Capsticks Report and NHS Whistleblowing

Justin Madders Excerpts

Wednesday 13th July 2016 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Main. I start by paying tribute to my hon. Friend the Member for West Lancashire (Rosie Cooper), who has ploughed what has at times been a very lonely furrow on this issue. She has shown incredible tenacity in pursuing the matter over a number of years. What makes this all the more remarkable is that, despite all of the inspection regimes and safeguards in place, the only reason we are debating this is because she had the courage and the determination to pursue these issues. She made a powerful and lengthy contribution today; I do not use that adjective in a critical way, but to highlight that there is so much that needs to be considered. The debate is certainly not going to be the end of the story. My contribution will perhaps not be as lengthy as on other occasions as I would like to give the Minister as much time as possible to set out how he intends to take matters forward.

At the heart of this is a random occurrence—my hon. Friend attending the trust in question as a result of her father being a patient there—and one can only wonder whether anything would have been done about the situation had she not attended, and had the brave staff on the ward not approached her after that. We heard from her about a whole catalogue of incidents, any of which in isolation ought to have raised alarm bells. When she spoke of the picture across the board, the number of grievances, some taking years to resolved, the suspensions that seem to be used as a punishment rather than the neutral act they are meant to be and the number of complaints of bullying and harassment it is clear that a wider pattern was there. In the words of the report:

“Non-Executive Directors took reassurance too easily and failed to provide sufficient scrutiny and challenge across a number of key areas. They collectively represented a series of missed opportunities to intervene.”

It should be said that there were also repeated failures by the executive directors to be open and transparent with the wider board, which included them not divulging details of a serious assault carried out on a staff member and keeping from the board the results of a staff survey that said 96% of respondents believed bullying was a problem to some degree within the trust. Will the Minister address whether he considers there needs to be more training or support for non-executive directors, so they at least know when they are not getting the whole picture? I also wonder whether there ought to be a requirement for at least one employee representative on each board so that, if there is a culture like this, there is a greater chance of it being revealed. What steps are being taken to prevent those non-executive directors who were involved in this from serving in a similar capacity in future?

The position of the executive directors deserves much sharper criticism, particularly when, as my hon. Friend pointed out, many of the senior people involved have found themselves in employment elsewhere in the NHS, and she quite rightly asked where the individual accountability is. Staff spending their last few days stood at a shredding machine is the sort of thing that goes on in multinational companies that have been cooking the books. It is not what should be happening in an open, transparent and accountable public body. It seems that the human resources team were used as a tool to enforce management’s will rather than to ensure the rules were applied fairly and consistently across the board. It is little wonder in those circumstances that staff did not feel confident that they could raise concerns freely.

I am sure we will talk about the duty of candour, but will the Minister give us assurances that this sort of situation will not happen again? Policies and good intentions can only take us so far, particularly when a culture develops that positively attacks those that raise concerns so that everyone is too frightened to raise those concerns in the first place. In my experience I have seen far too many times people who have legitimate concerns about a practice at their place of work but who do not have the confidence to raise those issues without fear of reprisal. A policy is only as good as the people entrusted to honour it and that is down to the people at the top. They set the tone and they have a duty to ensure that every person who raises a legitimate concern is protected. It only takes one bad experience or one failure to act in good faith on a concern raised and the entire system falls into disrepute.

I am sure that nobody goes into public service with the intention of creating such a culture of fear but it is clear that good intentions can be diverted by other influences and pressures. In this case, the central conclusion in the report, which needs more careful consideration, is that when the trust made the decision to go for foundation status what happened was an

“accompanying focus to reduce costs, which resulted in enormous pressures on many front line services and the emergence of a culture of bullying and harassment of staff at various levels within the organisation and the delivery to some patients of poor and in some cases sub-standard care.”

The report also said:

“For many of these concerns, it is hard to come to any other conclusion than that they were managed in the way they were in order to ensure the Trust application for NHS foundation trust status remained on track.”

That is pretty damning.

Aside from the financial pressures faced, we know that other pressures on staff are not going away, with significant numbers reporting work-related stress. We know that vacancy rates and rota gaps still remain unacceptably high and there are serious problems with staff morale across a whole range of services. I pay tribute to all NHS staff who are working hard in very trying circumstances, but we should also be realistic about the challenges they face. The staff at the trust have been key to delivering the improvements we have already seen, and the latest CQC report recognises that there have been improvements, which is not only a credit to those staff but also to the new leadership team.

It is fair to say that there is clearly still some way to go. For example, the performance of paediatric speech therapy service was worse than at the last inspection to the extent that the trust had to suspend the waiting list for a year. It was also noted that, despite some improvements, too many patients are developing serious pressure ulcers, which is something that ought to be eradicated altogether. Inspectors also highlighted “significant improvements” in the culture of the organisation and praised the trust for the measures it has introduced to keep staff safe, which is clearly one of the biggest and most important changes that was needed.

Whether that change in culture is permanent can only be tested by events, but we should reinforce at every opportunity the importance of speaking out with confidence. In that regard, it appears the future of the national whistleblowing helpline is still being considered. I would like to see the local guardians as complimentary to, rather than a replacement for, the national helpline. I would be grateful if the Minister will address whether any decision has yet been taken on the future of that national helpline.

In conclusion, I add my voice to the calls made by my hon. Friend the Member for West Lancashire for an independent clinical review into patient harm associated with the leadership failings at the trust. We also need an investigation into the adequacy of the actions taken at the same time by NHS Improvement, NHS England, the clinical commissioning groups and their predecessor organisations. Only then can we move into a position from which we can confidently say this is something that will never happen again.