Nicholson’s leadership of the NHS – the man with no memory

The failure of the NHS to use mortality data effectively is worrying to put it mildly and it seems clear from comments from other, such as Sir Brian Jarman, that Nicholson must take some responsibility for that.  Nicholson may argue that he did not know, cannot remember, did not see the emails etc and play the role to quote from the Daily Mail of the ‘man with no answers’.  Perhaps in the wake of his climbdown to the Public Accounts Committee and his eventual admission that Gary Walker did blow the whistle to him he should now be called the ‘man with no memory’.

Well here is another one where he cannot say he was not told.  It is an extract from my evidence to the Health Select Committee dealing with a report Nicholson personally commissioned into allegations of bullying:

‘a)   The report when it was released was shocking.  At paragraph 15 it stated ‘we frequently encountered differing accounts of the nature [of meetings and telephone conversations]’ in the face of conflicting evidence about what happened in meetings and in phone calls they decided to ‘principally use extracts from relevant correspondence and reports as a more reliable account of the tone and style of communications and therefore relationships…’. 

b)   I considered this an absolutely extraordinary approach when dealing with allegations about bullying and amounted to suggesting that bullying must be in writing either for it to count or for it to be investigated.  It is extraordinary to suggest that correspondence and reports would be a ‘more reliable’ account of relationships. If, as a former Chief Executive of a local authority employing 20,000 staff, I had allowed such a criteria to be used in such an investigation I would expect to be strongly ridiculed.  If I had been David Nicholson I would have binned the report as soon as I got to that paragraph.

c)    Last year I was asked to conduct a review of the culture of NHS Lothian, one of the largest health organisations in the UK, after the manipulation of waiting lists.  I was commissioned to submit a confidential report to Nicola Sturgeon, Deputy First Minister and to produce a public report.  We conducted around 60 one to one confidential interviews and were informed of numerous incidents where staff were either told or witnessed others being told that they would ‘get their P45’ or be ‘parted from their livelihood’ if they did not meet targets. These threats were never in writing.  If my review of NHS Lothian had been based on the Goodwin criteria as set out in paragraph 15, its conclusions would have been very different and completely inaccurate.

d)   I remain appalled at the quality of the report and it is difficult to conclude other than the results were a foregone conclusion and just part of the culture of cover up evident elsewhere in other parts of the NHS. I referred to it as whitewash.

e)   However the position is even worse than that in that David Nicholson ignored limitations of paragraph 15 and added further whitewash.  In spite of the report making it clear that there were conflicting accounts of meetings and phone conversations, David Nicholson issued a statement saying that there was no bullying ‘whatsoever’.  The word whatsoever does not appear in the report.’

 Now the Mid Staffs report refers to bullying and makes it clear that it exists in other parts of the NHS.  In this brave new post Mid Staffs world we need leaders who will challenge such conduct and make it clear that it is unacceptable and inconsistent with safe care.  In this case you may well conclude that Nicholson was party to the use of whitewash as alleged above  or he genuinely believes that correspondence and reports can be more reliable in the assessment of bullying.  Either way……..

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Would you want to be a ‘frequent flyer’ of the NHS with Nicholson in charge?

Just when you thought it couldn’t get any worse, Prof Sir Brian Jarman criticised the NHS for failing to use mortality data to improve safety in our hospitals.  There is media speculation that the failure to use this information could have led to 20,000 preventable deaths over the past 10 years.

Shocking.

But then we recall David Nicholson’s comments at the Mid-Staffordshire Inquiry don’t we?  The comments were ‘Quality was not an organising principle of the NHS’.  Staggering comment from somebody running an organisation that we place our trust in for our, and our families, life saving care.

On these number round 200 patients per month die needlessly, about as many passenger as you get on the average flight.  If a major airline decided that quality was not an ‘organising principle’ of its services and had the equivalent of one plane crash per month you wouldn’t fly them would you?  You would definitely not want to be a frequent flyer. If you were the regulator you would ground them, wouldn’t you? If you were a shareholder of the company you wouldn’t accept that the person who was running the company could remain in post,  would you?

It is truly shocking that after the Mid-Staffordshire report and these revelations that Sir David Nicholson remains in post.

What is even more shocking is our politicians and Sir Bob Kerslake, the head of the civil service, leave him there.

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Grieving relatives slam Cameron

Cure the NHS, the organisation representing  grieving relatives in Mid Staffordshire and Patients First have sent a scathing letter to our beloved leader and Prime Minister, David Cameron.  It berates him for protecting NHS boss David Nicholson in the wake of the scandals besetting the NHS.  It essentially accuse Cameron of having one rule for ordinary NHS staff (and bankers for that matter) and another for Nicholson…. Of having double standards no less.

The letter is an extraordinary indictment of the Government and its willingness to embrace the changes called for in the Francis Report.  The first chance it get to change the culture by changing the head of the NHS it ducks based on what appear to be wholly improper grounds.  Shocking.

 

Full text below:

23rd February 2013

Dear Prime Minister

Formal complaint against Sir David Nicholson

We refer to our letter of 14 February 2013 calling upon you to intervene and encourage David Nicholson to do the decent thing and resign as head of the NHS, in the wake of the Mid Staffordshire scandal.

To date we have not received a reply to our letter or even an acknowledgement. Media comments and articles lead us to believe that you continue to back and support Sir David.  We are surprised at your reported comments commending Sir David for ‘the grip and grasp’ he has over the NHS and his ‘knowledge and understanding’ on the one hand and then not accepting that he either did or should have known about the problems the NHS faced in Mid Staffordshire and elsewhere and take personal responsibility.  This with respect is contradictory and illogical.

Ministers seem to be encouraging regulatory authorities, and indeed the police to pursue individual members of staff in Mid-Staffs who have failed to fulfil their duties properly and effectively which is a proper course of action.  We do not wish to condone any of those who failed but we do note that first Mid-Staffordshire report said that staff pursued targets at the expense of patient safety as they were in fear of losing their jobs.  We note that the more recent report was critical of the ‘system. In some cases these two factors may have been a significant cause of an individual’s failure of judgement or conduct.  We note and contrast the ministerial encouragement to pursue those individuals, who relented to this ‘system’ and ‘climate of fear’ and failed their duties, and the government’s refusal to pursue those who either created or failed to change that system or climate of fear.  We find such double standards by the government totally indefensible and a travesty to the memory of patients who have unnecessarily died as a result.  This is a deeply shameful and unjustifiable position for any government to adopt.  It is even more shameful when it is suggested that the pursuit of Sir David would be scapegoating whilst the pursuit of other individuals is not.

Furthermore we contrast this astonish stance with the government’s frequent statements about the banking system, that staff must not be rewarding for failure, and its determination to hold the senior managers of banks accountable and take responsibility for the activities of all of their staff.  We note, as the public will note, the inconsistency of the government that the same apparently does not apply to the NHS.

Furthermore we are extremely disturbed at media reports of your and Stephen Dorrell’s comments which amount to the protection of Sir David Nicholson because he has faithfully implemented government policies particularly at a time when the currently reform programme was extremely politically difficulty.  We find it a shocking indictment of your government and public conduct and public behaviour for ministers to shield senior civil servants from true accountability because they have been politically loyal.  It is even more shocking that occurs with a callous disregard for the views of grieving relatives.

Your refusal to intervene and the failure of moral leadership from the government together with Sir David’s unwillingness to resign, and take responsibility, leaves us with no alternative other than to submit a formal complaint to the Head of the Civil Service about Sir David and demand that it be thoroughly investigated.

You will be aware that complaints were first made in July 2012 and have not been investigated, through political interference or otherwise.  We would ask for your assurance that there will be no political interference in this broader and more extensive complaint, which goes well beyond the confines of Mid Staffordshire, and that you will support our call for a full and thorough investigation to be carried out by an individual unconnected with government or the civil service.  We would remind you of the Ministerial Code of Conduct.  We will, when we submit the detailed allegations to the Head of the Civil Service, ask for similar assurances.

If any frontline professional neglected their duty with regard to raising concerns and listening to concerns this would be investigated and, should that investigation identify that there is a case to answer, would immediately face disciplinary proceedings. Often the member of staff would face a “non-detrimental” suspension. We ask that Sir David be treated no better or worse than any other NHS member of staff.

We wish to emphasise that the complaint to the Head of the Civil Service will not be a re-run of the Mid Staffordshire Inquiry which was about a narrow issue of one specific hospital.  Indeed the Inquiry refused to accept evidence of broader NHS failures and so much of what we will raise has never been the subject of a proper independent investigation.  It is now clear that there are widespread systemic failings in the NHS which Sir David has been responsible for leading.  We utterly refute that this is scapegoating.  It is holding those in a position of trust and authority to account.

You will be aware of the NHS Code of Conduct for Managers requires Sir David to make the care and safety of patients my first concern and act to protect them from risk’ and ‘to accept responsibility for my own work and the proper performance of the people I manage’; you will also be aware of concerns about the use of public funds to protect personal or institutional reputations and the role of the Accounting Officer.  In addition there are allegations concerning United Lincolnshire Hospitals NHS Trust.

From the above you will realise that we are truly horrified by media reports which suggestion that Sir David is not to be exposed to the same system of personal accountability you are proposing for the rest of the staff of the NHS, allegedly due to his close relationship with Ministers and the ‘debt’ owed to him by your party.

Dr Kim Holt, Consultant Paediatrician MBCHB BSc DCH MRCP MSc, Chair of ‘Patients First’ and Lead Consultant.  Jennie Fecitt, RN, BSc (Hons), Specialist Practitioner (Adult Nursing), NMP, PGCE Lead Nurse, ‘Patients First’. Julie Bailey For ‘Cure the NHS’.

 

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NHS lies to its own staff………?

Sometimes it’s gloss, other times it’s spin but on other occasions it’s downright lies.  That’s England’s NHS for you.  A management culture so dire that it’s full of cover-ups, fiddling of waiting lists and gagging of whistleblowers.

This corrupt culture reached new lows with a statement from ULHT last week after its second attempt to gag whistleblower Gary Walker blew up so spectacularly.  The Minister Jeremy Hunt asked for an explanation of why they wrote to Mr Walker in an attempt to enforce the gag and prevent him appearing on the BBC Today programme. It got even worse, if that is possible, when ULHT wrote to its own staff on Tuesday.

ULHT’s statement last week issued after the Minister’s wrath is beyond spin; it’s not devious or deceitful, it just appears a downright dishonest pack of lies.  How do we know this?  Because the letter that was recently sent to Mr Walker to seek to gag him has been published.  This is what ULHT are reported to have said after the Minister blew his top:

“Allegations that ULHT has attempted to stifle debate about patient safety issues are incorrect. There never has been any such intention……… We can confirm that under the terms of our agreement with him, Mr Walker is able to raise any concerns about patient safety at ULHT.

To nail the point home it trumpets:

The trust has a clearly established culture of openness and transparency……”

The yesterday it proudly told its own staff

‘It was never intended to gag concerns regarding patient safety….’

The Trust then wheels out the Public Interest Disclosure Act which says that if people make statements in the public interest they cannot be sued so of course Mr Walker can speak out – he has just misunderstood what was intended; But under the act the burden is with Mr Walker to prove that it is in the Public Interest.

Lets have a shot of truth in this cocktail of denial; what was the intent? To do that you just have to look at the letter which unfortunately for ULHT is in the public domain to see what it actually said.  The NHS claim this letter was ‘not an attempt to stifle debate.. Mr Walker is able to raise concerns…he has misunderstood what was intended’  The letter says:

We understand that you have either provided an interview or are proposing to provide an interview to the BBC Today programme tomorrow morning. Having seen an outline of the issues, we have advised our client that if you have provided an interview or should this interview proceed you will be in clear breach of the agreement and as a result the Trust
would be entitled to recover from you the payments made under the agreement and any costs including its legal costs.

After Mr Walkers recoded his interview with the BBC on Monday 11th February expressing his concerns about patient safety, the BBC outlined Mr Walkers allegations to the DoH the following day asking for a response.  So in the full knowledge of what Mr Walker had said they threatened Mr Walker that such statements breached the agreement and his gagging clauses and that he may well be pursued by the NHS for the money back plus their legal costs.

It goes on to say that Mr Walker:

shall not repeat the allegations contained in your witness statements which were served on the Respondent during the proceedings. (Note these were about safety) You agree to take reasonable steps by asking the other witnesses to abide by the same duties of confidentiality as are agreed by you under this Agreement.

Finally, just in case Mr Walker did not understand the letter he is told:

If you have already recorded an interview [ we want] a written undertaking that you will immediately inform the Today Programme that you no longer wish to participate and that you wish to withdraw the statements that you have made.

They are caught in what appears to be an old fashioned lie.  Notwithstanding that the gagging clauses in Mr Walkers agreement may be unenforceable they did intend to ‘stifle’ Mr Walker and the the safety issues he was raising.

It is so sad for the staff of ULHT, who work hard in underfunded over stretched facilities.  They have leaders who would rather spend even more money on solicitors and cover-ups than spend it on patient care and worse still mislead them as well.

And to add to the sad and sorry state of affairs ULHT then claim to have a culture of openness and transparency!  Well it is the NHS – they just do not use the same dictionary as the rest of us.

Perhaps they should consider the comment of Eric Hoffer ‘we lie the loudest when we lie to ourselves’.

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Cameron to be put on spot about commitment to safety in NHS

Today at 12.00 Cure the NHS and Patients First will be handing in a devastating critique of David Nicholson’s leadership of the NHS. It throws down the gauntlet to the PM – are you prepared to put the reform of the culture above his own reform programme.

Full text below

The Rt Hon David Cameron MP
10, Downing Street
London SW1A 2AA

14th February 2013

Dear Prime Minister

PATIENT SAFETY

We represent the views of concerned patients, concerned clinicians and NHS whistleblowers and believe that we can talk with authority about the NHS and its culture.

We are writing to you because of our extreme disappointment at the Government’s response to the latest report into Mid Staffordshire.  We wish to draw to your attention information you may not have been aware of when you expressed your support for Sir David Nicholson, the Chief Executive of the NHS.

The Francis report condemns the ‘culture’ of the NHS but any organisational culture is set or heavily influenced by its leaders and in this case specifically the Chief Executive of the NHS.

In 2008 the Joint Commission International Report said of the Department of Health/NHS culture that

A ‘shame/blame’ culture of fear appears to pervade the NHS and at least certain elements of the Department of Health. 

Furthermore it stated that this culture ‘stifles’ the development of an organisation and its ability to deliver ‘quality and safety’.  A damning indictment.

In the same year the Institute for Healthcare Improvement report to the Department of Health gave an example of the mindset in the NHS:

The NHS has developed a widespread culture more of fear and of compliance than of learning, innovation and enthusiastic participation in improvement.

They highlighted typical comments:

The risks of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.

Given this was the national culture it is hardly surprising that the first Mid-Staffordshire report stated:

This evidence satisfies me there was an atmosphere in which frontline staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs.

It is not clear whether the senior leaders of the NHS have created this culture or whether they are simply incapable of changing it.  Sir David Nicholson was put on notice of this dangerous culture and its potential impact on patient safety as early as 2008.  There is no evidence that he changed such a dangerous culture, indeed the reverse.

More recent reports (November 2012) in the Health Service Journal suggest the culture persists with a headline:

NHS Chief Executives highlight a ‘climate of fear’.

We would cite a notorious example of a failure of moral leadership.  Mr Gary Walker the brave Chief Executive of United Lincolnshire Hospitals NHS Trust personally blew the whistle to David Nicholson and other senior NHS staff about the conflict between targets and safety. The result was that he was sacked and around £0.5m intended to be spent on patient care was instead spent on gagging Mr Walker and his witnesses to keep highly damaging papers implicating senior NHS staff from public scrutiny.  Given the involvement of very NHS senior staff in the planned Employment Tribunal it is inconceivable that such a cover up was not sanctioned at the highest of levels.

You have been written to separately with very serious complaints about the involvement of senior civil servants in this particular cover up and the failure to investigate those complaints, first made in July 2012.

Sir David’s repeated failures to support whistle-blowers is indicative of concerns that he will not command the respect of staff in creating the open and transparent culture called for in the latest Francis report. His assertions to the Inquiry that Mid Staffordshire was ‘singular rather than the systemic’ was described as ‘a very dangerous attitude to take’ further underlining the lack of confidence we have in him taking the culture change forward.

Our call for Sir David to go is not scapegoating; it is asking for the accountability called for in the Francis report.

There is media speculation that your support for Sir David is driven by his importance to the government in driving through the current reform programme.  With respect there is no reform programme more important that a change in the culture of the NHS.  We hope that in the light of this new information you will appreciate that Sir David will not command the necessary respect of patients, or staff confidence, in leading that cultural reform programme and that he should stand down.

It is often said that opinion polls show that the public do not regard the NHS as being safe in the Conservative Party’s hands.  You have the opportunity of taking the sort of decisive action which could change that image.

Yours sincerely,Dr Kim Holt, Consultant Paediatrician MBCHB BSc DCH MRCP MSc, Chair of ‘Patients First’ and Lead Consultant. Julie Bailey,  for ‘Cure the NHS’ Jennie Fecitt, RN, BSc (Hons), Specialist Practitioner (Adult Nursing), NMP, PGCE Lead Nurse, ‘Patients First’.

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The £0.5m, 677 death cover up

This is an appalling story about how 3 months after the person who expressed concerns about putting targets before patient safety was forced out of Lincolnshire’s Hospitals (in a half million pound cover up) and 9 months after the publication of the first Mid Staffordshire report, staff in Lincolnshire’s hospitals (ULHT) were being pressured to take risks with your safety.  Worse the death rates became so high that the government announced, this week, a special review of safety with the number of excess deaths in Lincolnshire’s hospitals being estimated at 677 between 2009 and 2012.

Even though they tried to intimidate Gary Walker in a threatening letter and prevent him from speaking out on the BBC Today programme the intimidation and threats did not work.

Its long and complex but stick with it – it could be you or your family who are affected.

In the wake of the Mid-Staffordshire report into the NHS it would be all too easy to go down the rabbit warren of regulation and structure but that would be a mistake.  Patients don’t care about things like Monitor, CQC etc.  They want their local hospital to focus on safe care for them.  Simple.

So what do you have to do to fix that?  Do you recall the Clinton comment – ‘It’s the economy, stupid’.  Well the equivalent for the NHS would be ‘It’s the culture, stupid’. The second report into Mid Staffs slams a culture where your care comes second to making some bureaucrat look good in the targets league table.   If you do not fix the culture you cannot fix the NHS.  Also ‘Simple’.

But why are some people surprised at what the latest Mid Staffordshire report says about NHS culture?  The concerns have been around for quite some time.  In January 2008 the Joint Commission International report said, on page 4, about the Department of Health/NHS culture that

A ‘shame/ blame’ culture of fear appears to pervade the NHS and at least certain elements of the Department of Health. 

Furthermore it stated that this culture ‘stifles the development of an organisation and its ability to deliver ‘quality and safety’.

In the same year the Institute of Healthcare Improvement reported to the Department of Health giving an example, on page 24, of the mindset in the NHS that:

The NHS has developed a widespread culture more of fear and of compliance than of learning, innovation and enthusiastic participation in improvement.

They highlighted typical comments about the prevailing mindset:

The risks of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.  Ouch – so it is more damaging to your career to fail to meet targets than to kill patients?

Pretty damning indictment – a culture which cannot deliver safety.  In a healthcare organisation!!!  If the NHS was an airline it would have been grounded. You would have though the report was enough to get people sacked…….

Note this is 5 years ago.  Who was the CEx of the NHS at the time?  David Nicholson.

And of course the first Mid-Staffordshire report stated in 2009:

This evidence satisfies me there was an atmosphere in which frontline staff and managers were led to believe that if the targets were not met they would be in danger of losing their jobs.

More recent reports  (November 2012) in the Health Service Journal are headlined:

NHS Chief Executives highlight a ‘climate of fear’.

So this culture has been around for some time and is still around.  It is not clear whether the senior leaders of the NHS have created this culture or whether they are simply incapable of changing it.  Either way can we have confidence in a change in culture, which is essential for the recovery of the NHS, whilst of Sir David Nicholson remain in post?

Chief Executive’s set the overarching culture of any organisation and must lead by example.  The NHS is notorious for its negative attitude towards whistleblowers.  I cannot recall incidents where senior NHS leaders have come in to protect whistleblowers and challenge what is happening to them.

The latest Mid Staffs report makes stark reading for Nicholson.  Questions may remain about the degree to which David Nicholson is personally implicated in Mid Staffs,  but he was involved locally in the Gary Walker case.  Walker was the brave Chief Executive of the United Lincolnshire Hospitals Trust who personally blew the whistle to David Nicholson and his right hand woman, Barbara Hakin.  Hakin was the head of the regional NHS in Nottingham.  Walker was concerned that he and his staff were being put under pressure to meet targets when the hospitals were already dangerously overfull (echo’s of Mid Staffordshire?).  Walker was forced out allegedly as a result and brought a claim against the NHS in an Employment Tribunal.  In a pre-hearing for his Employment Tribunal the Judge stated that in his opinion Walkers letters to both David Nicholson and Barbara Hakin were prima facie public interest protected disclosures.  Hmmmmm….. you shouldn’t sack whistleblowers and gag them.  How do we know that?  Because David Nicholson says so…...

Walker complained to Nicholson about the ‘culture’ of the NHS ( just like Francis) ‘that gave this country a Mid Staffordshire’  which in the case of Lincolnshire ‘threatens patients and must be stopped’ and asked that the letter be treated as whistleblowing. Nicholson was also written to about senior NHS staff ignoring a vital code designed to protect patient safety when hospitals are overfull and the conflict between national targets and patient safety.

The first cover up was a report commissioned by Nicholson which did not address they key issues of the conflict between targets and patient safety and staff ignoring a vital code.  It looked very narrowly at written, yes written, evidence of bullying.  In the bizarre world of the NHS you can only bully people in writing.  Buckets and whitewash come to mind.  Some of the key documents Walker used in his ET case such as regional staff expressing concern about patient safety in overfull hospitals apparently being ignored by more senior people saying to have to meet targets whatever demand were only released under an FOI 2 days after the review report was issued, and so were not taken into account.  Now there’s a co-incidence.

Walker expected Nicholson to protect him as a whistleblower and ensure he remained in post to shield the organisation from external pressure and make sure priority was given to safety.  Walker was subsequently forced out allegedly for swearing at the end of 2009.  Perhaps he had every right to swear.

Being out of a job and blacklisted in the NHS Walker challenged his sacking.   With his house on the line he had to settle pre-Tribunal and accept a Supergag which not only gagged him but required him to write to all his witnesses to seek to gag them as well!!!

In a quote from a the document from the Judge, which the NHS has gone to great lengths to conceal, the Judge said in connection to a letter sent by Walker to Hakin on 8th April 2009

‘I have read it. Prima facie it is a Public Interest Disclosure…it raises concerns about patient safety.

Of letters to Nicholson and the Interim Chair of the Trust dated July 2009 the Judge said

‘…they are prima facie Public Interest Disclosures’

It cost and an incredible £0.5m to settle with Walker and to keep almost 3,000 pages of documents concealed from you, the public.

It’s a lot of money so what is being concealed and what were they worried about?  Read on it gets really scary now.

Walker expressed concern about the pressures at his hospitals and the consequences for patient safety should those pressures continue and he refused to put pressure on his staff to meet targets for non urgent patients.  Before he was forced out a secret external report confirmed this and said of the Trust under Walker’s leadership:

‘All we spoke to acknowledged that safety had a high priority within the Trust and at the Board…the Review Team did not identify any immediate issues of concern in terms of patient safety or experience….

After Walker was side-lined and forced out all of that was about to change as shown by a series of letters recently released by the Lincolnshire Independents to local news media with a press release.

Clinician started to complain and one complained at length after being put under pressure to do an operation on a patient to meet the targets when he would not be available for post operative care.  He says

‘I do not think I should be coerced into performing surgery on a patient in an environment which I consider unsafe.’

Another complained, in a letter commencing

In the aftermath of this unfortunate death of an otherwise well patient…

about overcrowded surgical lists with a very clear suggestion that such overcrowding, to meet targets,  may well have been a contributory factor to the patient’s death.

Most damning a Clinical Director of the Trust wrote to the Chairman in March 2010 in very stark terms about

‘bullish and ruthless pressure from above……a culture has evolved …..caused a significant shift… in the balance of care between achieving targets and the quality and safety of our services to patients.

and

an insidious and remorseless increase pressure that could result in poor judgements or staff taking risks with patient safety which in normal circumstances they not take.

IN OTHER WORDS ABOUT 3 MONTHS AFTER WALKER WAS SACKED AND 9 MONTHS AFTER BLOWING THE WHISTLE TO NICHOLSON AND HAKIN AND 9 MONTHS AFTER THE PUBLICATION OF THE MID STAFFS REPORT, PRESSURE WAS BEING APPLIED TO STAFF TO MEET TARGETS AT THE EXPENSE OF SAFETY.

Lincolnshire Hospitals – ULHT – continue to have some of the highest mortality rates in the country.   Dr F Hospital Guide 2012  on page 14 identifies ULHT as one of only 12 trust in the country with mortality rates higher than expected on two key measures. You will see the earlier blog which reports calculations that it could be as high as 677 ‘excess’ deaths; but of course many more will have come to some sort of harm.

Given that at least 3 doctors were prepared to stand their ground and from my knowledge of staff at ULHT I doubt (and hope) that such calculations as above are incorrect.  But this is not just about deaths.  It is about harm as well.

Examples have been alleged of surgical patients being placed in medical wards and due to being in the wrong type of ward complications not being identified quickly enough leading to, for example, amputations.

Other documents covered up include reports from the Regional Health Authority’s own staff expressing concern that overfull hospitals such as Lincolnshire’s could be unsafe, and that ULHT’s staff were ‘tired’ due to severe pressures.  Such warning were seemingly ignored by their bosses as the documents include a handwritten note  allegedly by a very senior official that targets must be met ‘whatever demand’.  Seriously, ‘we know your hospitals are dangerously overfull and your staff exhausted but still meet the targets’.  Also under lock and key are allegations that Walker was pressured not to put the Hospitals on ‘Red Alert’ when they were full (a safety measure) presumably as it would compromise senior officials in the eyes of the Minister, with allegations of threats of financial sanctions for so doing; references to conversations with Health Department officials and the subsequent concern about the ‘consequences’ of not meeting targets; manipulation of financial information as part of a cover up again presumably to make people look good and much much more.  Enough to blow the lid off the NHS  – again.  But unlike Mid Staffordshire there appears to be a smoking gun from the Trust to those higher up.  Well several smoking guns actually.

The biggest smoking gun is that after Walker put them on notice they carried on regardless and now have some of the worst mortality rates in the country.

The £0.5m Supergag now makes some ‘sense’ at least to those potentially implicated, who’s reputations may be damaged if Walkers allegations are true and made public, but no sense at all to us taxpayers or users of the NHS. 

The Lincolnshire Independents have speculated that there could be charges against those who authorised the gagging deal of misconduct in public office for the misuse of £0.5m of public funds.  If the pending safety review shows that the high death rates are due to failing to heed Walker then some think charges of manslaughter against those responsible should be called for.

So here we have a mini Mid-Staffordshire only in this instance the Chief Executive blew the whistle.  He personally blew it to Barbara Hakin, now on the national NHS Commissioning Board and also to her boss David Nicholson.  What happened to Walker?  He is now virtually unemployable in the NHS for having done the right thing. A complete reverse of those in Mid Staffs who’s negligence led to so many death; they were let off the hook.

Unless or until there is a clear out at the top of the NHS of those who have either created this culture or failed to challenge or change it, our hospitals will remain unsafe.

But don’t hold your breath.

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Shocking letters from clinicians at Lincolnshire’s hospitals releasesd

Three letters were released today by the Lincolnshire Independents.  They are a shocking indictment of our local hospitals and they do give an indication as to why ULHT are one of only 14 hospitals in the country to be subjected to a special safety review announced in the wake of the Mid Staffs report.

In previous blogs I questioned who gives a damn given the silence from out major political parties.  It seems that somebody does give a damn such as the 3 doctors who from their letters were prepared to hold the line.  But also the Lincolnshire Independents who do not have national party loyalties to put above the interests of patients.  Full text below.  Subscribe to this site to keep up to date as more is revealed.

 FROM LINCOLNSHIRE INDEPENDENTS

Conservatives cannot be trusted to run the NHS.

In the wake of the shocking Mid-Staffordshire report into the NHS released last week and the announcement that ULHT is to be investigated over its high death rates the Leader of the Lincolnshire Independents Marianne Overton has declared that ‘If elected in the May 2013 County Council elections we will, through the Health Scrutiny Committee, carry out a new and urgent review of the quality and safety of patient care in Lincolnshire and governance at ULHT.  We have been shocked at the documents we have uncovered and that the Conservative led government has turned a blind eye to a cover up about concerns over patient care.  Equally appalling is that nearly three years into a conservative led government we still have virtually the worst funded hospitals in England.  Our conservative MPs and councillors appear to have done nothing – no doubt they do not want to annoy their party bosses in London.

The Lincolnshire Independents today released three letters (attached) which have not been made public before, which suggest that there have been clinical concerns about safety at ULHT.  In the first a clinician complains about being Coerced into doing things which are unsafe.  The second refers to surgical lists being overcrowded in order to meet targets and refers to a patient death, with an implication that this overcrowding was a contributory cause, and the third from a clinical director warns the Chairman of the Trust, Paul Richardson that there has been a shift toward meeting targets at the expense of patient safety.

Chris Brewis the only independent on the current Health Scrutiny Committee said he was ‘shocked at the revelations in the letters’.  He continued ‘It is well-known that Lincolnshire’s NHS is virtually the worst funded in the entire country and our hospitals have been and continue to be under huge pressure.  We cannot allow the disgraceful culture highlighted in the Mid-Staffordshire report to put Lincolnshire patients at risk.  I am appalled that we have looked at safety before as a Committee but these letters which were not made available to us at the time suggest that we have been misled. What else is being covered up? The national mortality data shows Lincolnshire’s hospitals at the wrong end of the league table.’

Phil Scarlet who is standing as an independent in South Holland and resigned from ULHT as a Non-Executive Director over concerns about how Paul Richardson was running the Trust said ‘It is shocking that ULHT spent £0.5m on gagging its former Chief Executive who raised concerns about safety.  He said if you put more pressure on the system it will be dangerous for patients.  This money was intended for patient care but instead it is being used to suppress around 3000 pages of documents.   How many others are there like these we have released today?  These letters are some 9 months after Walker was forced out and show the new regime at the Trust putting targets before safety just what Walker tried to stop.  The announcement this week that ULHT are to be the subject of a mortality review demonstrates the implications for that; high death rates which are shocking.  We will have to look at this very carefully; it raises seriously questions about the governance of ULHT.  Let’s be absolutely clear the use of taxpayers’ funds to conceal wrongdoings should be regarded very seriously and could even be misconduct in public office by misuse of public funds for a cover up. When a Trust spends such money on a cover up, how can we trust what they say?  I call on Paul Richardson, Chair of the Trust to account for the £0.5m and these letters which have been concealed.  He should resign to restore patient confidence.  We will also consider whether we need to go to court to challenge the legality of the suppression of documents from the public.  It is shocking to have the suppression of around 3000 pages of documents when the Francis report on Mid Staffordshire talks about openness and transparency

Marianne Overton, Leader of the Independents, the second largest group on the County Council said ‘As Independents we will stand up for Lincolnshire. 

“On NHS Lincolnshire, we fought hard for improvements for people in hospital, with weekly meetings between senior staff and even having a special improvement board. But the NHS remains very centrally controlled, with finance and targets set under close government control. Conservative MP’s knew what was going on, but the Conservative-led coalition has ploughed on with increasing privatisation and “reorganisation”.  Were MP’s and local Councillors in fear of embarrassing their own government?  Are these revelations the tip of an iceberg? Is the NHS is safe in the current Conservative hands?” 

In April, Lincolnshire County Council takes over responsibility for Public Health from the NHS.  A new committee then oversees health in Lincolnshire, called the “Health and Wellbeing Board”. In Lincolnshire, the only Councillors allowed on it are card-carrying national party members, making strong Conservative party control.”

“Independents put Lincolnshire first and put patient safety first. An Independent-led Council will take our NHS and health seriously. We commit to investigate health issues thoroughly and seek essential improvements. It is not good enough to continually accept a higher level of risk, in order to cut costs.”

Ends

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Underfunded, overstretched hospitals. But who gives a damn?

I am actually very, very angry today.  The Telegraph reports that analysis by the highly respected Prof Sir Brian Jarman shows that our hospitals in Lincolnshire have, over the period 2009 to 2012, the second highest level of ‘excessive’ deaths out of all hospitals Trusts in England.

677 more than expected.

Now to be fair it is very difficult to measure what an ‘expected’ mortality rate is and often these sorts of headlines can be misleading, but given that Lincolnshire’s hospitals are virtually the worst funded in the country, given the numerous interventions by the Health Regulator, the CQC, in United Lincolnshire Hospitals NHS Trust particularly at Boston Pilgrim Hospital (expressing concerns about staffing levels and the quality of care) it seems inevitable that some patients will have come to harm in our overstretched and underfunded hospitals.  But concerns have been expressed by many and covered up by others spending £0.5m in so doing.

But who gives a damn about our grossly underfunded and under pressure local hospitals – well enough to do anything about it?

Probably not some of our Conservative MP’s who have, with few exceptions, been noticeable by their absence? Not Labour either; they ran the NHS for over 10 years in the past 15 and did not fix Lincolnshire’s funding in spite of Lincoln City having,  in Gillian Merron MP, a Junior Health Minister?  Possibly not many of the local or regional bureaucrats too frightened to speak out and challenge the  culture of the NHS, so roundly condemned in the Francis Report on Mid Staffordshire?  Perhaps not Stephen Dorrell Conservative MP and Chair of the Parliamentary Health Select Committee who refused to look at it? And what about the NHS’s national Chief Executive, David Nicholson still clinging to his £260k pa job by his fingertips?

What makes the anger even greater, is that they had all been put on notice of problems in Lincolnshire to a lesser or greater degree.

Sign up now to this blog, as in the next few days there will be revelations which will appall you, truly appall you.  Worse is to come. You, like me, will then be angry, very angry indeed.

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Same as it ever was.

I was sent a clipping recently. It was from the Lincolnshire Free Press letter page of the 9th October. The clipping was a short letter from Richard Davies, the Conservatives Candidate for the post of Police and Crime Commissioner for Lincolnshire.

Article from Lincolnshire Free Press

In that letter he “offers his complete support” for more police officers for Lincolnshire. He adds “ The myth that pervades Whitehall regarding the shire counties not suffering crime needs to be consigned to the dustbin”.

I am so pleased he has decided to follow my lead on this especially as he has chosen to use almost the exact words i.e. “The Myth of low crime etc” from my blog, published almost 2 weeks earlier as part of the build up to my visit to Downing Street to highlight the issue.

A more jaundiced eye may accuse Mr. Davies of obvious plagiarism of my content and ideas. That’s as may be. I’m sure Mr Davies has some ideas of his own but in this case I’m pleased he chose to re-broadcast one of mine.

The lack of police funding to rural counties is so important a matter, particularly to this County and it’s people, that I have opened a petition which can also be signed on the Number 10 system about this very issue. Rather than just copy what I say perhaps he can actually support the campaign for better funding. Mr Davies, you can meet me collecting signatures whilst I am canvassing and sign it in public or access that petition and sign it here.

Mr Davies has done a complete about turn on this issue. Unlike other, more notable, politicians from Grantham this ‘lad IS for turning’. You may ask how I can make such an outrageous comment? Evidence shows he has Tweeted in the past about the (implied) pointlessness of arguing for more money. And now, in the letter above , he argues the opposite.

He starts off by saying that it is a national issue and a ‘distraction’:-

He then build his case for doing nothing about it:



These read as though they are from somebody who believes Lincolnshire Police can’t, or shouldn’t, get more out of Whitehall, or perhaps from somebody who is a defeatist at best or can’t, or won’t, be bothered to ask at worst.

Worse is still to come however. In this Tweet Mr Davies argues that “Police performance is not a function of funding”. Then why does he now say that we need more money? Could it be he is coat-tailing? He leaves himself open to question. I ask you, just which face do you believe is the true face of Richard Davies?

Mr Davies appears not only to be a plagiarist, he’s also forgetful. I should remind you Mr Davies was a paid member of the Conservative led Police Authority who was in control when the Police Rural Fund was removed by his party masters when Whitehall decreed it in 2011.  Perhaps, had he complained too vocally he would not have been selected as the Conservative’s candidate for the PCC role? Who can tell, but the avowed Conservative, Mr Davies, was virtually silent about removal from the funds of Lincolnshire Police Force of, a not inconsiderable, £1.8m a year. I’m sure Whitehall must have been happy with him.

It’s hard to see how he can explain his inaction in this matter. Compare, for example, his current stance about funding and rurality with the inertia he showed when he had the chance to do something about underfunding. It just “doesn’t stack up” to use Mr Davies’ own phrase.

It’s just impossible to reconcile the two positions he wants to occupy i.e the one espoused in his Tweets and now the one in the Lincolnshire Free Press piece. They don’t “stack up” either; other than to say that he is electioneering. So, same as it ever was, he like politicians in general, will he show you any face they think provides a better chance to get them elected? And afterwards…

As Mr Davies is now so “pro” this issue I hope he will sign my petition himself and suggest to his followers to do the same.

It’s not party political. It’s common sense.

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Career politicans do not put Lincolnshire First

Over the last 30 years we have created a ‘political class’ of full-time politicians.  Not just in central government but also in local government.  They have political careers and their careers do not depend upon doing the best for their constituents but on keeping their party bosses, particularly those in London, happy.

Many of them wish to progress in the party hierarchy to become a more senior councillor, MP, Minister or beyond.  That is not achieved by standing up for their local communities and clashing with local or national party bosses.  Indeed there is so much money in politics and elections these days that they need their political party election machine to get re-elected.  I can well recall a conversation with a senior Lincolnshire politician when he explained why he was backing something he was very uncomfortable with saying ‘you cannot bite the hand that feeds you’.

We need a radical change in party and election funding if we are to reverse this trend of ‘career politicians’ disconnected from their communities. The level of authorised spending on election campaigns should be drastically reduced and party funding overhauled.   The number of political posts paid for by the public, such as political advisers should be substantially reduced and subject to strong statutory limit.  We should seriously question whether the cabinet style of local government and the hefty payments received by a small handful of politicians has served us well.

The degree to which political parties want to control those in public positions can be starkly demonstrated over the border in Cambridgeshire where the conservative party were originally going to back an independent candidate for the post of Police Commissioner.  When they realised that when the candidate said he would not join the party he meant it, he was promptly deselected.

The failure of strong local leadership in Lincolnshire has cost the county dear.  It has the worst funded NHS in the country and the worst funded police force.  It is often said that you could stick a blue rosette on a donkey and it would win in Lincolnshire.  And that is the crux of the problem.  Nationally the conservatives know they will always win here, Labour know they never could – and so the county gets ignored.  If you want attention you need to be in a marginal constituency.

You’re better able to stand up for Lincolnshire if you’re not looking over your shoulder, blindly implementing policies coming out of London or having an eye to developing your own ‘political career’.

Its time we had more politicians in Lincolnshire who are independently minded and who will put Lincolnshire First.

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