187 comments By David Drew
Thanks Nick at 2205. Applaud the public spirit of the doctor reporting this to CQC. And correct for CQC to progress it. But this from NHSI website:
NHS Improvement’s Non-executive Appointments Team offers a range of support in finding and developing the very best chairs and non-executive directors for NHS provider boards. We appoint and support NHS trust chairs and non-executives. The power to make, suspend and terminate these ministerial appointments is delegated by the Secretary of State for Health.
Surely, that is where the responsibility lies.
In March 2019 HSJ ran a piece in which Sir Robert Francis QC accepted that the Fit and Proper Person test has not worked and does not work. So why this charade? He added his own opinion that it is now time for a professional regulator for NHS managers.
The reference group on Kark's watered down recommendations has shown an understandable reluctance to make NHS managers accountable in anyway that staff or the public can use.
So good luck with this Dr A. On receipt of the foregone conclusion you will have the option of complaining through your MP to the Ombudsman. Who will tell you that you have suffered no injustice and under PCA 1967 he is unable to investigate. Just Culture?
Linda Fairhall: “I have been utterly humiliated, my life has been left in chaos and my professional integrity has been called into question, leaving my reputation irreparably damaged." That after a lifetime of selfless service to NHS patients.
Exactly 5 years ago Jeremy Hunt reported Sir Robert Francis' statement in his Freedom to Speak up report:
"Sir Robert said he heard again and again of horrific stories of people’s lives being destroyed—people losing their jobs, being financially ruined, being brought to the brink of suicide and with family lives shattered—because they had tried to do the right thing for patients. Eminent and respected clinicians had their reputations maligned. There are stories of fear, bullying, ostracisation and marginalisation, as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny”, with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers”, who were then blacklisted from future employment in the NHS as the system closed ranks."
Little change there then.
The only exceptional thing about this case of whistleblower victimisation is that the claimant was successful at ET under the current inadequate PIDA legislation.
Sadly, Linda demonstrates once again that NHS staff often pay for raising concerns with ruined lives. That serves as a disincentive to all staff that no amount of propaganda from the National Guardian's Office can counteract. And the Trusts response, despite the ET's damning judgement, is to consider an appeal. More managerial madness.
AM at 10:15. Far better if HSJ publishes comments with authors names attached.
No-one ought to be surprised at this. When I met Kark and Russell as an informant to the Kark review I was told in no uncertain terms that since NHS management was already pretty unattractive the review would be doing nothing to make it even more so.
My own interest lies in discouraging CEOs and trust boards from victimising staff who raise concerns about patient care, safety, safeguarding etc. I (and a number of others) submitted information to Kark on the failure of CQC to hold such individuals to account using the Fit and Proper Person Requirement. In my case I had reported a CEO with solid evidence of multiple offences. Something that Francis in his PI report recommended should be a criminal offence. I have also sent details of this individual to NHSI, NGO and PHSO. There is no mechanism to have directors with solid evidence of misconduct investigated. The very thing Kark’s HDSC would have been able to do. Doctors and Nurses should be rightly aggrieved to hear that managers continue to avoid the scrutiny of their conduct that their own regulators ensure. The reference group charged with this decision is almost entirely from the managerial hierarchy. Managers rule. Not OK.
Sad to see no acknowledgement of the immense suffering caused by Paterson but also indirectly by those who could and should have stopped him. Fear and self-interest, bystanding, which are present to some extent in every healthcare organisation, always militate against patient interests. We may not see anything as outrageous as this again in the near future but it is happening on a smaller scale. Somewhere near you. I pay tribute to Dr Kim Holt, Mr Ed Jesudason, Dr Chris Day, Mr Peter Duffy and so many others who spoke up for patients with harm coming their way. They suffered for it. And in a system so deeply corrupted that it can allow someone like Paterson to harm so many that is all the reward they can expect.
I've sent information on NHS whistleblowing and reporting culture to HSC for many years. Sarah Wollaston despite her strong public statements, made no significant contribution. Now we have Jeremy Hunt as chair. The man who in 2014/15 met Whistleblowers, praised their courage and ethical stand then sold them down the river via the Francis FTSU report. Now we have the scandal at West Suffolk where Whistleblowers have been treated like dissidents in N. Korea; and maternity scandals in Shropshire and Kent where staff were either too afraid to speak up or silenced if they did so. JH said he'd put his hand up to past mistakes (affection for black-box learning) but will not. Freedom for clinical and other staff to speak up when things are wrong is of fundamental importance to patient safety. Something he claims to care about. His long tenure as SoS has made no impression on this. Disappointed.
Shaun Lintern ex-HSJ writing for the Independent today telling it like it is: CQC ‘was wrong’ to bury whistleblower’s report into failings at hospital where patients were abused. "
This is dire. How can CQC be trusted to improve on its own failings when it cannot even explain why they happened. There is widespread anxiety that CQC does not take seriously concerns that are raised with it. And CQC of course "hosts" the tragically inept National Guardians Office.
Find me a whistleblower who has been ignored or suffered retaliation who has faith in either organisation. Two rececent PHSO reports show, that Whistleblowers who reported NHS directors to CQC under FPPR for victimisation were likewise ignored. (And more evidence there of CQC's apparent inability to keep records that can be used to explain their actions.)
Nul points CQC. From some of those with experience of your ways.
The Kirkup report on the scandal at Morecambe Bay was publishes 5 years ago. Recommendation 42 stated:
"We further recommend that all external reviews of suspected service failures be registered with the Care Quality Commission and Monitor, and that the Care Quality Commission develops a system to collate learning from reviews and disseminate it to other Trusts.
Action: the Care Quality Commission, Monitor."
CQC accepted this in full. In 2016 when I wrote to them they denied they had taken this responsibility on. When I pressed they claimed they were putting a system in place. The point of the recommendation was to ensure the whole NHS learned from failures in individual organisations. Looks like another CQC failure here.
One big mistake JH made was to meet 6 high profile Whistleblowers with Simon Stevens in 2014, tell them how courageous they had been, then sell them down the river via the Francis FTSU review.
This failed to recommend legal protection for Whistleblowers which is now being pursued by other agents including an SNP MP.
The National Guardian, set up with no evidence base, and no powers of investigation or enforcement, is a mistake. It has not resulted in Whistleblowers being "guarded" or any demonstrable improvement in reporting culture. FPPR, held up by Francis as the means of holding victimising CEOs to account is a flop. As even Francis admits.
As a result NHS Whistleblowers are still immersed in protracted ET procedings; many staff are reluctant to raise concerns having seen what happens; and Trusts like West Suffolk are still free to ruthlessly pursue Whistleblowers using draconian methods with impunity. It is well known that even the most prolific serial Whistleblower victimisers are allowed, by Dido Harding, Ian Trenholm and Henrietta Hughes and the regulators they lead, to continue with their careers.
So, yes, JH has a lot to answer for. To patients and staff.
The report says nothing about whether trusts are transparent (honest or candid) with complainants. Nor does it say anything about the extent to which trusts learn from complaints. Rather, it lays out how transparent trusts are at reporting their complaints processes and their learning. These are different things. We do not appear to know how transparent trusts are with complainants or whether they ever learn from their mistakes.
The transparency Sir Robert should be interested in is whether complainants are told the truth, particularly about serious incidents. Rising litigation and high levels of complaints to PHSO (I suspect most do not have the resources to go down either route) suggest that many complainants rate provider transparency very low.
The statutory Organisational Duty of Candour, introduced in 2014 is there to encourage a habit of candour when trusts deal with mishaps. There is no objective evidence to the best of my knowledge that this has made any significant difference. Although cover-up is widely acknowledged to be prevalent in the NHS, and even the Chief Inspector of Hospitals acknowledges regular withholding of information from CQC, there are almost no examples of this being detected by this statute., and sanctioned.
Most people I imagine would be dismayed and puzzled to note the apparent effort and expense that have gone into investigating healthcare failures in the last 10 (or 20) years matched against the still unanswered questions and absence of improvement.
I'm not saying as another commentate has done that Sir Robert has been played, although DHSC past behaviour makes this completely credible. Like many on social media including Mid Staffs voices and Whistleblowers, who he has misled and let down, I do think he has largely failed and should let someone else try a new approach which is free of any political constraints.
“How very little can be done under the spirit of fear.” said the Lady with the Lamp. Yet it is leadership from "the very top" of the NHS which is promoting such fear. Time for Matt Hancock, DHSC, Simon Stevens, Dido Harding, Ian Trenholm, Ted Baker, Henrietta Hughes et al to reflect?
The human and financial cost of NHS bullying, including a clear and present danger to patient safety, is crystal clear.
Culture is largely driven from the top (although no-one at any level has any excuse for bullying) and a remedy can only come from there.
"The first principle of a hospital is that it should do the sick no harm." The Lady also said that. Today she might have added, "should do its staff no harm."
"CEO Oliver Shanley said she did not receive a ‘clear and defined’ outcome until recently."
That's gobbledygook for "Michelle has been denied justice for 4 years." The CEO at NELFT for most of that time was self-proclaimed "social justice champion" Mr John Brouder. Surely he has a few questions to answer.
The RCN likewise. They also apperently protected the perpetrator and asked Michelle to sign a non-disclisure agreement (NDA) to keep her silent. NDAs have supposedly been banned by successive SoSs. Sexual harrassment is endemic in the NHS and according to a recent QCs report at least one regulator (BMA). One might have expected better of the principal nurses union.
All of this and more is in the public domain in Michelle's tweets @MotherMRuss. I hope the full details of this report are made public. This feels like a MeToo moment for victims to speak up against perpetrators and those in positions of authority who shelter them.
Effectively a screening programme for a hyperendemic condition. It's important, impacting staff health and patient safety. But is the natural history properly understood? Is there a reliable and acceptable (to target population) "test?" Is there a practical remedy? Apart from reducing work pressure, workplace bullying, and rota gaps. And the other measures which might have prevented this epidemic. Something obviously needs to be done. Monitoring is something. So let's monitor.
Hi Anon at 13:28. At least some of what these 3 SATH directors think is on public record as late as 31 August 2018 in the trusts response to media reports on the scandal. Including, "To suggest that there are more cases which have not been revealed when this is simply untrue is irresponsible and scaremongering." Presumably this statement was signed up to by the board. It also carries the unmistakable imprimatur of trust legal advice. That was at a time when the Ockendon inquiry was nowhere near finished. And today Shaun Lintern is able to report 400 case files that have not yet been released to Ockendon. Delay. Defend. Deny. Francis said it in 2013 and little has changed. Past "leadership" at this trust has questions to answer.
Two weeks ago Ted Baker told The Patient Safety Learning conference that hospital managers routinely hide evidence from the CQC. It's widely recognised that trusts deny, delay, defend against complaints of patient harm. Still, the statutory organisational DoC, 5 years after its introduction, appears to have made little or no difference. Are our legislators and NHS regulators really that incompetent? Similarly, the statutory Fit & Proper Persons Requirement introduced at the same time has also been ineffective. Sir Robert Francis told us in person in 2014 that FPPR would be used to call to account any director surpressing sraff who report cover ups. He has been a CQC NED overseeing the administration of these statutes for some years. The two recent PHSO reports on CQC failure suggest he is not doing so well at this. I presume he he is disappointed with progress.
Am I the only one to wonder why one provider can be fined for 13 breaches of regulation 20 while all the others have a clean sheet?
Good reference Julian at 14.09. And, as Melanie Leahy said of NHSI/NHSE, “I really have no confidence in the paper shuffle reviews being suggested." Yet here we have another. I'm surprised Averils dad has agreed to let Rob Behrens team investigate its own failings. (And has he been involved in setting the scope?) Apart from an annual light-touch visit to PACAC the Ombudsman is largely above scrutiny. This cannot be right. My own experience of registering 5 complaints with the Ombudsman under PCA 1967 (2 upheld, 3 not investigated) is that they are prolonged and, despite the best will of the investigator, clunky. Also, as far as I can see the organisation guilty of maladministration in the 2 successes has so far shrugged the reports off.
Hi at 7:24. Well done is something of an irony. As the rest of my comment makes clear. NHS organisations often delay deny & defend as a matter of course. They only do too little too late when there is no alternative. So, Ben is reflecting a wider dysfunctional culture that serves neither patients nor staff. Expect nothing and you will not be disappointed.
Well done Ben Reid. Except. This is seven years late. This "independent" review has been forced on the trust following Les' successful tribunal claim, the HSE prosecution and CQC pressure against a background of a very dysfunctional culture. Les was dismissed within minutes of reporting the asbestos risk. The trust has known it was wrong from that point. Les must be given freedom to help decide the Tors and the investigating panel. A good man's life has been ruined. The review should be given the power to make full restitution.