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Content ArticleA Brighton GP surgery is under threat despite providing excellent services and strong links to the local community. This decision flies in the face of the proven 'social value' being delivered and potentially puts patients at risk. The reasons are presented in this excellent article which exposes the continued 'race to the bottom' due to an apparently unnecessary tendering exercise, a decision made behind closed doors and a failure to consult. Quote from Polly Toynbee's article in the Guardian: "Here’s the puzzle. Andrew Lansley’s calamitous system that opened the NHS to “any willing provider” to compete for contracts was supposedly swept away in 2022, replaced with ICBs that strove for cooperation across all NHS and social services in England. Yet some ICBs still apply the old competitive impulse to NHS services, even though they now have an obligation to ensure that tenders help to reduce inequalities."
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News Article
Cut ‘board headcount’, ICBs told
Patient Safety Learning posted a news article in News
A “blueprint” for integrated care board cost-cuts says “headcount should be reduced at board level”. The “model ICB blueprint” issued by NHS England says the organisations should “look to streamline boards to deliver [their] core role”. HSJ understands the biggest reductions in board members are expected to come from ”greater collaboration” such as shared roles, and “clustering” of integrated care board leadership in many regions – expected to involve sharing of chairs and CEOs. Discussions about consolidation are already well underway in several regions, although NHSE understands formal mergers are likely to be delayed until at least next year. The blueprint document indicates ICBs must also remove some board posts which are linked to functions being axed or transferred. These functions include performance management, workforce, and “digital leadership and transformation”. The guidance says ICBs should “streamline” boards “with the right roles and profiles to deliver core Model ICB functions”. Read full story (paywalled) Source: HSJ, 6 May 2025 -
News Article
Hospital whistleblower wins right to protection in landmark case
Patient Safety Learning posted a news article in News
Max McLean didn’t see himself as a whistleblower. As chair of the Bradford Royal Infirmary he had simply raised a number of issues including preventable deaths in newborn babies But he was, he claims, forced out by the Board. And when he tried to take the trust to an employment tribunal, they argued that he was not a worker and was not protected under whistleblowing law. Now, in a landmark ruling, the tribunal said he was a worker and was protected. The tribunal ruling will have massive implications for those who sit on trust boards across England. Too often when there have been scandals involving patient care there has been a resounding silence from those who are meant to be holding senior executives to account. Now they are being told that they can speak up and that they will be protected. Dr McLean, a former police officer, had been trust chair for two years when he raised his concerns, which were confirmed by an independent report. He told Channel 4 News: “There is no freedom to speak up. It is a sham.” Read full story Source: Channel 4 News, 26 March 2025 Related content on the hub: Speaking up for patient safety: A new interview series about raising concerns and whistleblowing -
Content ArticleThe Centre for Perioperative Care (CPOC) is recruiting for its next CPOC Patient Lead to begin in post in summer 2025, for a three year period. CPOC is looking for an enthusiastic and committed person to represent the patient voice on the CPOC Board and lead the team of patient representatives. The Patient Lead will be someone who is familiar with the wider healthcare landscape and can demonstrate collaborative engagement with colleagues or stakeholders at board level. Applicants should be keen to help advance the cause of perioperative care in the UK. This is an unpaid, voluntary role although reasonable expenses will be paid. Much of the CPOC Board's work is done remotely but some travel may be required to meetings in London. Closing date 9 May 2025
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News Article
Consultants express no confidence in trust chair and board
Patient Safety Learning posted a news article in News
Consultants at a prestigious teaching hospital have written a letter of no confidence in its chair and board, and have made a string of serious allegations against members of the trust’s leadership team. The senior medics at Moorfields Eye Hospital Foundation Trust sent the letter, obtained by HSJ, to the organisation’s governors on 26 February. Allegations in the letter include: there was a bullying culture at the organisation, including “coercive behaviour” by the trust’s chair; the trust’s reputation as a research institution was being damaged; and there was “a lack of corporate integrity”. The letter, from consultants’ committee chair Hari Jayaram, said more than half of the senior doctors — more than 80 consultants — at the trust had contacted him to “voice a lack of confidence in the organisation by the current chair and board”. It also said morale among these senior doctors was “at a significant nadir, which most colleagues do not ever recall experiencing in their consultant careers” and that senior staff have lost confidence in the trust’s Freedom to Speak Up process. Read full story (paywalled) Source: HSJ, 27 February 2025 -
News Article
Letby trust chair resigns after damning tribunal verdict
Patient Safety Learning posted a news article in News
The chair of a foundation trust has resigned after a tribunal found he unfairly forced out its former CEO, because she raised concerns about his bullying behaviour. Susan Gilby was CEO of the Countess of Chester Hospital Trust from 2018 until she was suspended and excluded from the premises in December 2022. The events unfolded at a hugely consequential time for the hospital. Dr Gilby, a former intensive care consultant, joined as medical director in August 2018. But she was made acting CEO shortly after, when her predecessor Tony Chambers was forced to leave, amid a rift with paediatricians and others over the Lucy Letby case. As she approached four years as CEO, the tribunal found Dr Gilby was the subject of a coordinated campaign instigated by chair Ian Haythornthwaite and carried out by chief people officer Nicola Price and two non-executives. The campaign was dubbed “Project Countess” and was “designed to protect the [chair] and manoeuvre [Dr Gilby] out of the trust”. It was launched after Dr Gilby began raising concerns with directors in spring 2022 about Mr Haythornthwaite’s “confrontational and aggressive behaviour”. The tribunal commented on Mr Haythornthwaite becoming angry with junior staff about the refurbishment of the trust offices while the “struggling organisation” faced “an erosion of public faith” in the trust against the backdrop of “a multiple murder inquiry”. This, it said, was “indicative of a chair prioritising his own self-interest above that of the trust and failing to work collaboratively with the CEO and staff”. Mr Haythornwaite joined the trust in 2021. COCH this evening said he had ”taken the decision to step down with immediate effect”. He said in a statement: “I have made this decision in the best interests of the trust so that the focus of the organisation can continue to be on delivering the best possible care to patients.” Read full story (paywalled) Source: HSJ, 14 February 2025 -
News Article
Letby trust CEO was forced out by ‘self-interested’ chair, tribunal finds
Patient Safety Learning posted a news article in News
A foundation trust CEO was unfairly forced out of her role, after whistle blowing about the bullying behaviour of its chair, a tribunal has ruled. Susan Gilby was CEO of the Countess of Chester Hospital Trust from 2018 until she was suspended and excluded from the premises in December 2022. The events unfolded at a hugely consequential time for the hospital. Dr Gilby, a former intensive care consultant, joined as medical director in August 2018. But she was made acting CEO shortly after, when her predecessor Tony Chambers was forced to leave, amid a rift with paediatricians and others over the Lucy Letby case. As she approached four years as CEO, the tribunal found Dr Gilby was the subject of a coordinated campaign instigated by chair Ian Haythornthwaite and carried out by chief people officer Nicola Price and two non-executives. The campaign was dubbed “Project Countess” and was “designed to protect the [chair] and manoeuvre [Dr Gilby] out of the trust”. It was launched after Dr Gilby began raising concerns with directors in spring 2022 about Mr Haythornthwaite’s “confrontational and aggressive behaviour”. The tribunal commented on Mr Haythornthwaite becoming angry with junior staff about the refurbishment of the trust offices while the “struggling organisation” faced “an erosion of public faith” in the trust against the backdrop of “a multiple murder inquiry”. This, it said, was “indicative of a chair prioritising his own self-interest above that of the trust and failing to work collaboratively with the CEO and staff”. In summer 2022, Dr Gilby raised her concerns directly with Mr Haythornthwaite, who refused suggestions of mediation, and reacted angrily, banging his desk. In September of that year, Dr Gilby “was subjected to concerted, aggressive and unjustified verbal attacks at the private board meeting [which] were not ’shut down’ by the [chair] when he could have and should have done so” according to the tribunal. The tribunal found “on the balance of probabilities” the chair and two NEDs “had agreed before the meeting that [Dr Gilby] would be personally criticised and held accountable for [the trust’s] financial position and steps taken to remedy it”. Read full story (paywalled) Source: HSJ, 14 February 2025 -
Content ArticleThe NHS Oversight Framework (NOF) outlines NHS England’s national approach to oversight of integrated care board (ICBs) and trusts, and how it monitors performance against key NHS commitments. The Recovery Support Programme (RSP), working with regional and national NHS England teams, provides focused intensive support and oversight to ICBs and NHS trusts/foundation trusts that are in segment 4 of the NHS Oversight Framework. The RSP has been in place since July 2021 and replaced the previous special measures’ programmes. There are currently 20 NHS providers and 3 ICBs enrolled in the RSP and the list of organisations is published on the NHS England website. Organisations in the RSP receive support (for example, financially and through the provision of additional resource) for a time-limited period with exit criteria agreed that will demonstrate sustainable improvement and recovery. The RSP approach can be applied to an individual NHS organisation, or across a whole system, comprising the ICB and constituent NHS providers. This paper outlines the current RSP approach and describes the work underway to update NHS England’s approach to improve performance in the most challenged organisations.
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News Article
Chair’s ‘insidious’ bullying ‘drove out trust CEO’
Patient Safety Learning posted a news article in News
An acute trust’s former chief executive was driven out by “manipulative and insidious” bullying by its current chair, she has told a tribunal. Susan Gilby left the Countess of Chester Hospital Foundation Trust at the end of 2022 following a breakdown in relations with chair Ian Haythornthwaite. She is claiming unfair dismissal against the trust and Mr Haythornthwaite, saying she was “bullied, harassed and undermined” by the chair. Dr Gilby joined the Countess initially as medical director in August 2018. This was shortly after its neonatal nurse Lucy Letby, later convicted of murder and attempted murder of babies, had first been arrested, and with investigations ongoing. Dr Gilby was made CEO in 2019, and was in post throughout the peak covid periods, before being suspended in December 2022, and resigning shortly after. According to court documents, issues first arose in late 2021 when a new chair, Mr Haythornthwaite, was appointed. Mr Haythornthwaite made efforts to “assert control through his subtle (and sometimes not so subtle) bullying techniques”, according to Dr Gilby, a former intensive care consultant and medical director. “He would often tell me that ‘people’ (who he refused to name) had ‘said things’ about me, but would refuse to elaborate further,” Dr Gilby wrote in her witness statement. Read full story (paywalled) Source: HSJ, 28 November 2024 -
News Article
NHSE board members face regulation under government proposals
Patient Safety Learning posted a news article in News
A major consultation on introducing professional regulation of NHS managers and leaders proposes applying the measures to NHS England board members. One of the questions in the Department of Health and Social Care’s consultation on regulating NHS managers, published this afternoon, asks participants whether “appropriate board members at arms-length bodies (for example, NHS England)” should face a system of regulation. However, the consultation does not ask participants whether NHSE employees should be included in plans for an individual statutory duty of candour, which could see managers face legal penalties for failing to report safety concerns. Instead, it only asks if managers at Care Quality Commission-regulated organisations should face tougher legal accountability, and at which level this should be considered. The consultation, set to run for 12 weeks, will consider the type of regulatory system that would be deemed appropriate, which managers should be in scope, what kind of body should be responsible for its regulation, and what types of standards managers should be required to demonstrate. Read full story (paywalled) Source: HSJ, 27 November 2024 -
Content ArticleArticle exploring the learning from shared leadership models in provider trusts in England. Key points: The last decade has witnessed the biggest shift in the architecture of the NHS provider sector since the creation of NHS trusts. This has included a shift towards much larger trusts and a dramatic rise in the number of trusts sharing board-level leadership. This arrangement is now in place in a third of English NHS trusts. This significant change in organisational form has developed organically and been subject to little scrutiny, evaluation and research. Now, ten years on from Sir David Dalton’s pioneering review of organisational forms, this report unpacks what works and what doesn’t when it comes to shared leadership models. Drawing on the insights of those who know the subject best – NHS leaders who have established and led provider group models at system or regional level – it puts forward a set of recommendations for those considering similar arrangements. Shared leadership models offer a beneficial and pragmatic option for NHS trusts and local systems when they are delivered for the right, clearly defined and locally determined reasons and when implemented flexibly and sensitively. While these changes are disruptive, shared provider leadership arrangements offer an alternative approach to a merger in which a pathway towards integration and closer working arrangements can be managed and determined at a controlled pace as benefits are delivered. Several trust group models are already showing the benefits of working together, including more aligned clinical strategies, shared learning, joint investment in critical infrastructure and clearer routes towards clinical and economic sustainability. Despite the varied nature of shared provider leadership models, the NHS, national regulators and independent policy organisations would benefit from recognising, supporting and evaluating them, given the importance of these models in the evolving NHS provider landscape. National regulators, including the Care Quality Commission, should consider adapting the arrangements for inspecting and reporting on groups of separate trusts under one board, or shared senior directors, to reflect this new type of governance arrangement more consistently across England. The critical role that trust chairs play in the development of shared provider group models, particularly in their formative period, should be formally acknowledged, with NHS organisations encouraged to resource the role and its support arrangements. NHS England could benefit from developing standard governance models which are compliant with a revised NHS Code of Governance to reduce the cost and complexity of developing local arrangements. This would strengthen and simplify governance and ensure common approaches between participating trusts as quickly as possible.
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News Article
‘Tension’ and ‘poor behaviours’ uncovered on trust’s board
Patient Safety Learning posted a news article in News
The board of a mental health trust grappling with serious culture and safety concerns is “not functioning well”, an NHS England investigation has found, amid the early departure of its chair. Black Country Healthcare Foundation Trust has faced several challenges this year with poor staff survey results, a long-running dispute between the provider and its medical consultant group, and NHS England’s Midlands team being sent several letters by anonymous groups of staff on a range of serious issues. The NHS England investigation found staff across the organisation “consider that the board is not functioning well, and that it is not able to resolve conflicts constructively.” A report of the findings, published this week, added: “There has been a tolerance of poor behaviours at board and a hesitancy previously to tackle them. “There is a need to refresh and reset relationships built on trust and respect, to create an environment where people feel comfortable to raise concerns in board meetings, not outside, [and] to enable resolution.” Read full story (paywalled) Source: HSJ, 5 November 2024 -
Content ArticleIn this article for LinkedIn, Dr Nadeem Moghal discusses the use of the patient story to start Board meetings and the possible reasons behind this,
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Event
Scrutiny, regulation, and improvement - CQG Series
Sam posted an event in Community Calendar
The overall objective of this masterclass is to build good governance commitment, capacity, and resilience in the face of severe resource constraints and complex staff, patient, political and regulatory expectations. The programme is interactive, developmental, based on best practice and focused on achievable improvement of practice, behaviours and outcomes. The course includes online access to the relevant CQG e-learning module for 12 months and a discount code to purchase additional modules. This masterclass is one of a series that will help enhance your understanding and application of governance in healthcare, this module recognises the mechanisms and drivers for improvement available to the board, including creating a culture for effective analysis and reporting of outcome measures and benchmarking internally. We clarify the role of the board in organisational scrutiny and challenge. We also look at the ways the board can add value and ensure exemplar organisational effectiveness by developing its own culture of improvement. Each masterclass has its own set of learning objectives, the final one of each is to be able to apply the learning to the participant’s own organisation using the provided CQG Maturity Matrix. The matrix can be used to set strategic objectives and consider progress over coming months. At the completion of this module, the participants will be able to: • Understand the mechanisms and drivers for improvement available to the board. • Clarify the role of board scrutiny and challenge. • Assist the board in adding value and ensuring organisational effectiveness by developing its own culture of improvement. • Apply the learning to the participant’s own organisation using the CQG Maturity Matrix. Register -
EventuntilIn this webinar hosted by NHS Providers, attendees will: learn about the different models of co-production with communities and how these could be applied to the work at your trust hear about the value of working with underserved communities to understand their experiences accessing healthcare services and how this can contribute to the wider agenda of reducing health inequalities discuss with others the enablers and blockers that trusts face when seeking to engage with communities in their service design and development. This webinar is open to NHS board members and health inequalities leads from trusts, foundation trusts and ICBs. Confirmed panel Louise Ansari – chief executive, Healthwatch England Keymn Whervin – head of experience, National Voices Sarah Balchin – director of community engagement and experience, NHS Solent Book a place at the webinar
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Content ArticleIn June 2022, General Sir Gordon Messenger and Dame Linda Pollard published their final report on the review of leadership and management in the health and social care sector, as commissioned by the Secretary of State for Health and Social Care in October 2021. This briefing by NHS Providers summarises the key areas covered by the report, grouping recommendations under the following headings: Training Development Equality, diversity and inclusion Challenged trusts, regulation and oversight
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Content ArticleThe Fit and Proper Person Test (FPPT) Framework has been developed by NHS England in response to recommendations made by Tom Kark KC in his 2019 review of the FPPT (the Kark Revew). This framework introduces a means of retaining information relating to testing the requirements of the FPPT for individual directors, a set of standard competencies for all board directors, a new way of completing references with additional content whenever a director leaves an NHS board, and extension of the applicability to some other organisations, including NHS England and the CQC. It will help prevent directors who have been involved in or enabled serious misconduct or mismanagement from joining a new NHS organisation. This new FPPT Framework consists of the following resources: NHS England Fit and Proper Person Test Framework for board members Appendix 1: Recommendations from the Kark Review (2019) Appendix 2: The board member reference template Appendix 3: New starter/annual NHS FPPT self-attestation Appendix 4: Letter of confirmation Appendix 5: Annual NHS FPPT submission reporting template Appendix 6: Privacy Notice Appendix 7: FPPT checklist Appendix 8: Future considerations for the Fit and Proper Person Test Framework.
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Content ArticleIn July 2018, the then Minister of State for Health, Stephen Barclay MP, commissioned Tom Kark QC to write a report and to make recommendations in relation to the fit and proper person test (FPPT) as it applied under Regulation 5 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Tom Kark QC review of the fit and proper person test (the Kark review) was published in February 2019 and made seven recommendations on how to improve the operation and effectiveness of Regulation 5. 2022 update The approved proposals which now form the basis of the current implementation work overseen by the newly established Kark Implementation Steering Group (the 2022/2023 Steering Group), are as follows: All Directors (executive, non-executive and interim) should meet specified standards of competence to sit on the board of any health providing organisation. Where necessary, training should be available. That a central database of directors should be created to hold relevant information about qualifications and history. A mandatory reference requirement for each director should be introduced. The FPPT should be extended to all commissioners and other appropriate arms-length bodies. The ministerial position is that Kark recommendation 5 (‘the power to disbar for serious misconduct’) is not being progressed at this time. Ministerial support was received for recommendation 6, and this will be taken forward as an action by the Department of Health Social Care (DHSC) and the Care Quality Commission (CQC): Remove the words “been privy to” from regulation 5. The final Kark recommendation related to extending the FPPT to social services. This is outwith the scope of the current NHS England work and will not progress as part of this programme of work.
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Content ArticleAn independent review of how effectively the test prevents unsuitable staff from being redeployed or re-employed in health and social care settings. The review was led by Tom Kark QC. It sets out 7 recommendations, including: developing competencies for directors making a central database of directors’ qualifications, training and appraisals expanding the definition of serious misconduct. The current fit and proper persons test is designed to ensure that senior staff who are responsible for quality and safety of care are fit and proper to be in their roles. The test applies to directors in the NHS, the independent healthcare sector and the adult social care sector.
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Content ArticleIn this article, Roger Kline looks at the responsibility of Board members in speaking up and responding to concerns raised about patient and staff safety concerns.
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Content Article
This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Dan talks to us about how his experiences as a paediatrician and military doctor have influenced his view of patient safety. He also describes the increasing complexity in healthcare systems and highlights the need for the Government to commit policy and resources to building and sustaining the NHS workforce. -
Content ArticleVariation persists in the quality of board-level leadership of hospitals. The consequences of poor leadership can be catastrophic for patients. The year 2019 marks 50 years of public inquiries into healthcare failures in the UK. The aim of this article is to enhance our understanding of context-specific effectiveness of healthcare board practices, drawing on an empirical study of changes in hospital board leadership in England. The study suggests leadership behaviours that lay the conditions for better organisation performance. We locate our findings within the wider theoretical debates about corporate governance, responding to calls for theoretical pluralism and insights into the effects of discretionary effort on the part of board members. It concludes by proposing a framework for the ‘restless’ board from a multi-theoretic standpoint, and suggest a repertoire specifically for healthcare boards. This comprises a suite of board roles as conscience of the organisation, sensor, shock absorber, diplomat and coach, with accompanying dyadic behaviours to match particular organisation aims and priorities. The repertoire indicates the importance of a cluster of leadership practices to fulfil the purposes of healthcare boards in differing, complex and challenging contexts.
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Content Article
Professor Jane Somerville, emeritus professor of cardiology at Imperial College, talks about the issues facing doctors who raise concerns about patient safety issues in the NHS. She shares her views on the risks facing doctors who speak up and the ways that healthcare managers treat whistle blowers. She also highlights issues in the employment tribunal system and outlines the need to regulate NHS managers. In the video, Jane mentions the employment tribunal of Dr Martyn Pitman. Since this interview was recorded, Dr Pitman lost the case he brought for retaliatory victimisation. Transcript I'm Jane Somerville. I'm a retired professor of cardiology, having been on the staff of the Royal Brompton Hospital and Heart Hospital. I don't practise medicine anymore. I'm interested in whistleblowing doctors. I became involved because I went to a conference at the Royal Society of Medicine which unfortunately they wouldn't repeat, although they promised to do so, and I was horrified at what is happening to people in my profession who speak up for the safety of patients. Firstly, they're supposed to speak up for the safety of patients, it's called our Duty of Candour, and secondly the treatment by the trusts, mainly managerial, is absolutely appalling, and I decided with my colleague David Ward that we really ought to work and do something. And why should we? Well, because I'm untouchable—they can't take my career from me, they can't prevent me doing anything, they can't do anything and I'm senior enough in the profession to be able to speak with some authority, at least about how medicine works. So I thought, nothing to lose and everything to gain for my profession. Question: How are you supporting the work to protect doctors who speak up? David Ward and I are working with Justice for Doctors and they include us in their meetings. We try not to get involved or allied with them but they know we're on their side and we speak out, and by virtue of our seniority we get to see people, make some sensible suggestions. Working with the excellent David Hencke who is writing Westminster Confidential— the actual facts. And he has brought the facts of the most horrible tribunal that's been going on with this Martyn Pitman, a distinguished and useful obstetrician and a gynaecologist doing good work, and the Royal Hampshire has behaved extraordinarily badly, in my view. Question: Why aren’t existing systems in the NHS protecting doctors who speak up for patient safety? The Freedom to Speak Up Guardians are usually not strong enough to bang and say to the CEO or the chief executives or the chairman or the board. They're just not strong enough to say, “This has to stop,” so who's to stop the trust managers or the trust managing executives (who could be doctors)? Who's to stop them if they want to persecute? It is part of the coverup culture that unfortunately exists since managers came into the health service. When I grew up, which wasn't yesterday, but also my younger colleagues, we didn't have all this until we had managers. Nobody regulates managers, they can just do what they like, they don't have a General Medical Council—they don't have anything! They have no code and lots of them aren't even educated to be a manager. It needs to be properly regulated and they need not to have both the money and the command, and our foolish profession has allowed both. They have control of the money—thousands of pounds are spent on legal fees of very expensive lawyers and it's a very unjust set of arms. The litigant or the complaining doctor has almost nothing unless he happens to be a rich consultant, and the trust has everything, with these managers in control. There's another side to this which is very, very serious, that I don't want really to touch on except to tell you and that is the question of employment tribunals. They manage to get these doctors to employment tribunals and it's not by chance that the respondents, the trusts, win 97%— that can't be justice, 97%! But I think the justice system has to look into the trouble of the employment tribunals, but it's very unjust on the doctors and very unfair ultimately for the patients. Question: How widespread are the issues facing NHS whistleblowers? Do I have any knowledge of how widespread it is? Answer, no. Why? Because they don't keep statistics in the Department of Health, We've asked them at quite a high level—no idea, thought it was a rather strange question. So we don't have statistics, complaints are not registered and you can't get information. And coupled with that is the improper making and signing of NDAs, which they do to the doctor and of course they're (the doctor) not allowed to go to the press, they're not allowed to speak to anybody and bad things happen even, I regret to say, suicides. To end how widespread it is, of course we don't know. It's more widespread than we think and there are more people who have suffered than we know—they're frightened to come forward. It's a culture of fear in a culture of cover up. Question: What needs to be done to protect doctors who speak up for patient safety? Key number one is stop persecuting doctors who speak up for the safety of patients. All that matters to us is the safety of patients and so therefore they must be given respect. They may not always be right, they may be saying silly things or they may be absolutely on the ball, but they must be listened to and they must not be persecuted by managers. Then next comes they (managers) must be regulated in their behaviour and I am hoping, although it is very serious, that something will come of this corporate manslaughter problem that is going to be brought up. That will concentrate the minds of the managers. They'll be a bit more careful automatically. So stopping the persecution should be automatic—ordered by the Government, ordered by the Prime Minister, ordered by whoever—but they have to stop it. Secondly, there's the question of the regulation of the funds used to have unequal arms—very expensive lawyers and leading QC's cost the Earth so the thing gets more and more and it shouldn't get to the employment tribunal. That needs looking into, but I don't think that's our business. Maybe employment tribunals do some good—not as far as the doctors are concerned. It's a very, very bad system. So let the judiciary get on and organise their own as we should organise our own medical aspects and concern ourselves about the safety of patients. It really is urgent to do something about this in the health service. It's the sort of thing that is losing doctors and doctors in training—I mean who wants to go into a health service where the managers can treat you like dirt, and do. Safety within the health service, within the doctor's brief, is vital and absolute and primary. Related reading Jane Somerville interview on staff speaking up: Transcript from Times Radio Breakfast (7 September 2023) The NHS whistleblowing crisis (8 February 2022) Westminster Confidential - Tribunal of the absurd: My verdict on the Dr Chris Day whistleblower case (David Hencke, 19 November 2022) -
Content ArticleTrust boards’ regular oversight of the quality and safety of maternity and neonatal services has been the subject of successive inquiries and reviews. In this report, the Sands and Tommy’s Joint Policy Unit review publicly available board papers and minutes for seven NHS Trusts in England. They analyse whether the information presented to boards, the process for review, and actions taken enabled boards to deliver effective oversight over the safety and quality of maternity and neonatal services. The review highlights the following policy and practical needs: The need for clearer guidance on the minimum metrics required by boards, which should include any new measures identified by the Maternity and Neonatal Outcomes Group to provide an early warning of service quality and safety declining. Better ward-to-board communication is required to contextualise data and findings. They state that this requires integrating more insights from Clinical Service Leaders in reports to the board to contextualise the metrics presented, as well as board members’ engagement with wards and staff. Reports to the board should include reviews over a longer time frame. Review current systems and processes in each Trust and whether they allow boards to have meaningful oversight over the quality and safety of services. They make the case that there is a need to review the meeting frequency and/or length to ensure sufficient time for meaningful scrutiny or to delegate this scrutiny further, alongside improved transparency of committee-level discussions. Transparent reporting of the issues discussed outside of public board meetings, such as at sub-committee level. The need to review the extent to which the maternity incentive scheme in its current form incentivises transparent reporting of performance issues so that they can be addressed in a timely way. It states that there is a risk that the boards and services focus on demonstrating compliance with the scheme rather than supporting the improvements in safety. Clarity over the role of Local Maternity and Neonatal Systems in oversight of quality and safety and the implications for Trust boards’ responsibilities.
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Content ArticleIn this opinion piece, BMJ journalist Clare Dyer examines how the healthcare system is grappling with the question of how Lucy Letby was allowed to get away with killing babies in plain sight for so long. She looks at culture and governance issues that meant that concerns raised by consultants were not appropriately acted on.
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