“Our whistle-blower reporting program is an independent, investigative ethics service operated by our multi-disciplinary team of forensic accounting and investigative professionals. Our security consultants have experience dealing with personal and corporate safety, and security concerns that may be identified by callers.”
Should a company which profits from the whistleblowing industry really be conducting a review of UK whistleblowing law?
Moreover, in common with other similar large corporations, Grant Thornton has been repeatedly fined both here and abroad for breaches of audit standards.
Also of concern, the Whistleblowing APPG’s controversial secretariat, the the private company WhistleblowersUK,, has suggested publicly that it has access to the government’s review process:
This raises a question of whether the government’s review is being conducted fairly and inclusively.
It is especially a concern given that WhistleblowersUK are pro bounty. The company recently made this very clear:
The event was co-sponsored by Kohn Kohn & Colapinto, a huge and powerful US law firm which has made a fortune out of the US bounty hunting arrangements. A partner, Stephen Kohn, spoke at the Whistleblowing APPG’s event.
I asked Grant Thornton for information on the timetable for the whistleblowing law review and how evidence is being collected and marshalled for the review.
Her LinkedIn profile states that she is/was a Departmental Assistant Director.
I suggest that any parties who oppose the US bounty hunting model, which the Whistleblowing APPG and its associates are pursuing, let the government know of their views via the above email addresses.
The Department will be asked for more information about its review and how Grant Thornton were hired.
A prominent member of the Whistleblowing APPG who daily rails on social media at financial corruption and inequity, Prem Sikka (The Lord Sikka) has been vociferous in criticising Grant Thornton:
WhistleblowersUK has also made critical comments about Grant Thornton, accusing them of colluding in “criminal activity”:
I have written to Prem Sikka about Grant Thornton’s role in the whistleblowing law review, and I have also written to Andrew Verity at the BBC, who attended one of the APPG’s events.
Dr Minh Alexander retired consultant psychiatrist 27 July 2023
Questions have been raised about whether Post Office Ltd treated ethnic minority postmasters less favourably in its discredited Horizon prosecutions. There was also a question of harsher sentences for such postmasters.
The Communications Workers Union published this challenge last year:
At that point, the Post Office refused to provide a full list of the individuals convicted for Horizon issues.
“Eastern Eye’s request for a list of the 738 postmasters who were convicted between 2000 and 2015, in order to investigate the matter further, was rejected by The Post Office for, in their words, ‘data protection reasons’.
El Shaikh @ElCShaikh a campaigner who has supported her local postmaster and the harmed postmasters generally, recently unearthed evidence of Post Office Ltd (POL) using outdated and offensive racial terms such as “negroid” to describe the individuals whom it had prosecuted.
However, the police are also required to use self-defined ethnicity codes, including where a suspect’s self-assessment differs from an officer’s visual assessment:
“The Home Office requires Section 95 Criminal Justice Act 1991 (a statutory framework providing data about Black and Minority Ethnic people and the criminal justice system) information to be provided in both SDE and visual assessment formats.”
“Self-defined ethnicity does not relate to visible appearance but to a person’s self-image in relation to his or her own cultural origins. Where it is to be used, a police officer must record the SDE category chosen by the person encountered, even if the category chosen is clearly at odds with the officer’s visual assessment.”
Related to the gathering of ethnicity data, the public sector duty to promote Equality, applies both to public bodies and bodies which exercise public functions.
As a wholly publicly owned company discharging a function such as prosecution, it would be reasonable to expect that Post Office Ltd should adhere to the legal public sector Equality Duty and to “Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.”
As the law presently stands, a private body might be held to be exercising a public function and thus subject to the general equality duty if, in respect of that function, some or all of the following factors are present:
it is publicly funded, or has significant reliance on public funding
it is exercising powers of a public nature directly assigned to it by statute
it is taking the place of central or local government
it is providing a public service
it is acting in the public interest
its structures and work are closely linked with that of the delegating or contracting-out State body
there is a close relationship between the private body and any public authority
it is supervised by a State regulatory body, or
it is exercising coercive powers devolved from the State.[1]”
The public sector Equality Duty requires the collection of evidence, to demonstrate an organisation’s level of Equality practice and to monitor progress.
“5.15 In order to give proper consideration to the aims set out in the general duty, a relevant body will need to have sufficient evidence of the impact its policies and practices are having, or are likely to have, on people with different protected characteristics. Such information is referred to in this guidance as equality evidence.
“5.1 If a body subject to the duty does not have sufficient evidence to make an informed decision about the impact of their functions for some protected characteristics, the authority should consider gathering more evidence.
The Post Office’s publicity material suggested that the company was not routinely collecting Equality data on postmasters, with this explanation:
“We don’t collect data on the ethnicity make-up of our Postmasters. The main reason for this is that there are a number of different ways of becoming a Postmaster. You can be an independent Postmaster who runs your own Post Office. But we also have Post Offices operated by our Strategic Partners, for example WH Smith, Tesco, Co-op and Spar. They employ staff to run Post Offices. Some Post Offices are also run by registered companies or as partnerships trading as a business.”
However, the POL blog does reveal:
“There are over 7,000 independent Postmasters and around 1,300 completed the survey. Almost one in three (29%) described their ethnic group as Indian, 6% described it as Pakistani, 1% Bangladeshi, 8% any other Asian background and 1% a mixed White and Asian background. Whilst these stats cannot be deemed statistically representative of the whole independent Postmaster population, it nevertheless gives an insight into why it’s so important that Post Office celebrates and champions South Asian Heritage Month”
Moreover, an FOI request on 30 May 2022 by Gurpreet Kaur via the What Do They Know website revealed that in 476 cases of postmasters “convicted potentially using evidence from the Horizon system”, ethnicity was not recorded in 160 cases. Where ethnicity was recorded (in 316 cases), there were 123 postmasters were from Black, Asian or Minority Ethnic backgrounds. Or in other words, about 39% of the convicted postmasters were of Asian or other minority background, assuming missing ethnicity data for 160 cases was similar to the sample of 316 cases for which ethnicity was available.
I asked POL for more information about ethnicity data and possible equality impact assessments that might have been carried out on the Horizon prosecutions.
The company indicated that it had not carried out any Equality impact assessment on Horizon prosecutions.
“Post Office can also confirm that, in response to Q4, it has not carried out any Equality Impact Assessments of convicted postmasters nor has it analysed the ethnicity data of those prosecuted.”
“With regards to Q5, Post Office has not carried out any specific review of this case in respect of bias and/or race impact. Sentencing is of course solely a matter for the Courts.”
The imprisonment of Seema Misra raised not just Race Equality issues but also issues of Sex Equality. At the time of her imprisonment, female offenders and their families were recognised to have special needs and serious vulnerabilities. The 2007 Corston report had recommended that women should not be imprisoned except for risk of violence and that no woman with children should be sent to prison without a full social circumstances report:
“Custodial sentences for women must be reserved for serious and violent offenders who pose a threat to the public….Women must never be sent to prison for their own good, to teach them a lesson, for their own safety or to access services such as detoxification.”
“Defendants who are primary carers of young children should be remanded in custody only after consideration of a probation report on the probable impact on the children.”
“The Government has recently published a Review by Lord Carter of Coles, ‘Securing the Future: Proposals for the Sustainable and Efficient Use of Custody in England and Wales’. As a result of that Review, Ministers will consider the Government’s response to the broad thrust of Lord Carter’s recommendations in relation to the issue of women offenders. The intention is to ensure that, in making any changes in response to Lord Carter’s recommendations, the approach is appropriate for women and complements the commitments in this Response to the Corston Report.”
“The Post Office’s former senior criminal lawyer, Jarnail Singh, described his team’s success as destroying the defence’s arguments against the Post Office Horizon accounting software.”
“In the email, which was copied to several executives, Singh wrote:
“After a lengthy trial at Guildford Crown Court [Seema Misra] was found guilty of theft. This case turned from a relatively straightforward general deficiency case to an unprecedented attack on the Horizon system. We were beset with unparallel [sic] request for disclosure requests by the defence. Through the hard work of everyone, counsel Warwick Tatford, investigation officer Jon Longman and through the considerable expertise of Gareth Jenkins of Fujitsu, we were able to destroy to the criminal standard of proof (beyond reasonable doubt) every single suggestion made by the defence. …”
Gareth Jenkins, who was praised in the email, is currently under investigation by the Metropolitan Police for potential perjury in the trials of subpostmasters where he gave evidence.”
It is also surprising to hear that POL believed they were not required to routinely record protected characteristics. The police and CPS have been collecting information about offender characteristics for many years.
The CPS introduced a Single Equality Scheme in 2006 which included the CPS’ Race Equality Scheme 2005-2008. This identified the following as CPS functions of relevance to Race Equality:
“The following key priorities were raised following the earlier consultation which took place as part of the development of the Race Equality Scheme 2005-08 and are included in this Scheme:
o Effective handling of racist crime, to include the elimination of inappropriate down grading of charges and increase successful outcomes
o Effective handling of religious crime, to include the elimination of inappropriate down grading of charges and increase successful outcomes
o Monitoring of terrorism related cases oAssuring communities of the independence of the CPS in the context of Statutory Charging
o Charging of ethnic minority offenders o Community Advocacy”
[my emphasis]
Despite omitting to even collect proper data on the protected characteristics of the people whom it prosecuted, and its refusal to conduct a retrospective equality impact assessment, Post Office Ltd claimed that it did not tolerate racism:
“We would like to make you aware that Post Office has instigated an investigation into the document in media reports you refer to. Post Office does not tolerate racism in any form and an update on the investigation can be found on our website here:
“Post Office has begun a search of all known active and historical documents to ensure there are no other documents that may contain racist or offensive language.”
“Post Office has appointedJeremy Scott-Joynt,a barrister from Outer Temple Chambers, as an external legal advisor to review all evidence, contribute to the direction of the investigation and assist in drafting the Final Investigation Report.”
It is a pity the same energy cannot be directed at a proper review of whether Post Office Ltd discriminated against BME postmasters in its Horizon prosecutions.
In keeping with a theme of reputation management, POL was keen to distance itself from its past leadership:
“Since the 2019 change of leadership, Post Office has been clear that it will never again carry out its own prosecutions.”
I have asked POL to provide the early CPS guidance which it claims did not require it, as a prosecutor, to keep records on the protected characteristics of people who it prosecuted.
I have also asked the Post Office if it ever established formal data collection on the protected characteristics of those whom it prosecuted.
It seems a very serious matter that a prosecutor appears unable to account for whether it treated ethnic minorities fairly, when there is evidence that the organisation has used racist terminology.
The more so in a matter of such grievous and widespread miscarriage of justice.
Dr Minh Alexander retired consultant psychiatrist 26 July 2023
Summary: After a delay and only as a result of intervention from the ICO, the GMC has disclosed information on its processes which shows that it is not centrally collating data to track variations between employers who refer doctors to the GMC. It has not followed up many cases where employer referrals have not even led to an investigation by the GMC, by feeding back to the relevant employers. This is despite a claim that it is GMC procedure to do so. GMC’s policy does not cover feedback to employers after cases which are investigated but result in no further action, which seems an omission. Although the GMC advises that it works with employers to reduce the level of unnecessary referrals, it does not keep a record of whether referrals are necessary. The GMC declines to tighten its rules to deter medical managers from making vexatious referrals. The GMC has also finally broken its silence about referrals by University Hospitals Birmingham NHS Foundation Trust. According to the GMC, even “corrected” data by the trust contained inaccuracies, but a broad picture of a high proportion of referrals leading to no investigation or to no further action by the GMC is confirmed. It is hard to see how GMC is safeguarding whistleblowers effectively given the above omissions.
The General Medical Council is the professional regulator for doctors and is funded by compulsory fees paid by doctors.
It has lost the confidence of many doctors after years of poor decisions, including the harmful handling of cases and related suicides of referred doctors, inconsistent approaches and perceived unfairness towards of ethnic minorities, caprice in both excessive harshness and leniency, failure to protect the public from doctors such as Ian Paterson the jailed breast surgeon whilst allowing employers to harm whistleblowers and latterly, and latterly failure to take action in cases of vaccine disinformation by a few individuals.
At the recent annual BMA conference, a motion of no confidence in the GMC passed. This included a call for senior officers of the GMC and Medical Practitioners Tribunal Service to be dismissed.BMA declares it has no confidence in the GMC 4 July 2023
Last year, UHB supplied flawed data about its GMC referrals. It was asked to correct these when it became clear from published MPTS data that the UHB FOI data was flawed. UHB did not correct the data until 13 April 2023:
RESPONSE BY DAVID BURBRIDGE, UHB CHIEF LEGAL OFFICER, 13 APRIL 2023
Dear Dr Alexander
Please find below a response to your email to Dame Yve Buckland, dated 29 March.
For the period 1 April 2012 to 31 March 2022:
– How many doctors the trust referred to the GMC ?
At UHB (prior to and post the merger with Heart of England NHS Foundation Trust (“HEFT”)) there were 22 referrals
At HEFT (prior to the merger with UHB) there were 16 (3 of these are dated just after the date of merger 1.4.2018, but are attributed to HEFT – we believe this may be because there was contact before the change of RO)
– How many of these referrals were signed off by the medical director?
At UHB 14/22, the remainder were signed off by Deputy Medical Director or acting Medical Director
At HEFT 6/16 were signed off by the Medical Director and the remainder were by Deputy or Associate Medical Directors.
– How many of these referrals resulted in no further action by the GMC?
UHB – 4 were concluded at triage, 7 were investigated and concluded with no action, 11 were subject to advice, warning, undertakings, suspension or erasure HEFT – 3 were concluded at triage, 4 were investigated and concluded with no action, 9 were subject to advice, warning, undertakings, suspension or erasure
– How many doctors died whilst under GMC investigation or monitoring? None
– How many doctors died by suicide whilst under GMC investigation or monitoring? None Regards
David Burbridge Chief Legal Officer
In the months between, the trust and ICB had the gall to spin the supply of false data by UHB as misreporting by BBC Newsnight, who merely reported what the trust had claimed.
It is a detailed reply, with some claims of good practice, but it is evasive and obfuscatory on important points.
Data about UHB’s referrals to the GMC
The GMC’s response provides the following data on GMC referrals by UHB:
“With respect to the data that UBH provided, the data on the total number of referrals is correct, however there is an inaccuracy in the data on cases which concluded at triage / concluded with no actions:
“UHB reported that of the 22 referrals, four were concluded at triage, seven were investigated and concluded with no action, 11 were subject to advice, warning, undertakings, suspension or erasure.
In fact, of the 22 referrals from UHB the outcomes were that three were concluded at triage, eight were investigated and concluded with no action and 11 were subject to advice, warning, undertakings, suspension or erasure.
Turning to Heart of England NHS Foundation Trust (HEFT), the data you were provided with states that six of 16 referrals were signed off by the Medical Director and the remainder were by Deputy or Associate Medical Directors. Our data indicates that the number of referrals by the Medical Director was five.
Finally, one of the nine referrals which was said to have ended by way of advice, warning, undertakings, suspension or erasure actually ended by means of being referred to the doctor’s Responsible Officer.
Further information on outcomes
Of the 11 investigations stemming from UHB referrals which were subject to advice, warning, undertakings, suspension or erasure, two were closed with advice. The number for HEFT is also two.”
GMC’s tracking of the quality of employers’ referrals
The GMC has advised that since May 2022, it has operated a policy of feeding back to employers where referrals do not result in a GMC investigation, but has only provided feedback on three occasions:
“The feedback loop between our Case Examiners and the Employer Liaison Service (ELS) was implemented in May 2022 in response to the following recommendation in Fair to Refer?
Where a referral is received from an employer/provider which does not result in the GMC opening an investigation, the ELA [Employment Liaison Adviser] and RO [Responsible Officer] should have a discussion to identify learning in relation to the original referral. If a referral comes in that either doesn’t involve an ELA, or does involve an ELA but doesn’t get past our initial triage stage, the ELA team scrutinise this to understand what learning can be taken from the referral. For those referrals that get to a CE decision, if the CE [Case Examiner] identifies learning for the referring organisation about the referral, then that is shared back via the ELA.
Providing feedback is at the discretion of the CEs to do so when appropriate. As of May 2023, there had been three cases where it was appropriate to utilise this feedback loop.”
“Triage / RO feedback loop:
we have also implemented a further feedback loop between the team that initially assess concerns (triage) and our ELS to support further discussion between the ELS and ROs on cases that have been considered and closed by us at triage where there are opportunities to feedback on aspects of the referral that would be useful learning for ROs and their organisations.”
GMC has indicated in its FOI response that 85% of these referrals from employers pass the threshold for investigation:
“85% of the referrals we received from ROs [Responsible Officers] in 2022 met our test for an investigation.”
It seems anomalous that the GMC has given feedback to employers on only three occasions since May 2022.
It is also a concern that GMC appears not to be concerned about the levels of referrals from employers which are investigated but result in no further action by the GMC.
The GMC claimed in its FOI response that it is working to reduce the level of unnecessary referrals:
“We’re supporting the work of our partners to standardise local investigation processes and how these might address disproportionality at the early stages of a concern being raised, to avoid unnecessary GMC referrals.”
However, GMC does NOT collate data about whether referrals that it receives are necessary:
“In respect of your question as to if referrals which ended in advice were necessary, we don’t hold data on whether referrals were necessary…”
This seems half-hearted.
Although the GMC monitors the performance of individual employers through its attached Employment Liaison Advisers, it has not provided any evidence that it systematically uses the information to track differences between organisations and to thus identify outliers.
In response to a question on whether the GMC has plans to track differences between employers’ referral patterns, the GMC strangely referred me to the following document:
The document is about GMC performance targets on tracking how doctors with protected characteristics and related factors are treated, and not differences between employers.
So, whilst superficially adopting the recommendations of the Hooper review, the GMC still protects the powerful through wilful blindness and failure to actively check for signs of abuse. It does not seek to actively identify outliers and seems not to collate nor extract data that would enable comparisons and the identification of outliers. Leaving abusers unpunished is not effective safeguarding of whistleblowers.
And yet GMC received this advice from Hooper in 2015:
“24. The effect of the reprisals on individuals at work and at home is likely to be devastating. Doctors who have devoted their lives to the care of others face the prospect of their careers being brought to an end. One of the consequences may be that the doctor against whom the retaliatory measures are being taken becomes clinically depressed. His or her depression may then be used as justification for further action against the doctor.
25. It is self-evident that the fear of suffering reprisals acts as a powerful disincentive to raising concerns, as does also a belief that the concern will be ignored. The attainment of the objective of patient safety therefore requires that the risk of reprisals is reduced or eliminated, and that concerns are not ignored.”
GMC resisted a suggestion to amend Good Medical Practice for medical managers, to make it a proscribed practice for doctors in leadership positions to carelessly or knowingly make unsubstantiated or false GMC referrals or PPA referrals on doctors whom they manage. GMC claimed that its existing general guidance on conduct is sufficient. Many harmed whistleblowers would likely disagree, based on years of GMC inaction over abusive medical managers.
A telling detail from the GMC’s FOI response is that GMC says it deploys a special protection for referred whistleblowers. It checks whether the referrer’s claims can be corroborated before launching an investigation:
“In the cases where a doctor has raised concerns in the public interest, we seek independent corroboration of the concerns raised by the employer before deciding whether to open an investigation. If a full investigation is needed, we ensure the investigation focuses on independent corroboration of concerns raised by the employer.”
Should the GMC not be doing this for ALL doctors who are referred?
After all, the trauma and serious harmful health effects of a GMC referral and investigation are well known.
In all, the GMC appears to remain establishment-centric. Its bias is towards power. It has implied that it routinely opens investigations without corroboration of employers’ concerns. It appears to have not followed up on many cases where employers’ referrals have not led to a GMC investigation. It avoids data analysis and collation that might reveal rogue employers, and it will not tighten the rules for medical managers to deter vexatious referrals.
“NHSE has powers regarding the replacement of trust leadership which it uses in extreme and exceptional circumstances, and applies fairly, reasonably and proportionally, and with the interests of those served by the trust in mind.”
I have asked GMC for some further details and clarifications regarding the responses it gave which were vague or evasive.
I have also asked for a list of NHS trusts which since May 2022 have made referrals which did not result in GMC investigation, and the numbers of such referrals made by each of the trusts in question.
Dr Minh Alexander retired consultant psychiatrist 24 July 2023
This is a post to share correspondence to the Information Commissioner about a stubborn failure by NHS Resolution to fully disclose data on personal injury claims by NHS staff during the years since the pandemic started.
NHS Resolution has been handling personal injury claims by NHS workers affected by long COVID, but claimed it could not provide data about this, because it had no specific code for long COVID.
When asked to disclose data on all claims spanning the pandemic years, under all existing codes, NHS Resolution bizarrely cherry picked and supplied data relating to only a few injury codes.
It has prevaricated and delayed in supplying the withheld information, which includes claims which fall under codes such as “breathing difficulties”, sensory loss and “brain damage”.
I have referred the matter to the ICO.
The correspondence is below. The headline figures quoted from NHSR in the appendix relates to the period 2018/19 onwards. (Pre-pandemic years were included in the request for comparison).
BY EMAIL
Information Commissioner
24 July 2023
Dear ICO,
Failure by NHS Resolution to provide information about NHS staff personal injury claims during the pandemic
I have been trying to seek out information about how long COVID has affected the NHS workforce.
This is information of substantial public interest for a number of reasons.
Firstly, the government and NHS oversight bodies have indicated that they have not been collating data on the scale of harm to NHS staff from long COVID, which seems a negligent omission.
The infection of NHS staff and resulting significant disability is a reflection on infection control processes, and the government should be recording all relevant information in order to learn from the harm and to mitigate risks.
The scale of harm is a basic starting point in evaluating matters.
I therefore approached the matter from a different angle, and asked NHS Resolution on 6 March 2023 to provide me with data on all personal injury claims by NHS staff under all existing injury codes for a period spanning the COVID pandemic and the two years prior to the pandemic for comparison.
Inexplicably, NHS Resolution provided me with data on only some of the personal injury claims by NHS staff in the period in question.
NHSR limited its response to a small selection of its injury codes, and failed to disclose data relating to claims under the rest of the injury codes.
It offered no valid legal grounds for exemption of disclosure under FOIA with respect to the information that it had withheld.
When I challenged this, including with information from past FOI disclosures by NHS Resolution which showed that it held data relevant to the omitted injury codes, NHSR apologised on 10 May 2023, claimed that it was seeking advice from “subject matter experts” and indicated that it would provide me with a substantive response within two weeks.
Since then, NHSR has repeatedly failed to provide the missing data and despite further unreliable promises to do so:
NHSR email 30 May 2023:
“We hope to provide you a substantive response within 2 weeks”
NHSR email 19 June 2023:
“We hope to be able to provide you with a response by the end of next week”
I should point out that all this is very uncharacteristic behaviour by NHS Resolution, which is usually punctilious in responding to FOI requests.
I do not think it is reasonable wait any further, especially as all coded information is electronically accessible and there should be no reason why NHS Resolution could not have provided the requested information, in full, much sooner.
I would be grateful for the ICO’s help in accessing the missing data.
In the appendix below, I set out the injury codes for which NHSR has provided personal injury claims data, and the remaining injury codes for which NHSR has still provided no claims data.
The correspondence with NHSR, including the original FOI request on is forwarded below.
Many thanks and best wishes,
Dr Minh Alexander
Cc Helen Vernon CEO NHS Resolution
Baroness Heather Hallett UK COVID inquiry
APPENDIX
NHS Resolution has provided data on personal injury claims made NHS staff which fall under the following codes:
Orthopaedic Injuries
2,403
Psychiatric Damage
372
Facial Injuries
199
Head Injuries
185
Injuries to Internal Organs
96
Burns
51
Damage
50
Sickness/Disease
45
Injuries affecting the senses
33
Other
24
Fatality
15
Scarring (Except Facial)
12
Unknown
#
Damage to Hair
#
NHS Resolution has failed to provide data on personal injury claims by NHS staff which fall under the following codes:
Dr Minh Alexander retired consultant psychiatrist 22 July 2023
I am unable to do this serious matter justice and am posting in summary to share a recently published report on a surgical scandal at Salford Royal Hospital, which is now part of the Northern Care Alliance NHS Foundation Trust:
The trust’s predecessor body the Salford Royal NHS Foundation Trust was for some years practically deified by regulators as an exemplar of unimpeachable safety practice. It was one of several trusts used by Jeremy Hunt as a rod with which to batter struggling, under resourced NHS trusts.
In August 2014 an anonymous whistleblower raised concerns with:
– The trust (in predecessor form, as the then Salford Royal NHS Foundation Trust)
– The General Medical Council
– Robert Francis
– The Care Quality Commission.
The “look back review” stated:
“In August 2014, an anonymous whistleblower contacted Salford Royal NHS Foundation Trust (now known as the Northern Care Alliance NHS Foundation Trust), General Medical Council (“GMC”), Care Quality Commission (“CQC”) and Sir Robert Francis then QC, now KC, (a barrister who has chaired several high-profile medical inquiries) with concerns about Consultant Spinal Surgeon A. The letter from the anonymous whistleblower described a number of areas of concern relating to Consultant Spinal Surgeon A’s behaviour, conduct, probity and capability.
“Finally, I am announcing an independent review into creating an open and honest reporting culture in the NHS chaired by Sir Robert Francis QC, who chaired the landmark inquiry into the poor standards of care in Mid Staffordshire NHS Foundation Trust. The review is being established to provide independent advice and recommendations on measures to ensure that NHS workers can raise concerns with confidence that they will be acted upon, that they will not suffer detriment as a result and to ensure that where NHS whistleblowers are mistreated there are appropriate remedies for staff and accountability for those mistreating them. The review will consider the meritsand practicalities of independent mediation and appeal mechanisms to resolve disputes on whistleblowing fairly. It will do this by listening to and learning the lessons from historic cases where NHS whistleblowers say they have been mistreated after raising their concerns and by seeking out best practice.”
It is reasonable to surmise therefore that the anonymous whistleblower disclosed to Francis personally in expectation of a best practice system response to their concerns.
According to the just published report, what followed was that the surgeon was dismissed in January 2015.
It was not until September 2015 that the trust invited the Royal College of Surgeons to review possible harm to patients:
“In September 2015, the Trust contacted the Royal College of Surgeons to request an Invited Service Review of the Trust’s spinal surgery service and to undertake a clinical review of 10 clinical records relating to patients at the Trust who had been under the care of Consultant Spinal Surgeon A1.”
The RCS reportedly found no substantive concerns:
“…there were no overall concerns about the standard of care provided to the patients that formed part of the review, although a series of complications were acknowledged. From the information present in the clinical records, it appears that the way in which the complications were managed once identified was appropriate in each case.”
Crucially, it appears there was more whistleblowing at the trust in 2016, which was not acted upon:
“In 2016, an internal request was made to review 17 patients to determine if any required either a clinical follow up or an appointment to determine possible preventable harm. The SPSLBR has been unable to determine if this progressed as the review did not follow the usual governance processes and at the time of producing this report, it has not been possible to determine why this was the case.”
FIVE years later, processes were finally established to review patient harm:
“In 2021, a multi-professional staff support group was established under the Trust’s Freedom to Speak Up process which raised new questions and concerns around the conduct, probity and capability of Consultant Spinal Surgeon A whilst they were employed by the Trust. This group raised concerns directly with the Trust Chief Executive and following this, the concerns were triangulated, leading to the realisation that clinical notes cannot be taken as accurate and correct, and emerging themes were identified with specific concerns around Consultant Spinal Surgeon A’s conduct, probity and capability whilst they were employed by the Trust. As a result, in January 2022, the Trust commissioned the SPSLBR Investigation Group to investigate these concerns.”
Why had concerns not been “triangulated” before, to reveal that the patient records were not reliable?
Did CQC and Robert Francis diligently ensure that the original 2014 whistleblower’s concerns were properly addressed?
Did CQC and or Francis receive any further disclosures, and if so, what did they do about them?
In 2018 when CQC renewed Salford Royal Hospital’s rating of “Outstanding”, it nevertheless noted some warning signs about whistleblowing governance in surgical services:
“Not all staff were aware of the role or purpose of the Freedom to Speak up Guardians, there was some concerns about the culture in theatres.”
“Whilst most departments felt supported and valued by the executive team and senior managers, some departments did not feel recognised by their peers, for example, in oral surgery. The oral surgery department had recently accessed the Freedom to Speak Up service resulting in the division undertaking a full comprehensive review within oral surgery that was going to be presented nationally”.
The trust’s external “look back review” also identified what it considered to be culture of low reporting in the spinal surgery service:
“The SPSLBR identified that there was a culture of low reporting of spinal surgical incidents within the timeframe of cases considered.”
Is this something that the CQC should have identified and followed up?
The review also concluded that there was both moderate and serious patient harm over a ten year period:
Robert Francis recommended in his report of the Freedom To Speak Up review that patients harmed by failures to manage NHS whistleblowing properly should receive redress.
Yet his model neither worked efficiently nor quickly at Salford, despite the claims that the organisation had better than average culture.
Also, until 22 December 2022, the CQC continued to rate Salford Royal Hospital as “Outstanding”.
David Dalton the CEO of the Salford Royal NHS Foundation Trust, and then the Northern Care Alliance NHS Foundation Trust 2001 to 2019, was a powerful and much feted NHS CEO.
He authored the 2014 Dalton Review for Jeremy Hunt, advising on how NHS improvements could be made. It is full of “transformation”, “ambition”, “transaction” and suggestions for how successful organisations should be allowed to “expand their reach and have greater impact”.
Importantly, Dalton was part of a group selected by Jeremy Hunt to work on the details of the Legal duty of Candour, which arose from Robert Francis’ Mid Staffs public inquiry recommendations. According to this briefing by AVMA Dalton advised as follows:
“Their report recommends that moderate as well as serious injury, or death, should be included in the new statutory duty of candour that the Government is about to introduce.”
Dalton’s joint report with Williams on Duty of Candour can be found here.
Status and hierarchy are often unhealthy in healthcare
Sirs and Dames, long letters after your name, friends rewarding friends and backscratching, beget incestuousness and circularity.
It can also impede accountability or give false assurance.
The look back review has noted:
“During the Trust’s Consultant Spinal Surgeons’ discussions with patients, a theme emerged that patients specifically sought out Consultant Spinal Surgeon A due to them holding senior roles in national professional bodies in the spinal surgical field. The patients’ interpretation of them holding such roles was that this demonstrated their clinical ability and that they were one of the leading surgeons in their field. These were non-elected roles. It is recommended that a copy of this SI report and action plan will be shared with those organisations where Consultant Spinal Surgeon A held senior roles and with their current Responsible Officer.”
Dr Minh Alexander retired consultant psychiatrist 20 July 2023
Summary: A BBC Newsnight investigation into the Good Governance Institute a private company which employs a sacked former NHS director has resulted in Companies House writing to the company to ask it to stop using a name for which it apparently had no prior approval. The word in contention is “institute”, which may not be used without permission from the Secretary of State for Business. The use of this name is usually reserved for bodies which conduct high level research or are professional bodies of the “highest standing”. Companies House has advised the BBC that use of the name “institute” without prior permission is an offence. Other concerns were unearthed. I have asked NHS England to consider whether it wishes to review whether this is a company with which the NHS should have any links.
This arose from Newsnight’s investigation into the governance and patient safety failures at University Hospitals Birmingham NHS Foundation Trust (UHB), where the GGI has been involved.
Of concern, UHB was repeatedly and favourably assessed by external reviewers, including the GGI, despite significant issues.
The review found no major concerns. The BBC concluded that there was no evidence that the GGI did anything wrong, but the remit of the review was too limited.
BBC Newsnight raised a question about the narrow scope of these types of well led reviews, which clearly do not always identify important problems, yet cost the public purse dear. In the case of the UHB, the GGI’s bill was reportedly £72,000 for the well led review and other services.
The BBC reported that the Good Governance Institute does not have permission from the Secretary of State, and that the GGI’s chief executive Andrew Corbett-Nolan instead registered a shell company in the Irish Republic under the name “Good Governance Institute”, where no special permission is needed to use the word “institute”. According to the BBC’s company research, this entity appears to have no assets, no staff and seems to conduct no business.
But is it within the rules for a UK company to use a trading name that includes the word “institute” if there is no permission from the Secretary of State?
It seems it is not: The government rules apply to any names under which someone carries on business:
Companies House told the BBC that it is an offence to use the term “institute” without prior approval, and they have written to the GGI to ask it to stop using the term.
Companies House also indicated that the registration under the name “institute” in another jurisdiction had no bearing on the matter.
The GGI responded:
2. The GGI’s chief executive used a title of “professor” based on a visiting rather than a substantive professorial post, and that he continued to use the title “professor” after the end of his time-limited, visiting position at the University of Chester.
Following Newsnight’s enquiries, Mr Corbett-Nolan stated that he had not been informed that his visiting professorship had ended, and he removed the title of professor from his website.
3. The GGI’s CEO had been previously repeatedly and publicly wrongly described as “Dr” in a number of GGI documents and other documents, when he did not hold a doctorate.
A colleague from the GGI had also previously been wrongly described as “Dr” when he only held a bachelor degree.
Andrew Corbett-Nolan explained this as error and confusion by others:
Andrew Corbett Nolan commented to Newsnight that Mr Fitzgerald was “talented and experienced”.
He also commented to Newsnight that most clients were happy to receive services from Mason Fitzgerald:
This appears to imply that Mason Fitzgerald may well be working for some NHS bodies, despite his previous dismissal by East London NHS Foundation Trust.
Mason Fitzgerald commented to the BBC:
NHS England has to date refused to confirm or deny that it hired Mason Fitzgerald to work on ICS governance AFTER his false qualification claim was discovered and he was sacked by East London NHS Foundation Trust.
“An NHS England spokesperson said: “Any money spent by the NHS on third parties for their expertise is scrutinised in accordance with our Standard Financial Instructions and in line with public contracting regulations.
“The funding cited as spent by NHS England and Health Education England adhered to these standards, while procurements led by other NHS organisations would have been managed at local and regional levels.”
Although NHS England emphasised in its most recent correspondence that it had checked its contracts and could confirm that it had no current contracts with the GGI, it did not actually say it would not hire the GGI again in the future.
Will the further investigation findings by Newsnight make any difference, or will NHS England start hiring the GGI again when the fuss has died down?
I have asked Amanda Pritchard about her plans regarding NHS commissioning of services from the GGI.
“BY EMAIL
Amanda Pritchard
CEO NHS England
20 July 2023
Dear Amanda,
In the most recent exchange of correspondence, NHS England informed me that it had checked its current contracts and none involved the Good Governance Institute (GGI).
This followed NHSE’s hiring of the GGI last autumn via the Chief Nurse’s directorate, AFTER the GGI employed the sacked former NHS trust director Mason Fitzgerald.
Companies House advised the BBC that no company should include the sensitive word “institute” in its name without permission from the Secretary of State, and that to do so is an offence. According to the BBC, Companies House has written to the GGI to ask it to stop using its current name.
There were also other matters of concern.
Will NHS England take the additional step of reviewing whether this company should ever be used again by the NHS?
As a wider point, Rachael Maskell MP questioned the usefulness and value for money in outsourcing governance reviews in this manner. Prof Andrew Sturdy from Bristol University pointed to the “demand inflation” that is driven by the self-interest of private consultants looking for repeat business, when they transact with the NHS.
Many thanks and best wishes,
Minh
Dr Minh Alexander
Cc Health and Social Care Committee”
Newsnight sought expert advice from Prof Andrew Sturdy, School of Business, University of Bristol who advised that NHS bodies are spending on average £1.2 million annually, each, on external consultancy which is making them less efficient. External consultants in his view want repeat business, cultivate friendly relationships and are reluctant to tell Emperors that they are exposed.
Prof Sturdy and colleagues’ 2020 paper on the NHS’ wasteful use of external consultancy can be found below:
Rachel Maskell MP questioned the sense of outsourcing such high-priced consultancies. She submits that governance determinations should be formal, statutory and subject to proper review of improvement.
We have of course been assured by the relevant parties that it was a fair and competitive appointment. Perhaps in the same way that the UHB gave assurances that the FPPR investigation on David Rosser was sound, but have refused to publish it.
University Hospitals Birmingham NHS Foundation Trust announces Group Chief Executive
Published on 17/07/2023
Jonathan Brotherton, Group Chief Executive of University Hospitals Birmingham NHS Foundation Trust (UHB).
“I am very pleased to announce, that following a rigorous and competitive recruitment process, Jonathan Brotherton has been appointed as Group Chief Executive of University Hospitals Birmingham NHS Foundation Trust (UHB).
“Jonathan, UHB’s interim chief executive, was successful in securing the role after a multi-staged process, involving a wide range of external and internal stakeholders, including senior clinical and non-clinical staff, governors and regulators.
“On behalf of the Board, I would like to offer our sincere congratulations to Jonathan on his successful appointment.
“I very much look forward to continuing to work alongside him and the Board, to deliver our ambitious – but fundamental – priorities, which will make real and noticeable differences to our patients and colleagues.
“Jonathan takes up his role with immediate effect.”
Speaking on his appointment, Jonathan said: “I am absolutely delighted to be chief executive of such an amazing organisation. As someone who was born in Birmingham and has worked in the area for a number of years, both clinically and managerially, it is a real privilege and an honour.
“For the past seven months – as interim chief executive – I have sought out the thoughts, opinions and concerns of many people, during what has been a very challenging time for UHB, its people and its patients. There is clearly a lot which needs to happen; we are reliant on the amazing people who work here to deliver that.
“As chief executive, I will be working hard to make sure that we have the kind of culture that allows people to flourish and thrive, to enable us all to do our very best for our patients.
“I want UHB to be a place where everyone is proud to work, where our patients are proud to be treated, and where we deliver the best possible and equitable care to each and every patient.”
Lastly, I made a small cameo appearance on the Newsnight broadcast, questioning why a governance organisation would employ someone who had been dismissed after a false qualification claim.
I see that the GGI has responded.
RELATED ITEMS
Darren Grayson was a former NHS CEO at East Sussex who resigned after a very critical CQC report. He sold services to the NHS though the Good Governance Institute, including at Sussex. Most recently, he secured a job at Sussex Uiversity Hospitals NHS Foundation Trust, as Chief Governance Officer.
Dr Minh Alexander retired consultant psychiatrist 14 July 2023
I raised concerns in a post earlier this week about NHS England’s refusal to heed concerns from bereaved families and whistleblowers about the suitability of a Jeremy Hunt favourite, Marianne Griffiths former Sussex NHS trust CEO, to investigate the North East Ambulance Service (NEAS) deaths scandal.
I also pointed out that she gave sketchy details about her investigation team, which seemed to lack clear credentials for handling complex legal issues thrown up by the matters at NEAS.
A concerned party has now contacted me to say that they believe that Griffiths’ investigation team at NEAS were in fact former trust colleagues from her days at Sussex.
I have written to Amanda Pritchard, CEO of NHS England, copied to parliament and others, seeking clarification.
The correspondence is shared below and is hopefully self-explanatory:
BY EMAIL
Amanda Pritchard
CEO NHS England
14 July 2023
Dear Amanda,
Concerns about the selection of Marianne Griffiths’ investigation team at North East Ambulance Service
I write to enquire about the composition of the team which, led by Marianne Griffiths former CEO of Sussex University Hospitals NHS Foundation Trust, which conducted NHS England’s investigation into the deaths scandal at North East Ambulance Service (NEAS).
As you can see, the credentials of the investigation team members were not clearly and fully provided.
It did not seem clear to me that there was sufficient expertise within the team to determine complex issues of whistleblowing, employment, coronial and criminal law which arose from the matters at NEAS.
It was not obvious that there were any practising lawyers on the team.
A concerned party has now contacted me to say that they believe all members of the Griffiths NEAS deaths investigation team were former colleagues of Marianne Griffiths at Sussex.
The person believes these are the relevant employment details of the NEAS investigation team members:
“Marianne Griffiths – CEO, Western Sussex Hospitals/Brighton and Sussex Hospitals/University Hospitals Sussex – 2010 – 2022
Denise Farmer – Director of Organisational Development and Leadership, Western Sussex Hospitals/Brighton and Sussex Hospitals/University Hospitals Sussex – 2010 – 2022
Lynn Woolley – Head of Midwifery and Gynaecology, Brighton and Sussex Hospitals/Western Sussex Hospitals – 2012 – 2021, Director of Maternity Services, Portsmouth Hospitals – 2021 to current (also CQC adviser on maternity)
Sian Finlay – Executive assistant to the CEO (Marianne Griffiths) and the Chair (Alan McCarthy) at University Hospitals Sussex 2017-2022”
Could NHS England kindly confirm if the individuals in the Griffiths investigation team have been correctly identified.
Concerns arise if so.
The impression of a handpicked team of Marianne Griffiths’ former Sussex NHS trust colleagues is troubling, especially from a trust which is now under police investigation into whistleblowers’ disclosures about deaths, which may amount to allegations of gross negligence manslaughter.
Dr Minh Alexander retired consultant psychiatrist 12 July 2023
Summary: NHS England resisted concerns from several parties about the fact that it had appointed Marianne Griffiths former CEO of Sussex University Hospitals NHS Foundation Trust to investigate the deaths scandal at North East Ambulance Service (NEAS). It officially stood by her AFTER the police investigation into deaths at her former trust in Sussex became public in early June, stating that it was “content” with her. Her report today has been understandably dismissed by bereaved families as a whitewash. There are other concerns about the report. The credentials and suitability of Griffiths’ investigating team are not clear, especially with regards to the complex legal matters involved at NEAS. There is also still no sign of a persistently withheld report on bullying and whistleblowing governance at NEAS, only scant summary of findings of opinion without facts. As bereaved families have commented, “This is the NHS investigating the NHS”.
NHS England’s investigation into North East Ambulance NHS trust has been published today:
It was led by Marianne Griffiths former NHS CEO despite multiple objections from bereaved families and several whistleblowers, including those who reported she failed them. I objected over a year ago, based on concerns about governance at her former trust in Sussex where she was CEO, and received the usual stonewalling from NHS England.
After fits and starts of correspondence and long silences, NHS England eventually spat out its reluctant response on 20 June 2023:
“In brief, NHS England is content with Dame Marianne Griffiths’ suitability to lead this review and expect it to conclude soon.”
This was remarkable as it came AFTER revelations about the police investigation at Griffiths’ former trust in early June.
There was nothing in NHSE’s response to address the governance issues I raised about her former trust at Sussex. Or any sign that NHSE had investigated the ongoing issues at Sussex, some of which were seeded during Griffiths’ tenure.
Importantly, NHS England confirmed in its response to me that Griffiths had received a copy of a review about bullying and poor whistleblowing governance at North East Ambulance Service, as part of her investigation into the trust.
Email from NHS England 20 June 2023:
“Hi Minh
Apologies for the delay in responding to your email. NHS England take all whistleblowing-related issues seriously and as such I have taken the time to review your concerns.
In brief, NHS England is content with Dame Marianne Griffiths’ suitability to lead this review and expect it to conclude soon.
With regards to the Stanley/Boylin report, it was shared confidentially with Dame Marianne Griffiths. NHS England does not intend to request investigation documents, nor to commence a review of the investigation contents. We await the findings of Dame Marianne’s review, and will then consider whether any action needs to be taken in response to that review.
I note you have also emailed recently about the ‘implications of governance failings at Sussex’ and I hope this response addresses the point you raise there too.
I am sorry again for the delay in responding to you. I know there is another matter I have yet to respond to you on, and will aim to do so next week.
With best wishes
Tom”
[My emphasis]
The review about bullying and whistleblowing failures at NEAS took place in 2020, and it was carried out by Jennie Stanley (née Fecitt) and Tracy Boylin.
The report has been suppressed by NEAS ever since.
Affected trust staff were only given superficial feedback about the outcome of the investigation, that concerns were partly upheld.
The trust has refused to disclose it under FOI, whether in full or as summary findings and recommendations.
Griffiths’ report on NEAS, unveiled today, is a woeful affair. It refuses, on a test of the balance of probabilities, to find that repeatedly altering original documents and withholding documents from the coroner was deliberate concealment.
Tracey Beadle, Quinn’s mother, told HSJ that the report was a “complete whitewash” due to issues including its limited scope and key details being omitted from previous investigations, and that the review failed to examine why the Care Quality Commission did not take action when concerns were raised with them. She also questioned the suitability of Dame Marianne to lead the review, given cultural problems previously highlighted at her former trusts.
“This is the NHS investigating the NHS,” she said. “Therefore no impartiality exists.”
She added NEAS “have [been] afforded protection from [CQC and NHSE], putting their reputations before the safety and wellbeing of patients”.
Griffiths’ conclusions reduce NEAS’ use of illegal and unenforceable clauses in settlement agreements, which prevented whistleblowers from pursuing public interest concerns further (applied in one case and rejected in another), to a matter of “misinterpretation” and “perception”:
“In those two cases, the circumstances were sufficiently sensitive and contentious as to make any form of proposed settlement open to potential misinterpretation. NEAS accept that there were perception issues with that, and its processes have been strengthened.”
It is unclear what specialist expertise informed Griffiths’ investigation. The full credentials of the investigation team are not supplied:
What credentials did the Griffiths investigation team have to make determinations on issues of whistleblowing, employment, coronial law and criminal law? It is not obvious that there were any practising lawyers on the team.
Griffiths’ analysis of NEAS’ general whistleblowing governance is staggeringly superficial and brief. The report’s section on Freedom To Speak Up was less than two pages long (see pages 62 and 63) and totalled 641 words. The specific section on the coronial whistleblowers tries to paint a “can of worms” type picture. This can be a technique that is sometimes used for misdirecting attention in whistleblowing matters.
I cannot find explicit mention of the Stanley/Boylin report’s outcome in Griffiths’ report.
I found this passage:
“6.34 Between 2019-20 there was a significant change in executive leadership; a new Chief Executive (CEO) (following a gap of 4 months), new Director of Quality and Safety, new Finance Director and new (and the organisation’s first substantive) Director of HR (HRD). The incoming CEO put the new executive team together including investing in Board development work. She also actioned the outcome of reports relating to behaviours and culture including meeting staff who had raised concerns.”
There were also these passages about an unspecified external Freedom To Speak Up commissioned by NEAS concluded in 2020, which would fit:
“7.38 The findings made clear that the functioning and leadership of HR, and relationships between senior staff, had been difficult for some time and had not been addressed effectively up to 2020.
7.39 Senior leaders had allowed dissent and factions to interfere with proper processes and therefore added to serious risk for HR and professional matters, and to the support given to the organisation, including to the staff raising concerns and grievances.
7.40 There was clear evidence of a lack of professional respect, and a lack of acknowledgement of professional duties and responsibilities and the consequent need to co-design processes.
7.41 There was a lack of transparency and consistency between the operational management of services and professional leadership.”
The facts supporting these opinions are not provided.
Opaquely, Griffiths gives no bibliography of the documents examined by her investigation.
A search of her report for the words “bully” and “bullying” yield zero hits, although she was tasked with examining culture.
Why has there been so much secrecy about the Stanley/Boylin report outcome?
Why has over £35K public money not been properly accounted for?
Why do private contractors undertake these types of reports without a clear condition that such reports will be openly published?
Is it because there would be no repeat customers if NHS organisations cannot cherry pick what is reputationally advantageous to publish?
Why are NHS bodies allowed to misuse public funds in the support of managerial self interest and against patients’, families’ and the workforce’s rights to transparency?
The bad, bad smell that still hangs over NEAS will likely intensify as the scandal at Sussex unfolds.
Perhaps NHS England will invite Helen Ray the NEAS CEO to review Sussex at some point. Only once CQC has confirmed improvement at NEAS and upgraded the trust to “Good” or “Outstanding”, of course.
But unaccountable senior NHS managers are bulletproof for now.
But this serves to emphasise how perfectly unfit the NHS’ governance is when things go wrong, and how only hard law reform will suffice to protect whistleblowers.
RELATED ITEMS
I have written to the Secretary of State about the missing Stanley/Boylin report.
08.07
BY EMAIL
Steve Barclay
Secretary of State for Health and Social Care
12 July 2023
Dear Mr Barclay,
Suppressed report on bullying and poor whistleblowing governance at North East Ambulance Service
Marianne Griffiths’ investigation on North East Ambulance Service for NHS England was published today and references your predecessor’s announcement last year about this investigation.
One of the NEAS whistleblowers understandably declined to cooperate with this flawed exercise. The investigation was also criticised by the bereaved families.
I write to draw your attention to the fact that NEAS paid over £35K for a 2020 report on bullying and poor whistleblowing governance at the trust, which it has suppressed ever since. This was the so-called Stanley/ Boylin report. Its findings appear to be absent also from today’s Griffiths report.
NHS England confirmed in a note to me last month that Marianne Griffiths had been provided with a copy of this report.
However, I can find no clear mention of its findings in her report today. I could find only this paragraph:
“6.34 Between 2019-20 there was a significant change in executive leadership; a new Chief Executive (CEO) (following a gap of 4 months), new Director of Quality and Safety, new Finance Director and new (and the organisation’s first substantive) Director of HR (HRD). The incoming CEO put the new executive team together including investing in Board development work. She also actioned the outcome of reports relating to behaviours and culture including meeting staff who had raised concerns.”
Marianne Griffiths also provides no bibliography at the end of her report to transparently list the documents examined by her investigation. A search of her report for the words “bully” and “bullying” brings up zero hits.
The section of her report on Freedom To Speak Up is less than two pages long and comprises of 641 words.
The report claimed it could not say that the repeated alteration of original documents and withholding of documents from the coroner, which the trust had previously been warned were potential crimes, was a deliberate act of concealment.
I really do not think that the public interest has been served by this report. It is in my opinion a sample of what we should expect if the NHS is permitted to conduct its own “exit Fit and Proper Person tests”, as currently proposed by NHS England.
I forward below the correspondence from NHS England which informed me that Marianne Griffiths had been provided with the Stanley/Boylin report.
This brief response was the culmination of over a year of my raising concerns with NHS England about Marianne Griffiths’ suitability to lead the NEAS investigation given the previous concerns about whistleblowing governance at her former NHS trust in Sussex.
Additional concerns arose over the course of that year. You will see that none of this swayed NHS England.
With best wishes,
Minh
Dr Minh Alexander
NHS whistleblower and retired consultant psychiatrist
Cc Tom Kark KC
08.54
BY EMAIL
Steve Barclay
Secretary of State for Health and Social Care
12 July 2023
Dear Mr Barclay,
My apologies.
I need to correct my earlier letter today of 08.07.
I have found a further passage in Marianne Griffiths report which seems to give a brief outcome of the 2020 Stanley/Boylin report, although the report is not explicitly identified.
It is stated that an external report commissioned by NEAS concluded in 2020 with the following:
“7.38 The findings made clear that the functioning and leadership of HR, and relationships between senior staff, had been difficult for some time and had not been addressed effectively up to 2020.
7.39 Senior leaders had allowed dissent and factions to interfere with proper processes and therefore added to serious risk for HR and professional matters, and to the support given to the organisation, including to the staff raising concerns and grievances.
7.40 There was clear evidence of a lack of professional respect, and a lack of acknowledgement of professional duties and responsibilities and the consequent need to co-design processes.
7.41 There was a lack of transparency and consistency between the operational management of services and professional leadership.”
My understanding is that affected staff were advised that their concerns were partly upheld by the Stanley/Boylin investigation, but that they were given no other information. I have seen some of the feedback correspondence from the trust.
In Marianne Grittith’s above summary, opinions are given but the specific facts supporting them are not.
She provides little comment on the issues of whistleblowing governance examined.
Information relevant to mounting an effective Fit and Proper Person challenge remains largely withheld from affected parties.
Dr Minh Alexander retired consultant psychiatrist 11 July 2023
Steve Barclay Secretary of State waffled before Health and Social Care Committee on 20 June 2023, in response to questions about the failure of the government’s Freedom To Speak Up project to protect NHS whistleblowers, after eight long and miserable years.
In consequence, I asked him some questions under FOI:
In brief, the Department says it has accepted the following four recommendations from the Kark review on Fit and Proper Persons in the NHS, but hasn’t a clue when they will be implemented, because it’s been palmed off onto NHS England:
“With regard to recommendations 1 to 4, DHSC does not hold the information you have requested. However, you may wish to contact NHS England, which may be able to provide an update on the timetable for recommendations 1 to 4.”
“Recommendation One
All directors (executive, non-executive and interim) should meet specified standards of competence to sit on the board of any health providing organisation. Where necessary, training should be available.
Recommendation Two
That a central database of directors should be created holding relevant information about qualifications and history.
Recommendation Three
The creation of a mandatory reference requirement for each Director
Recommendation Four
The FPPT [Fit and Proper Person Test] should be extended to all Commissioners and other appropriate Arms-Length Bodies (including NHSI and NHSE).“
Disbarment has been dumped
Importantly, it is also confirmed that Barclay has ditched Kark’s fifth recommendation, for a mechanism to disbar NHS managers for serious misconduct:
“The power to disbar directors for serious misconduct”
This is blamed on NHS England:
“The Government agrees with NHS England that effective safeguards are currently in place by ensuring an exit fit and proper person test is completed when directors leave employment and that any conduct issues which arise after their employment remain on the national register. These safeguards, together with a robust referencing process, will prevent unsuitable leaders being re-employed in the NHS and also act as a deterrent to misconduct itself.”
So, “an exit Fit and Proper test” has been secretly mooted but kept hidden even after publication of the NHS Workforce plan on 3 July 2023.
It sounds like a ludicrous fig leaf, that everyone knows is a ludicrous fig leaf.
Interestingly, NHS England previously blamed ministers for disbarment being dumped, telling me there was no “ministerial support” for this Kark recommendation.
How they all twist and turn.
It is worth remembering that Kark’s review reserved disbarment for matters such as criminal convictions leading to a custodial sentence, victimisation of whistleblowers or knowingly allowing the victimisation of whistleblowers, “Causing, facilitating, colluding in, or requiring any staff member to fail to comply with the duty of candour including by means of a settlement or confidentiality agreement” and “Falsification, concealment or suppression of records, data or other information which is required to be provided to any other person or organisation”.
And the disbarment mechanism also fell short of full regulation. The latter is rightly expected of hundreds of thousands of NHS staff who are responsible for patients’ lives. But so are NHS managers, who have been dodging regulation since it was recommended by the Bristol heart public inquiry over twenty years ago.
“Now Stephen Barclay, a health minister, has told The Independent he wants the “fit and proper” person test for NHS directors – introduced in 2014 – to be widened to require action on harassment and discrimination.
Mr Barclay said: “That one in four NHS staff have experienced bullying, harassment or abuse – and that more than twice as many BAME [black, Asian and minority ethnic] staff have suffered discrimination from their manager or colleagues than white staff – is deeply alarming and should be a call to arms for urgent action across the NHS.
“I am determined to put an end to this, which is why the NHS is already working to close the equality gaps and tackle bullying.”
It is also worth remembering that Barclay recently wondered out loud at Committee on 20 June 2023:
“What accountability is there for senior managers when wrong doing is established? Are they just rotated through the system? Or are people held to account?”
Really Mr B!!!!
UPDATE 23 AUGUST 2023
The Telegraph yesterday asserted that the ministerial fashion for dumping disbarrment originated with Matt Hancock:
RELATED ITEMS
NHS England’s “exit Fit and Proper Person test”
I have written to the Chief Workforce Officer at NHS England to ask for details of the “exit Fit and Proper Person test” mentioned in the Department’s FOI response:
“The Government agrees with NHS England that effective safeguards are currently in place by ensuring an exit fit and proper person test is completed when directors leave employment and that any conduct issues which arise after their employment remain on the national register. These safeguards, together with a robust referencing process, will prevent unsuitable leaders being re-employed in the NHS and also act as a deterrent to misconduct itself.”
I would be grateful if in your reply to my enquiry of 4 July 2023 you could additionally include the details of the “exit Fit and Proper Person test” that is envisaged by NHS England, and by whom it will be applied.
If no such exit test has yet been devised, please indicate the timescale within which the test will be developed and ready for use.
Would the exit test will be applied by a local employer with possible vested interest, as opposed to an independent central body, as disbarring mechanism would be?
I must say I cannot see how for example, University Hospitals Birmingham NHS Foundation Trust would have applied an exit test reliably to David Rosser, its former CEO who was criticised by the Employment Tribunal for his behaviour towards a whistleblower. He also received a warning from the General Medical Council. The trust board has still not published a flawed FPPR investigation review on David Rosser, conducted by a subordinate trust employee which it claimed cleared him. The trust board also misled the public in a bizarre fiction, claiming that Rosser stepped down as CEO and moved to a regional role, when he remained a trust employee as revealed by an FOI request. As the trust board continues to deny that its FPPR investigation found cause for concern, if left in control of an exit FPP test, I imagine it would allow him to recirculate in the NHS.
Many thanks and best wishes,
Minh
Dr Minh Alexander
NHS whistleblower and retired consultant psychiatrist
Cc Tom Kark KC
Health and Social Care Committee
Secretary of State for Health and Social Care
Is the Patient Safety Commissioner a Prescribed Person under PIDA?
Under this law, there are a number of designated bodies and individuals to whom whistleblowers may make so-called “protected disclosures”.
This too is a useless system as the Prescribed Persons sometimes are clueless about their responsibilities, and are legally obliged to do little more than to log the concerns received and to publish a superficial annual report about the numbers of concerns. No one is legally obliged to protect the whistleblower or act upon their concerns.
Barclay implied to Committee on 20 June 2023 that the Patient Safety Commissioner (for Medicines and Devices only) might be a Prescribed Person for whistleblowers’ disclosures. She is not currently listed as one. I asked him if the Department intended to give her this legal status. It did not reply.
The Patient Safety Commissioner was of course the second and particularly objectionable NHS National Freedom To Speak Up Guardian who expended most of her and her Office’s energies on PR, self-promotion and supporting an establishment narrative. Not to mention instances of failure to apologise and learn when her Office actually harmed whistleblowers:
Dr Minh Alexander retired consultant psychiatrist 6 July 2023
Disappointing BBC News coverage featured Robert Francis and the latest NHS Freedom To Speak Up Guardian Jayne Chidgey Clark on 3 July 2023.
The piece helped to legitimise the National Guardian’s Office, when it is in fact a threat to NHS whistleblowers.
The BBC team who produced the material did not balance claims by the National Guardian with evidence of her Office’s failures or with criticisms of her Office by whistleblowers.
They also chose not to include whistleblowers with the strongest cases which exposed the serious failings of the National Guardian’s Office. Whistleblowers from whom they had agreed to take this evidence were ignored.
Below is a letter to the relevant BBC team, placing my concerns about the coverage on record:
The thrust of the BBC reportage was on airing a defunct and empty argument that culture change alone is needed.
Robert Francis commented disingenuously that NHS boards need to “buy into” and “understand” about whistleblowing. He knows full well that many boards understand, but simply choose self interest and suppression. He used to advocate dismissal for abusive NHS CEOs.
Culture change is of course needed but it is not going to happen without enforcement. Road safety laws on safety belts and drink driving are an example of law changing behaviour and culture.
Power, however, naturally fears enforcement of whistleblowers’ rights to protection and action upon their disclosures.
The BBC News coverage appeared the day after The Guardian ran an item featuring the BMA’s call for reform of UK whistleblowing law:
Moreover, BBC News featured the National Guardian’s claims to purportedly support accountability for whistleblower reprisal:
“Dr Chidgey-Clark says the main healthcare regulator – the Care Quality Commission (CQC) – and NHS England itself could do more to protect individual whistleblowers and rein in rogue managers.
“I do call on them to do everything they can within their power to ensure there is accountability and these serious issues are looked into,” she says, “because without that, more high-profile cases will happen and, potentially, more patient harm and worker harm will happen. And in our society, in our healthcare system, we don’t want to see that.”
It is hypocritical of the National Guardian and her Office to call for others to ensure accountability for whistleblower reprisal and detriment, when they have done the opposite.
And why the distasteful focus on “high profile” cases? Every whistleblowing case matters, because every patient matters.
The National Guardian’s Office was primarily set up to provide independent reviews of poorly handled NHS whistleblowing cases, but has conducted a shockingly low number of case reviews since the Office was established in 2016.
Case reviews by the National Guardian since 2016:
Southport and Ormskirk NHS Trust 2017
Northern Lincolnshire and Goole NHS Foundation Trust 2017
Derbyshire Community Health Services Foundation Trust 2018
Nottinghamshire Healthcare NHS Foundation Trust 2018
Royal Cornwall Hospitals NHS Trust 2018
Brighton and Sussex University Hospitals NHS Trust 2019
Northwest Ambulance Service NHS Trust 2019
Whittington Health NHS Trust 2020
Blackpool Teaching Hospitals NHS Foundation Trust 2021
Thematic review of ambulance trusts 2023
The case reviews turned into toothless systems reviews and are now not even called case reviews anymore. They have been renamed “speak up reviews”, hiding their original purpose.
The NGO’s case reviews have avoided criticising any senior manager for harming whistleblowers.
… 1.12 Communicate that detriment for speaking up will not be tolerated, act to prevent detriment occurring, and put in place procedures that would enable cases of detriment to be looked into effectively when they are reported.”
That is hardly accountability for serious wrongdoing. It glossed over serious harm already done to the trust whistleblowers.
At North Lincolnshire and Goole, where the trust Chair publicly and notoriously attacked a whistleblower, the National Guardian made no reference to this incident in its case review report other than to say that the Chair expressed “regret” and made no recommendation for regulatory action to be taken against the trust Chair.
“We carried out this review because we had received information that the trust’s support for its workers to speak up did not always meet with good practice.”
Whitewash Central in other words.
In the latest case review by the current National Guardian, which was a thematic review of ambulance trusts, the resultant review report listed grievous examples of detriment (pages 43 and 44).
But the National Guardian did not criticise any managers responsible and kicked the can down the road by only suggesting that the Kark review recommendations should be implemented:
“One of the Kark Review recommendations called for processes to ensure greater accountability for leaders, including a focus upon behaviour which suppresses the ability of people to speak up about serious issues in the health service. This recommendation must be implemented as a matter of urgency.”
It was in fact within the National Guardian’s gift, and indeed arguably one of her duties, to request that the CQC review trust directors under Fit and Proper Persons regulation, and that NHS England should take related action. But she did not report that she did so.
Compounding these failures to hold abusive managers to account and to set the right tone, successive National Guardians have also refused to facilitate access to redress for harmed whistleblowers. This is despite the fact that this was recommended in the 2015 Freedom To Speak Up Review:
They have repeatedly taken the indefensible line that it is not part of their job.
Unsurprisingly, the National Guardian and her Office are not trusted by the NHS workforce and regularly receive only a tiny number of qualifying disclosures as a Prescribed Person under UK whistleblowing law, from an NHS workforce of 1.4 million.
BBC News reported quite wrongly that the National Guardian’s Office received over 25K contacts last year. This was actually the contacts received by local NHS trust Freedom to Speak Up Guardians and others.
Appallingly, the NGO sent 13 of these 30 staff back to their trusts:
“Signposted a worker to the Freedom to Speak Up Guardian at their organisation, so that the worker could contact them for support to raise matters relating to their disclosure”
When NHS staff contact the NGO (and some of them will be NHS trust Freedom To Speak Up Guardians who have been blocked or victimised for helping whistleblowers), they will have lost confidence in their employers.
It is unsafe and abusive to give such staff the runaround and make them go back to their employers.
Yet the NGO tried this approach in the whistleblowing case of Mr Shyam Kumar surgeon from University Hospitals Morecambe Bay NHS Foundation Trust (UHMBT), despite the fact that this trust was already notorious for several serious whistleblowing failures. This included a trust cover up of breast screening failures.
I am aware of at least seven whistleblowing cases from UHMBT, and yet the NGO has studiously avoided any case review of this organisation.
That must surely be a serious failure in the NGO’s duty of care to trust staff, and another example of the political nature of the NGO in how it sidesteps matters that are inconvenient to power.
That is hardly holding erring senior trust managers to account.
I asked Ian Trenholm CQC CEO to investigate the failure of the NGO at Sussex since the police investigation became public knowledge. He passed it to the CQC complaints team, who replied on 5 July 2023:
“After considering your email, we will not be considering this as a corporate complaint, as it goes beyond the time limit of what we would consider under our policy.”
So no accountability.
In the case of whistleblower Dr Jasna Macanovic who asked for help, the National Guardian’s Office told her to come back after her Employment Tribunal had concluded. This meant there would be no help for her or for patients for years. This too has happened to other NHS whistleblowers.
It was left to the whistleblower community to refer Dr Macanovic’s dismissing Medical Director to the CQC (the National Guardian’s employer) under Regulation 5 Fit and Proper Persons, who as usual refused to find any breach of the regulation.
I have seen correspondence supplied by an NHS whistleblower with a very serious case who was dismissed despite seeking help from their local trust Freedom To Speak Up Guardian.
They contacted the National Guardian’s Office for help. They gave the NGO a detailed account of what had happened to them, including their attempts to seek help through the local trust Guardian.
The National Guardian’s Office, under Jayne Chidgey Clark, wrote back last year suggesting:
“We understand that you were a worker at REDACTED and have attempted to speak up about a number of issues, including those around patient safety. We understand that you do not feel able to speak to the Guardian at the Trust as they are employed by them. However, we would encourage you to contact them if you have not already done so.”
The NGO correspondence continued in this incompetent and insensitive vein, such that the whistleblower questioned whether the NGO had actually read their original request for help.
This is a typical example of how the NGO operates.
The Office resists requests for help, and its first response is to try to send NHS whistleblowers back to the organisations in which they have lost confidence.
Sending victims back to abusers is not a recognised method of safeguarding.
I hope that BBC News will at some point acknowledge that the NGO’s actions smack more of collusion than accountability.
As does the disgracefully low number of case reviews conducted by the NGO.
The National Guardian’s Office simply does not protect whistleblowers.
RELATED ITEMS
The lack of evidence base for the Freedom To Speak Up project
It was reported that the prototype Cultural Ambassador role had disappointed some staff:
“The Staffordshire and Stoke on Trent Partnership NHS Trust created a role of ‘Ambassador for Cultural Change’. This innovative role was designed to allow the staff voice to be heard and concerns from staff to surface in a way that focused on the topic rather than the individual, protecting the identity of any staff member wanting to remain anonymous. This initiative received significant national attention. We saw that not all staff were happy with this role. They were often guarded and concerned they might not have the full protection promised. While some staff engaged with the Ambassador for Cultural Change many felt that the actions from this did not follow on as expected.”
And the trust was rated “Inadequate” on the Well Led domain partly because trust executives had not addressed staff concerns:
Francis et al did not put these salient facts in the glossy Freedom To Speak Up promotional material.
The truth, as ever, struggled to lace its boots whilst its counterpart had already been widely disseminated by government spin doctors.
Alexander's Excavations 