I first heard “Nodding NEDs” used at the Midstaffs Public Inquiry mainly in the conversation of relatives attending the hearings. I immediately and intuitively understood what it meant. In its “Roles and Responsibilities of Non-executive Directors” the Trust Development Authority envisions an entirely different image. The NEDs role is to:
“Commit to working to, and encouraging within the trust, the highest standards of probity, integrity and governance and contribute to ensuring that the trust’s internal governance arrangements conform with best practice and statutory requirements”
There has been extensive comment on and criticism of NHS Trust Boards over the last year; of how they do and do not work. I was dismissed as a senior paediatric consultant in 2010 for Gross Misconduct and Insubordination. As far as the BMA has been able to tell me I am the only doctor ever to have been sacked for insubordination. Insubordination is a punishable offense in hierarchical organisations which depend upon people lower in the chain of command doing what they are told. It is hard to see how that could apply to a hospital’s most senior paediatrician. It is now a truism that hierarchies are bad for patient safety. They have no place in the NHS. All voices must be heard.
Over Christmas I took a couple of hours to read Sir Ian Kennedy’s Breast Care Review report published in December. In his executive summary Sir Ian gives an outline of the story:
“It is a story of women faced with a life threatening disease who have been harmed. It is a story of clinicians at their wits’ ends trying for years to get the Trust to addresswhat was going on. It is a story of clinicians going along with what they knew to be poor performance. It is a story of weak and indecisive leadership from senior managers. It is a story of secrecy and containment. It is a story of a Board which did not carry out its responsibilities.”
Since my own experience had been of repeatedly reporting problems of competence and conduct to Trust senior management the whole report had a certain resonance. As a result, in the New Year I found myself writing to Mr. Nigel Summer, Vice Chairman of Walsall Healthcare NHS Trust. Nigel had been in post over the period 2008 to 2010 when I was raising my concerns at the hospital. He also had the advantage of being on the disciplinary panel that dismissed me for….insubordination.
I have used personal names and they have not been redacted here. To do otherwise is confusing. In any case as a result of legal proceedings, the extensive media coverage my case has received and my previous blogs there is widespread knowledge of those involved. I have of course taken care to make statements that can be evidenced by documents and or witnesses.
NHS Trust Boards: Sir Ian Kennedy offers useful advice.
I hope you have had time to read the Kennedy Breast Care Review which was published in December. There is much that Walsall Healthcare NHS Trust Board can learn from it. Here are a few bullet points:
- Trust culture is largely set, in practice, by its leadership.
- The Board has a responsibility to promote openness and candour in the organisation.
- The Board must create an environment in which members of staff feel able and free to raise matters of concern regarding the care and treatment of patients.
- It is difficult to challenge the behaviour and poor performance of colleagues. (Failing to challenge Mr Patterson has proved costly for patients and HEFT.)
Kennedy found the Heart of England Foundation Trust (HEFT) Board was kept in the dark by the executive during the Patterson years. This was the situation I found at Walsall particularly in my last years in the Trust. Sue James, the Chief Executive, was rarely seen on the paediatric wards in those days and most clinicians did not know who the Board members were. In 2010 a Royal College Review concluded that the Board had no way of knowing what was happening in a key department, Paediatrics. The report was suppressed so few people know that.
Sue James, with the support of the Trust Chair, Ben Reid OBE, set the culture. Here is the account she gave of me to the Employment Tribunal as reported in the Daily Telegraph in May 2012.
“During an eight day employment tribunal Sue James Chief Executive of Derby Hospitals said that Dr. Drew produced a toxic environment at the hospital by constantly raising complaints against his co-workers.”
Sue James’s statements are a good demonstration of just how dangerous raising concerns about colleagues can be. In fact I raised valid concerns about 5 individuals all of which were subsequently shown to be significant and of substance.
- I raised concerns about a consultant paediatrician I was managing, Dr Walia. He replaced an excellent consultant who had been killed in a road traffic accident at a time when there was a dearth of good paediatricians on the market. He had had problems with his practice in his previous consultant post, had needed an assessment by NCAS and then left his employing trust. I have it on record from the current Walsall Chief Executive that the Trust relied on his references and failed to obtain details of this assessment. Why? There were general concerns about his competence from both consultant and nurse colleagues in his early days at the Trust. In June 2006 he sent a toddler (Child K) home with suspicious unexplained bruising against medical and nursing colleague’s advice, contrary to policy and as a result of fundamentally flawed reasoning. Child K died of non-accidental injury a week later. I have seen all the Board minutes referring to Child K. The consultant and his failings are not mentioned. In 2009 Sue James wrote a press statement about Child K’s death which was untrue. In April 2008 Dr. Walia was removed from the role he was appointed to, lead clinician on the neonatal unit, by the Medical Director, after widespread concerns about his underperformance. In 2009 groups of trainees on 3 separate occasions complained to the West Midlands Deanery that he was a bully and unsupportive, failing to come in out of hours etc. I was right to raise these concerns about him. I did it for the benefit of the department, our trainees and our patients, things which you as a Board were largely blind to.
- In 2008 three managers were put in charge of the department after I was removed as head of department by the Medical Director for expressing my concerns about the above consultant. These three were subsequently judged by a panel recommended by the Royal College of Paediatrics to have had no knowledge or experience in Paediatrics, to be managerially aggressive and as failing to engage with frontline clinical staff. Their appointment by the executive was criticized as inappropriate by the same panel. The conclusions the panel came to about these managers were the substance of the concerns I had been raising with Sue James for more than a year. The Trust was instructed to remove two of these three by the same panel. The other one who was frankly foul-mouthed and a bully who had been reported to the Chief Executive on earlier occasions by consultants and senior nursing staff left the trust at a later date. Again I am not sure that you as a Board knew much about this.
- I registered a grievance against the Medical Director for wrongfully excluding me from my work as a consultant. This was fully upheld by the RoyalCollege panel and he was instructed to apologise to me verbally and in writing. On Sue James’s instruction he never did.
Sue James, using pure spin, convinced the Board that I was the one creating a toxic environment with my concerns. I have seen the Board minutes in which she states specifically that I was the principle risk to the paediatric department’s future. No member of the Paediatric Department at that time held that view. I must stress that Sue James would not have succeeded with this without the full support of Ben Reid. Whether Sue James misled you with her account of my misconduct will at some point be resolved. It will be for others to decide if she perjured herself at the Employment Tribunal.
In October 2009 after I disclosed in a letter to Sue James a host of serious failings in the Paediatric department Ben Reid agreed to commission an Independent Review of Paediatrics. This was in line with Kennedy’s recommendation:
“The Trust should ordinarily appoint external experts or the relevant Royal College to carry out investigations into the safety and quality of care.” (14.24)
However, Kennedy goes on:
“The Board should receive copies of the Reports produced at the end of investigations. These are necessary requirements to enable it to discharge its responsibility.” (14.25) and
“The Board must be alert to ensure that Reports which are produced from reviews and investigations are shared widely. The risk must be avoided that only a few Executives have the relevant knowledge and understanding of the whole picture, making it difficult for other staff and the Board to act effectively.” (14.26)
The report of the Independent Review of Paediatrics which was commissioned at my request as a result of the serious concerns about patient care that I had raised from 2008 to 2009 was produced in March 2010. It largely upheld my concerns about the department and its mismanagement by the executive and the middle managers it had inappropriately appointed to run the service. It was highly critical of the Trust Board and it’s Executive. The report was vigorously suppressed by Sue James. No-one was allowed to see the unabridged report. Even the Board did not see it. Sue James told the Employment Tribunal this was because “they did not ask”. The Royal College of Paediatrics through whom the Review was commissioned has not been allowed to see it as the panel claims to be silenced by confidentiality agreements. Sue James put together a sanitized version of the report which omitted embarrassing detail and falsified the Review’s instruction for the report’s dissemination. This version was circulated to a small select group in the Trust. Even the most senior doctors who were heads of their departments were not allowed to see it. The Senior Medical Staff Committee asked and expected to see it but Sue James put this off until September 2010 by which time she was able to tell the consultants that she was unable to discuss the Review as it was a part of a consultants disciplinary proceedings. Mine. This is not an open culture. This is secrecy and fear. It is the culture deprecated by every major report produced in the last year on failing NHS hospitals.
The Board had responsibility for ensuring the dissemination of the Review’s findings. Mistakes had been made at every level. There was much to be learned. The Board prevented this. HEFT is Walsall’s neighbouring trust. In 2010 the HEFT CEO, Mark Newbold, who commissioned the Kennedy Breast Care Review took a Royal College Review of its Children’s Services which was every bit as embarrassing as Walsall’s and put it on the Internet. That is what is meant by transparency. The BBC put in a Freedom of Information request for a copy of the Walsall Review and Walsall, in complete contrast, refused to disclose it even in redacted form. Interestingly Mark Newbold pipped Sue James to the post for the HEFT CEO job. That was, in my own opinion, a near miss for HEFT. Had Sue James been appointed it is hard to imagine, given her record, that she would ever have published its Review of Children’s Services. And we might still be waiting for the Kennedy Review. Good leadership is key.
The Walsall Review was of legitimate public interest. It was of particular interest to Walsall families who depend on the service. The Review was funded by the tax-payer. It was used, despite upholding my concerns, by Sue James and Martin Brewer, the Trust solicitor, to engineer my dismissal. Incidentally, Kennedy himself and the Health Select Committee are adamant that doctors raising concerns should not be dealt with using disciplinary proceedings or employment law. You Nigel have helped to preside over this. Hundreds of thousands of pounds has been taken out of the Walsall healthcare economy. Walsall children have been robbed of a good and much loved doctor who had not put a foot wrong in almost 20 years. I have lost my career, my professional reputation and a small fortune in legal fees and lost earnings. And all this in my opinion because as a Board you were not up to scratch, unwilling to find out for yourself what was happening in the Paediatric Department and incapable of challenging the Chief Executive on matters of fact.
As a postscript can I say that in June 2010 Sue James offered me (the BMA was present and a digital recording made) a large sum of money with a good reference to leave immediately having signed a compromise agreement. That, conveniently for Sue James, would have put an end to the story at more public expense. Sue James claimed that it was the view of the Board that I leave under these circumstances. She is on record as saying that no Board member dissented from that view. I did of course reject this offer. It was completely unethical and involved Sue James in making a number of completely untrue statements. After the meeting I rang Stuart Gray who was at that time a non-executive director. “We knew nothing about it David. We’ve been kept in the dark,” he told me. On my refusal to take the money I said, “My conscience will not allow it Stuart. This is a matter of Christian principle”. “Nothing was ever achieved by principle David,” was his response.
My own experience of the Board at that time was that it did not put patients first, abhorred transparency, did not provide a safe environment for professional disclosures about poor care and was prepared to destroy the career of a good paediatrician who was determined to speak up for patients. As Vice-Chairman of the Trust and a panel member at my disciplinary hearing I hope you will reflect on my claims.
Best wishes for 2014
(I offered Nigel an opportunity to respond on my blog. I have had no reply.)