The Dilemma of a Whistle-Blower

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CRASH attended an event for NHS whistle-blowers at the Office of the National Guardian on 20th January. 

WARNING: this page contains a graphic image.

 

 

 

We went to the event already inspired by stories of whistle-blowers and the detriment they suffer. Many of their stories are already in the public domain (some on this blog) but an element of confidentiality, appertaining to those who attended the event, must be honoured. We came away in awe of their courage for which they have paid a huge price.

There were significant reservations expressed in advance of the event about the Office of the National Guardian. Read more on Dr Minh Alexander’s blog and twitter feed

These are just a few personal opinions and perceptions arising from the event.

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Negatives and problems

 

  • Your scribe perceived an air of paranoia¹ in the room, which is entirely justified. The National Guardian has a mountain to climb to gain trust.
  • The current line of accountability for the Guardian does not inspire confidence. Her office should be entirely independent of any NHS-related organisation (including the Secretary of State). The National Audit Office next door would make a good home. It has it’s own hotline – 020 7798 7999 – for concerns about public spending and conduct: unsurprisingly, it is rarely (if ever) publicised within the NHS.
  • Some of those attending the earlier event (largely made up of representatives from health trusts, regulators etc.) are not ‘fit for purpose’ in the context of their own organisations’ treatment of whistle-blowers. 
  • There should have been one event for all stakeholders – or the views of the whistle-blowers should have been heard first: the whistle-blowers felt ‘ghettoised’.
  • There was no confidence in the Care Quality Commission protecting whistle-blowers.
  • Does the National Guardian have sufficient resources to be effective or does she face the same problem the National Data Guardian found on taking up her post? 
  • The National Guardian should not use ‘weasel words’/NHS jargon to soften the meaning of reports. For example, ‘challenges‘ should not be used as an alternative to ‘problems‘ and ‘learning opportunities’ should not be used instead of ‘mistakes’. Mistakes‘ should be qualified on a grade of severity.
  • The problems and mistakes’ appear more serious in the mental health sector.

Analogies on NHS jargon:

Climbing Mount Everest is a challenge: falling into a crevasse on descent is not a ‘challenge‘ – it is a serious, life-threatening ‘mistake‘ and a ‘problem‘.

Shredding/amending a suicide patient’s notes before an inquest is not a ‘learning opportunity’ – it is a ‘mistake‘ (or as one Trust Chairman said, “A cock-up“) of such severity that it might constitute the criminal offence of perverting the course of justice.

Similarly, it is a ‘challenge‘ for NHS staff to have the courage to whistle-blow but it is often a ‘problem‘ for them once they have done so.

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Positives (not many yet).

 

 

  • There is good practice: at least one delegate was present who had not lost his job.
  • It is an opportunity to make a difference for those who have already ‘come out’ as whistle-blowers – albeit that it must be treated with due scepticism and, by those who have not ‘come out’, with considerable caution.
  • The Guardian, Dr Henrietta Hughes and her officials appeared empathetic and receptive to ideas – only time will tell.

Conclusion:

Whistle-blowers may find some of this contentious (but are welcome to add comments). However, I suggest Dr Hughes should at least given an opportunity by whistle-blowers, especially those who have already ‘come out’, to prove her doubters wrong.

Dr Hughes has requested advice and guidance on the following by 20th February 2017:

  • The criteria to select cases for review.
  • What [are] the greatest challenges of reviewing cases and how to meet those challenges [I know, but we warned you].

Send your suggestions to Dr Hughes by email here or by post to National Guardian’s Office, 151, Buckingham Palace Road, London, SW1W 9SZ. In addition to whistle-blowers, she wants to hear from anyone with an interest in the NHS, including patients and bereaved families. Names of whistle-blowers, who are fearful of speaking up, can be withheld.   

To paraphrase that great man and orator, Martin Luther King:

“Let us not wallow in valley of despair, I say to you today my friend. And so, even though we face the difficulties of today and tomorrow, I still have a dream.

I have a dream that one day even the [NHS], a [body] sweltering with the heat of injustice, sweltering with the heat of oppression, will be transformed into an oasis of freedom and justice.”

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2022 NHS Whistle-blower

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2017 NHS Whistle-blower

 

       We should dream too.

 

 

 

 


¹ In the common (not medical) understanding of the word.

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It’s over…

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CALL FOR TROUBLED SOUTHERN HEALTH TRUST TO BE BROKEN UP.

 

 

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals and Mental Health Lead at the Care Quality Commission and two regional CQC officials met Healthwatch Hampshire and members of ‘The Forum for Justice Accountability & Equality at Southern Health’¹,² on Friday in Winchester.

In a press release on 22 November 2016, the CQC implied that significant improvements had been found at an inspection of the Trust on 13 – 15 September 2016. Yet the report itself referred to on-going environmental issues relating to ligature risks, the layout of some wards and insufficient staff which did not may it easy to observe patients – including those who might be at risk of self-harm. In addition, local management teams had not consistently reviewed and learnt from incidents well.

Southern Health even told the CQC that every patient had in place an individual safety and risk management plan, relating to the ward environment but they found no such plan existed for a quarter of the records reviewed. The CQC raised these concerns with Southern Health at the time of the inspection in September not when the report was finally published. Read the full report here→

Commenting on the latest unexpected death by ligature of a Southern Health patient last week and developments over the last 12 months, a spokesman for the Forum said:

“We were deeply saddened by the news of another unexpected death of a Southern Health patient. Our hearts go out to the family: we share their grief. We cannot speculate without further information but, in the context of the CQC report, the obvious question is how can a patient, on 15 minute observations, use a bed-sheet as a ligature without it being attached to a fixed point? We are shocked by the tone of Southern Health’s announcement too. They might as well be reporting that the coffee machine had broken. It appears to be all about managing reputational risk again.

“In our view, the twelve months since publication of the Mazars Review and our meetings have demonstrated not only the continuing failure of leadership and governance at Southern Health but also that neither the CQC nor NHS Improvement are effective regulators. During this time, there have been more Inquests, more Coroner’s verdicts, more CQC Reports, more NHS Improvement Enforcement Notices and more sadness and reports from bereaved families and others. There has been plenty of tea and sympathy, but no discernible action.

“Critically, it appears the CQC does not monitor the Trust Medical Director’s implementation of Action Plans arising from Coroners’ Courts or from the Parliamentary and Health Service Ombudsman and, in practice, does not monitor the long-term execution of any action plans. “These are vital because the Plans are requested to address failings in patient care. It demonstrates that the Trust continues to jeopardise the safety and lives of patients.

“Conversely, the Forum is encouraged by the actions of the new Interim Chairman, Alan Yates, who appears keen to engage with patients, bereaved families, ex-governors and others, and with the few existing governors, who truly wish to improve things. To this end, the Forum has asked NHS Improvement and the CQC to give Alan every support in implementing his plans. Also, members of the Forum were delighted when Dr Lelliott and his colleagues agreed to consult them before, or at the start of, future inspections of Southern Health.”

The Forum concluded:

break-up-3Sadly, we have reached the conclusion that, unless positive steps are ‘seen to be’ taken in short order to improve governance, patient safety and leadership at the Trust (especially medical leadership) the only option is for the Trust to be broken up completely. Meanwhile, Alan Yates and the Regulators can be assured of our support.”

 

¹ The Forum is an influential group of bereaved families, carers, ‘rebel’ governors and others, who came together last May at ‘The Shambles‘ to exchange views and who are determined to see real improvements at Southern Health.² Members have held meetings with a Minister of State, Directors of the CQC, NHS Improvement and Southern Health, The National Audit Office, Healthwatch Hampshire and others. Further such meetings are planned. Members act individually on their own cases too.  

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Members of The Forum, who attended the meeting with Dr Lelliott, photographed at the venue – The Lakeside Room at South Winchester Golf Club.  ©John Green.

Anyone with an interest in joining ‘The Forum for Justice Accountability & Equality at Southern Health’ should email brief details by clicking here:

² DISCLAIMER

This blog (CRASH) is authored by a member of ‘The Forum for Justice Accountability & Equality at Southern Health’ but does not speak for or represent the views of the Forum, unless specifically stated as comments by a ‘spokesman’ for the Forum. In the latter case, statements are based on the majority view and are vetted by at least three members of the Forum before publication.

A Year for Change?

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Wish list for 2017

Events for January

 

 

It is over a year since the Mazars ‘Death’ Review into Southern Health and some           complainants have entered the 6th  year of their battle for justice. The only positive change in all this time is that Alan Yates (current Interim Chairman) and Julie Dawes(Interim CEO) are actually talking (and we believe ‘listening’!) to patient groups.

Our primary wish for 2017 is for something to be ‘seen to be’ done to make improvements. Not everything, which needs to be done, can be achieved quickly but there are measures that could be taken this month to demonstrate progress. 

There are 5 key meetings taking place in the next 28 days, most of which are open to all those with an interest in the improvement of mental health and learning disability services provided by Southern Health. 

To give Alan and Julie the support they need to overcome the laissez faire attitude of the rest of the Southern Health Board, most of the governors, NHSI Improvement and the Care Quality Commision (“CQC”) (demonstrated by these links), it is essential that these meetings are well supported and that we make our views known forcibly.

13th January 2017 – facilitated by Healthwatch Hampshire, an existing group of patient representatives, governors and others is meeting Dr Paul Lelliott (CQC Deputy Chief Inspector of Hospitals, mental health lead) and his Inspection Managers in Winchester. Email here for further information about the group: new members welcome.

The purpose and objectives of this meeting are outlined in a paper below, sent to the CQC in advance. 

18th January 2017 – a workshop for families, carers, patients and service providers, organised by Southern Health to discuss the development of an action plan, which follows a number of reports and reviews that show they are failing to adequately involve people who may be accessing their services.

Venue The Hall at Wells Place, Eastleigh, 1pm to 3pm (arrival from 12.45pm). If you wish to be involved email Mrs Chris Woodfine or telephone 023 8087 4146 or 07771 388495.

31 January 2017 –  9am Southern Health Board Meeting held in public at Trust HQ with an opportunity to ask questions and meet Board Directors. Full details here→ (where an agenda will also be available closer to the meeting). Advanced notice of attendance is not required – just turn up – but questions are requested in advance by email.

31 January 2017 – 2pm Southern Health Council of Governors’ Meeting held in public with an opportunity to ask robust questions about why Council Members (with notable exceptions) have failed to do their job properly in holding Non-Executive Directors to account and in representing the views of (and engaging with) the public .

Full details of the meeting here→ (where an agenda will also be available closer to the meeting) and more about the Council’s performance here→. Advanced notice of attendance is not required – just turn up. 

1 February 2017 – the same workshop as on 18 January at a different location.

Venue The West Wing at Portchester Community Centre, 1.30pm to 3.30pm (arrival from 1.15pm.)  If you wish to be involved email Mrs Chris Woodfine or telephone as above.

Meeting with CQC

This paper has been sent to the CQC for the meeting on 13th January 2017: it describes inter alia the current perceived state of play. We urge anyone, who is not a party  to the meeting, to make similar points by emailing Dr Paul Lelliott at the CQC or Jim Mackey at NHSI. cqc-purpose