Comments - Page 4
Auditing the process for compliance with the statutory duty of candour is relatively simple yet after 4 years CQC appear not have got even that right. The real problem is checking the factual accuracy of statements made to patients/families involved in moderate/serious incidents. It seems unlikely that CQC follows this through. It would involve looking at the details of cases, the investigations (completed or ongoing) and most likely hearing patient/family evidence. CQC have famously and repeatedly said that they do not investigate individual cases. Without doing just that it is hard to see how they can properly certify full candour.
Further evidence that CQC is not taking its statutory responsibility for regulation 20 seriously. Earlier I reported evidence to CQC of failure by an NHS Trust to be candid about the avoidable death of a baby including criticism by HMC. CQC promised to investigate and include this in the next inspection report. CQC wrote to me saying there was no breach. The inspection report made no reference to the case. I asked the local inspectors if the parents had been involved in their investigation. There was no need for that they replied. But who is in a better position to judge lack of candour than the parents. CQC has previously criticised trusts for failing to include families in investigations. I complained to CQC but they have refused to provide any details of their "investigation". The lack of candour on their part is disappointing.
Thanks Anonymous at 11:45. That's more or less a recognition that Francis' main plank in his remedy for whistleblower suppression in the NHS is a busted flush. Which practically every whistleblower who made a submission to the FTSU review understood on first reading the report. It is now widely recognised that failure of staff to speak up for whatever the reason is a clear and present danger to patients. In February 2015 Jeremy Hunt acknowledged that it would take a generation to change this. Neither patients nor professionals can wait that long. Dr Hughes should call for powers to enable her to ensure staff are safe to raise concerns or admit defeat.
Very disappointing. "The national guardian’s office does not record data on how the concerns were handled." Nor outcomes it seems. If a new (and in this case, untested and expensive) treatment were introduced to the NHS and 7,000 treated it would be unthinkable that its use would be reported with no mention of outcomes. NGO (as so often with NHS bureaucracies) seems to have gone out if its way to ignore data which must be easily available. What exact benefits has NGO and its offspring brought? We know nothing. Of particular concern are the 360+ staff who raised a concern and suffered detriment. What happened to them? It's reasonable to expect that with a grand title like National Guardian Dr Hughes should have some responsibility for protecting those who suffered detriment for, as Sir Robert said, "doing the right thing". At some point NGO will have to give a more credible account of what value the public is getting for its investment.
Rob Behrens inherited a sinking ship following the "departure" of the previous Ombudsman and her deputy, adverse reports from the Patients Association and with the office held in disrepute by many complainants who turned to it as their last chance of getting justice. He is to be congratulated for this latest initiative. The regulatory gap concerned was identified by David Behan at CQC some years ago. In 2016 after I had provided extensive evidence of the cover up of avoidable child deaths and harm at an NHS Trust NHSI (Medical Director) also claimed they had neither the power nor duty to investigate. Both regulators recognised the gap but neither showed any interest in bridging it. This could only happen for individual cases by the arbitrary decision of the Health Secretary. So, well done Professor Behrens and also Will Powell who has campaigned for many years to expose the cover up of the circumstances of his son's death. The Department of Health's refusal to take the original PACAC recommendation seriously is typical. No doubt at some future point (as today in the Langstaff Inquiry) their legal representative will be offering a formulaic apology that mistakes had been made. But that will not come until DH feels it has no other choice.
“We are committed to ensuring (the) Trust is able to learn as much as it can from the historical cases.. " Dr McLean, MD at NHSI.
I have always found the use of "historical cases" to be rather dismissive when used by NHS regulators. It is also regrettable that in the case of SATH Dr McLean omits, no matter how important the learning component of any investigation may be, that on this also hangs truth and justice for the families which are essential for their own grieving. Perhaps such concerns are not seen as part of the regulatory function.
Thanks Rebecca. Since this post is Francis' central plank in his system for supporting and protecting whistleblowers it is worth considering whether it served its purpose. Name of post-holder and contact details available.
Anon at 14:20 Agree. Local guardians unlikely to be of any help in serious matters. Have made representations to Dr Hughes, National Guardian, over NHS Whistleblower vindicated by independent investigation (Verita 2016) now in year 7 of exclusion from the workplace. (NHSI, CQC, SoS, NGO, NHSCFA, Health Select Committee all fully informed) Dr Hughes says there is nothing she can do. I rest my case.
Patrick at 10:13: The first port of call in NHS organisations for staff who get no joy when raising concerns (or worse, suffer retaliation) is the so-called Francis Guardian who reports to the National Guardians Office. At Shrewsbury the official title is Values Guardian. Unfortunately the whole system is an expensive sham with no powers of investigation or enforcement. I have asked Rebecca and Alistair if the Values Guardian played any role here. Tumbleweed. I gave evidence last week to the Kark Review on this. Ideally Trusts should be allowed to handle concerns. In situations such as this they have shown themselves unfit for that respobsibility. I agree that at this point an independent authority is needed to adjudicate. And the whistleblowers need prospective legal protection. We have given Sir Robert Francis the evidence that this is required. He failed to take notice. So staff and patients continue to suffer.
Target breach is a sackable offence? Speaking outside the trust is a disciplinary matter? Culture of fear? Staff dare not speak up in a hospital where patients are treated like cattle. Denial by by workforce director. "No threats have been made." Non-response by NHSI. This all sounds very good for patients and staff. It sounds like an organisation in free-fall. And presumably this is a situation other Trusts are just about containing. Time for a bit of honesty. Have the people running our NHS learned nothing?
HSJ is a management journal. I presume managers are its main prescribers. Not surprising therefore that there should be a management bias in the comments section if not in the article itself. One anonymous “senior clinician at the trust” is cited in a pro-Nadeem comment. No counter view. Readers comments (mostly anonymous) are largely pro-Nadeem. Many managers love the idea of an MD who will really take some of these dysfunctional consultants in hand. (I would not deny there is a problem with some consultants. As equally there is with some managers.) But there isn’t enough information in the public domain to make a reasoned assessment of what has happened in this instance. Presumably the 2nd Deloitte review (if genuinely comprehensive and competent) is something akin to aviation’s black-box. But it has not been and most likely will not be published. Until there has been a detailed and evidenced investigation of this matter with its findings put into the public domain we should reserve judgement. Such conflicts are rarely black and white. It is most likely six of one and half a dozen of the other. Meaning that both sides and everyone else has a lot to learn from this plane crash. Which at present we are unable to do.
And well done Professor Narinder Kapur for ensuing this review was done properly. Professor Kapur was himself a victim of an unfair NHS disciplinary procedure.
Another example of an NHS Trust having a passable disciplinary policy which is administered in such an incompetent and biased fashion that it destroys the life of a good member of staff. In this case it is quite likely that consciously or unconsciously there was an element of the investigation and disciplinary hearing getting the result the trust hierarchy would approve of. It cannot have helped Amin that he was BME and gay. The disciplinary process as currently administered in the NHS is a dangerous and unfair instrument which has wrecked many good professional lives. An apology in this specific case is appropriate but now requires a further investigation into the wider practice. Or malpractice.
This is a model situation for anyone interested in understanding why there is such a wide and growing gap between management and clinicians in so many places (LCT, WUHT, Dudley etc). And why the regulators often make things worse. A house divided against itself cannot stand.
Comments so far show management-side partisanship. And are, typically, Anonymous. I am a clinician and I put my name to my views. The Deloitte review, in comments on the other article, is a "whitewash", "corruption" even. On Dr Moghal the report understates the case: “However, there is also a view that, at times, the MD’s style and approach can be overly robust and that it is not always conducive to bringing the medical workforce with him.” My own experience of Dr Moghal in 2010 suggests another explanation for his current difficulties. Appointed Paediatric CD by the chair at Walsall Healthcare. Post not advertised. Department not consulted. He came as a management enforcer to deal with a complex and difficult situation. I have described his management style in my book "Little Stories of Life and Death @NHSWhistleblowr". He has not refuted anything I have written. He was a poor listener and not disposed to consider any views other than his own. I can see the possible difficulties staff may have had with his style. MDs need to bridge the management-consultant gap. I didn't see much evidence that Dr Moghal had the skills for that. We must await the Board's review of the "tensions". Dr Moghal is a board member of course. It would have been good to see a genuinely independent and competent process for this.
Sorry Anon. at 12:54, that is a naive view. There is no effective prescribed process for NHS whistleblowers. Staff who do so continue to be at risk. That's why a majority remain silent. Without the help of the press many NHS scandals would not have been exposed. The Dudley whistleblowers, while reporting this matter to the trust chair and the regulator, took the wise precaution of copying HSJ. The NHS in many places continues with a culture of secrecy and fear. Thank God we still have a relatively free press that can ensure these matters are brought to public and professional attention.
Anonymous (and ill - informed) at 14:44. CQC do not commission FPPR investigations. They certainly do not fund them. Practically everything else you have ever said on this matter is equally worthless. Anonymity becomes you. David Drew
4 years after FPPR became statute and we need a review to tell CQC that "inhibiting" or "discouraging" whistleblowers are to be "proscribed" behaviours in NHS directors. It is hard to think of a single behaviour potentially more harmful to patients (who the NHS exists to serve) than preventing staff speaking up about safety concerns. And now we need a distinguished QC to tell us this? Sir Robert Francis has said repeatedly that anything less than helping staff raise concerns is a clear and present danger to patients. The Department of Health accepted a recommendation from the 2002 Kennedy report to develop a safe reporting culture. There is no evidence that we are nearer now than then. Such protracted failure is unlikely to be an accident. As in other disciplines there is little appetite to genuinely support whistleblowers.
Hi Shaun. "could all be prescribed behaviours" should read "could all be proscribed behaviours". I understand what the sentence means but that isn't what, as it stands, it say.
"Agreeing secret pay deals without proper approval, inhibiting whistleblowers and failing to cooperate with review could all be prescribed behaviours under new fit and proper test" I presume you mean "proscribed" not prescribed which has the opposite meaning. Incidentally, Sir Robert Francis has said repeatedly, including in his Freedom to Speak up Review, that Whistleblower suppression is Gross Misconduct. CQC, the regulator responsible for the administration of regulation 5, has so far chosen to ignore this. Letting culpable directors off the hook.