Call for a Public Inquiry

[anonymous-user]

I am not sure why it happens or how to solve it. My experience over several years doing NHS related legal stuff has been that the senior managers at NHS Trusts are often of mediocre ability (there are some exceptions who are great), and that they inhabit a culture of CYA and blame others. The Trust Boards are often weak. I think that the whole NHS Trust concept may be flawed, but am not sure what we might replace it with.

Central Government (Labour and Tory) must take a lot of blame for things like the constant reorganisations of the NHS, the crazy target culture, and the ludicrous adherence to the idiocies spouted by management consultant types, obsessed with measuring things that can't be measured and burying everything in slogans, buzzwords, and huge, meaningless manuals, guidebooks etc.

[wc98]

FiF said:

I'll support this. They even spent 60k on a private investigator to try and drum up some dirt. Over 200 complaints to GMC all unfounded.

For one I would like to see the snivel serpents responsible for this named and shamed.

i would like to see them dragged kicking and screaming from the ivory towers and necklaced in the street ,some may think that a bit extreme,i do not.

[FiF]

IanA2 said:

I don't think there has been any inquiries specifically into the way whistleblowers are treated. The managers responsible for the outrageous behaviour in cases like Raj Mattu's have acted to date with impunity. I've been watching the scene closely over the last ten years and it does seem to me that there is genuine public revulsion to a greater degree than there was before, I really do think the mood music is very different than form even three years ago.

The problem at the moment seems to be that HMG want the CQC &/or Monitor to sort the "whistleblowing problem" and neither of them are really committed to effective resolution. So, maybe a Public Inquiry is what's needed.

BV. Why do you think so many NHS whistleblowers are hung out to dry? And do you have any suggestions about how to sort it?

Is there any other mechanism to look at this other than a public inquiry.

A House of Commons select committee perhaps but the standard of questioning is usually pathetically poor.

I would agree public mood has shifted.

[IanA2]

Breadvan72 said:

I am not sure why it happens or how to solve it. My experience over several years doing NHS related legal stuff has been that the senior managers at NHS Trusts are often of mediocre ability (there are some exceptions who are great), and that they inhabit a culture of CYA and blame others. The Trust Boards are often weak. I think that the whole NHS Trust concept may be flawed, but am not sure what we might replace it with.

Central Government (Labour and Tory) must take a lot of blame for things like the constant reorganisations of the NHS, the crazy target culture, and the ludicrous adherence to the idiocies spouted by management consultant types, obsessed with measuring things that can't be measured and burying everything in slogans, buzzwords, and huge, meaningless manuals, guidebooks etc.

Having had experience in the private and the public sector, and having interfaced frequently with NHS managers I have to say I was regularly amazed at the quality of the incumbents. Like you I have come across a few good/excellent types, but they were mainly in London and not the majority. What I think a lot of people don't realise is that by far the greatest number of senior managers have a PAM's background, with little management experience from the real non-NHS world.

The majority of the mediocre managers I came across seemed to me as though they were stunned at having got to where they had and were damn well going to stay there. At whatever cost to anyone who might cross them. Another trick was to employ someone to do the job they were employed to do so that they could concentrate on the next rung up their ladder.

Agree that the target culture doesn't help.

But none of this explains why so few whistleblowers succeed at ET.

[IanA2]

FiF said:

Is there any other mechanism to look at this other than a public inquiry.

A House of Commons select committee perhaps but the standard of questioning is usually pathetically poor.

I would agree public mood has shifted.

HSC looked at it on 18th March. You can watch the session on Parliament TV. I think Charlotte Leslie is pushing the agenda a bit.

Edited by IanA2 on Sunday 20th April 22:40

[anonymous-user]

IanA2 said:

...little management experience from the real non-NHS world.

Ian, I agree with most of what you say, but I would quibble with that terminology. I don't agree with the idea that there is a real world (this usually means "business") and a non real world (this usually means "public sector"). The NHS is about as real world as you can get, as it deals with matters that often involve life and death. The point may be better expressed as lack of experience in an environment in which there is less blame culture but more real accountability.

Like you, the excellent NHS managers that I have met have been mostly in London, where they work and meet with other good managers and tend to cooperate with the medical staff rather than engage in rivalry with them. Trusts like Stafford can be rather isolated from the rest of the system (that was one of Stafford's problems. London Trusts tend to talk to one another and are integrated with leading medical schools.

The most impressive NHS CEO I have met is a former Mental Health Nurse (quite a few CEOs are ex nurses). Some (many doctors included) say that doctors make poor managers, and this may often be true, but the best Director of a Trust that I have met is also a brilliant surgeon (but her CEO can't handle her brilliance).

How to promote such people and not the dunderheads is a difficult question, to which I have no clear answer. The good people may be put off by the back stabby and buck passing culture, and by the mountains of impenetrable MBA bilge pumped out by those who unconsciously favour mediocrity because they are themselves mediocre.

Edited by anonymous-user on Monday 21st April 07:15

[FiF]

Two points.

This London (excellent) vs Provinces (potentially dodgy) picture doesn't stand up. Ref GOSH.

Secondly one big complaint I have is the artificial way the NHS has been structured to mimic business profit centres and a free market when there is nothing of the sort. It has led to diversions from the main focus and further waste of resources.

What we end up with as you've pointed out is loads of management consultant clap trap and people talking in bullst bingo phrases, jargon and acronyms justtto appear as if they are superior.

Undoubtedly there are many many world class operators at all levels within the NHS. There needs to be some means to stop the sort of things develop where someone even needs to become a whistleblower in the first place. In most places there is. But where there isn't or the system has failed then whistleblowers need to be protected if their concerns are valid. After all a person becomes a whistleblower because their earlier attempts to do things better have been thwarted deliberately.

The only way this abuse of power will change and it's not just in the NHS is by prosecution and people getting sacked with it all being done properly according to the book so we don't end up with another Shoesmith scenario.

[williamp]

They dont need a public enquirey. All they need is a serious case review to learn lessons and emply a few consultant managers to ensure these are put into practice...

[carinaman]

Quality posts there Breadvan72 and FiF.

That there's some nonsense going on outside London may be confirmed by this:

http://www.hsj.co.uk/news/workforce/vasco-knight-s...

It's interesting to see what Health Care Professionals make of it, just as it is to see what BiB type in their own more exclusive police forums.

It was interesting to see the race card played in the Vasco-Knight case, 'If I was a white male I'd have gotten away with it' she seemed to be saying.

My two pence is it seems there is a fair bit of cronyism, nepotism and making up as you go along in the public sector. Both the private sector and public sector seem to have the same problems with people protecting themselves and their little empires. For a few it's not about results or the customers, it's about what's best for them.

Regarding FiF's point about the NHS being configured in what appears a commercial basis in terms of costs centres and internal customers, isn't that also part of the problem with the police. Neither the police or the NHS are companies making widgets or serving customers, so why overlay that configuration over them?

[IanA2]

Breadvan72 said:

IanA2 said:

...little management experience from the real non-NHS world.

Ian, I agree with most of what you say, but I would quibble with that terminology. I don't agree with the idea that there is a real world (this usually means "business") and a non real world (this usually means "public sector"). The NHS is about as real world as you can get, as it deals with matters that often involve life and death. The point may be better expressed as lack of experience in an environment in which there is less blame culture but more real accountability.

Like you, the excellent NHS managers that I have met have been mostly in London, where they work and meet with other good managers and tend to cooperate with the medical staff rather than engage in rivalry with them. Trusts like Stafford can be rather isolated from the rest of the system (that was one of Stafford's problems. London Trusts tend to talk to one another and are integrated with leading medical schools.

The most impressive NHS CEO I have met is a former Mental Health Nurse (quite a few CEOs are ex nurses). Some (many doctors included) say that doctors make poor managers, and this may often be true, but the best Director of a Trust that I have met is also a brilliant surgeon (but her CEO can't handle her brilliance).

How to promote such people and not the dunderheads is a difficult question, to which I have no clear answer. The good people may be put off by the back stabby and buck passing culture, and by the mountains of impenetrable MBA bilge pumped out by those who unconsciously favour mediocrity because they are themselves mediocre.

Edited by Breadvan72 on Monday 21st April 07:15

Agreed terminology wrong. I should have said just non-NHS world. Problem is as I see it is that many of those who climb the slippery pole have spent all there working life in the NHS. They have witnessed and been enculturated in a system that pushes people about cares little for transparency and subscribes to the "deny defend delay" school of how to get things done. Agreed, many senior managers, including CEO's come from nursing/occupational therapy/physiotherapy backgrounds (collectively known as Professions Allied to Medicine; acronym PAM's). I have come across one or two that are competent, but many more who are not. I mention this in relation to your observation: "..they work and meet with other good managers and tend to cooperate with the medical staff rather than engage in rivalry with them." Unfortunately there is a great deal of tension between PAMs and medics, and I have seen crappy managers see their position of power over medics as an opportunity to settle old scores. I think people would be amazed if they knew that most Trusts are run by PAMs and that medics don't have a huge input to management. More fool them perhaps. That said, some medical managers are equally awful, I know of one appointed to a Medical Director job worth pretty much no management experience. That MD uses the power/threat of a GMC referral to keep dissenters in line.

Another strand that needs consideration is the power of McKinsey. They are all over the NHS like a rash, they're everywhere, including on the boards of CQC and Monitor, they also have a lucrative line in providing "interim managers". I know of one chap whose first management job was as an interim (sub ceo level) manager and for this he was picking up one thousand three hundred pounds a day. Having done this for a year, he was then parachuted into a troubled Trust as the substantive CEO and hey presto, turned it around, allegedly, in just over a year. Just like that, as Tommy C would say.

[IanA2]

FiF said:

Two points.

This London (excellent) vs Provinces (potentially dodgy) picture doesn't stand up. Ref GOSH.

Secondly one big complaint I have is the artificial way the NHS has been structured to mimic business profit centres and a free market when there is nothing of the sort. It has led to diversions from the main focus and further waste of resources.

What we end up with as you've pointed out is loads of management consultant clap trap and people talking in bullst bingo phrases, jargon and acronyms justtto appear as if they are superior.

Undoubtedly there are many many world class operators at all levels within the NHS. There needs to be some means to stop the sort of things develop where someone even needs to become a whistleblower in the first place. In most places there is. But where there isn't or the system has failed then whistleblowers need to be protected if their concerns are valid. After all a person becomes a whistleblower because their earlier attempts to do things better have been thwarted deliberately.

The only way this abuse of power will change and it's not just in the NHS is by prosecution and people getting sacked with it all being done properly according to the book so we don't end up with another Shoesmith scenario.

Agreed GOSH is an example of how things go wrong, but I agree with BV, generally there is more peer supervision in London and generally more inter-Trust/Academic/Research activity so generally, and I do mean generally, the London scene is better, but there will always be exception, GOSH proves this.

The structure issue is about privatisation. Remember how they flogged off the railways.

The claptrap speak abounds, a lot of it emanates from McKinsey.

"There needs to be some means to stop the sort of things develop where someone even needs to become a whistleblower in the first place. In most places there is. But where there isn't or the system has failed then whistleblowers need to be protected if their concerns are valid. After all a person becomes a whistleblower because their earlier attempts to do things better have been thwarted deliberately."

I think the only long term way is improved management, but that will take time. The current problem for whistleblowers now is there is no effective protection. I know of a case where a consultant went to the CQC saying they had concerns and asked if the CQC would offer protection. The CQC go on to take action against the Trust and the Board is pretty much replaced. The whistleblower is then sacked. Did the CQC do anything, what do you think?

Edited by IanA2 on Monday 21st April 13:46

[anonymous-user]

Second raters in any field take refuge in buzzword bingo and management speak. The surrender by successive second rate governments to the second raters who run and work for management consultancy firms has left us with large public sector or quasi-privatised (but really public sector) organisations that are supposed to be run on the basis of multi-volume handbooks of bullst.

While working on the Stafford Inquiry, I was shown the "benchmarking manual" for nurses. It is longer than even the worst Harry Potter book and written entirely in gibberish. It was seriously put forward as a "tool" that nurses are expected to use in order to achieve "benchmarking", or, to be more accurate, "strategies towards benchmarking".

Not long ago I was asked to advise on a Government contract in the education sector. It had been drafted by management consultants, who took no legal advice on the drafting. It ran to two fat lever arch files. It was written entirely in meaningless cant, and contained not a single promise capable of being enforced against the contractor by a Court.

When I am King, McKinsey will be put to the torch. The RAF will be sent to bomb INSEAD, and anyone with an MBA will be rounded up and made to dig ditches in the rain until they come to their senses.

Edited by anonymous-user on Monday 21st April 14:05

[IanA2]

Breadvan72 said:

Second raters in any field take refuge in buzzword bingo and management speak. The surrender by successive second rate governments to the second raters who run and work for management consultancy firms has left us with large public sector or quasi-privatised (but really public sector) organisations that are supposed to be run on the basis of multi-volume handbooks of bullst.

While working on the Stafford Inquiry, I was shown the "benchmarking manual" for nurses. It is longer than even the worst Harry Potter book and written entirely in gibberish. It was seriously put forward as a "tool" that nurses are expected to use in order to achieve "benchmarking", or, to be more accurate, "strategies towards benchmarking".

Not long ago I was asked to advise on a Government contract in the education sector. It had been drafted by management consultants, who took no legal advice on the drafting. It ran to two fat lever arch files. It was written entirely in meaningless cant, and contained not a single promise capable of being enforced against the contractor by a Court.

When I am King, McKinsey will be put to the torch. The RAF will be sent to bomb INSEAD, and anyone with an MBA will be rounded up and made to dig ditches in the rain until they come to their senses.

Edited by Breadvan72 on Monday 21st April 14:05

That made me laugh. Thanks.

[IanA2]

Here's a piece from Ireland, same issues, same problems.


http://www.irishtimes.com/debate/we-need-to-tackle...

[IanA2]

See: http://www.itv.com/news/2014-04-22/nhs-whistleblow...

Raj Mattu says he probably wouldn't make a disclosures if he had his time again. Sad but inevitable; maybe that's why managers behave the way they do. I know someone who has been/is going through the same thing, and that's how they feel too. The real losers are those who depend on excellence for their health.