From April First next year the NHS has a new Chief Executive, Mr. Simon Stevens. This week he gave some clues as to what we can expect from his leadership. He called for a new era of openness and transparency in healthcare. “We are going to draw back the veil between what those of us working inside health know about it and what the people on the receiving end of our ministrations get to see – particularly care quality,” he told a world summit. That is a heavy curtain. He sets himself and us an ambitious task.
A swathe of recent reports from Francis, Keogh, Berwick, the Health Committee and Jeremy Hunt in their responses to Francis and Ann Clwyd subscribe to a view that the care of patients sometimes or often is not being given priority. Patients, patient and relative complainants, frontline professionals and whistleblowers find themselves in an unequal power relationship with those running the service. Whoever that is.
This week I tweeted a message to the effect that the Chief Executive of the Royal College of Paediatrics, Dr. Chris Hanvey, had misled me with respect to a review of the paediatric department at Walsall Manor Hospital conducted by College Fellows in 2010. The same day I received an email giving me 48 hours to retract. The College lawyers were being consulted, he threatened. Since my tweet was true I refused. I have a timeline and a mailbag full of opinions about this incident, largely reflecting my own view that this was a high-handed attempt to put the frighteners on me. Shameful was the commonest adjective in use.
Since July 2011 I have been seeking help from the Royal College after my dismissal for whistleblowing on poor care, child protection failures and other things. I have expressed particular concern over the failure of the review panel the Royal College sent to Walsall in 2010 to investigate these matters properly.
I have given Chris Hanvey and Hilary Cass, the College President, information about the cover-up of the hospital’s liability for sending a toddler home to his death and the subsequent failure of the hospital to address and remedy its “catastrophic mistakes”. See my recent blog http://t.co/Q46wHmJH6U which gives some insight into this.
I have provided evidence that the report of this review was suppressed by the Chief Executive and Trust Chairman. Even the Trust board, the hospital’s senior consultant committee and the Royal College of Paediatrics itself has not been allowed to see it. It is no coincidence that the report was highly critical of the Trust senior managers who commissioned it.
I have given evidence that the chairman of the review panel was appointed to a position in the hospital which helped him advance his own management career. He then helped with the suppression of this report which involved the Chief Executive altering the report’s instruction for disseminating its findings.
I have given evidence to Chris Hanvey that the College policy for conducting a review was breached severally by the panel. Also I informed Dr Hanvey that the report of the review, which was commissioned at my request following the serious and legitimate concerns I reported, was used by the Trust lawyer to convert my case into an employment dispute which resulted in my dismissal.
Dr Hanvey has informed me that the College has been unable to obtain a copy of the report and that the panel members will not co-operate with his investigation as they have “signed confidentiality agreements with Walsall Healthcare.” Dr Hanvey, while willing to bring in the College lawyers after taking personal umbrage over one of my tweets, has failed miserably to take seriously matters of the greatest concern to Walsall residents and the NHS in general. In my opinion he has shown more concern for his own reputation and that of the College than the issues I have reported to him. This is one of the major principles at stake in the battle for the new NHS culture that Simon Stevens aspires to.
On 11 December I met with David Prior, CQC Chair, and two of his senior officers. I discussed my own experiences as a whistleblower at Walsall Healthcare NHS Trust up to my dismissal in December 2010. We discussed the ways in which CQC could play its role in supporting and protecting staff who raise issues about patient care. I was impressed at the way the group had taken trouble to brief itself on the background I had provided. CQC, in the form of these individuals, clearly understands what the issues are with whistleblowing and is intent on action. Even if it is not yet sure what that action should be.
At this meeting I handed a document to David Prior on the serial failures of Dr Hanvey, Dr Cass, the Royal College of Paediatrics and its Walsall Independent Review Panel. Here it is in full. I leave the reader to judge if Dr Hanvey had any right to threaten me with the College lawyers. I will of course be interested to see what the same lawyers make of the revelations in this document.
My evidence that the Royal College of Paediatrics and Child Health has failed to act on reported patient harm and support the whistleblower reporting this.
I make this statement in good faith, believing it to be factually correct and of considerable public interest given recent scandals in the NHS.
In April 2007 after more than 7 years as Clinical Director of the Paediatric Department at Walsall Manor Hospital I was removed from this position by the Medical Director after I repeatedly expressed concerns about a consultant I was managing, Dr W. Dr W was at the same time removed from his lead position in the Neonatal Department because of general concerns about his competence in that role.
At that time the Trust began a major cost cutting exercise for PFI affordability and FT application. Three managers where put in charge who were later formally judged (by a Royal College Review Panel) to be without knowledge or experience of paediatrics, aggressive and failing to engage with senior clinical staff. This resulted in a host of problems and I raised concerns about these through line management up to the Chief Executive.
In April 2009 I was suspended as a direct result of these disclosures. The most serious allegation related to a patient, known from his Serious Case Review by Walsall Safeguarding Children Board as Child K. This toddler had been admitted under Dr W. He had suspicious unexplained bruising but was sent home by Dr W against the advice of colleagues and contrary to policy. He was unlawfully killed a week later. The Trust had failed to respond properly to this death and my most serious disclosure to the Chief Executive related to this. The allegations resulting in my suspension included a claim that I had dishonestly obtained correspondence about Child K, that in making my disclosure I had undermined a senior nurse manager and that according to the Medical Director I was suspected of leaking information to the press on Child K. This was categorically untrue and my concerns were accurate and expressed in good faith.
Following my suspension, having been told I had no case to answer by the investigation, I continued to raise concerns. Knowing that this could result in a further suspension I raised a grievance about my earlier suspension. I met the Trust Chairman with the BMA and he agreed to commission an independent review to examine my grievance and the concerns I had expressed about the paediatric department. The Royal College of Paediatrics recommended two Royal College Fellows, Dr. Nadeem Moghal and Dr. Peter Heinz, to conduct the review. They co-opted a third person to cover the HR aspects.
In my principle disclosure letter of 26 October 2009 to the Chief Executive I framed the problem in whistleblowing terms stating that my obligations to the Trust under the whistleblowing policy were almost discharged. In my correspondence with the Review panel chairman, Dr Moghal, I made it clear that I was a whistleblower. The panel sat on 4 and 5 March 2010. I provided a statement of case which had been in the Trust’s possession for 4 months and a corpus of supporting documentation. The Trust submitted a 16 page statement of case which I was not allowed to see. Its content was largely dedicated to a “disruptive physician narrative” which is a recognised method of dealing with whistleblowing doctors. There were 2 large folders of supporting documents. I obtained copies of these a year later using the Data Protection Act.
Specifically with reference to Child K:
- I provided documentation to the Review including admissions by the trust that this child had died following “catastrophic mistakes” and that if even “basic safeguarding procedures had been followed he would still be alive”. I even put the local press cuttings in my bundle.
- In my interview I gave a quite detailed account of my concerns and my (at that time partly unproven) suspicions about a cover up. The panel took notes on this.
- The most senior safeguarding officer from the PCT was interviewed by the panel. There can have been no reason for her being interviewed other than to provide evidence on Child K.
- I asked the panel to interview a number of witnesses. One of these was a safeguarding nurse who had been forced to resign as a direct result of managerial bullying. This was all done with the full knowledge of the Chief Executive. This kind of behaviour was damaging the department’s safeguarding development especially in the context of Child K’s death. The panel failed to interview her and did not even bother to tell me.
- The consultant who sent Child K home was interviewed.
- The Chief Executive and Medical Director (who had made a misleading press statement about Child K) were both interviewed.
There was no lack of evidence provided to the panel. I learned later that the panel destroyed all records of oral evidence when it produced its report. I was of course anxious to obtain these for my employment tribunal.
In November 2013 after intense lobbying by Child K’s father after I had made him aware of what happened to his son (he had not been told anything) the current Walsall Healthcare Chief Executive agreed to an independent review of Child K’s case. On the basis of the evidence I gave to the Review this is exactly what the report should have recommended.
The panel produced a report by the end of March and the Trust Chairman and I were given a copy. The report was pithy and provided no evidence for its conclusions or “required outcomes”. I was required by the Chief Executive to accept it in full without clarification. I refused and was asked to resign.
The report failed to even mention Child K, my concerns about the Trust’s failures with respect to him or the consultant responsible. The report concluded without giving any evidence that I was not a whistleblower. I have never been given an opportunity to get clarification on these or other anomalies in the report.
The Review chairman, Dr Nadeem Moghal, following an irregular appointment by the Trust Chair and CEO, became, weeks after the review, head of the paediatric department at Walsall. He repeatedly refused to discuss Child K and why he had been erased from the review. “You haven’t got a Baby P. There’s no conspiracy. There’s nothing you can do about this.”
Eventually the Trust started disciplinary proceedings against me for failing to accept the Review in full. I asked Dr Moghal to give evidence at my disciplinary hearing. The Chair of the hearing, Sue Hartley, Director of Nursing, wrote to him informing him that he did not have to appear if he did not want to. Dr Moghal did not appear.
After I was dismissed I took Walsall Healthcare to an Employment Tribunal. Dr Moghal did not appear. My counsel had no opportunity to cross examine on anything that went on in the Review or what went into its report. When asked about Review panel decisions the Chief Executive told him “ask them”. Of course this was impossible. I lost my case against Walsall Healthcare.
In 2011 I wrote to the Registrar at the Royal College of Paediatrics, Professor Hamish Wallace. I explained that I had been dismissed after raising concerns about patient care, child protection etc in Walsall. I had tried to understand how the Review had worked and had written several times asking Dr Moghal for a copy of the methodology he had used for the Review. He refused to provide this. I asked Professor Wallace for a copy of the College policy on conducting a Review. He failed to provide me with a copy. Two years later when I finally obtained a copy it was obvious that Dr Moghal had departed from the College policy in a number of important ways.
In August 2013 I wrote to Chris Hanvey, CEO of the Royal College of Paediatrics, to register a formal complaint about the conduct and outcomes of the Walsall 2010 Review. He agreed to investigate but on 27 August wrote to inform me that he had been unable to secure the co-operation of the panel members, Dr Moghal and Dr Heinz. “The two reviewers confirmed this in telephone interviews, making it clear they were bound by confidentiality agreements entered into with Walsall Healthcare NHS Trust and which restricted what they could discuss – both in 2010 and now.”
“Confidentiality agreements entered into with Walsall Hospitals NHS Trust” was new. This was the first time I had heard anything about the panel members being gagged. I sent an FOI to Walsall Healthcare. A month later the response assured me that the panel had not signed confidentiality agreements. But the gravitas of a Royal College CEO made me doubt Walsall not him. I wrote to the Walsall CEO, Richard Kirby. After valiant attempts he wrote back to report that there was no evidence that the review panel had signed any confidentiality agreements with Walsall. I went back to the College CEO to report this denial.
On 12 November he emailed me asking me to point Richard Kirby to the agreement signed in September 2010, 6 months after the review finished. Finally Richard Kirby spoke to Chris Hanvey, CEO at the College. Richard Kirby provided me today, 10 December, with a copy of an indemnity agreement signed in January 2010. This was his comment on it:
“I have discussed this with our lawyers and with Sue James and as far as I am able to establish:
– The agreement was drawn up by the Royal College at their request rather than at the request of the Trust.
– The main purpose of the agreement was to ensure that liability for any decisions taken by the Trust in light of the review sits with the Trust rather than with the Royal College.
– The agreement says that the report will be confidential but adds that the reviewers should share it with DH / GMC if they have concerns that need to be shared with those bodies and that the report can be shared in proceedings arising from its presentation. I do not think that this constitutes a “gagging clause” in that it sets out the circumstances in which the content of the report should be shared. “
The agreement which the Royal College of Paediatrics required to protect its own interests was the same agreement that in August its CEO had cited as the reason it was unable to investigate my complaint against the Walsall Review. There was no other. Astonishingly when I referred to this on Twitter the same CEO emailed me to say he was consulting College lawyers about this.
The Royal College of Paediatrics has failed to investigate my serious complaints about this Review. These include my claims that:
- The review’s chairman used the review to forward his own career.
- He helped the Chief Executive Sue James to suppress the report so that even the board and senior clinicians in the hospital were not allowed to see it.
- The case of Child K was airbrushed out. No reference was made to my disclosures about this. I raised concerns about this with the College President, Hilary Cass, in writing as early as June but she has not responded,
- The panel was wrong to conclude that I was not a whistleblower. No evidence was given to support this conclusion. I had framed my case as whistleblowing throughout. I presented evidence of what were clearly protected disclosures. This facilitated my dismissal and prevented me getting any legal hearing as a whistleblower. Independent legal assessment of my disclosures has confirmed their strength.
The College’s failure to investigate resulted from the panel’s claim to be gagged. The legitimacy of these gags has been accepted unquestioningly by the College CEO. If they are gagged it is the College that has gagged them. Walsall does not recognise any gag. The recent government response to Francis on gags is explicit. There can be no gagging anyone with respect to matters of public interest. Child K is a matter of public interest. The suppression by a senior NHS manager of a report which criticised her is of public interest. The dismissal of a whistleblower is of public interest. It would be nonsense to believe that the review panel cannot speak in full to the RoyalCollege about its work. The panel has not even given the Royal College a copy of its report for scrutiny. The College and the Review panel are working without any oversight, scrutiny or regulation in the vital matter of Independent paediatric departmental reviews. And in my opinion the College allowed the Walsall Review panel to get away with a botched job with impunity.
The Walsall Review was conducted at my request with BMA support after I suffered the detriment of completely unwarranted suspension (Review conclusion) for raising concerns about mismanagement at Walsall Healthcare. The Review was conducted in the Public interest. What could be of greater interest to Walsall residents than the medical care of their children? The Review was conducted at significant cost to the taxpayer. The costs to both Walsall Healthcare and me as a result of the subsequent legal actions run into hundreds of thousands of pounds.
The full report of this Review has not been seen by the Trust board, the senior consultant body, or even the Royal College of Paediatrics through which it was commissioned. Of those criticised in the report, including the board and executive and middle managers, no-one, apart from me, its instigator, has suffered any detriment. The report was deeply flawed but has never been subject to any scrutiny as a direct result it being shrouded in secrecy by Walsall senior managers, the Review panel members and the Royal College of Paediatrics Chief Executive. Openness, Transparency and candour are the new NHS cultural watchwords in the wake of the Francis report and the government response to it. I have seen no evidence of that here.
10 December 2013.