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Before an inquiry report is published, the author will typically carry out a “Maxwellisation” process which offers those being criticised a chance to respond.

The extent to which changes are proposed and accepted by the author can prove controversial – and it’s part of why those calling for an investigation tend to make such a fuss about it needing to be fully independent.

As revealed by HSJ in December, a draft review of a research partnership between The Christie Foundation Trust and pharmaceutical giant Roche outlined multiple shortcomings in how the project was handled, as well as citing deeper cultural issues within the trust’s research and innovation department.

But in the final report, the most serious criticisms have either been removed or significantly softened.

The reviewer, Professor Andrew Hughes, a former senior trust employee who is now chair of experimental cancer medicine at Manchester University, has said the changes were made “having reviewed further evidence provided than at time of initial draft; and [after] a final meeting with commissioners [The Christie].”

This has inevitably aroused suspicions from whistleblowers, who believe the changes seek to minimise criticism of the trust’s leaders.

Roger Kline, a former union official who has been supporting the whistleblowers, told HSJ: “It is not unusual for a critical NHS report to be watered down by those who commissioned it, but this revised version is dilution on an industrial scale.

“When you get this many changes to a draft report, it either means the commissioners think the draft report is rubbish, or pressure has been put on to change it. In this case it feels like the latter, because the evidence the draft review was based on hasn’t changed, but the conclusions drawn from it have done.”

Much now rests on the findings of a wider review led by Angela Schofield, chair of Harrogate and District FT, which has been commissioned by NHS England and therefore has greater independence in the eyes of the whistleblowers.

A one off or one of many?

The West Midlands is no stranger to reports of safety issues across its maternity services. Of course, the scandal in Shrewsbury and Telford Hospital Trust is the first one that comes to mind. But over the years others across the region were the subject of concerns – Walsall, Dudley, Worcestershire and now Sandwell and West Birmingham Trust.

According to a letter sent to the Care Quality Commission by two former staff members, a “toxic management” and “unsafe” community staffing levels have been left unaddressed and now risk damaging patient safety.

The trust has had a rocky year in terms of its leadership, with multiple changes in its executive team – could this have played a part in the problems falling off the radar? Potentially – a recurring theme in the document was a lack of visibility and support of senior management.

Overall the concerns do not appear to have reached the state of “scandal”, but as past scandals have warned us, governance issues can quickly turn into patient safety scandals if left unaddressed.

Another thing to consider is whether the problems reported at Sandwell are unique to the trust or a symptom of wider problems within the NHS’ maternity services.