.”

 

STFU not FTSU

 

 

The Whistleblowing APPG’s new Bill and unanswered questions about finances and potential conflicts of interest

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist, 30 January 2020

The controversial whistleblowing APPG,  funded by US bounty hunting lawyers Constantine Cannon, brought out its Bill for an Office of the Whistleblower on 28 January 2020.

The Bill was proposed by Baroness Susan Kramer, one of the APPG’s Co Chairs.

The Bill is very short and leaves it wide open for the functions of the Office to be further defined at a later point.

The powers given to the Office of the Whistleblower are described in rather opaque terms by the Bill, for example:

“(a) give direction to and monitor activities of relevant bodies prescribed by the regulations under section 1, including but not limited to confidentiality and the use of disclosed information;”

 This lack of detail as to how the Office will operate is troubling. This is particularly so because the APPG previously proposed that the Office of the Whistleblower should be under the control of either the Home Office or the Ministry of Justice, two of the most authoritarian and suppression-prone government departments.

There was also a proposal  by the APPG that all members of the public should be designated as whistleblowers. This would set up the conditions for deputising them as bounty hunters, replicating US models.

The lack of detail in Kramer’s Bill is also a concern given a number of allegations that have been made about WhistleblowersUK the APPG’s secretariat, regarding its treatment of whistleblowers, and financial arrangements.

Moreover, a document recently came to light which revealed that WhistleblowersUK asks whistleblowers to pay for help – “We charge £100 per hour for the work that we undertake.” – and to pay WhistleblowersUK 5% of any award or settlement.

WhistleblowersUK Statement of cooperation and agreement

The Financial Conduct Authority advised on 19 December 2019 that WhistleblowersUK is not a registered claims management firm.

Screenshot 2020-01-30 at 14.19.38

Moreover, enquiries to parliament have revealed that there are no meaningful controls on APPG secretariats, with respect to the Safeguarding of any vulnerable people with whom they may interact.

A concern amongst many whistleblowers is that the whistleblowing APPG is compromised by the nature of its funding from Constantine Cannon. There are questions about whether the APPG is acting in the public interest, or the interests of whistleblowing industry players, who profit from whistleblower litigation and the sale of whistleblowing compliance services.

My impression is that the Susan Kramer’s Bill does little to assuage these concerns.

There is no explicit commitment in the Bill to:

  • Prevention of harm to whistleblowers and the public, and proper follow up on whistleblowers’ concerns
  • Minimising expense to the public purse through early intervention mechanisms, to prevent entrenchment, conflict and wasteful litigation
  • Non-financial redress of harm, for example, erasing unfair appraisals or unjust disciplinary records, reinstatement after dismissal or restoration of lost promotion and seniority.
  • Deterrence of whistleblower reprisal and meaningful penalties for reprisal

 

Instead, Kramer’s Bill specifies items that would benefit the whistleblowing and compliance industry:

  • Opportunities for industry middlemen:

“(c) form and maintain a panel of accredited legal firms and advisory bodies to advise and support whistleblowers;”

  • Financial redress for whistleblowers, of which a percentage may of course be skimmed off by middlemen

“(e) provide financial redress to individuals whose disclosure is deemed by the Office to have harmed their employment, reputation or career;”

 

The organisation Protect formerly known as Public Concern at Work, which is currently the dominant UK industry middleman, has “welcomed” the Bill.

But it is very risky for whistleblowers if any Office is created which does not give primacy to whistleblowers’ interests and the public interest, and instead focuses on conflict and detriment, for profit.

Of additional concern is the APPG’s reluctance to answer questions about finances and potential conflicts of interest.

Norman Lamb former MP and APPG vice chair resigned from the Whistleblowing APPG last year because the WhistleblowersUK, the APPG’s secretariat, failed to answer questions which I had asked of the APPG:

Norman Lamb MP has resigned from the Whistleblowing All Party Parliamentary Group

 

A subject access request to the APPG for my personal data revealed that not only was the APPG’s secretariat reluctant to address my questions, but Susan Kramer suggested that a “simple” response should be given to my questions:

Susan kramer email about simple answer

In fact, I have never received a response from any APPG member to my questions about finances and probity.

I am also not sure that the APPG has made full disclosure in response to my subject access request. This is because disclosed documents refer to other correspondence that has not been disclosed.

The subject access request was handled respectively by Stephen Kerr APPG Co Chair and former MP, and then by Susan Kramer. The process has been a prolonged saga, with delays and an extra document being provided only after a query.

After I raised a second query about the completeness of disclosure of correspondence between Norman Lamb and the CEO of WhistleblowersUK about my questions on finances and probity, Susan Kramer maintained that disclosure by the APPG was complete and she commented:

“I have nothing more to add”.

Accordingly, the matter of whether all relevant documents have been disclosed is now being passed to the ICO.

It is hard to feel confidence in an APPG which calls for better governance but does not answer questions about its own conduct and interests, or in a Bill that does not clearly have public protection as its prime objective.

 

RELATED ITEMS

For real reform, ineffective UK whistleblowing law needs to be replaced with law that proactively protects whistleblowers and the public, ensures that whistleblowers’ concerns are acted upon, and sanctions those who cover up and harm whistleblowers.

Replacing the Public Interest Disclosure Act (PIDA)

Industry middlemen who profit from conflict and governance failure should not shape policy about the public interest.

 

Bounties Unwanted

 

NHS CV fraud, Peter Knight & CQC’s failure to safely implement Regulation 5 Fit and Proper Persons at Oxford University Hospitals NHS Foundation Trust

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 25 January 2020

 

 

Summary: The NHS continues to appoint senior officials without robust checks and the CQC continues to fail in its regulation of the Fit and Proper Person requirement. A glance at the small print in the case of convicted fraudster and former Department of Health Deputy Director Peter Knight reveals that CQC failed to detect or report failure by his employing NHS trust to check his primary qualifications. CQC then later glossed over the scandal of Knight’s fraud in another inspection report. There is little sign that the government and NHS Improvement intend to meaningfully reform Fit and Proper Persons practice in the NHS.

 

This week, Peter Knight former Department of Health Deputy Director and latterly a director of Oxford University Hospitals NHS Foundation Trust (Chief Information and Digital Officer) received a two year suspended prison sentence for CV fraud. He had claimed a Classics degree which he did not possess, to land a job which paid £130K.

A past list of Department of Health National Information Board members gives his summarised CV as follows:

Peter Knight – Deputy Director and Head of Information Intelligence

 Biography

Peter Knight is Deputy Director for Research Contracting, Information Intelligence and Stakeholder Engagement in the Research and Development Directorate at the Department of Health. Peter joined the Department in April 2010 having established the Research Capability Programme in 2008 that established a secure research data service now operated by the MHRA call the Clinical Practice Research Datalink. Prior to his these roles Peter was a Managing Director and interim Chief Executive at Winchester and Eastleigh Health NHS Trust.”

Oxford University Hospitals NHS Foundation Trust, its board stuffed full of illustrious big names, had apparently not seen fit to check Knight’s primary qualifications since his appointment at the trust in 2016:

“Additionally, in November 2017, the trust updated the files of its executive and non-executive staff as part of its duties under the fit and proper persons check, but when checked during the investigation Knight’s HR file did not contain a copy of the degree he claimed to have, according to the NHS Counter Fraud Authority.”

But why would chaps check up on other chaps? T’would be the height of rudeness under Club etiquette.

Oxford University Hospitals NHS Foundation Trust’s crown, as one of the powerful Shelford Group trusts, has slipped latterly. CQC downgraded its overall rating to ‘Requires Improvement’   in June 2019, and ‘Requires Improvement’ on the well led domain.

However, worryingly I found no mention of any Fit and Proper Persons issues in CQC’s June 2019 inspection report. This was despite the fact that the allegation about Knight’s CV fraud was raised anonymously with the trust in May 2018, and passed on to local counter-fraud, with Knight reportedly admitting in August 2018 that he did not have a Classics degree as claimed.

Did the CQC fail in its pre-inspection due diligence to liaise with NHS Counter-fraud services? Did the CQC know, but deliberately gloss over the scandal in its report?

Perhaps CQC did not wish to look foolish, because in an earlier inspection report of March 2018 it had declared the trust compliant with the Fit and Proper Persons regulation:

“Fit and Proper Person checks were in place. The trust was satisfied that staff with director level responsibilities, including the NEDs, were fit and proper persons in accordance with Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”

The unenthusiastic CQC, in that earlier inspection, had checked only three of the trust’s director files:

“We reviewed a random sample of three board level director’s personnel files and found all the necessary fit and proper person checks had been undertaken. Throughout our inspection, we had no concerns about the fitness of the board to undertake their individual roles”

Instead of thorough checks on the basics, CQC’s 2018 report threw in some guff:

“In April 2017 an independent review of divisional Leadership arrangements at the trust was undertaken. The review focused on leadership and governance within individual divisions and corporate oversight and support for divisions. The report was positive about the Divisional Directors (DDs) high levels of personal and clinical credibility as well as the strong leadership capability of Divisional General Manager (DGM) and Divisional Nurses (DND’s) or equivalent. The report was positive about multi-disciplinary teams working in a cohesive manner with high levels of personal and collective accountability across the Divisional Leadership Teams (DLTs).”

 In its marshalling of evidence of effective leadership at Oxford, CQC emphasised the trust’s digital initiatives:

“‘Go Digital’: To achieve digital transformation, to support excellent care and enable care to be delivered closer to home.”

which of course was flattering to the government’s digital ambitions.

And what of the Department of Health and Social Care? I cannot find any report of the Department’s HR practice in the Knight case. Yet it is likely the fact that Knight came to the trust from the Department contributed to the trust’s complacency in not checking his credentials properly.

According to the BBC, the trust’s chief executive Bruno Holtof (who since February 2019 has also been a non executive director and then Chair of Tristel, a business which supplies infection control products) had praised Knight’s expertise:

“Chief executive Dr Bruno Holthof said in the release that Knight brought a “wealth of experience and expertise” to the role.”

Moreover, in 2016 after Knight’s appointment, Jeremy Hunt the then Health Secretary bunged Oxford University Hospitals NHS Foundation Trust £10m to be a NHS “Global Digital Exemplar” and: “…to champion the use of digital technology to drive radical improvements in the care of patients.”

It remains to be seen if calls for certification of senior NHS IT leaders, which followed exposure of Knight’s CV fraud, will be heeded:

“Some 59% of NHS IT leaders say that top digital leadership roles should require certification.”

Just a few years ago, NHS Improvement  was painfully embarrassed when it emerged that the regulator had appointed Jon Andrewes a fraudster, to the Chair of the Royal Cornwall Hospital NHS Trust.

Andrewes had spectacularly defrauded the NHS over a long executive career in the NHS with a fraudulent CV, which contained obvious anomalies. He was even the Freedom To Speak Up Guardian at Devon Partnership NHS Trust, where he had been appointed as a non-executive director by NHS Improvement.

I asked NHS Improvement what it had learned from the Jon Andrewes shambles, and what it would do differently in future. The response was unimpressive and not at all reassuring:

Jon Andrewes fraud: NHS Improvement responds

Senior NHS managers can do immense damage, and cause much more harm to patients than individual frontline clinicians, because they control whole systems of care.

Recurring NHS scandals such as MidStaffs, Gosport , Liverpool Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust have shown what can go gravely wrong when health services are mismanaged.

Yet there appears little intention by the government, and its proxy NHS Improvement, to robustly ensure that Fit and Proper Persons are appointed to key positions.

NHS Improvement has dragged its feet on implementation of Tom Kark QC’s review of FPP in the NHS.

And for good measure, NHSI last year also appointed Paula Vennells the disgraced former CEO of Post Office Ltd to the Chair of Imperial College Healthcare NHS Trust.

 

Paula Vennells, Post Office Ltd CEO from 2012-2019

This is a profile by Nick Wallis the journalist who has covered the trial about the Post Office Horizon computer system controversy:

The Ballad of Paula Vennells

During Paula Vennells’ tenure, Post Office Ltd continued to unsafely accuse and prosecute subpostmasters for financial shortfalls, despite the organisation’s knowledge of numerous computer glitches which could have caused phantom shortfalls.

The subpostmasters were vindicated after they brought a legal action against Post Office Ltd.

The Post Office Horizon IT trial also revealed some thoroughly oppressive workforce practices by Post Office Ltd, which were described by one of the judges as behaviour akin to that of a “Mid-Victorian factory owner”.

Post Office Ltd’s prolonged denial, dishonesty and “extremely aggressive” and “attritional” legal tactics meant that only a fifth of the settlement reached  will be left for the badly harmed subpostmasters, after costs have been met.

There are currently calls for Vennells to stand down from her public roles at Imperial and the Cabinet Office, for her ministry as an ordained Church of England priest to cease, for the board of Post Office Ltd to be cleared out and for a public inquiry into the mass miscarriage of justice.

FPPR referrals have been made to CQC about Vennells’ appointment as Chair of Imperial.

One of the subpostmaster claimants in the trial has set up a petition for a judge led inquiry, which if you wish, you can support here:

Post Office Horizon Scandal Judicial Enquiry

 

 

Vennell’s appointment to the Imperial Chair was made despite the Kark FPPR review recommendations, and thus represents a pretty clear snub to any hopes that the government would implement FPPR more effectively in the NHS.

CV fraud in the NHS, including by managers, is a longstanding phenomenon. A list of some additional examples is provided in the appendix.

However, as the stealth privatisation of the NHS advances, and the whiff of loot intensifies, attitudes of entitlement, cronyism, backscratching, instances of unearned privilege, meritless appointments, and self-serving cover ups are likely to worsen. And the revolving door to private industry will likely spin faster.

 

RELATED ITEMS

Employers ‘aren’t bothering to verify candidates’ CV claims’

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

Crony Capitalism Babylon’s burning cash. Solomon Hughes reports on the healthcare privateers Babylon, their failed doctor-replacing app and their cosy relationship with Health Secretary Matt Hancock

Paul Bate – CQC strategy director to join Ali Parsa tech start up

Juliet Bauer to leave NHS England and move to online GP consultation provider

Malte Gerhold – Senior Care Quality Commission executive joins AgeTech startup Birdie

 

APPENDIX

Some past reports on CV frauds by NHS managers and clinical leaders:

 

Kerrine Devine

NHS HR manager who lied on CV ordered to pay £9,600 in costs

 

Lee Whitehead

NHS director jailed for lying about professional qualifications

NHS manager jailed for CV lies lands new NHS job   

 

Neil Taylor

  Hospital boss’ fake CV exposed 

NHS chief faked his CV to land £115,000-a-year job

Ex-NHS trust chief escapes jail

 

Hasan Tahsin

Suspended sentence for NHS manager who lied on his CV

 

Rhiannon Mackay

Woman who lied on CV that she had A-Levels to get NHS job is jailed for six months

 

Luis Conrad De Souza

‘Fake’ doctor given 18-month jail sentence

Bogus doctor: Conrad de Souza jailed for lying again

 

Philip Hufton

Nurse stole £350,000 from NHS by lying on CV and claiming fake expenses   

Man who lied on his CV to swindle nearly £350,000 out of the NHS to fund his ‘lavish lifestyle’ – all whilst pretending to have cancer – has been jailed for five years

Fraudster stole almost £350k from NHS and pretended to have cancer

Deborah Hancox

NHS manager locked up for £1m scam went back to work for health service after release from prison

 

fppr-copy

East Suffolk and North Essex NHS Foundation Trust, whistleblower reprisal & the curious case of Matt Hancock’s disappearing bloopers

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist 18 January 2020

This is a short ditty of our sad little post truth island, fluttering in the cold winds of oligarchs, cronyism and comedy politicians.

East Suffolk and North Essex NHS Foundation Trust was formed by the merger in July 2018 of Ipswich Hospital NHS Trust and Colchester Hospital University NHS Foundation Trust.

The CEO of Ipswich Hospital NHS Trust, Nick Hulme, took charge of the new trust. Hulme had previously been CEO of Croydon Health Services NHS Trust, which had been found guilty of serious whistleblower reprisal against Kevin Beatt cardiologist.

He had in fact been running Colchester in addition to Ipswich for some time before the official merger, with some controversy:

Hospital boss bans employees from telling patients trust is short-staffed

Colchester had its own long history of troubles with bullying and whistleblower woes, for example:

NHS whistleblowing laws ‘must change’…two administrative assistants at a scandal-hit hospital complained that they were “pressured or bullied” to falsify data relating to cancer patients to make it seem like people were being treated in line with national guidelines.

Colchester Hospital University NHS Foundation Trust ‘needs improvement’

I asked the National Guardian to review Colchester because of a high level of reported whistleblower detriment, but no action ensued.

In November 2019 I informed CQC Chief Inspector of Hospitals Ted Baker that I had analysed the National Guardian’s published speaking up data, which is based on unverified data submitted by NHS trust Freedom to Speak Up Guardians. Notwithstanding issues about data quality, I found an astonishing level of whistleblower detriment at Nick Hulme’s trust (44.3% of cases when the overall national average was 4.4%).

Based on the National Guardian’s data, East Suffolk and North Essex NHS Foundation Trust was a very clear outlier, even allowing for differences in trust size and type.

The National Guardian must have been aware of this continuing pattern.

Ted Baker acknowledged the data that I sent him and agreed that the CQC could probably make more use of data gathered by Freedom To Speak Up Guardians. He promised to get back to me in due course but has not done so yet.

In the meantime, on 8 January 2020, the CQC issued another ‘ Requires Improvement’ rating on East Suffolk and North Essex NHS Foundation Trust. Despite the very high reported levels of whistleblower detriment, the trust kept its ‘Good’ rating on the Well Led domain.

Yesterday, local news outlets – BBC Suffolk, East Anglian Daily Times and Ipswich Star – reported that Matt Hancock Health Secretary had publicly rode roughshod over the CQC rating of “Requires Improvement” by insisting that “Colchester and Ipswich hospitals were national trailblazers”.

Screenshot 2020-01-18 at 05.04.45

Screenshot 2020-01-18 at 04.31.38

Screenshot 2020-01-18 at 06.49.41

Screenshot 2020-01-18 at 06.49.52

Whatever one thinks of the CQC, it was most irregular that Hancock should publicly undermine his own regulator in this way.

Even more curiously, all these press stories have now disappeared from the internet. This is what remains:

Screenshot 2020-01-18 at 06.14.10

Only one cached version of yesterday’s story by the East Anglian Daily Times remained as far as I could see:

Hancock insists Colchester and Ipswich hospitals are national trailblazers

“Mr Hancock praised the leadership of the East Suffolk and North Essex NHS Foundation Trust as one of the best in the country despite the CQC report”

Were Hancock’s antics a step too far even by the grossly deteriorated governmental standards of our day? Did Hancock have his collar felt by senior mandarins who ensured that his juvenilia was quickly tidied away?

Never mind. For those bereft and suffering from Hancock withdrawal syndrome, here is some heart warming coverage of Mr Hancock and Mr Hulme smiling together at an Ipswich Suffolk Business Club lunch in March 2019:

Lunch with Secretary of State for Health & Chief Executive of Ipswich & Colchester Hospitals

Screenshot 2020-01-18 at 03.58.09

RELATED ITEMS:

Censorship of national health and social care whistleblowing data: CQC’s economy with the truth

Whistleblower witch hunt: West Suffolk NHS Foundation Trust in retreat and disarray

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

Replacing the Public Interest Disclosure Act (PIDA)

STFU not FTSU

Whistleblower witch hunt: West Suffolk NHS Foundation Trust in retreat and disarray

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist, 16 January 2020

 

Susan Warby died in August 2018 after surgery by ‘Outstanding’ West Suffolk NHS Foundation Trust.

Her inquest starts today:

Screenshot 2020-01-16 at 02.44.53

Her husband has reportedly initiated legal action against the trust:

“I have instigated a claim for medical malpractice. I am not happy how things were done, but the rest will have to wait until after the inquest.”

The Guardian revealed that the family received an anonymous letter about flaws in her care, which prompted an astonishing witch hunt by West Suffolk NHS Foundation Trust for the individual responsible.

Trust managers demanded fingerprints and handwriting samples from staff in order to purportedly identify the author of the letter.

They threatened staff by claiming that any refusal to provide samples would be interpreted as a sign of guilt:

[refusal to consent] “could be considered as evidence which implicates you in writing the letter”.

Even more astonishingly, the trust claimed to the press that its approach had been “backed” by the “NHS national head of whistleblowing”:

“In this case we shared our serious incident investigation process with the CQC [Care Quality Commission], and the NHS national head of whistleblowing, who backed our approach.”

I asked the trust’s chief executive Steve Dunn about the policy and contractual basis on which the trust had asked for biometric data, and to clarify to whom it was referring as the “NHS national head of whistleblowing”.

I also asked if the trust had carried out fingerprint testing of suspect documents, and on how many occasions it had done so.

I specifically asked the trust to clarify whether Dr Henrietta Hughes the National Freedom To Speak Up Guardian had been aware of and in agreement with the trust’s demand for staff fingerprints.

West Suffolk NHS Foundation Trust replied indicating that it regretted asking the involved staff for fingerprints. It disingenuously tried to argue that there had been no disciplinary threat to staff. The trust claimed that it had apologised personally to staff, in writing, and that it had no intention to seek fingerprint evidence again in the future.

However, the trust is in breach of the Freedom of Information legislation because it has failed to answer my above specific questions.

This raised questions about whether the trust bluffed about possessing fingerprint evidence, simply to intimidate its staff.  However, the Guardian has today reported that:

“The trust spent £968 on a handwriting expert and £1,512 on a fingerprint expert to try identify the letter writer.”

Staff say hospital bosses misled them in hunt for whistleblower

This therefore raises an alternative question of whether the trust’s evasion of my questions means that the trust has hunted for staff fingerprints on more than one occasion.

Another unsavoury fact reported by the Guardian today is that the trust mole hunt was led by a trust NED with links to the police force:

“The investigation was overseen by Louisa Pepper, a former assistant police chief constable, who sits as a non-executive director on the trust’s board.”

Screenshot 2020-01-16 at 13.14.32

The NHS as Big Brother, overreaching its authority and treading on staff’s rights, is not a pleasant idea.

The trust’s response to me also raises questions about whether the trust is under orders to protect and conceal the identity of officials from oversight bodies who were reportedly complicit with, or approved, the trust’s extraordinary bullying of its staff. The alternative is the trust was being untruthful when it claimed that it had obtained backing for its witch hunt.

As a whistleblower, I have raised concerns in a former Health Secretary’s constituency. West Suffolk NHS Foundation Trust whistleblowers run the extra gauntlet of persecution because they are in Matt Hancock’s backyard, and pose particular embarrassment. Indeed, he has repeatedly refused to meet and support them.

In the meantime, the CQC has defaulted on an FOI request for statistics on whistleblowing by the staff of regulated bodies, so no official information is available on the volume of recent, external whistleblowing by West Suffolk NHS Foundation Trust staff to the CQC.

However, the CQC’s report on West Suffolk is due imminently. It will be interesting to see how much CQC will admit about approaches that it has received from trust whistleblowers.

All this hardly gives confidence in the government’s handling of NHS whistleblowing and only further discredits its Freedom To Speak Up scam.

I have questioned the trust’s response to the FOI request. This is the correspondence with the trust so far:

Correspondence with West Suffolk NHS Foundation Trust about fingerprint testing December 2019 and January 2020

UPDATE 19 JANUARY 2020

I looked up the Information Commissioner’s advice on the General Data Protection Regulation (GDPR) provisions on biometric data.

ICO advises that biometric data is a ‘special category data’ when used for identification purposes, and that this requires ‘explicit consent’:

What is special category data?

The GDPR defines special category data as:

• personal data revealing racial or ethnic origin;
• personal data revealing political opinions;
• personal data revealing religious or philosophical beliefs;
• personal data revealing trade union membership;
• genetic data;
• biometric data (where used for identification purposes);
• data concerning health;
• data concerning a person’s sex life; and
• data concerning a person’s sexual orientation.”

What are the conditions for processing special category data?

Article 9 lists the conditions for processing special category data:

(a) Explicit consent
(b) Employment, social security and social protection (if authorised by law)
(c) Vital interests
(d) Not-for-profit bodies
(e) Made public by the data subject
(f) Legal claims or judicial acts
(g) Reasons of substantial public interest (with a basis in law)
(h) Health or social care (with a basis in law)
(i) Public health (with a basis in law)
(j) Archiving, research and statistics (with a basis in law)”

https://ico.org.uk/for-organisations/guide-to-data-protection/guide-to-the-general-data-protection-regulation-gdpr/lawful-basis-for-processing/special-category-data/

One imagines that threatening staff into giving fingerprint evidence does not comply with GDPR.

It also seems, de facto, that when the trust spent £1,512 on a fingerprinting expert to hunt down the identity of a whistleblower, it could not have been processing any biometric data with ‘explicit consent’.

This is an article on the Human Resources aspects of managing biometric data:

GDPR and the ethics of biometric attendance data

 

RELATED ITEMS

The National Guardian’s Office gets it badly wrong again, at West Suffolk NHS Foundation Trust

National Guardian looks set to throw Freedom To Speak Up Guardians under the government’s bus too

The government will inevitably brush off the West Suffolk scandal and shrug its shoulders. It has little intention of ensuring good whistleblowing governance in the UK, as to do so would shift the balance of power to ordinary people.

Meaningful reform of UK whistleblowing law and enforcement structure is needed.

Replacing the Public Interest Disclosure Act (PIDA)

 

Steve Dunn chief executive of West Suffolk NHS Foundation Trust, selfie enthusiast and Freedom To Speak Up project supporter (see lanyard), posing with Matt Hancock Secretary of State for Health:

Steve Dunn selfie with Matt Hancock and Freedom To Speak Up lanyard

Screenshot 2020-01-16 at 02.51.42

Censorship of national health and social care whistleblowing data: CQC’s economy with the truth

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 15 January 2020

 

 

Summary: In 2016 whistleblowers highlighted Care Quality Commission (CQC) secrecy about whistleblowing activity by the staff of regulated health and social care organisations. CQC blustered but began to reluctantly publish cursory whistleblowing data in 2017. Under the Freedom of Information Act CQC also provided two years’ of national whistleblowing data on specific health and social care providers from 1 April 2015 to 31 March 2017. The same FOI request was submitted again last November for update whistleblowing data from 2017/18 and 2018/19. CQC unlawfully delayed in its response to this request for no good reason. The data is easily retrievable from a central computer database. The data should have been released before the general election on 12 December 2019 but was not released until 10 January 2020, despite CQC being repeatedly chased. When the data arrived, it had been censored to remove the identities of specific provider organisations. CQC failed to argue clearly why it had done so. The missing data on specific provider organisations allows the government to hide a multitude of sins, including regulatory failure by CQC and ineffectiveness by the National Guardian for whistleblowing. CQC will be pursued for the missing data. Parallel to this the government has fought an FOI request for sub-departmental staff survey data.  The Department of Transport has so far been overruled by the ICO, the Information Tribunal and the Upper Tribunal. It will be illuminating to see if the government continues to resist accountability and appeals again. We are likely to see more abuses and government failures of transparency. Our Prime Minister and his inner circle have expressed amity and admiration for Viktor Orban the Hungarian Prime Minister and his administration, who amongst other unpleasantness have been busy neutering their judiciary, controlling information and disempowering the free press.

 

 

UK government’s praise of an authoritarian regime

The political back drop to debate about the UK government’s transparency and whistleblowing governance includes its links with the much criticised Hungarian government.

How democracy died in Hungary

“From the beginning of his premiership in 2010, Viktor Orban has steadily eroded the checks and balances in Hungary’s once-promising democracy, especially the independent media”

Hungary’s Latest Assault on the Judiciary

The website that shows how a free press can die

What happened in the Hungarian media could happen in your country too

A Top Boris Johnson Aide Says The UK Will Have A “Special Relationship” With Viktor Orbán’s Hungary After Brexit

Boris Johnson shaking hands with Viktor Orban.png

Boris Johnson tweet congratulating Viktor Orban 9.04.2018.png

 

Why whistleblowing data matters and gaps in the system

In order to properly learn from whistleblowing, organisations should track and examine themes from whistleblowing data. The government is a great repository of whistleblowing information, as whistleblowers often end up whistleblowing to many agencies on their long and lonely journeys, and are forced to repeatedly escalate through layers of unresponsive government bodies.

Under the ineffective UK Public Interest Disclosure Act, some public bodies are designated as Prescribed Persons to whom whistleblowers can disclose concerns. The Prescribed Persons system is ramshackle and ineffective, with some Prescribed Persons that are blissfully ignorant of their statutory status and responsibilities. Not that there are any real responsibilities that are conferred under current whistleblowing law. There is only an obligation on Prescribed Persons to receive and record concerns, and latterly to report annually in a very cursory manner. There is no obligation under current UK whistleblowing law for Prescribed Persons to investigate nor act upon whistleblowers’ disclosures.

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

The Care Quality Commission (CQC) is a Prescribed Person but is not compelled to investigate any individual whistleblower’s concerns. The government has refused for over a year to answer a question on whether it will change CQC’s regulations so that CQC has the power and duty to investigate individual whistleblowers’ concerns. The obvious inference is that the government vehemently opposes any such investigation.

This is all extremely unsafe because external whistleblowing to the CQC by the staff of regulated bodies usually reflects some failure by employers. Whether it is failure to create a safe and receptive environment in which staff know about and feel confident in whistleblowing systems, or receive helpful organisational responses to their whistleblowing. Many whistleblowers turn to the CQC after lengthy attempts to raise concerns internally are obstructed by their employers. For the CQC to disrespect and brush off such significant disclosures is negligent and harmful to patients and social care service users, and to safety culture.

Data on whistleblowing to the CQC is in fact very precious, and an important barometer of problems in the system.

 

CQC’s whistleblowing data cover up

The CQC is steadily cutting down on the transparency about whistleblowing into which it forced in 2017, and an example is given below.

In 2017 CQC revealed under the Freedom of Information Act the extent of whistleblowing disclosures that it received from specific health and social care provider organisations over a two year period. This allowed some comparisons.

Granted, these comparisons are very broad and consideration should be given to the varying size of regulated organisations and their different roles. Nevertheless, there was marked variation in levels of reporting about organisations. In the NHS, the trusts which generated the most whistleblowing incidents to CQC were as follows:

An FOI request shouldn’t have been necessary. The CQC should have made such data public as a matter of routine. But it didn’t take the hint, and it did not publish proactively even after the FOI request.

Accordingly, in November 2019, I asked the CQC for an update of the same data, for the period 1 April 2017 to 31 March 2019.

The CQC dragged its feet and was unusually late by its standards in replying to the FOI request. It should have responded before the general election on 12 December 2019 but did not respond until 10 January 2020, despite being repeatedly chased.

CQC FOI response Ref CQC IAT 1920 0743

Moreover, the data provided was excised of specific health and social care provider organisation’s details:

Data on whistleblowing to CQC 2017/18 and 2018/19 by staff of all regulated health and social care providers

CQC claimed some FOIA exemptions that it had not claimed before, listing these in a  very generic manner, not matching specific exemptions to specified, omitted data.

CQC listed privacy considerations (FOIA Section 40 exemption on personal data) amongst its defensive excuses for not relinquishing the data requested.  This is nonsense. The CQC is only allowed to withhold data that might identify individuals. There are no grounds to argue that anonymised data over a long period could identify individuals, except at a stretch where numbers are very low (five is the commonly accepted threshold).

CQC has also claimed FOIA Section 41 and 44 exemptions on information given in confidence are applicable. Again, flawed, over-blown claims which are undermined by the fact that:

  • CQC used to regularly publish whistleblowing alerts for specified organisations in its “intelligent monitoring” data (this stopped because CQC binned its unreliable intelligent monitoring initiative).
  • CQC continues to report on provider staff whistleblowing in its inspection reports.

Similar arguments apply to a claim by CQC that FOIA Section 31, law enforcement, is relevant and justifies withholding the requested data. The CQC argument in this aspect is very thin and speculative. It claims that transparency might deter provider staff from whistleblowing. This is pure fantasy and a misrepresentation of information that is of legitimate public interest. Whistleblowers whom I have known and worked with usually desperately scour the public record to find out if others have raised concerns about their organisations. The general public and harmed patients and families also take interest in whether there have been whistleblowing concerns about specific providers.

Moreover, the CQC advances improbable arguments that release of data could prejudice its Safeguarding investigations and regulatory assessments. One suspects this part would be more correctly phrased: “The CQC does not want the public to know about instances in which CQC has taken inadequate regulatory and Safeguarding action, in the face of considerable whistleblowing intelligence”.

The net effect of CQC’s clumsy censorship is that the data provided tells me little more than the superficial, headline whistleblowing statistics that CQC already publishes in its corporate material.

Why should CQC hide specific provider organisations’ whistleblowing data?

Is CQC hiding evidence of failure of government’s Freedom To Speak Up scam?

Is there embarrassing data about NHS trusts that the National Freedom To Speak Up Guardian has endorsed, or reviewed without any resulting improvement?

Is the CQC helping to cover up whistleblowing by staff at ‘Outstanding’ West Suffolk NHS Foundation, which demonstrated its excellence by demanding fingerprints and handwriting samples from staff as part of a whistleblower witch hunt?

Doctors at West Suffolk hospital ‘too scared’ to report safety issues

Is the CQC trying to cover up whistleblowing about severe NHS strain, such as whistleblowing by ambulance service staff, which tends to be a weather vane for insufficient hospital beds and dangerously stretched acute services?

The CQC is certainly still dumping the majority of whistleblowing contacts in a drawer, labelled as either ‘no further action’ or ‘information noted for the next routine inspection’.

In CQC’s hospital directorate, a shocking 76.7% (1473 of 1918) whistleblowing disclosures are treated in this manner.

Screenshot 2020-01-15 at 14.49.14

Is the CQC trying to protect itself after the Whorlton Hall scandal, in which a very serious cover up and whistleblower suppression by CQC was exposed?

Internal CQC correspondence by Whorlton Hall whistleblower Barry Stanley-Wilkinson, disclosed to Joint Committee on Human Rights

Whorlton Hall hospital abuse and how it was uncovered

Four resign from government review after Whorlton Hall scandal

Colin Groombridge Winterbourne View whistleblower on the Whorlton Hall scandal:

“I never wanted to speak out the first time. It’s something that I feel I have to do now. We wanted meaningful change – there hasn’t been any.”

Is the CQC covering up embarrassing information on whistleblowing by staff of the provider company in question, Cygnet?

CQC has just issued a carefully worded “Well-Led” inspection report on the Cygnet estate, which whilst conceding failures, has the distinct look of half truths. In fact, it is a re-run of CQC’s carefully crafted review of Castlebeck facilities after the Winterbourne View abuse scandal.

With supreme irony, CQC’s report criticises Cygnet because its Data was not presented to allow trends in whistleblowing to be identified by location over a period.”

Crucially, CQC gives a selective account of whistleblowing by Cygnet staff, restricted only to the year up to April 2019:

“In the 12 months up to April 2019 the CQC received 37 whistleblowing or staff concerns which were followed up with Cygnet Health Care”

This selectivity, and CQC’s severe restriction of the whistleblowing data that it has just disclosed to me, avoids scrutiny of the scale of whistleblowing disclosures that CQC received about Whorlton Hall in the run up to its clearly nonsensical ‘Good’ rating in May 2018, In fact, patients were being abused as revealed by Panorama.

Is the CQC also trying to hide whistleblowing about other highly controversial private providers, who soak up millions in public money, like St Andrews Healthcare which has been an abusive employer, and has in the region of 1,000 workers on zero hours contracts.

What other embarrassment for the government lurks in the withheld data?

I will pursue CQC for the withheld data, and in particular the 2017/18 whistleblowing data for Cygnet and Whorlton Hall. I will try to further elucidate the anatomy of this latest cover up, but anticipate a great deal of obstruction.

Parallel to all this, I have encountered extraordinary government resistance to an FOI request for Air Accident Investigation Branch staff survey data, a branch of the Department for Transport. The DfT was overruled by the ICO. It has since appealed against this ICO decision to the Information Tribunal and then the Upper Tribunal. The DfT has been unsuccessful on both occasions. I am waiting with curiosity to see if the government will attempt yet another appeal.

Buckle up. Expect official deception of all sorts to proliferate. Lies of omission and concealment, outright porkies, lies of distortion, manipulation and sleight of hand, and lies by carefully sculpted implication.

And don’t be surprised either if the UK government makes another attempt to nobble the public’s FOI rights.

After all, that’s what Viktor did in happy, sunny Hungary:

Hungary: Government cracks down on freedom of information

 

UPDATE 20 JANUARY 2020

Meanwhile in a parallel universe, a kind person has sent me a 17 January 2020 report by Ridouts the law firm which often acts for NHS bodies, which says that the CQC has been been expensively but quietly binning inspection reports , purportedly because of concerns that they are “unsound”. The affected providers are not identified.

 

RELATED ITEMS

2015: Justice Secretary Michael Gove’s FoI plans would ‘significantly restrict’ act, campaigners warn

The spreading CQC Whorlton Hall scandal – emerging allegations at ‘Outstanding’ Newbus Grange. Another CQC deception?

Counting the cost of the CQC: Abuse, Whorlton Hall and CQC spin doctors

Ivy Atkin’s death & more CQC evasion

CQC covered up suspected rape in care home

CQC is no stranger to claims of cover-up

“Ministers told the Care Quality Commission not to release its verdict on Basildon and Thurrock hospital in Essex, where patients were dying from poor care.”

Barbara Keeley’s letter to Ian Trenholm CQC CEO about CQC’s whistleblower suppression and cover up of care failures at Whorlton Hall:

Barbara Keeley letter to Trenholm 14.06.2019 part 1

Barbara Keeley letter to Ian Trenholm CQC 14.06.2019 part 2

Barbara Keeley letter to Ian Trenholm 14.06.2019 part 3

newbus grange outstanding photo
Newbus Grange, another ex-Castlebeck ex Danshell, Cygnet facility, rated ‘Outstanding’ by CQC two months before physical abuse became public

After the Post Office Horizon Trial: Paula Vennells, Mammon and the bishops

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist 11 January 2020

Summary: The Post Office has failed to defend major legal action by hundreds of subpostmasters who were seriously mistreated, falsely accused, unsafely prosecuted and in some cases jailed. Some of the victims have died. Paula Vennells, former Post Office chief executive for seven years, is a priest in the Church of England. She also has two central roles, assisting with talent management and advising on ethical investment. The Church’s ethical investment policy includes not doing business with companies that do not promote the well being of their staff. Should the C of E continue with the ministry of a former director of a company which was responsible for unsafe prosecutions, conviction, imprisonment and ultimately, deaths? Does the C of E need to strengthen its Safeguarding approach to proactively review the ongoing fitness of any clergy who interact with vulnerable people?

Post Office Ltd, a company owned by the government which is supposed to have a social purpose, has been trounced in legal action brought by hundreds of mistreated subpostmasters.

Post Office Ltd behaved very oppressively, earning it a judge’s comparison to a “Mid Victorian factory owner”.

Hundreds of its subpostmasters were unfairly blamed for apparently missing money that the Post Office knew could be due to computer glitches in its “Horizon” IT system. The subpostmasters were roughed up with threats and searches of their homes, presented under duress with ready made “confessions” to sign, unfairly prosecuted, fined, made to “repay” phantom deficits, and sent to jail. Many were made ill and ruined, some died including by suicide.

Victim Testimony

Post Office refuses to comment on pregnant sub-postmistress jailed over Horizon scandal

Alan Bates: The ‘details man’ the Post Office paid the price for ignoring

The Post Office computer problem that destroyed the lives of pillars of the community

Criminal Cases Review Commission investigation of miscarriages of justice

A former village postmistress sentenced to 18 months in jail is one of 34 people whose convictions are being reviewed

Rubbina Shaheen was jailed for 12 months at Shrewsbury Crown Court in 2010 after she was accused of stealing £43,269.

Noel Thomas: “But his life was turned upside down when he was jailed for nine months in 2006 after being accused of taking £48,000.”

Post Office IT fiasco: ‘Decade of hell’ for accused

Decent lives destroyed by the Post Office: The monstrous injustice of scores of sub-postmasters driven to ruin or suicide when computers were really to blame

My uncle took his own life after the Post Office went after him – this High Court ruling is too little, too late

Victims of the Post Office’s sub-postmaster scandal on their decade of hell Hundreds of sub-postmasters had their lives ruined when a faulty IT system led to them being accused of fraud. Katie Glass hears their stories of torment, prison — and the unfinished battle to clear their names

Woman who was thrown in jail aged 19 for ‘stealing’ from Post Office is among hundreds who are suing amid claims they were wrongly sacked because of an IT glitch

Jo Hamilton ‘Victory against Post Office one of the best days of my life’

Oxford Post Office manager speaks out after £57m pay-out

“I hate everything about it. I will not go into a post office.”

“…I was told by Post Office that their system was infallible…. At the time the PO assured me I was the only person, claiming it was a computer error”

Tragic Redditch postmaster died before being exonerated of false accounting

“The horror of that whole Post Office fiasco was a major factor in her death.”

Depression, bankruptcy and jail: Why we sued the Post Office

 

Post Office Ltd prolonged the subpostmasters’ ordeal for years through denial.

Day 9 write-up: Paula Vennells implicated

This included an attempt by Post Office Ltd to suppress a critical report detailing flaws in their Horizon computer system, Private Eye 1378:

Screenshot 2020-01-11 at 05.38.50.png

The Managing Director of Second Sight the forensic accountants who produced this suppressed report is highly critical of Post Office Ltd:

Second Sight’s Ron Warmington breaks his silence

“As a fraud investigator who has, for decades, dealt with real fraudsters and confidence tricksters, it struck me, six years ago, as I interviewed Subpostmaster after Subpostmaster, that these are good, honest, straight-talking people. It was very rapidly obvious that many have suffered life-changing damage because they received no investigative support when mysterious shortfalls appeared in their accounts.”

Instead of taking responsibility, Post Office Ltd harmed the subpostmasters even more with dishonourable and aggressive litigation tactics. It squandered public money that it had a duty to husband responsibly.

As one person put it, “…the Post Office went psycho, going to war with its subpostmasters”

Neither has Post Office Ltd yet repaid the money that it bullied out of bewildered and distraught subpostmasters, based on its unsafe accusations of theft and fraud:

Postmasters jailed and forced to pay millions after an IT glitch wrongly showed shortfalls should be repaid their money by the Post Office, forensic accountant claims

All this took place in the context of a politically sensitive and controversial privatisation of the Post Office, which after criticism of “crony capitalism” the Coalition government needed to vigorously spin as a success.

The Horizon IT scandal was not helpful to Ministers, and indeed David Cameron was forced to respond to concerns in parliament.

And at the helm of Post Office Ltd as chief executive during 2012-2019 was Paula Vennells, who was also a Church of England minister ordained as a priest in 2006 and who was first appointed as a Post Office manager in 2007

Christian essays abound on the ethics and theology of money lending and wealth accumulation.

Justin Welby Archbishop of Canterbury started life in the oil industry, but as Archbishop he has cut a publicly progressive figure.

He has spoken out on Mammon’s evils of exploitation, the gig economy, modern usury such as pay day loans, excessive executive pay and inequality. For example:

UK facing ‘crisis of capitalism’, says Archbishop of Canterbury. Elite have failed to learn lessons of 2008 financial crisis, warns Justin Welby

His writings have included eye catching titles such as;

“Dethroning Mammon: Making Money Serve Grace”

Yet Paula Vennells the ordained C of E minister earned millions as Post Office Ltd CEO.  She enjoyed a sharp pay hike whilst subpostmasters suffered depressed pay and conditions.

She partook of the modern fashion for publicity, PR and glossy events.

Mark Davies Post Office comms team together image.png

PV Tweet top team Post Office Events 10.06.2017.png

PV who's for the bubbly

Vennells stepped down from her job at Post Office Ltd last year as the Horizon IT litigation gained momentum, but she continues to hold board positions at other large corporations – Morrisons and Dunelm.

Her public persona has emphasised her Christian faith and tenets of ethical business, including claims of supportive and inclusive employment practices. Her brand was one of trust.

Faith in Business. Paula Vennells: A Profile

Paula has taken biblical inspiration from the young King Solomon, who showed humility in asking God for a wise and understanding heart, so that he could rule his people with justice (1 Kings 3:6-12). Her leadership style has consisted in confronting the problems she faced, setting a powerful shared vision, engaging with all the stakeholders, and widening and delayering leadership. She has sought to improve standards of courtesy and respectful listening in what had often been fraught and ill-tempered encounters between different groups.”

The female curate offering salvation to the Post Office

And while she says her skills as a vicar make little difference to her day job, honesty and trust are big words in her vocabulary.

“I won’t say things I don’t mean,” she says.”

In the Church, Vennells’ business background was an oft cited speaking point, sometimes worthy of revenue generation by some parishes:

CoE Politics Priesthood and Post Offices http:::www.churchesofarden.org.uk:files:1317310561.pdf

In 2018 Vennells received a CBE despite the commencement of legal action by the subpostmasters.

She even endorsed one of Justin Welby’s books, “Reimagining Britain: Foundations for Hope”.

Her corporate skills have been harnessed by the C of E in a central programme led by Justin Welby, of “Nurturing and Discerning Leadership”, for talent spotting and beefing up business:

  1. A tension between the priestly and corporate leadership of the Dean had led to some early concerns about the programme. However, those who attended were unanimous that exposure to the content of an academic MBA (including marketing, finance, project management and team leadership) was very supportive in enabling them to discharge their considerable accountability for the good stewardship of the commercial running of the cathedrals as major places of worship, as tourist attractions, and as community venues.”

Vennells was also appointed to the C of E’s ethical investment advisory group.

This group’s job is to advise the Church on how to invest its fortune with Christian values in mind, including through the selection of businesses with enlightened employment practices:

Investment exclusions

The NIBs do not wish directly to profit from, or provide capital to, activities that are materially inconsistent with Christian values, and are also mindful of the danger of undermining the credibility, effectiveness and unity of the Church’s witness were they to do so. A range of investment exclusions is therefore maintained.”

Ironically, the group’s investment exclusions include excessive executive remuneration and poor practice regarding the wellbeing of employees and other stakeholders.

Vennells’ social media activity shows acclamation of various Bishops, retweets of their words of wisdom, an offer to sponsor one Bishop’s half marathon and other interactions. A few examples:

 

Screenshot 2020-01-11 at 10.09.09.png

Screenshot 2020-01-11 at 10.49.36.png

Screenshot 2020-01-11 at 10.38.01

CoE Justin Welby PV twt great confidence and clarity

Screenshot 2020-01-11 at 10.42.08

CoE John Sentamu flat cap

Screenshot 2020-01-11 at 10.45.20.png

CoE Bishop of Landaff PV congrats 28.04.2017.png

 

Screenshot 2020-01-11 at 10.27.10.png

CoE Bishop of Manchester PV twt inspiring video on debt help.png

In December 2017 the ecclesiastical press claimed that Vennells was tipped for promotion:

“Priests like Sarah Mullally and Paula Vennells, currently the Chief Executive Officer of the Post Office and tipped for a Diocesan post in the near future, represent a new normal for ministry and priesthood.”

She has shown interest in the appointment of female clergy and legislative changes to enable female bishops to take seats in the House of Lords.

Screenshot 2020-01-11 at 11.37.50

Screenshot 2020-01-11 at 11.40.41.pngScreenshot 2020-01-11 at 10.50.06.png

But what now that the Post Office trial has revealed such a litany of corporate failure and  disregard for the subpostmasters and their families?

There have been calls for Post Office Ltd’s board to be cleared out and for Vennells to step down from her senior roles in the public sector, which she took up last year after her departure from Post Office Ltd.

Post Office Ltd’s failures and abuses were so serious that there has also been pressure for a public inquiry.

Numerous suspected miscarriages of justice by Post Office Ltd are under investigation by the Criminal Cases Review Commission.

One of the Horizon trial judges has also passed a file to the Director of Public Prosecutions because of “grave” concerns about the veracity of Post Office Ltd witnesses.

Clearly, the already very high profile scandal has the potential to further seriously embarrass the Church.

How will Justin Welby et al handle complaints about Vennells’ continuing ministry?

The early signs are that he may distance himself from complaints.

A letter officially drawing his attention to the issues around the Post Office scandal was passed to a correspondence officer, along with a resultant message that His Grace was unable to deal with all correspondence himself.

Lambeth Palace, 10th January 2020

“Thank you for your recent email. Much as he would like to, the Archbishop is unable to respond personally and in detail to all the emails and letters that he receives, so I have been asked to reply to you on his behalf. 

The Reverend Paula Vennells is a priest in the Diocese of St Albans. The Archbishop cannot and does not intervene in the running of individual dioceses and parishes outside his own diocese of Canterbury, therefore you may wish to direct your concerns to the Bishop of St Albans, in whose diocese Ms Vennells is licensed.

Thank you again for taking the time to write.”

There was no comment about the hundreds of Post Office Ltd’s victims.

A general enquiry about how the C of E ensured the Safeguarding of vulnerable people and the related ordination of suitable individuals was not addressed.

When pressed, Welby’s Office responded curtly by simply pointing to a Church Safeguarding policy document.

This document has limited detail on ensuring suitable appointments:

“2. Safely recruiting and supporting all those with any responsibility related to children and vulnerable adults within the Church

The Church will select and vet all those with any responsibility related to children, young people and vulnerable adults within the Church, in accordance with the House of Bishops safeguarding policy and practice guidance.

It will train and equip Church Officers to have the confidence and skills they need to care and support children, young people and vulnerable adults and to recognise and respond to abuse. This will be done by supporting the roll-out of consistent and accessible safeguarding training in accordance with House of Bishops safeguarding policy and practice guidance.”

A related parish handbook on Safeguarding includes a foreword by the Archbishop which states:

“Safeguarding is at the heart of our Christian faith.”

The parish handbook gives more detail on safe recruiting procedure, and requires DBS checks. It advises:

“Any blemished DBS checks or information of concern on the CDF [Confidential Declaration Form] must be risk assessed by the DSA [Diocesan Safeguarding Adviser].”

This is the C of E’s Confidential Declaration Form, as of November 2019.

It includes the question:

  1. To your knowledge, has there ever been an allegation made against you (whether substantiated or not) that your conduct has amounted to or resulted in ill-treatment, neglect or other harm to a child and/or vulnerable adult, or putting a child or vulnerable adult at risk of ill-treatment, neglect or other harm? YES / NO”

Completion of the form is required upon appointment and this applies to “…all roles, including clergy, employees, ordinands and volunteers who are to be in substantial contact with children and / or adults experiencing, or at risk of abuse or neglect.”

Although the Archbishop’s foreword in the parish handbook emphasises the prevention of harm:

“We will work to prevent abuse from occurring. We will seek to protect those who are at risk of being abused and respond well to those who have been abused. We will take care to identify where a person may present a risk to others, and offer support to them whils ttaking steps to mitigate such risks”,

I could not see any requirement in the handbook for ongoing, proactive monitoring of suitability after appointment.

The C of E’s business model has been questioned by some:

Justin Welby under fire over C of E’s zero-hours contract. Archbishop of Canterbury called hypocritical after he rebuked gig economy as ‘an ancient evil’

Progressive Christianity Network Britain: Business Plan for the C of E??

“Recruiting the next generation of church leaders was the topic of discussion as 600 clergy from across London came together in 2017 for Calling London. The Diocese of London invited the ordained Chief Executive of the Post Office, Revd Paula Vennells, to address those attending. Nothing remarkable in that at first sight. A female priest in a high-powered role what could be wrong with that? Except is Paula Vennells really the right advisor to call? Certainly her business like no nonsense approach would fit in well with the current Church strategy. The Revd Paula Vennells has led the Post Office as it has undertaken the largest branch modernisation programme in UK retail history. So maybe a good fit and the right one to inform Church of England planning as it undertakes the largest “branch modernisation” programme in UK church history if the Bishop of Islington gets his way.

The Revd Vennells is not unalloyed good news though if one looks at her stewardship of the Post Office. Many sub-postmasters faced criminal charges as the Post Office toughed it out and failed to admit its IT had problems (despite Parliamentary committee pressure to own up and be transparent there was no confession from Paula or firm purpose of amendment.) Paula Vennells has indeed led the Post Office to profit on the back of its ongoing “transformation” programme. Profits rose from £13m to £35m for 2017/18. However £22m of that increase in profit was in large part due to putting further squeezes on the country’s under-remunerated postmasters and sub-postmasters. The remuneration of the sub-postmasters for the services they provide was cut by £17m, and that followed a £27m cut the previous year (while her own remuneration rose 7% to £718,000.) I suppose this is Paula Vennells way of helping the rural sub postmasters to face reality in the same way Ric Thorpe wants to do to the rural church. Perhaps this is the model the Church of England thinks is appropriate.”

It remains to be seen if the Church will respond justly to the very serious questions raised by the Horizon IT trial.

If the Church’s policy is not to invest in businesses which do not promote their staff’s wellbeing, should it really hire a former director of a company that unsafely accused and prosecuted workers when it knew they could be innocent, leading to convictions, imprisonments and deaths?

UPDATE 20 JANUARY 2020

Christopher Head one of the claimants in the Post Office trial has set up an online petition for a judicial inquiry into the scandal:

https://www.change.org/p/beis-horizon-scandal-judicial-enquiry?utm_source=share_petition&utm_medium=custom_url&recruited_by_id=75df65d0-393b-11ea-8956-efb177e9a8f1

UPDATE 2 MARCH 2020

I have raised a Safeguarding concern with Paula Vennells’ bishop, Alan Smith Bishop of St Albans about her continuing ministry. The Safeguarding referral is supported with testimony from harmed subpostmasters.

A Safeguarding referral to the Church of England regarding Rev Paula Vennells, former Post Office Ltd CEO & current Chair of Imperial College Healthcare NHS Trust

 

RELATED ITEMS

  1. The Church of England has an £8.2 billion investment fund. This is the annual report which gives more details of the investments:

The Church Commissioners Annual Report 2018

2. A key concern is the fact that Paula Vennells has been appointed as Chair of Imperial College Healthcare NHS Trust. A referral has been made to the Care Quality Commission  under Regulation 5 Fit and Proper Persons.

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

CoE Justin Welby live well together holding placard.png

“But we had to sell everything we owned at car boot sales, and later even my engagement ring.”

 

Andrew Smith, unfairly sacked NHS whistleblower and trade union rep, asks the National Guardian again for help

By Dr Minh Alexander NHS whistleblower and former consultant psychiatrist, 9 January 2020

The government’s response in the last five years to the embarrassment of repeated NHS whistleblower scandals has been to spin, spin and spin some more.

It has wasted our money on the non-evidence based, hollow,  Freedom To Speak Up project which serves only as a firewall against whistleblowers, whilst pumping out shameless government propaganda.

There is a copious trail of failure by the National Guardian and her Office, which demonstrates arbitrariness and a bias to protecting the powerful, at the expense of safety culture and patients.

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

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

One of the National Guardian’s most serious failures is her resistance to helping ensure redress for harmed whistleblowers.

Some have been ruined after refusals by the National Guardian and her Office to intervene and challenge the detriment that they have suffered.

Poor handling of patient safety concerns has also been kicked into the long grass, because the National Guardian decided to reject referrals from whistleblowers if there are any outstanding employment processes, importantly including litigation. The latter can drag on for years.

“11. If I submit a case review referral, will the NGO definitely review my case?

The NGO will not review cases where:

• There is a police or fraud investigation
There are outstanding decisions to be made in the case, such as an on-going employment tribunal
• There are practical barriers to the review, for instance where the matter relates to historic issues and appropriate evidence may not be available
• Where the available information suggests that minimal learning will be obtained by undertaking a review”

https://www.nationalguardian.org.uk/wp-content/uploads/2019/12/case_review_phase_2_faqs.pdf

This is a ludicrous position. It allows ongoing harm both to whistleblowers and patients. It also sets up the excuse for another exclusion criterion – diminished relevance and limited scope for learning, based on arguments about the passage of time and turnover of key managers. In other words, defend and delay.

Contradicting this strategy of prolonged non-intervention, the National Guardian’s Office in fact promised in 2017 to recommend the reinstatement of unfairly sacked whistleblowers. But there has been no obvious sign that it has actually done so in the intervening years:

National Guardian’s undelivered promise to seek reinstatement of unfairly sacked NHS whistleblowers

 

Andrew Smith’s whistleblowing case at Mid Essex Hospital Services NHS Trust

Andrew Smith was a clinician, Gulf veteran and trade union representative who fell foul of Mid Essex Hospital Services NHS Trust just for doing his job as a rep.

In particular, the trust – which has a history of proven financial irregularities – objected to his pursuit of concerns that recruitment and retention premia payments had been wrongly withheld from frontline staff.

He reports that there was no adequate investigation of his concerns about payments being withheld from staff, and that a review looked only at a limited period in time, thus omitting vital evidence.

Alongside the controversy about the recruitment and retention payments for trust staff, the trust continued to struggle with serious workforce shortage:

  “NHS Mid Essex: why longstanding problems need ‘success regime’  An estimated £32m deficit, serious difficulty attracting staff and a catalogue of failings in patient safety have made it a cause for major concern” 

Andrew Smith won an employment tribunal claim for unfair dismissal and whistleblower reprisal, with senior nursing officers being personally criticised for mistreating him as a whistleblower. The trust was a sore loser and appealed, wasting more public money, but lost.

These are some summarised aspects of his legal case:

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

Even though he had been so clearly twice vindicated by both the ET and the EAT, the National Guardian’s Office ungenerously declined last year to review his case because there was still a remedy hearing to come.

The remedy hearing is now concluded.

Andrew Smith did not succeed in his request to be reinstated, and he believes that the trust did not give a fair account to the ET of the issues around reinstatement.

He also reports that trust management evidence to the ET included a remarkable comment that managers feared he might continue to raise concerns if he was reinstated.

A very far cry from Robert Francis’ utopian vision of NHS trusts being re-educated by the Freedom To Speak Up project to see whistleblowers as valuable assets.

Principle 5 Culture of valuing staff:

Employers should show that they value staff who raise concerns, and celebrate the benefits for patients and the public from the improvements made in response to the issues identified.”

Andrew Smith has now asked the National Guardian if she will support him with reinstatement, in line with her Office’s promise in 2017.

He has also re-submitted his request for a National Guardian case review.

There are no real excuses left to the National Guardian not to help.

Mid Essex Hospital Services NHS Trust is still not safe or well led, and it even attracted an additional CQC rating of “inadequate” use of resources:

Screenshot 2020-01-09 at 11.05.42

The CQC noted in January 2019 that trust whistleblowing governance was unsatisfactory:

“There was a mixed culture within the trust. There were some concerns that staff did not always feel as if their concerns were listened to and managed appropriately.”   

If the National Guardian will not help a legally vindicated, unfairly sacked whistleblower, that would further damage the credibility of her Office.

Especially when one of the trust’s senior nurses who were criticised for whistleblower reprisal went onto employment as an Improvement Director at NHS Improvement.

NHS Improvement acknowledged that the ET finding of reprisal was of concern, and it advised that the manager in question had been spoken to and had agreed to reflect on the matter. NHS Improvement also indicated that it would: “carefully consider whether we need to do anything further.”

If there is no restoration of career loss suffered by whistleblowers, contrasting with job security for those who harmed them, there is no real culture change.

And whistleblowers deserve much better than the unkind, tokenistic and variable NHS whistleblower employment support scheme.  

Andrew Smith’s letter to the National Guardian seeking help with reinstatement is provided below in the appendix.

Many whistleblowers will recognise in this letter the stress and suffering not just to whistleblowers themselves, but also their families.
RELATED ITEMS

The abuses will not end until there is genuinely fit for purpose UK whistleblowing law and complementary infrastructure to enforce governance standards. Replacement law should favour robust early intervention, harm prevention for both whistleblowers and the public, and swift redress where harm occurs. It also needs to recognise harm to third parties, such as family members.

Replacing the Public Interest Disclosure Act (PIDA)

APPENDIX

Letter 8 January 2020 by Andrew Smith to National Guardian

Please note a slight error of fact – where the letter refers to the CEO of NHS Improvement, this should say ‘Chair’.

 
“BY EMAIL, copied to PIDA date fao Mr Cleverly Mp / DOH safety reports and CQC Mid Essex Inspector.
Dr Henrietta Hughes
National Guardian
Care Quality Commission

Dear Dr Hughes,

Request for help with reinstatement after a finding of unfair dismissal

I understand from information in the public domain that your Office gave an undertaking in 2017 to help reinstate NHS whistle-blowers who have been unfairly sacked.

https://minhalexander.com/2020/01/04/national-guardians-undelivered-promise-to-seek-reinstatement-of-unfairly-sacked-nhs-whistleblowers/

I whistle-blew at Mid Essex Hospital Services N.H.S Trust, and suffered serious reprisal, including vexatious disciplinary processes and dismissal.

The Employment Tribunal (ET) determined that I had been unfairly sacked and that I had been the victim of a witch hunt. The trust still did not accept responsibility for its misconduct despite the ET finding in 2017. It prolonged my and my family’s ordeal, and wasted public money by appealing, but it lost this appeal in 2018.

https://minhalexander.com/2019/02/07/the-unfair-sacking-of-andrew-smith-nhs-whistleblower-and-trade-union-representative-a-heady-cocktail-of-tainted-ingredients-or-how-cqc-nhs-improvement-mid-essex-hospital-services-nhs-trust-w/

I am a skilled, experienced theatre anaesthetic nurse of 28 years N.H.S service, with an unblemished clinical record and specialist skills. I am a Gulf war veteran and served my country.

But since being unfairly sacked, I have struggled to get work and it appears that I have been stigmatized and most likely blacklisted as a result of whistle-blowing. I have been turned down for many jobs for which I am amply qualified. I have either not been shortlisted or not even received responses to my job applications. I can only pick up sporadic, small pieces of agency work.

The compensation from my Employment Tribunal action against Mid Essex Hospital Services N.H.S Trust was not enough to make up for the serious financial loss that I have suffered as a result of being unfairly sacked.

I have a spouse to support and four older children whom I would ordinarily support. However, because of the detriment caused by Mid Essex Hospital Services N.H.S trust, my older children have had to use their savings to financially support me and my wife in order to make ends meet and to keep our home. In addition I am carer for a child, due to circumstances in our family, and the financial uncertainty has been a struggle.

My savings have been used up in the long years of legal dispute with my former employer, and I have no reserves for the future. The stress of our financial struggle and insecurity has made both me and my wife ill. After losing the ET and EAT cases, Mid Essex Hospital Services NHS Trust nevertheless resisted my reinstatement in remedy hearing.

During oral evidence to the Employment Tribunal, one of the trust managers claimed that I could not be reinstated because there were no vacancies, and the only way to give me a job would be to take a job away from someone else and remove the post from who replaced me. I very much doubt that this was true, because contacts at the trust have informed me that there were vacancies and that the trust had to rely a lot on agency staff.

[Redacted] manager…previously advised “Andrew could return, with right support from managers”. In 2019 that changed in 2019 from his previous statement. He further advised the Tribunal that he had not even read the two Tribunal Judgements 2017-18, or seen the evidence in legal bundies. He advised Tribunal that he had based his assertion on the previous managers. No learning appears to have occurred from my whistle-blowing case.

Therefore I believe the trust simply did not want me back, despite me being cleared by tribunal. The same trust manager at remedy hearing said in oral evidence that he was concerned that if I returned to the trust, I would continue raising concerns. I believe that is a completely improper reason for resisting my reinstatement.

I need employment to keep my health and my family together. I was a charge Nurse in the Regional Burns and Plastics Theatres the only one of its type in my area. Non reinstatement will impact on my 1995 NHS pension plans of my NHS career.

Please can you advise what help you can offer with respect to supporting my reinstatement?

I should add that I did ask your Office to review my case previously, but it turned me down, referring me to [NHSI] whistleblowing complaints dept. I was advised non review was because I had an active Tribunal, which in my case took from 2015-December 2019.

I hope that you will now conduct a case review with regards to my treatment by Mid Essex Hospital Services N.H.S trust now Tribunal is finalised.

This is especially as one of the senior managers who was found guilty by the Employment Tribunal of mistreating me as a whistle-blower has walked away from the matter unscathed. She went on to become a director at N.H.S Improvement, whilst I and my family suffer the immense stress and worry of just keeping a roof over our heads and basic bills paid.

I have included you a copy of 2017 Reserve Judgements as it is not available online from Tribunal office. N.H.S.I C.E.O is aware of my complex case via N.H.S.I W.B complaint dept.

Once again following completion of Tribunal process in 2019 my case was returned to NHSI W.B complaints dept, despite my requesting CEO N.H.S.I forwarded it to National Guardian for a case review.

N.H.S England N.H.S.I have been aware of my complex Multi Agency P.I.D.A a number of years, whilst Meht was placed into special Measures June 2015 at the very same point of my unlawful Disciplinary process.

I had warned of my safeguarding and case concerns in Meht and via Multi Agency P.I.D.A 2013-15. Meht managers and Executives failed the safeguarding promised in Francis Reports. Safeguarding also never materialized via Doh or CQC/ NHS England 2013-19.

Please see below time line link regarding Broomfield M.E.H.T System wide failures and success regime June 2015..

NHS Mid Essex: why longstanding problems need ‘success regime’

Not least of all, I am very concerned that the trust represents an ongoing risk to other whistle-blowers and therefore an ongoing risk to patients.

You can obtain my contact details from N.H.S.I W.B Complaints dept, who have an active file. My legal bundles are soon to be released would help a case review and current Regulatory body investigations.
Yours sincerely,

Andrew Smith

Eng Rn1

Raised Concerns in Broomfield MEHT 2011-2014.
Multi Agency External P.I.D.A 2013-20
Sir Francis “Right to Speak up Contributor” 2014-15.

Tribunal case 3202272/2015, Judgements 2017,18, 19.”

 

By day Henrietta, by night Lanyard Woman

National Guardian’s undelivered promise to seek reinstatement of unfairly sacked NHS whistleblowers

By Dr Minh Alexander, NHS whistleblower and former consultant psychiatrist, 4 January 2020

The government’s strategy on NHS whistleblowing scandals has been to manage the news but not to manage the problem.

Accordingly, for the last week the NHS denial machine has been revving hard to publicise the government’s dubious award of an OBE to Henrietta Hughes the National Guardian for services to the NHS.

NHS England, NHS Improvement, CQC, PHSO, NMC, GMC and BMA have led the faux cheerleading to spin a story of achievement. Ambitious acolytes have paid their careerist taxes in fawning tribute.

There is no evidence that the National Guardian has genuinely improved NHS whistleblowing governance. But there is plenty of evidence of continuing serious detriment to NHS whistleblowers

In 2014, Jeremy Hunt, former Health Secretary and Spinner In Chief commissioned thepolitical theatre of the watered down Freedom To Speak Up Review by the then recently knighted Robert Francis.

Some questioned if the knighthood was a reward for the dilution of the MidStaffs public inquiry:

Knighthood for a whitewash?

Francis’ Freedom To Speak Up Review report was a compromised effort, with many loopholes in employers’ favour.

But he managed a few words on ensuring redress of detriment, recommending that the National Guardian should help to ensure redress.

Since then, the Department of Health and Social Care and its arms length bodies which fund and control the National Guardian’s Office have done their best to erase this inconvenient detail. Their policy documents were written to focus instead on vague culture change, instead of any practical help and protection for whistleblowers. And the National Guardian has toed this political line:

  Whistleblowing in the NHS isn’t fixed yet, and this leaves patients exposed. An overview of unfinished policy business.

However, in a rash moment her Office promised in 2017 to recommend the reinstatement of unfairly sacked whistleblowers.

There has been no sign that it has done so.

I have written to the National Guardian as below to ask if the promise will be made good.

Dr Minh Alexander

 

BY EMAIL

Dr Henrietta Hughes
National Guardian
Care Quality Commission

4 January 2020

Dear Henrietta,

National Guardian’s remit for helping to redress harm suffered by whistleblowers

I write to re-visit an undertaking by Russell Parkinson, your Head of Office (copied below) which was given in response to a letter to you.

It relates to the recommendation by Robert Francis in his report of the Freedom To Speak Up Review that your Office should help ensure:

“redress to any patients or staff harmed by any failure to address the safety risk”.

http://freedomtospeakup.org.uk/wp-content/uploads/2014/07/F2SU_web.pdf

In response to my question to you of 18 April 2017:

“….may I ask if (and if so, how) the National Guardian’s office will intervene by challenging employers who appear to have dismissed whistleblowers as an act of reprisal,”

Russell replied on 5 May 2017:

“Where a case review finds evidence that a whistleblower has been dismissed inappropriately, we will make recommendations that action is taken, as appropriate.  This may include recommending that the employer reinstates the worker concerned.”

Since then, I have not been aware of any case in which the National Guardian has recommended the reinstatement of a whistleblower who has been unfairly sacked.

Rather, I have been aware of subsequent advice from your Office to whistleblowers that it cannot intervene in employment disputes.

Congruent with this, your published advice explicitly states thats you will not conduct a case review if there are outstanding employment processes:

“The NGO will not review cases where….There are outstanding decisions to be made in the case, such as an on-going employment tribunal”

https://www.nationalguardian.org.uk/wp-content/uploads/2019/12/case_review_phase_2_faqs.pdf

To my knowledge, your case review reports have not featured recommendations for redress of detriment suffered by individual whistleblowers, and have focused on generic governance issues.

Nevertheless,

1. Please can you advise if your Office will stand by its 2017 promise to recommend the reinstatement of unfairly dismissed whistleblowers?

Andrew Smith NHS whistleblower and trade union representative was found by an Employment Tribunal to have been unfairly dismissed by Mid Essex Hospital Services NHS Trust.

Would you recommend a whistleblower’s reinstatement, if they so desired it, on the basis of such legal findings of fact?

2. I am aware of whistleblowers proven to have been unfairly dismissed who have not been accepted by your Office for case review.

Can you advise if your Office has accepted any unfairly dismissed whistleblowers, or whistleblowers who tell you that they have been unfairly dismissed, for case review?

https://minhalexander.com/2017/05/18/national-guardian-reprieves-nhs-employers-but-condemns-whistleblowers-and-patients/

If so, has your Office recommended the reinstatement of any of these unfairly dismissed whistleblowers, and were the recommendations accepted by employers?
Yours sincerely,

Minh

Dr Minh Alexander

 

RELATED ITEMS

There is no shortage of evidence of National Guardian failure. Here are just a few of the items:

National Guardian reprieves NHS employers, but condemns whistleblowers and patients

National Guardian’s Office: Why it cannot be a model for protecting whistleblowers

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

Fake government firewalls against whistleblowers, such as the unspeakable National Guardian’s Office, must be swept away and replaced with real protection:

Replacing the Public Interest Disclosure Act (PIDA)

STFU not FTSU