Download pdf - Whistleblowers unheard by CQC FINAL · 1 Whistleblowers unheard by CQC By Minh Alexander, Pam Linton, Clare Sardari and a fourth NHS whistleblower, 30 November 2016 Summary Common

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WhistleblowersunheardbyCQCByMinhAlexander,PamLinton,ClareSardariandafourthNHSwhistleblower,30November2016SummaryCommondecencyandgoodgovernancerequiresthatwhistleblower’sconcernsarelistenedto,properlyexplored,analysedforpatternsandtransparentlylearnedfrom.However,governmentsmaydeliberatelyputineffectiveorinadequatestructuresandprocessesinplacetodealwithwhistleblowers,tomakeitlookasifsomethingisbeingdonewhenitisnot.1ThePublicInterestDisclosureAct(PIDA)2iscriticallyflawedpartlybecauseitdoesnotsetouttheresponsibilitiesofthebodiesthathavealegaldutytoreceivedisclosuresfromwhistleblowers–socalled“prescribedpersons”.SincePIDAcameintoforcein1999,prescribedbodieshaverevealedlittleinformationaboutthenatureandextentofwhistleblowers’concerns.TheCareQualityCommission(CQC)isaprimeexampleofsuchopacity,despiterepeatedpromisestobetransparent.TheCQChasforyearsresistedproper,proactiveuseofwhistleblowerintelligence.TheCQChasunparalleledwhistleblowingdata,yetithasstillnotprovidedasystematic,nationalpictureofwhistleblowinginhealthandsocialcare.TheCQChasrespondedreluctantly,scantilyandsometimesinaccuratelywhenaskedfordataaboutitsanalysisanduseofwhistleblowerintelligence.EvenwithveryincompleteandpossiblyinaccuratereportingbyCQC,itseemstherehavewellbeenover33,347whistleblowingcontactswithCQCsinceitsinception.Fromdatafortheyear2012/13,thegreatmajority(86%)ofwhistleblowingcontactshaverelatedtosocialcare.However,thereisverylittledataonthenatureofconcernsorhowtheywereresolved.OnlypartialinformationhasbeenprovidedunderFOI,buteventhisshowsthatCQCisofteninformedaboutseriouscarefailuresandinstitutionalcoverups.However,thedataalsosuggeststhatCQCreliesheavilyonwhatemployerssaytheyhavedonetoresolvestaffconcerns.Quiteoften,CQCdoesnotevencontacttheregulatedbodyandmerelyrecordsveryseriousdisclosuresas“informationnotedforfutureinspections”,withnofurtherrecordofoutcome.1AnexampleofthisisthesituationinHungarywherewhistleblowerprotectionlawwaspassed,butnoagencywasestablishedtoreceiveorinvestigatedisclosures.http://blog.transparency.org/2013/11/12/hungarys-whistleblower-law-offers-no-real-protection/2PublicInterestDisclosureAct1998http://www.legislation.gov.uk/ukpga/1998/23/contents

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QuestionsariseaboutCQC’spastclaimtoHealthCommitteethatitwouldinvestigate“everysingle[whistleblower]case”.3ThereisnoevidencethatCQCsystematicallytrackswhetherwhistleblowersexperiencedetrimentafterwhistleblowing.CQChasmadenoefforttoanalyseintelligencesuppliedbyEmploymentTribunalsaboutwhistleblowingclaimsagainstemployers.CQClargelydoesnotrevealthenumbersofwhistleblowersineachorganisation.Thisaddstoisolationandmarginalisationtowhichwhistleblowersaresometimesdeliberatelysubjectedbyemployers.CQChasnottakenanyevidentactiontodeterstillwidespreaduseofgagsintheNHS.Ithasnotuseditspowerstoremoveanyseniormanagerswhohavecoveredupandmistreatedwhistleblowers.Whistleblowersarenotproperlyprotected.Unmetharmandneed,andmalfeasanceidentifiedbywhistleblowersremainlargelyobscured,atatimeofharshpublicsectorcutswhenwhistleblowers’voicesneedtobeheardloudandclear.CQChasfailedwhistleblowersandthepublicinthepast.Itstilldoesnotmeetparliament’sexpectationsonwhistleblowing.CQChasalsonotactedproperlyontherecommendationsoftheFreedomtoSpeakUpReviewonNHSwhistleblowing.WecallonparliamenttorecognisethatCQChasseriouslyfailedandisunlikelytochangeitsapproach,andtoensurethatthereisnowseriousandcrediblewhistleblowingreform.ContentsSummary Page11.Background Page32.CQC’shandlingofwhistleblowerintelligenceandapproachtowhistleblowers

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2.2.Parliament’sexpectations Page52.3.Key,relevantrecommendationsfromtheFreedomtoSpeakUpReview

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2.4.CQC’spromisesandperformanceonwhistleblowing Page6

3OralevidencebyMikeRichardsCQCChiefInspectorofHospitals17June2014toHealthCommitteeinquiryonwhistleblowing:“Whatwecansayisthateverysinglecasewillbeinvestigated.Wewilllookatthosewhistleblowingcasesaswehearaboutthem,orotherpatientconcerns,andsay,“Whoisthemostappropriatepersontobedealingwiththat?”Itmaybeoneofourinspectorsoritmaybeoneofourmanagers,oneofourheadsofhospitalinspection,butwewilltakeitseriouslyeverytime.”http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/health-committee/complaints-and-raising-concerns/oral/10801.html

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2.4.1CQCpolicy Page72.4.2CQCdenialofresponsibilityforwhistleblowing Page72.4.3CQCregistrationandratingofproviders Page82.4.4CQCresponsetoWinterbourneView Page102.4.5CQCfailuretorecordwhistleblowingoutcomes Page102.4.6ExternalreviewofCQC’sresponsetowhistleblowers Page112.4.7CQC’swhistleblowingdatapilot Page112.4.8CQC’sinspectionmethodology Page122.4.9CQC’sintelligentmonitoring Page132.4.10CQCannualreports Page142.4.11CQCpublicationofdata Page152.4.12CQCFOIdisclosuresaboutwhistleblowingcontacts Page152.4.13ThereisaquestionovertheaccuracyofCQC’swhistleblowingfigures

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2.4.14CQChandlingofintelligencefromEmploymentTribunals Page202.4.15CQChasnottoourknowledgesystematicallymeasuredwhistleblowers’experienceofitsprocess.

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2.4.16CQC’sfailuretoapplyRegulation5FitandProperPersons Page222.4.17CQC’sfailuretoregulatetheuseofcompromiseagreements Page223.Conclusions Page221.BackgroundPIDAsaysremarkablylittleaboutthedutiesofprescribedpersons.4ThegovernmentsaidinareportofMarch2015thatthisisthepurposeofaprescribedperson:

“Thepurposeofaprescribedpersonprovidesworkerswithamechanismtomaketheirpublicinterestdisclosuretoanindependentbodythatmaybeabletoactonthem.Aworkerwillpotentiallyqualifyforthesameemploymentrightsasiftheyhadmadeadisclosuretotheiremployeriftheyreporttoaprescribedperson.”5

443FDisclosuretoprescribedperson.(1)Aqualifyingdisclosureismadeinaccordancewiththissectioniftheworker—(a)makesthedisclosureingoodfaithtoapersonprescribedbyanordermadebytheSecretaryofStateforthepurposesofthissection,and(b)reasonablybelieves—(i)thattherelevantfailurefallswithinanydescriptionofmattersinrespectofwhichthatpersonissoprescribed,and5DepartmentofBusiness,SkillsandInnovation.PrescribedPersonsguidanceMarch2015https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/415172/bis-15-201-Prescribed-persons-guidance.pdf

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Theresponseofprescribedpersonstodisclosuresisun-standardised.Thegovernmentsaysthatprescribedpersonsmaytakearangeofactionsdependingontheirindividualpowers,butisvagueaboutwhattheseactionscomprise.Thesamereportalsostressestheimportanceof“managingthewhistleblower’sexpectations”.Andyetthegovernmentacceptsthatprescribedpersonsarecruciallyimportantwhenwhistleblowershavebeenunabletoprogresstheirconcernsinternally:

“Theprescribedpersonisparticularlyimportantwherethereisinternalresistancetoaddressingtheconcernsraised,eitherdeliberateorthroughinertia,orwheretheconcernsareembeddedwithinanorganisation,systematicallysupportedwithinitsoperationsoroccuratthehighestlevels.”

ThegovernmentrespondedtocriticismbythePublicAccountsCommitteein2014thatwhistleblowerintelligenceisunder-used6,byrequiringthatprescribedpersonsshouldpublishdataaboutthenumberofwhistleblowingdisclosuresreceivedandactiontakeninresponsetodisclosures.7ThisdutycomesintoforceinApril2017.Thegovernment’sproposalsinfactfallshortofPublicAccountsCommittee’srecommendationsformoremeaningfulandproactiveanalysis:

“Departmentsshouldcollectandapplyintelligenceonconcernsraisedbywhistleblowersfromthefullrangeofarm’slengthbodiesandotherprovidersinvolvedintheirsectors.Theyshoulduseandanalysethedatatoidentifyanysystemicissues.”6

TheyalsofallshortofPublicAccountsCommittee’srecommendationsforactivetrackingofdetrimenttowhistleblowers:

“24.Somedepartmentsacknowledgedatourhearingthattheydonotcollectgoodqualityintelligenceinconnectionwithwhistleblowing.Wefound,forexample,thatdepartmentsdonotrecordeventhemostbasicinformationonwhetherwhistleblowinghasbeendetrimentaltoanindividualordamagingtotheircareers.Noneofthedepartmentscouldtellushowmanywhistleblowerswentonlong-termsickleaveafterraisingaconcern.ThisindicatorisonethatisusedbytheUSCongressandbyEuropeaninstitutionstogaugewhetherarrangementsareworkingappropriately.

6PublicAccountsCommittee,Inquiryreportonwhistleblowing,1August2014http://www.publications.parliament.uk/pa/cm201415/cmselect/cmpubacc/593/593.pdf7DepartmentforBusiness,SkillsandInnovation.Prescribedbodies.Annualreportingrequirementsonwhistleblowing.March2015.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/411894/bis-15-2-whistleblowing-prescribed-bodies-reporting-requirements-government-response.pdf

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…Departmentsshouldalsoconsiderhowtheycanenhancetheirsupportforwhistleblowers,lookingforinstanceatmeasuresliketrackingemploymentskillsandcareerprogressionandaskingwhistleblowersabouttheirviewsonthewhistleblowingprocess.”6

PublicAccountsCommitteehascontinuedtocriticisethegovernment’slackofappetiteforensuringgoodwhistleblowinggovernance.82.CQC’shandlingofwhistleblowerintelligenceandapproachtowhistleblowers2.2Parliament’sexpectationsExternalwhistleblowingdisclosurestoCQCrepresent,inmostcases,afailureofgovernancebyemployerstocreatetheconditionsinwhichconcernscanbesafelyraisedandresolved.HealthCommitteehasaskedCQCtoshowthatithastakenactioninresponsetowhistleblowingdisclosures:

“…inthemostseriouscasestheCQCmustdomorethansimplylistentothepublicandincorporatecommentsintoriskprofiles.IftheCQCistogenuinelytreatfeedbackfromthepublicasfreeintelligencethenitmustshowthatitcanactswiftlyonintelligencewhenseriouscomplaintsaremade.”9

HealthCommitteehasgoneasfarastorecommendthatCQCshouldrefusetoregisterproviderswhodonotcreateasafereportingenvironment:

“Akeyelementofthisassessmentshouldbeajudgementabouttheabilityofprofessionalstaffwithintheorganisationtoraiseconcernsaboutpatientcareandsafetyissueswithoutconcernaboutthepersonalimplicationsforthestaffmemberconcerned.Anorganisationwhichdoesnotoperateonthisprincipledoesnotprovidethecontextinwhichcarestaffcanworkinamannerwhichisconsistentwiththeirprofessionalobligations.ItshouldthereforeberefusedregistrationbytheCQC,”9

8PublicAccountsCommittee,Progressreportonwhistleblowing.11March2016http://www.publications.parliament.uk/pa/cm201516/cmselect/cmpubacc/602/602.pdf9HealthCommitteereportofaccountabilityhearingwithCQC,2012http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/592/592.pdf

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2.3Key,relevantrecommendationsoftheFreedomtoSpeakUpReviewInFebruary2015RobertFrancisadvisedviahisreportoftheFreedomtoSpeakUpReview10thatCQCandotherregulatorsshoulddomoretoprotectwhistleblowers.

“Ibelievethereisscopeforthesystemregulatorstoplayabiggerroleinsupportingstaffwhoraiseconcerns.Irecommendthattheydomoretoexercisetheirpowerstotakeregulatoryactionagainstanyregisteredorganisationthatdoesnothandleconcerns,ortheindividualswhoraisetheminlinewiththegoodpracticesetoutinthisreport.Thisshouldincludeprotectingthosewhoraiseconcernsdirectlywitharegulator,aswellasthosewhohavedifficultieswithinternaldisclosures.”

Headvisedthatifneeded,regulatorsshouldseekchangesintheirpowersinordertoprotectwhistleblowers:

“CQC,Monitor,NHSTDAinconsultationwiththeDepartmentofHealthshouldworktogethertoagreeproceduresanddefinetherolestobeplayedbyeachinprotectingworkerswhoraiseconcernsinrelationtoregulatedactivity.Wherenecessarytheyshouldseekamendmentoftheregulationstoenablethistohappen”

InhisreportoftheFreedomtoSpeakUpReview,RobertFrancisalsorecommended:

“AllNHSorganisationsshouldpublishintheirQualityAccountsquantitativeandqualitativedataaboutformallyreportedconcerns.ThiscouldthenbeusedbytheNationalLearningandReportingSystemtoidentifysafetyissuesthatarecommonacrosstheNHS,andtospreadlearningandbestpractice.ThisrequirestheNHSsystemregulatorstoadoptacommonapproachtodataaboutconcerns,withasharedunderstandingofwhatgoodlookslike…”

2.4CQC’spromisesandperformanceonwhistleblowingAnauthoritativesourceonceobserved:

“CQCendedupwitharoletheydon’tunderstandorwant.…WhistleblowingalertswerediscussedbetweenCQCinspectorsandmanagerswithasigh.…Whatthey

10FreedomtoSpeakUpReview11February2015http://webarchive.nationalarchives.gov.uk/20150218150343/https://freedomtospeakup.org.uk/wp-content/uploads/2014/07/F2SU_web.pdf

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exceliniskeepingalidonwhistleblowers.…Andthat’swhattheSecretaryofStatereallyrequiresoftheorganisation.”

CQChasbeenrepeatedlycriticisedoverfailurestoactappropriatelyuponwhistleblowers’disclosures,bothinhealthandsocialcarecases.111213Therehavebeenvariouselementstothisfailure.2.4.1.CQCpolicy:InthefirsttwoandahalfyearsofCQC’slife,itdidnotevenhaveanyexternalwhistleblowingpolicytogovernthehandlingofwhistleblowingdisclosuresbythestaffofregulatedbodies.ItwassuggestedtoCQCinJune2011–amonthafterPanoramahadrevealedthecarescandalatWinterbourneView-thatCQCshouldhaveanexternalwhistleblowingpolicywithclearstandards.14ItwasnotuntilDecember2011thatCQCpublishedsuchapolicy.15CQChasalsoindicatedviavariousFOIdisclosuresthatitonlystartedrecordingwhistleblowingcontactsfromJune2011.2.4.2CQCdenialofresponsibilityforwhistleblowing:Inresponsetoa2014FOIenquiryaboutwhetherithadconductedanyanalysisofwhistleblowingintelligence,beyondsimplenumbers,CQCextraordinarilydeniedinDecember2014thatithadanyremitforwhistleblowingconcerns:

“ToclarifyCQCcanonlyreportonvolumes/outcomesinrelationtothewhistleblowingconcernsthatwereceive.However,itisnotwithintheroleofCQCtodealwithwhistleblowingconcerns.”16

Insteadofawillingnesstoseekchangestoitsregulationstoprotectwhistleblowers,asadvisedbyRobertFrancis,CQChasmoreoftenemphasisedwhatitcannotdotoprotectwhistleblowers.

11WinterbourneViewSeriousCaseReview4September2012http://sites.southglos.gov.uk/safeguarding/adults/i-am-a-carerrelative/winterbourne-view/12OrchidViewSeriousCaseReviewJune2014http://www.hampshiresab.org.uk/wp-content/uploads/June-2014-Orchid-View-Serious-Case-Review-Report.pdf13DoyoubelieveintheCareQualityCommission?DrPhilHammond23September2015http://www.drphilhammond.com/blog/2015/09/23/private-eye/medicine-balls-private-eye-1341/14LetterfromMinhAlexandertoJoWilliamsCQCChair23June2011“Iwouldalsosuggestthatallpublicbodieshaveawhistleblowingpolicythatisnotjustfortheirownstaffbutcoversotherpartieswhomaydisclosetothem.Soforinstance,thattheCQChasawhistleblowingpolicythatitcanroutinelygivetostafffromallNHSorganisationswhomaycontactthecommissiontoprovideintelligence,whichgivesclearinformationontheCQC'srelevantresponsibilitiesinthematter,confidentiality,howtheCQCwilldealwiththeperson'sconcerns,andtimescales.”15CQCstatement14December2011aboutthepublicationofanexternalwhistleblowingpolicyhttp://www.cqc.org.uk/content/quick-guide-raising-concern-about-your-workplace16CQCFOIresponse29December2014https://minhalexander.files.wordpress.com/2016/09/cqc-foi-response-29-12-2011-wb-data-analysis-20141229-to-cqc-iat-1415-0691.pdf

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CQC-throughitsChiefInspectorofHospitals-promisedHealthCommitteeinJune2014that“everysingle[whistleblower]casewillbeinvestigated”.3However,CQCrepeatedlytellswhistleblowersthatithasnoremittoinvestigateindividualmatters.CQC’sDecember2014report“ComplaintsMatter”stressesthis:

“PeoplewithhistoriccasesalsocontactCQCinthehopethatwecanhelpresolvetheirconcernsorholdaprovidertoaccountforitsactions.Whileeachcaseprovideslearningforusabouttheproblemsthatcanoccur,andhowweneedtomouldournewmethodsofinspectiontodetectsimilarproblemsandtakeeffectiveaction,wedonothavetheremittoresolveanindividualcase.Aswithcomplaints,webelievethereisaregulatorygap…”17

CQChasalsoarguedthatoversightmay“undermine”employers’responsibilityfordealingwithconcerns:

“Finally,wewouldliketoemphasisethatthefirstresponsibilityfordealingwithstaffconcernshastobewithproviders.Anyproposedchangesthatintroducedfurthertiersororganisationsintothesystemshouldavoidunderminingtheresponsibilityofproviders.”18

2.4.3CQCregistrationandratingofproviders:Asforparliament’srecommendationthatCQCshouldrefusetoregisterprovidersongroundsthattheyhavefailedtocreateasafereportingculture,wearenotawarethatCQChaseverdoneso.Infact,weareawarethatCQChasratedorganisationswherewhistleblowershavereportedseriousdetrimentas“Good”andeven“Outstanding”.WellknownexamplesincludeSheffieldTeachingHospitalsNHSFoundationTrust,HomertonUniversityHospitalNHSFoundationTrust,BasildonandThurrockUniversityHospitalsNHSFoundationTrust,NorthumberlandTyneandWearNHSFoundationTrustandtheChristieNHSFoundationTrust.Therehavebeenmultiplewhistleblowersatthesetrusts.AnaccountbyoneoftheHomertonwhistleblowersonCQC’sfailurestoactproperlyuponconcernsispublishedbyparliament.19

17ComplaintsMatter.CQCreportoncomplaintsandwhistleblowing.December2014http://www.cqc.org.uk/sites/default/files/20141208_complaints_matter_report.pdf18CQCsubmissiontoFreedomtoSpeakUpReview17September2014https://minhalexander.files.wordpress.com/2016/09/20140917-cqc-submission-to-the-francis-review-freedom-to-speak-out-up.pdf19WrittenevidencebyPamLintontoHealthCommitteeInquiryonComplaintsandRaisingConcernshttp://data.parliament.uk/WrittenEvidence/CommitteeEvidence.svc/EvidenceDocument/Health/Complaints%20and%20Raising%20Concerns/written/7200.html

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WhistleblowersoftensaythatCQCinspectionreportsdiluteevidenceofpoorwhistleblowinggovernance.AnexampleofthisisCQC’sreportingaboutSheffieldTeachingHospitalsNHSFoundationTrust.

SheffieldTeachingHospitalsNHSFoundationTrustTheCQCratedSheffieldTeachingHospitalsinJune2016as“Good”acrosstheboard.20CQCdealtminimallywithwhistleblowingdisclosuresinitsinspectionreport.Thisisdespiterecent,multiplewhistleblowingeventsandwhistleblowers’dissatisfactionwiththewayinwhichCQChasrespondedtotheirdisclosuresaboutpoorcare,manipulatedinvestigationsandthetrust’sbehaviourtowardswhistleblowers.CQCstatesinitsinspectionreport:

“Thetrusthadpreviouslyhadconcernsraisedinasmallnumberofservices.Theseincludedconcernsregardingclinicalcareandbullyingandharassment.Theinformationwereceivedwastakenintoaccountbytheteamsinspectingtherelevantcoreservices.Wedidnotfindanyevidenceofbullyingandharassmentduringtheinspection.…Whereissueshadbeenidentified,wesawtheyhadbeeninvestigated.Thisincludedthetrustcommissioningexternalindependentreviewsinresponse.Somereviewshadtakenlongerthanexpectedandthismeantfindingsandactionswerenotalwaysimplementedinatimelymanner.Welookedatthecommissionedexternalreviewsincardiacsurgery,plasticsurgeryandaudiovestibularmedicineandnotedthattherewerenosubstantialclinicalconcernsidentified”

FOIdatadisclosedbyCQCinfactrevealedatotalof22recordedwhistleblowingcontactsfromSheffieldTeachingHospitalsstaffsince2012(datawasalsorequestedfor2011butCQCadvisedthatitdidnotstartrecordingwhistleblowingcontactsuntilJune2011).21ItwasalsoevidentthatCQCmostlyreliedonwhatitwastoldbythetrustaboutthesematters.CQCinitiallyrefusedtodisclosethenumberofSheffieldwhistleblowersonspeciousgroundsoflownumbersandpotentialidentifiability,buteventuallyconcededthatthereitheldmorenamesthanitoriginallyclaimed.Intotal,therewere7namedwhistleblowersandanunknownnumberofanonymouswhistleblowers.22

20CQCinspectionreportonSheffieldTeachingHospitalsNHSFoundationTrust9June2016http://www.cqc.org.uk/sites/default/files/new_reports/AAAE8129.pdf21CQCFOIdataonwhistleblowingdisclosuresreceivedfromSheffieldTeachingHospitalsNHSFoundationTruststaffhttps://minhalexander.files.wordpress.com/2016/09/20160803-sheffield-teaching-hospitals-whistleblowing-contacts_ir7989-v2.xlsx22CQCFOIresponseaboutthenumberofwhistleblowersatSheffieldTeachingHospitalshttps://minhalexander.files.wordpress.com/2016/09/cqc-foi-response-number-of-sheffield-whistleblowers-6-september-2016.pdf

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Suchinformationisofgreatimportancetowhistleblowersforavarietyreasons,butCQCinspectionreportsrarelyprovidecompletedataonthenumbersofstaffwhohaveraisedconcerns.Significantly,SheffieldTeachingHospitalshadahighnumberofcompromiseagreements(228overfiveyears).WhistleblowersbroughtthistoCQC’sattentionbutthereisnoevidenceinCQC’sinspectionreportthatithasexaminedanyofthese.23

2.4.4CQC’sresponsetoWinterbourneView:AftertheWinterbourneViewscandalinwhichaseriouscasereviewconcludedthatCQChadfailedpatientsandwhistleblowers,andwasnotcapableofdetectingthe“factandextentofinstitutionalabuse”11,theCQCpromisedthatwhistleblowerdisclosureswouldbetrackeduntilresolved.24Itproducedguidanceforitsstaffonhowtoprocesswhistleblowingcontacts.25CQCalsopromisedthatitwouldaudititshandlingofwhistleblowingdisclosures.CQChasnotpublishedanyoftheaudits,butDavidBehanCQCchiefExecutiveclaimedinoralevidencetotheHealthCommitteethatinternalauditshowed17ofasampleof40whistleblowingcontactstriggeredresponsiveinspections.24ItisnotclearwhatstandardsCQCauditeditselfagainst.Thesestandardsshouldbeinthepublicdomainandavailableforcritique.

2.4.5CQCfailuretorecordwhistleblowingoutcomes:CQC’shandlingofwhistleblowingdidnotimprovedespitethepromises.Scandalscontinuedtoemerge.CQC’ssubmissionof September 2014 to the Freedom To Speak Up Review, via David Behan CQC chiefexecutive18revealedthatCQC-hadupto2014-beenfailingtorecordtheoutcomesofwhistleblowers’ disclosures in thousands of cases. In 2013, 3154 of 9495 (33%) ofwhistleblowingdisclosures toCQChadno recordedoutcome.This submissionbyCQCwas not initially published, and only reluctantly disclosed months after CQC waschallengedaboutthislackoftransparency.

23FOIresponsebySheffieldTeachingHospitalsNHSFoundationTrustoncompromiseagreementshttps://minhalexander.files.wordpress.com/2016/09/sheffield-11-02-2016.pdf24Oralevidence,HealthCommitteeaccountabilityhearingwithCQC2012http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/592/120911.htm25CQCguidanceforstaff.HandlingconcernsraisedbyworkersofprovidersregisteredwithCQC.November2013https://www.whatdotheyknow.com/request/350100/response/855109/attach/3/CQC%20Whistleblowing%20Policy%20CQC%20IAT%201617%200300.pdf

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2.4.6ExternalreviewofCQC’sresponsetowhistleblowers:InawrittensubmissionofFebruary2014toHealthCommittee’sinquiryintocomplaintsandraisingconcerns,theCQCclaimedthatitwouldundertakeareviewofitsperformanceasaprescribedpersonunderPIDAandthesupportthatitprovidedtowhistleblowers:

“An external independent review will also be conducted looking at how CQChandles protected disclosures made to it as a ‘prescribed person’, under thePublic InterestDisclosureAct (PIDA) by staff in care providers and can supportpeople who approach the CQC under PIDA. The terms of reference of both ofthese reviewshave justbeen finalised. It isanticipated that the reviewswillbecompletedbySpring2014.”26

TheCQCwassubsequentlyreluctanttoprovidemuchinformationaboutthisexercisewhenaskedtodosolastyear.Itadvisedthatitdidnotintendtopublishtheresultsofthereview,whichitadmittedcostapproximately£150K27andincludedthehireofaCapitaconsultant.CQCclaimedthatdespitethesignificantexpenditure,therewasnoreportontheoutcomeoftheexercise.IteventuallydisclosedcorrespondencebytheCapitaconsultanttoDavidBehan,whichpurportedtoserveasaprogressreport.28ThiscorrespondencegavenomeaningfuldetailonhowCQC’shandlingofwhistleblowinghadbeenorwouldbeimproved.Nevertheless,DavidBehanwrotetoHealthCommitteetoinsistthatCQChadbeentransparent.292.4.7CQCwhistleblowingdatapilot:CQCclaimedincorrespondenceonanoverlappingmatterthatitwasundertakingapilotofdatacollectionaboutwhistleblowingevents.Whenpressedformoreinformation,CQCreportedthatitwasexperimentingwithcategorisingthenatureofconcernsraisedbywhistleblowersbasedonananticipatedsampleof360whistleblowingcontacts.Ofconcern,CQCstatedthatitmightnotcontinuecategorisationofwhistleblowingdisclosuresalongtermbasis.30CQCalsoadvisedthatitwouldnotpublishtheoutcomeofthedatapilot.3126CQCwrittenevidenceFeb2014toHealthCommittee’sinquiryonComplaintsandRaisingConcernshttp://data.parliament.uk/WrittenEvidence/CommitteeEvidence.svc/EvidenceDocument/Health/Complaints%20and%20Raising%20Concerns/written/7294.html27CQCFOIdisclosure1October2015aboutcostofexternalreview(thisrelatedbothtoresponsestowhistleblowersandother“customercare”issues)https://minhalexander.files.wordpress.com/2016/09/cqc-foi-response-1-october-2015.pdf28Email2February2015fromCarolineFawcettCapitaconsultanttoDavidBehanCQCchiefexecutivehttps://minhalexander.files.wordpress.com/2016/09/cqc-iat-1516-0597-documents-for-disclosure.pdf29Letter24September2015byDavidBehantoSarahWollastonMPChairofHealthCommitteehttps://minhalexander.files.wordpress.com/2016/09/cqc-ext-indep-review-behan-response-24-09-2015-20150924-pocu-1516-0181-letter-to-dr-sarah-wollaston-re-dr-minh-alexander.pdf30Letter26August2015fromDavidBehantoMinhAlexanderhttps://minhalexander.files.wordpress.com/2016/09/20150826-pocu-1516-0181-dr-minh-alexander-wb-intel-final.pdf31Letter15September2015fromDavidBehantoMinhAlexanderhttps://minhalexander.files.wordpress.com/2016/09/cqc-behan-letter-re-pub-wb-pilot-received-16-09-2015-copy.pdf

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Whenrecentlyaskedtodisclosetherelevantreportsfromthepilot,theCQCinitiallyclaimedthatitheldnosuchdata.Whenchallenged,theCQCadmittedthatitsinitialresponsewasincorrect.32Itdisclosedtworeports,onedated25September201533andanundateddocumentthatreportedonatrialofatriagetoolthatwascarriedoutinJuly2015.34Neitherofthesereportspecificallyonthe360whistleblowingdisclosuresorhowtheywerecategorised.Thereportsfocuslargelyonbureaucraticaspectsofcallhandling,suchasCQCstaffworkload,“efficiencies”,“productivity”andrespondingtoCQCinspectors’complaintsthattoomanywhistleblowingenquirieswerecodedas“high”priority.Theoutcomeoftheexercisewasthatalmosthalfofcallscodedashighprioritywerere-classifiedtomediumpriority.CQCconcludedthat:

“…informationcouldinsteadgodirectlytointelligenceforanalysisandreducedinspectorworkload”33

Soinshort,itseemsthattheobjectoftheexercisewasnottosomuchapatient-centredattempttoimprovelearningfromwhistleblowerintelligence,butaninstitution-centricexerciseincostcuttingtoreducetheinconvenienceposedbywhistleblowers.2.4.8CQCinspectionmethodology:CQCpromisedparliamentinFebruary2014thatitwoulddevelopamethodologyforinspectingregulatedbodies’whistleblowinggovernance:

“Wehavealsomadeacommitmentto‘inspectthewayhospitalslistenandrespondtocomplainantsandwhistleblowers…’andareintheprocessofdevelopingamethodologythatwillallowustodothisacrosshealthandsocialcareaspartofournewapproachtoinspections.”26

Famously,CQCrecruitedawhistleblowerviaasixmonthsecondmenttohelpimproveitsresponsetowhistleblowers.WhilstthisearnedCQCanendorsementandCQCusedthisventureformuchpublicrelationsgain,thereisnosubstantiveaccountorevidenceofchangesthatCQCactuallymadeasaresultofthiswork.ItissuggestedinablogpublishedbyCQCfourdaysaftertheFreedomtoSpeakUpReviewwasreleased,that

32CQCFOIcorrespondence21November2016https://minhalexander.files.wordpress.com/2016/09/20161121-final-decision-notice-cqc-iat-1617-0511.pdf33CQCinternalreport25September2015fromRespondingtoConcernsProgrammehttps://minhalexander.files.wordpress.com/2016/09/document-one-cqc-iat-1617-0511.pdf34UndatedCQCreportfromstafffocusgroupsonanewtriagetoolhttps://minhalexander.files.wordpress.com/2016/09/document-two-cqc-iat-1617-0511.pdf

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thereweresubsequent“trials”andevaluation.ToourknowledgetheoutcomesofthesetrialsandevaluationshaveneverbeentransparentlyreportedbyCQC:

“Althoughmysecondmentendedlastyear,Iwasinvolvedintheevaluationoftheworkoncethetrialshadbeencompleted.IhavebeenkeepingacloseeyeonthingsastheydevelopatCQC;Ihaveeveryfaithinthem–andthatperhapsthingscanchangeforthebetter.”35

Similarly,CQCemployedahighprofile“NationalAdviserforPatientSafety”,whogaveoralevidencetoHealthCommittee’sinquiryoncomplaintsandraisingconcerns.Atahearingon17June2014,theNationalAdviserreportedthatCQCwasdevelopingaframeworkforinspectingwhistleblowinggovernancebyregulatedbodies.3However,wearenotawareofanysubsequent,specificCQCguidancetoinspectorsonhowtoinspectwhistleblowinggovernance.Thereareonlysomebriefsupportingnotestoinspectorsaboutthebasicsofwhistleblowerlegislation.CQC’sreport“ComplaintsMatter”gaveindicationsofbroadareasofinspection,buttherewasnodetailedmethodology.17ExaminationofgenericCQCinspectionframeworks36revealsnoclearstandards,onlygeneralquestionswithnoassociatedmeasures.Forexample:

“Dobothleadersandstaffunderstandthevalueofstaffraisingconcerns?Isappropriateactiontakenasaresultofconcernsraised?”“Doesthecultureencouragecandour,opennessandhonesty?”“Howarelessonslearnedfromconcernsandcomplaints,andisactiontakenasaresulttoimprovethequalityofcare?Arelessonssharedwithothers?”

A letter to CQC by whistleblowers in October 2015 about CQC’s lack of crediblemethodologyforinspectingwhistleblowinggovernance37didnotresultinanyeffectiveactionbytheCQC.2.4.9CQC’sintelligentmonitoring:CQCacknowledgesthatithas“…auniqueoverviewofqualityacrossthehealthandadultsocialcaresector”butithaspublishedlittleorganisation-levelwhistleblowingdata.

35BlogforCQCbyKimHolt,16February2015http://www.cqc.org.uk/content/whistleblowers-story36CQCinspectionframeworkshttp://www.cqc.org.uk/content/inspection-frameworks-hospital-and-ambulance-core-services37Letter19October2015toDavidBehanbywhistleblowers,onCQCinspectionmethodologyhttps://minhalexander.files.wordpress.com/2016/09/c2a0letter-to-cqc-19-october-2015.pdf

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CQC’sso-called‘intelligentmonitoring’reportssometimesflagwhetherspecificorganisationshavebeensubjectto‘whistleblowingalerts’,buttheygivenoindicationofnumberandthemes.Forexample,foroverthreeyears,NorthCumbriaUniversityHospitalsNHSTrusthasbeenthetrustwiththemoststaffwhistleblowingdisclosurestoCQC(moreinformationisprovidedlaterinthisreport).However,fromthepublic’spointofview,allthatisvisibleisfiveintelligentmonitoringreportsthatacknowledgetherehavebeenwhistleblowingalerts.382.4.10CQCannualreports:CQCannualreportshavealsoprovidedlimitedandincompleteinformationonwhistleblowing,ininconsistentformats.CQChasreceivedwellover33,347whistleblowingcontactssinceinception.ThefulltotalisunknownbecauseCQChasnotprovideddataforthreeoutofsevenyears.Table1.DatainCQCannualreportsaboutwhistleblowingYear Datagiveninannualreportaboutwhistleblowingdisclosures

receivedbyCQC2009/10 Nospecificmentionofwhistleblowing2010/11 Afewanecdotalreferencestowhistleblowers’sdisclosurestoCQC,

butnostatisticaldataprovided2011/12 InresponsetofailuresexposedatWinterbourneView,theCQC

claimedthatithadestablishedawhistleblowingteamtospecificallydealwithconcernsreceived,thatitwasreceivinganaverageof400whistleblowingdisclosuresamonth,andthatitwasundertaking“periodicauditsofasampleofcasestoanalysehowwhistleblowinginformationisbeingused.“[Assumingthattherateofcontactswas400/monththroughthewholeyear,thisgivesatotalof4800whistleblowingcontactsfortheyear]

2012/13 CQCreportedthatthenumbersofwhistleblowerdisclosureshaddoubledto8643overtheyear,andthatthevastmajorityrelatedtosocialcare–7456(86%)

2013/14 CQCreportedthatithadreceived9473whistleblowerdisclosuresandthatithadaskedanNHSwhistleblowertoadviseitonimprovingitsprocesses.

2014/15 Nodataprovidedonwhistleblowingdisclosures,apartfromonecaseexample.[Inoralevidencetoparliament,DavidBehanstatedthatCQChadreceived1573whistleblowingcontactsintheperiod1April2014toJune2014]

2015/16 CQCreportedthatwhistleblowingdisclosuresformed11%ofall80,530concernsreceivedbyCQC.[Thisgives8858whistleblowing

38CQCintelligentmonitoringreportsonNorthCumbriaUniversityHospitalsNHSTrusthttp://www.cqc.org.uk/provider/RNL/reports

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disclosures]Total Theabovegivesatotalfigureinexcessof33,347whistleblowing

contactstoCQC,todate

2.4.11CQCpublicationofdata:Asabove,RobertFrancishadanexpectationthatallNHSorganisationsshouldregularlypublish“quantitativeandqualitativedata”onwhistleblowingconcernsraisedbytheirstaff.

CQChasnothelditselftothisstandard,eitherwithrespecttoreportingonwhistleblowingbyitsownstaff,orwhistleblowingbystaffoftheorganisationsthatitregulates.CQCgavenoinformationonwhistleblowingbyitsstaffinthetwoannualreportspublishedaftertheFreedomtoSpeakUpReview.Moreover,CQChasdecidedthatitsownlocalFreedomtoSpeakUpGuardianshouldnotrelatetotheNationalGuardian.39

“ThedecisionbyCQCtoappointitsowninternalGuardianisseparatetothearrangementsfortheNationalGuardianandtherewillbenoformalworkingrelationshipbetweenthetworoles.”

ThestructuralisolationofCQC’slocalGuardianandCQC’slackofaccountabilityaboutitsinternalwhistleblowingaffairssetapoorexampletotheorganisationsthatCQCregulates.2.4.12CQCFOIdisclosuresaboutwhistleblowingcontacts:InMay2014,viaFOI,CQCprovideddataonthenumberofwhistleblowingdisclosuresabouttheNHSintheyearbetweenMay2013andApril2014.40Thisdisclosurerevealedatotalof981contactsbythestaffofEnglishNHStrustsovertheyear.Analysisofthedatarevealsarangeof1to33whistleblowingcontacts(averageof4.8)pertrust.Twentyfivetrusts,mostlyacute,werethesubjectof10ormorewhistleblowingcontactstoCQC.TheyaccountedforalmosthalfofallwhistleblowingcontactstoCQC(402of981).Mentalhealthtrustsaccountedforalmostaquarterofthewhistleblowingcontacts(222of981).41The25trustswiththehighest

39CQCFOIresponse25January2016https://minhalexander.files.wordpress.com/2016/09/cqc-local-guardian-appt-nat-guardian-foi-response-25-01-2016-iat-1516-0638.pdf40CQCFOIdataMay2014https://minhalexander.files.wordpress.com/2016/09/cqc-foi-on-wb-disclosures-may-2013-to-april-2014.xlsx41AnalysisofdisclosurestoCQCaboutmentalhealthtrusts1May2013to30April2014https://minhalexander.files.wordpress.com/2016/09/wb-disclosures-to-cqc-on-mh-trusts-may-2013-to-april-2014.xlsx

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numberofwhistleblowingcontactsaregiveninTable2.Manyofthenameswillbeveryfamiliartowhistleblowers.Table2.TrustswiththehighestnumberofstaffwhistleblowerdisclosurestoCQCNHSTrust Numberofstaffwhistleblowingcontacts

madewithCQCMay2013-April2014NorthCumbriaUniversityHospitalsNHST 33BartsHealthNHST 27YorkshireAmbulanceService 25UniversityHospitalsofLeicesterNHST 24ColchesterHospitalUniversityNHSFT 23OxfordUniversityHospitalsNHSFT 22NorfolkandSuffolkNHSFT 19HeatherwoodandWexhamParkHospitalsNHSFT

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MidYorkshireHospitalsNHST 15EastLancashireNHST 15HeartofEnglandNHSFT 14WirralUniversityTeachingHospitalNHSFT 14CroydonHealthServicesNHST 13NottinghamUniversityHospitalsNHST 13TamesideHospitalNHSFT 13DorsetHealthcareUniversityNHSFT 12HullandEastYorkshireNHST 12UnitedLincolnshireHospitalsNHST 12StGeorgesHealthcareNHST 12BrightonandSussexUniversityHospitalsNHST

11

StGeorgesHealthcareNHST 12LiverpoolCommunityHealthNHST 11NorthernLincolnshireandGooleNHSFT 11UniversityHospitalsofMorecambeBayNHSFT

11

LeedsTeachingHospitalsNHST 10Significantly,CQCstatedinthisFOIresponsethat“CQChasnotperformedanycentralanalysisofthereasonsbehindeachwhistleblowingconcernwehavereceived.”Clearly,thisinformationhasthepotentialtoseriouslyembarrassthegovernment,butsuchanalysisisvitaltounderstandingsystemicproblemsandriskstopatientsandsocialcareusers.

17

AglimpseintoCQC’svastpoolofwhistleblowingdatawasaffordedwhenthemediareportedonanFOIaboutthenatureofNHSwhistleblowingdisclosurestoCQC.42TheCQCdeclinedtoprovideallthedatarequested,butevenitspartialdisclosureonstaffconcernsinfivetrustswiththehighestnumberofwhistleblowingreportsrevealedseriousanddisturbingmatters.43ThefivetrustswereNorthCumbria,OxfordUniversity,Colchester,MidYorksandBarts.TherewereallegationsthatNHSmanagersignoredconcernsandriskstopatients,manipulatedthesystemandtoldstaffto“lietoCQCinspectors”.Forexample,theseweresomeofthestaffdisclosuresabouttheverytroubledColchesterHospitalUniversityNHSTrust:

“Complaintaboutlackofpermanentstaff-onlytemps.Alsolackoftransparencyreinvestigations.Staffareunabletoraiseissueswithmanagers,astheydiscriminate.AlsoallegationthatmanagersemploymorestaffpriortoCQCinspection.”“Concernswithstaffinglevelsonward.AllegationelderlySUarebeingneglected.”“Allegationsofabullying/blameculturefromseniormanagementleadingtostafffearingtoraisewhistleblowingconcerns.Alsoconcernsthatpatientsareatriskduetopatientsbeingoffloadedfromambulancesandleftincorridorswithminimumfacilitiesandsupportforextendedperiodsoftime.”

AnupdateFOItoCQCrevealedthattherateofwhistleblowingcontactsbyNHStruststaffhascontinuedatbroadlythesamerateoverthefinancialyears2013to2016,withatotalof2959contactsandanaverageof986ayear,withanaverageof3.9contactspertrustperyear.44NorthCumbria,oneofthe14“Keogh”trusts45,remainsthetrustthatwhistleblowerscomplainaboutthemosttoCQC.Inthethreefinancialyears2013to2016,therewerea

42WhistleblowingNHSstaffcomplainedabouthospitalfailingsincludingdrugdealingandpoorcare,MatthewDavis,Mirror26April2015http://www.mirror.co.uk/news/uk-news/whistleblowing-nhs-staff-complained-hospital-558469943CQCFOIdataonwhistleblowingdisclosuresbyNHSstaffhttps://minhalexander.files.wordpress.com/2016/09/cqc-foi-20150330-cqc-iat-1415-0865-enquiries-top-5-internal-review-for-disclosure.xlsx44CQCFOIdisclosure24October2016onwhistleblowingdisclosureshttps://minhalexander.files.wordpress.com/2016/09/20161019-final-information-for-disclosure-cqc-iat-1617-0427.xlsx45Reviewintothequalityofcareandtreatmentprovidedby14hospitaltrustsinEngland:Overviewreport,BruceKeogh,NHSEngland16July2013http://www.nhs.uk/nhsengland/bruce-keogh-review/documents/outcomes/keogh-review-final-report.pdf

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totalof83disclosures,manyofwhichrelatetobullying,failuretolistentostaff,unsafestaffing,whistleblowerreprisal,allegedmanipulationanddishonestyinthemanagementofthetrust.Table3.SomeofthemostworryingdisclosuresaboutNorthCumbriawereasfollows:Dateofdisclosure

NatureofconcerndisclosedtoCQC ActionthatCQCsaysittookinresponsetodisclosure

December2013

Concernsthatincidentsarenotbeingproperlyinvestigatedandclosedinordertomanipulateperformancefigures

Informationnotedforfutureinspection

January2014 ConcernaboutmonitoringandcontrolofthebacteriaPseudomonasinthehospitalwatersupply

DiscussedwithTrustchiefexecutive

March2014 Concernsthatincidentsarenotbeingproperlyinvestigatedinordertomanipulateperformancefigures.


April2014 Concernthatlessonsnotlearnedfromrecentnevereventreviews


April2014 Concernsthatawhistleblowerwasbadlytreatedafterraisingconcernswithmanagementandacultureofbulllyingandharassment.


September2014

Concernsaboutincidentreporting,thatmanagementdonotinvestigateincidentsappropriatelyandallegationthatinvestigationoutcomefiguresaremanipulated.


November2014

Concernthatmanagementarepressurisingstafftosigntosaytheyhavehadtrainingwhentheyhavenot.Staffhavetotrainthemselvestouseequipment.Lackofconsistencyintraining/competenceacrosswards.

HeadofHospitalsInspectioninformedNotedforfutureinspection

March2015 Concernsaboutpoorstaffinglevelscompromisingcareofserviceusersandmanipulatingofresultstomakethedepartmentlookgood


March2015 Concernsaboutmanipulating/misplacingresultscausingpatientcaretobecompromised


April2015 Concernsaboutmanipulatingresults Notedforfuturereviews

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ItisofgreatconcernthatrepeatedallegationsoffalsificationbyNorthCumbriamanagementweresimplynotedbyCQCforfutureinspection.AkeystandardrecommendedbyRobertFrancisandadoptedbythegovernmentisthathealthcareorganisationsshouldpublishtruthfuldata.Amoreresponsiveapproachissurelyrequiredwhenthereareallegationsthatorganisationsarereportingdishonestly.Ofthe83whistleblowingdisclosuresbyNorthCumbriastaff,67weresimply“notedforfutureinspection”or“notedforfuturereview”.Ofthese67,aHeadofHospitalsInspectionwasinformedin12instances.ThemostthatCQCdidinresponsetowhistleblowerdisclosureswastooccasionallydiscusstheissueswiththeTrust.Nowhereisthereanyreferencetoactive,externalreviewofthetrust.Infact,whenonewhistleblowercomplainedthatconcernsthatweredisclosedtotheKeoghreviewteamhadnotresultedinmeaningfulaction,CQCalsosimplynotedthisforfutureaction.Whilstthepicturethatemergesfromthisdataisdisturbing,itcorrelateswiththeexperienceofmanywhistleblowerswhohavereportedbeingfobbedoffbytheCQC.ThedatacertainlydoesnotsupportaclaimmadetoparliamentbyCQC’sChiefInspectorofHospitalson17June2014:

“Whatwecansayisthateverysinglecasewillbeinvestigated.”3

Indeed,thedataandinspectionreportsprovidealmostnoevidencethattheCQCfollowedupthegravedisclosureswithchecksonNorthCumbriawhistleblowers’wellbeing,andwhethertheyperceiveddetrimentafterwhistleblowing.ThisisoneofthemostdisappointingaspectsofCQC’sresponsetowhistleblowers.Parliamenthasadvisedthatitisimportantforpublicbodiestorecordandmonitordetrimentexperiencedbystaffwhoraiseconcerns.RobertFrancisadvisedthatCQCshouldassessthewayNHSproviderstreatedwhistleblowersaspartofthe“WellLed”domain.CQChasapproachedthissuperficiallyinmostofitsinspectionreports.Itreportsprimarilyonstaffwillingnesstoraiseconcerns,andusuallyavoidsanyaccountsofreporteddetrimenttowhistleblowers.CQC’sinspectionreportsonNorthernCumbriahavenotrevealedthegravityofstaffdisclosures.Theyrefermostlytothefactthatdisclosureshavebeenmade,butnotwhattheycomprise.CQCreportsreferredtoproblemsofculture,withoutreportingthattheseincludeseriousallegationsofdishonesty.TheinspectionreportscontainnoreferencetoFitandProperPersons,otherthancommentsonthetrust’scompliancewithbureaucraticprocess.Despitethestaffreportsofseriousmanagementmisconduct,CQCasserted:“Manyoftheconcernscouldandshouldhavebeenaddresseddirectlybymanagerswithstaff.”Thisisaminimisationofthesevererisksandobstaclesthatstafffacewheretherearemanagementcoverups.

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Italsoevidentthatatnationallevel,CQCisstillnotanalysingthethemesfromwhistleblowingdisclosures.On13September2016CQCadvisedthat“currentlytheCQChasnotconductedanyanalysisofenquiriesrecordedaswhistleblowing”.46On21September2016,CQCadvisedthatthewhistleblowingdataitholdscentrallyrelatesonlytothenumbersofdisclosures,andnootherinformationhasbeencentrallycollated.47Ofcourse,afailuretoanalysedatahastheeffectofprotectingCQCfromFreedomofInformationrequests,andundertherules,enablesCQCtorefuserequestsfordataonthenationalpictureongroundsofcost.2.4.13ThereisaquestionovertheaccuracyofCQC’swhistleblowingfigures.InanFOIresponseof13September2016,CQCclaimedthatithadreceivedatotalof254whistleblowingcontactsfromthestartoffinancialyear2016/17.Prorata,thisgivesanumberof609fortheyear,whichisasharpdropfromthepreviousyear.However,CQChasdeniedthatitsmethodofcountingwhistleblowercontactshaschanged.2.4.14CQChandlingofintelligencefromEmploymentTribunals:Asaprescribedbody,CQCreceivesnotificationsfromEmploymentTribunalsaboutlegalactiontakenbywhistleblowersagainstregulatedbodies,ongroundsofwhistleblowingdetriment.Thisinformationisaveryimportantindicatoroflikelycoverupsandmistreatmentofwhistleblowers.However,FOIdatarevealsthatCQChasalsofailedtoproperlyanalysethisintelligence:

“WedonotcurrentlylogorrecordET1forms[ET1formsaresummariesofindividualclaimstotheEmploymentTribunal]inacentraldatabaseandhavenotconductedanoverallanalysis.Instead,anyET1formwereceiveisloggedagainstourrecordsfortherelevantprovider.”48

CQCrefusedtoprovidenationaldataonET1formsreceived,ongroundsofpurportedcost.Adatadisclosedon24November2016,onasampleoftrustsknowntohavehadsignificantwhistleblowingproblems,revealsrelativelylownumbersofnotificationsbytheEmploymentTribunal.

46CQCFOIresponse13September2016https://minhalexander.files.wordpress.com/2016/09/pam-linton-cqc-foi-correspondence-september-2016.pdf47CQCFOIresponse21September2016https://minhalexander.files.wordpress.com/2016/09/cqc-correspondence-21-09-2016-only-numbers-held-centrally.pdf48CQCFOIdisclosure27October2016https://minhalexander.files.wordpress.com/2016/09/cqc-foi-response-et1-intelligence-27-october-2016.pdf

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WebelievetheET1datasuppliedbyCQCisunreliable:

2.4.15CQChasnottoourknowledgesystematicallymeasuredwhistleblowers’experienceofitsprocess.Instead,CQCisaversetochallengeandhasonoccasionsoughttocharacteriseitscriticsasdifficult.Ithasattimesrespondedlegalisticallyandthreatenedorimposedcommunicationbans.CQChasalsotriedtoresistrequestsforinformationbythreateningtodeclareoractuallydeclaringrequestsas“vexatious”.Forexample,CQCdeemedanFOIrequestaboutDavidBehan,DavidPriorandWinterbourneViewas“vexatious”.Theinformationcommissionersubsequentlyoverturnedthis.49CQCalsofrequentlyrefusestohearfromwhistleblowersabouttheirexperiencesofvictimisation,claimingthatemploymentmattersarenotwithinitsremit,wheninfactreprisalagainstwhistleblowersisinfactaveryseriousgovernanceissue.

49ICOdecisionnotice20August2014https://ico.org.uk/media/action-weve-taken/decision-notices/2014/1021508/fs_50532615.pdf

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2.4.16CQC’sfailuretoapplyRegulation5FitandProperPersons:InadditiontoCQC’swilfulblindnessandrelativesilenceaboutwhistleblowerdetriment,CQChasalsonotuseditspowersunderRegulation5FitandProperPersons(FPPR)toremoveanyseniormanagerswhohavesuppressedandharmedwhistleblowers.5051ItsgeneralfailureonFPPRhasbeensoseriousthatevenRobertFrancis,aCQCnonexecutivedirector,haspubliclyacknowledgedthatFPPRisnotworking.522.4.17CQC’sfailuretoregulatetheuseofcompromiseagreements:RobertFrancisadvisedintheFreedomtoSpeakUpReviewreportthatCQCshouldinspectthecompromiseagreementsusedbyemployers.CQCclaimedthatitwoulddosoif“necessary”.ThereisinfactnoevidencefromareviewofallinspectionreportsonNHStruststhatCQChasexaminedanycompromiseagreements.53OngoingFOIworkshowsthatgaggingremainswidespreadintheNHSandthatsomeemployersusegaggingclausesasstandard.3.ConclusionsCQC’srepeatedfailurestoactappropriatelyuponwhistleblowers’concernshavedamagedpublicconfidence.Thereisnosubstantiveevidenceofchange.CQC’sinspectionmethodologyonregulatedbodies’whistleblowinggovernanceisnotrigorous.Itlacksclearlydefinedstandardsandsodoesnotlenditselftoauditandmeasurement.CQC’sresponsestowhistleblowers’disclosuresaretoooftenpassiveandreluctant.CQCstilldoesnotanalysethemesinwhistleblowingdisclosures.CQCdoesnotseemtohavestoredwhistleblowerintelligencereceivedfromEmploymenttribunalsinasystematicmatter,andithasnotanalysedthisvitalinformation.

50CQC’sFitandProperParade.MinhAlexander29July2016https://minhalexander.com/2016/09/24/cqcs-fit-and-proper-parade/51FitandProperMess.MinhAlexander19October2015https://minhalexander.com/2016/10/19/fit-and-proper-mess/52RobertFranciscallsforregulationofseniormanagers.HealthServiceJournal9November2016https://www.hsj.co.uk/topics/workforce/exclusive-robert-francis-calls-for-regulation-of-senior-managers/7013089.article53NHSgagging.HowCQCsitsonitshands.MinhAlexander22September2016https://minhalexander.com/2016/09/23/nhs-gagging-how-cqc-sits-on-its-hands-2/

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Fromtheperspectiveofwhistleblowers’experience,whistleblowingisahighlyriskyventure.Riskofreprisalincreasesifstaffpersistinraisingtheirconcernsormakedisclosuresoutsideoftheirorganisations.WherestaffarebraveenoughtotaketheaddedriskofcontactingtheCQC,thisoftendoesnotresultinsatisfactoryorproportionatesystemresponses.Employersmaybetippedoff(evenifdisclosuresaremadeanonymously),andtheycanrealisticallycountontheCQCnottotakemuchrealactionorfullyrevealtheextentofgovernancefailures.CQCisnotrigorouslytrackingwhistleblowers’experience,eitherofemployers’orCQC’sprocesses,andisnotinacrediblepositiontojudgewhetheremployershavegoodwhistleblowinggovernance.CQCreportsverysuperficiallyonhoworganisationstreatwhistleblowers.Thisregulatorywilfulblindnessgivesemployersafreehandtointimidateandvictimisestaff.CQC’sfailuretoreportclearlyonthenumbersofwhistleblowersforeachorganisationalsohastheeffectofreinforcingtheisolationandmarginalisationthatemployersdeliberatelyimposeonwhistleblowers,todisempowerandintimidatethem.ThesefailuresareallthemoreseriousbecausetheypersistoversevenyearsafterCQCwasestablished.ThislevelofrepeatedfailurecallsintoquestionwhetherCQCwishestosupportbetterwhistleblowinggovernance.WedonotbelieveontheevidenceavailablethatCQCprioritisesthepublicinterestorwhistleblowers’welfare.Webelievethatparliamentshouldstoppatchingupanunrepairable,unreliableregulatorymodel.Muchmorefundamentalreformofwhistleblowerprotectionisneeded.Thisshouldincludesubstantivelawreform,robustandindependentinvestigationofwhistleblowers’concernswhenneeded,andmuchgreatertransparencyaboutthesystemresponsetowhistleblowers.END