The Department of Health has published the summary findings of Neil Goodwin’s review of allegations of bullying and harassment of the United Lincolnshire Hospitals NHS trust by the East Midlands Strategic Health Authority (see previous post here).
The review found “no evidence” to support the claims against East Midlands Strategic Health Authority (SHA). However, concerns have been raised about the independence of Neil Goodwin, a former SHA chief executive (click here).
According to Mr Goodwin “Given the increasing pressures on NHS leadership and management that will result from the impact of the economic downturn on public services there is the possibility of firm performance management being interpreted as bullying or harassment.”
Key recommendations made by Mr Goodwin’s relate to improving the performance of board members and boards. In particular, he recommends that “Assessing board effectiveness should be a required component of the annual work programme for all NHS boards and the results included in performance management and regulatory assessments.”
Read the summary findings of Mr Goodwin’s report, along with NHS chief executive David Nicholson’s response here.
Readers may recall a recent post criticising both the NHS counter fraud service and police following the collapse of a fraud trial involving the former CEO of a private hospital group (click here).
The Telegraph (26 August 2009) picks up the story of how the former hospital CEOs life has been “wrecked” following the “bungled investigation” of a “malicious allegation.”
According to the Telegraph article, the former hospital CEO, “Mr Breeze, 54, found himself under arrest after a member of staff going through a disciplinary procedure accused him and two colleagues of defrauding the NHS out of £2.5 million at the privately-run Cawston Park psychiatric hospital near Norwich by overcharging for services.
Mr Breeze said there was no substance to the allegation but accused Norfolk police of setting out to “establish guilt rather than the truth, to construct a case rather than impartially investigate a suspected crime”.
Concerns have been raised in the past about the methods employed by, and the apparent lack of accountability of the NHS counter fraud services. Given the collapse of the fraud trial involving Mr Breeze, Healthcare Governance Review strongly advocates an independent review of the methods adopted by NHS counter fraud services, together with the conduct of the police involved in the investigation. The review should cover all cases since the establishment of the NHS counter fraud service that have not resulted in conviction and should include cases that have not gone to court.
According to the Patient Association, patients have been telling them for years just what sort of information they want so that they can decide where to go for treatment. They need to know essential facts like:
• Clinical outcomes of individual consultants
• Ward infection rate – not just the overall hospital’s statistics
• Nurse:patient ratio – because too few nurses endangers their care
• Mixed sex accommodation – patients should not have to share toilets and wards with members of the opposite sex
• Hospital parking charges
The Patients Association says that patients need to be satisfied that information provided is totally accurate and up to date, so that they can give proper consent and do away with the postcode lottery.
The Health Service Journal (HSJ) has reported that the Department of Health is to launch an independent review into allegations of bullying and harassment against East Midlands strategic health authority (SHA).
The allegations were made by the chair of United Lincolnshire Hospitals NHS trust, David Bowles, who resigned recently amid claims that the SHA was substituting bullying for performance management. Mr Bowles further said that he refused to work in a system which he says has not learnt the lessons of Mid Staffordshire and which has lost sight of patient safety issues. Further details of Mr Bowles allegations can be found here.
Of particular interest to Healthcare Governance Review, is the statement made by one of the responders to the HSJ article who says: ”Interesting that it is a good friend and colleague of Mr Nicholson in Neil Goodwin who is undertaking the INDEPENDENT review.”
Readers might like to reflect on whether they feel Mr Nicholson is following the principles of good governance on this matter. Read the full HSJ article here and leave your comments below.
As reported in the Health Service Journal today (27 July 2009), the chair of an acute NHS trust has resigned, calling on NHS chief executive David Nicholson to investigate the behaviour of East Midlands strategic health authority in pressurising him to meet access targets.
David Bowles, chair of the United Lincolnshire hospitals trust, says he refuses to work in a system which he says has not learnt the lessons of Mid Staffordshire and which has lost sight of patient safety issues, and that it is his duty to resign and bring attention to that.
His stance has been supported by the other non executives at the trust, who have also written to Mr Nicholson asking him to investigate.
In an email, seen by HSJ and attached to their article (see below), to shadow health minister Mark Simmonds, who is MP for neighbouring Boston and Skegness, Mr Bowles said: “What I have witnessed from outside the trust appears to be a substitution of bullying for performance management and an obsession with targets rather than safety.”
“It is often said that the culture in the NHS, particularly at the more senior levels, is not to listen, not to understand, to avoid responsibility, and to blame others.
“In the interests of patient safety I can not and will not give the unequivocal assurance that the SHA is seeking on non-emergency targets especially at a time when the Lincolnshire health economy is out of control with the highest ever level of weekly emergency admissions this month.”
He added that he had had allegations from staff about bullying by NHS staff from outside the trust.
Read the full HSJ article, along with Mr Bowles detailed e-mail to Mark Simmonds, here.
His reappointment was made by the NHS Appointments Commission, following its announcement at the end of last year that it was making a special exemption to allow Sir Michael to compete with other candidates for the position.
Usually people can remain chairs for a maximum of 10 years, which Sir Michael would have reached in April. However, he will be chair for only two more years rather than the four years that other candidates would have been able to hold the position.
At the time the exemption was made, commissioner for public appointments Janet Gaymer decided the expansion of NICE following health minister Lord Darzi’s next stage review represented an “exceptional circumstance”.
Some readers may be interested in a paper from a 2007 issue of Clinician in Management (now the International Journal of Clinical Leadership) that describes a practical governance framework that attempts to ensure that obstacles are not put in the way of progressing with innovative clinical quality improvement projects.
With the advent of evidence-based practice and the need to demonstrate the effectiveness and efficiency of service provision, healthcare practitioners find themselves having to comply with increasingly complex governance requirements surrounding the collection of data within an NHS organisation. A number of authors have suggested that the administrative burden that accompanies clinical effectiveness activities could in itself stifle innovations in practice. Putting obstacles in the way of ‘quality improvement’ projects could lead to poor practice and a potential reduction in the much needed service developments. This anxiety has to be balanced by the need to fully comply with research governance processes and ensure ethical considerations apply to both research activities and service evaluations.
Debate exists about the differentiation between such activities, whether the activity is research requiring full governance, audit or service development improvement projects. This paper describes the work undertaken at Sheffield Teaching Hospitals NHS Foundation Trust to develop a framework for classification of data collection activities, by using ’simple rules’ and subsequent ‘rule in questions’. The paper discusses how this framework ensures that appropriate ethical considerations take place for all activities and how an NHS organisation can reduce the risk of contravening research governance and local clinical governance requirements whilst still encouraging quality improvement projects.
The NHS Constitution was published on 21 January 2009. It was one of a number of recommendations in Lord Darzi’s report ‘High Quality Care for All’ which was published on the 60th anniversary of the NHS and set out a ten-year plan to provide the highest quality of care and service for patients in England.
The Constitution commits the Government to providing a statement of NHS accountability. This document accompanies the NHS Constitution and provides a summary of the structure and functions of the NHS.
Both the NHS Constitution and the statement of NHS accountability are key documents relating to the governance of the NHS in England.
According to the government, “The NHS belongs to us all. The NHS Constitution brings together in one place for the first time in the history of the NHS, what staff, patients and public can expect from the NHS.
As well as capturing the purpose, principles and values of the NHS, the Constitution brings together a number of rights, pledges and responsibilities for staff and patients alike. These rights and responsibilities are the result of extensive discussions and consultations with staff, patients and public and it reflects what matters to them.
Subject to Parliamentary approval, all NHS bodies, and private and third-sector providers supplying NHS services in England will be required by law to take account of the Constitution in their decisions and actions. The Government will have a legal duty to renew the Constitution every 10 years. No Government will be able to change the Constitution, without the full involvement of staff, patients and the public.”
Download the NHS constitution and statement of NHS accountability, along with other documentation, here.
According to www.publicservice.co.uk (the information portal for the public sector, 7 January 2009) Stoke-on-Trent Primary Care Trust (PCT), now NHS Stoke-on-Trent, made Lee Whitehead its new director of planning and modernisation but had to sack him when they found out that he had lied on his curriculum vitae (CV) about having a Master’s degree and a doctorate. Not only did Whitehead lose his £78,000-a-year job, but he has also been sent to prison for 12 weeks after the Department of Work and Pensions decided to take the matter to court.
According to a report in the Stoke-on-Trent Sentinel newspaper, Whitehead said in November 2006 that he had a first class science degree, a post-graduate science degree, a PhD in psychology, and that he was a member of the British Psychological Society. The only truthful statement was that he had a science degree but it was second class. The irony is that none of these made up qualifications were needed for him to get the job.
Paul Kay, prosecuting for the DWP, said: “The post-holder was not required to hold either a Master’s or a PhD, or be a member of the BPS. But clearly these assisted him in getting the job.”
It wasn’t any checks made by the PCT that brought Whitehead’s lies to light but another member of staff who was suspicious about his qualifications. When the PCT then challenged Whitehead he failed to provide any proof and the bodies he said he studied at and was a member of had no record of him. The court heard Whitehead had told the same lies to get his previous job with another PCT.
A spokesman for NHS Stoke-on-Trent said their selection procedures had been tightened up, adding: “We weren’t the first organisation Mr Whitehead made his irresponsible claims to. People can be assured that we have strict checks in place to ensure that all our staff are qualified to do their jobs.”
The Association of Certified Chartered Accountants (ACCA) has published an interesting 24 page guidance document for directors on resigning from a board. Whilst written for directors of UK listed companies, ACCA believes the guide will be useful to members and potential members of other governing bodies in the public and not-for-profit sector, including the NHS.
The guide might be of particular interest to existing and prospective NHS foundation trust board members – both executive and non-executive.
If you are an existing NHS board member you might like to consider the following non-exhaustive list of possible resignation issues presented in the guide. Could any of these apply in your situation? If so, you should download and read a copy of the ACCA guide.
1. Are you sure that the board has taken a fundamental decision with long-term impact, perhaps on long-term strategy, that you are convinced is wrong and that you will not be able to support going forward?
2. Can you see clearly that the company is embarked upon a policy that will lead to a future crisis and from which you have been unsuccessful in persuading the company to pull back?
3. Is the board acting dishonourably by supporting, or conniving in, a significant course of action in breach of:
• covenants entered into with a third party (without
sufficient restitution)?
• the duties of directors?
• the law?
4. Is there a breakdown of trust and confidence between members of the board which has proved impossible to resolve, but which your resignation is the best way to resolve?
5. Has the board rejected the advice of a committee of the board on a significant matter that the committee considers it cannot compromise over; and have all means to resolve the disagreement been exhausted?
6. Is it apparent that you are unable to make an effective contribution as a director?
7. Do you have irresolvable concerns about disclosure and financial reporting to the extent that you consider published results to be misleading?
8. Have you failed to obtain action to align the financial interests of top management with the interests of the company’s members?
9. Have you failed to persuade the board to address your significant concerns about the quality of the company’s corporate governance?
10. Have you lost confidence in the integrity of colleagues on the board, with no real potential of being able to address this successfully?
11. Have you lost confidence in the competence or integrity of non-board management, for actions that you as a director will be held responsible, but which you as a director have been unable to resolve?
Download the ACCA guide Resigning from a board: Guidance for directorshere.
The Government has asked Sir Michael Parkinson, the chat-show host, to act as an ambassador for its “dignity in care” campaign to establish how well hospitals throughout England look after patients, in particular elderly people.
Ministers say they want to know if patients were treated with dignity and respect, about cleanliness and the nature of staff teamwork.
Comments should be posted on the NHS Choices website at www.nhs.uk
The Committee on Standards in Public Life is an independent public body which advises government on ethical standards across the whole of public life in the UK – including working in the NHS.
The Committee was responsible for establishing the following seven principles, which are enshrined in NHS governance guides:
Every 2 years the Committee publishes a public report on public that assesses public attitudes, expectations and perceptions towards the behaviour of those in public life.
Interestingly, the last report, in 2006, showed that only 43% of the public trusted senior managers in the NHS to tell the truth, compared to 93% trusting family doctors to do likewise. The next report will be published on 10 November 2008.
The Committee has a new website, which can be accessed here.
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