By Minh Alexander, Redundant whistleblower, Consultant Psychiatrist 1999 to 2013     27 December 2014

The CQC is an arms length body of the Department of Health, accountable to The Secretary of State for Health, who must account to Parliament. Procedurally, the CQC must align itself with Department of Health (DH) strategy[1].

 What does CQC behaviour say about DH strategy regarding whistleblowers? 

The CQC has been well known to chant to whistleblowers seeking help and protection, the DH mantra: “It’s an employment issue”.

On 22 December 2014 a CQC Non Executive Director tweeted, albeit in a personal capacity:

 “At the moment, it is an HR/employment issue. Unsure how this can change tbh”.

 When a whistleblower commented that it was scandalous that CQC seemed to have no role in protecting whistleblowers, that person was accused thus by this CQC Non Executive Director:

 “If you twist words & attack, you damage the cause”

 When I opined that the “HR/employment” comment was very alarming, and that poor HR governance and whistleblower suppression were patient safety issues, I too received a similar response:

 “You are twisting my words – unhelpful. This is behaviour that needs to stop…”

 The CQC has a history of poor HR governance, and of a bullying culture. In my view its ineptitude in handling whistle blowing, both by its own staff and by staff from the bodies that it regulates, has been clear.

 In 2011 I wrote to the CQC to question the fact that it had no published policies on whistle blowing. It seemed to me that this dearth of written commitments was a natural extension of the CQC’s poor values and attitudes to whistle blowing, and to whistleblowers.

 So, have things changed under the new the CQC regime?

 When Raj Mattu and colleagues whistle blew to the CQC’s predecessor body in 2001, it “mystifyingly” passed their names to the Trust’s CEO.[2] Raj subsequently endured a decade of catastrophic persecution, including countless complaints about him to the GMC.

 Fast forward to the present. In November 2014, veteran whistleblower Shiban Ahmed passed dossier to the CQC about 22 cases of unsafe circumcision, and expressed concerns that the CQC had not done enough previously about his disclosures. In response, a CQC inspector copied an email about his disclosure to his employer. Shiban has since been suspended and referred to the GMC.[3]

 Not a lot of change evident there then.

 Perhaps the CQC should reflect on the degree to which its activities trigger whistle blower persecution, and its responsibility for severe detriment and suffering that follow.

 No apology from the CQC is apparent for what has happened to Shiban, or the fact that very unsafe circumcisions of children continue, despite his repeated disclosures. Instead, there is a carefully worded denial:

 “The CQC has not reported Mr Ahmed to the GMC or to his trust and has not invoked any disciplinary action against him”

 When faced with pressure to protect a whistleblower, a CQC response may include protestation that it has no legal powers to do so. I have personal experience of this particular CQC rebuttal.

 On the matter of the CQC’s powers, the above CQC Non Executive Director tweeted on 22 December 2014:

 “You need a legal basis. Otherwise no point”.

 Whilst the CQC’s claim that it has no formal powers to protect whistleblowers is arguable, we all know that a great deal is done by influence. Early in my journey, a supportive and effective CQC inspector protected me. I know it can be done, and it should be a model for CQC practice.

 However, the mayhem often starts when the CQC turns a blind eye, fails to respond appropriately to whistleblowers’ disclosures, and claims that it has no jurisdiction to protect. Washing of regulatory hands can be a green light for whistle blower suppression and victimisation.

 Continuing, un-rectified, gross injustices to whistleblowers, and failures by the CQC to act appropriately, light up that particular neon beacon. Homelessness, grave illnesses and financial ruin are poor reward for dedication. Whistleblowers are also still forced to make disclosures through the media.[4]

 Despite the new CQC regime’s claims that it would be more responsive to concerns, and that it would operate more transparently, an FOI enquiry forced the CQC to admit, on 17 June 2014, that it had undertaken no “central analysis” of the reasons behind 981 whistleblower disclosures, received in the preceding 12 months.[5] When I recently asked the CQC if it would carry out an analysis and publish it, the CQC did not answer the questions straightforwardly. Instead, it said my enquiry would also be dealt with as an FOI request. Will the CQC meet the fast approaching deadline for disclosure 29 December 2014, or will it tarry?

 Transparency is also lacking in the CQC’s failure so far to publish its evidence to Sir Robert Francis’ review on whistle blowing. In an interesting form of words, the CQC stated in its December 2014 report, “Complaints Matter”, that it would publish a “fuller account” of its activities when Sir Robert publishes. [6] However, I have received no response from David Prior (CQC Chair), to several requests for the CQC to clarify if this means that CQC will publish all of the evidence that it has submitted to Sir Robert.

 I can see no valid or credible reason for organisations’ submissions to the Speak Up review remaining confidential. Opacity serves only to avoid constructive challenge and scrutiny. Is the CQC’s failure to publish its evidence a symptom of unaccountability, and image management, by a “comfort-seeking” organisation? [7]

 “Comfort-seeking behaviours are defined here as being focused on external impression management and seeking reassurance that all was well; consequently, what was available to organisations was data, but not intelligence. Serious blind spots could arise when organisations used a very limited range of methods for gathering data, were preoccupied with demonstrating compliance with external expectations, failed to listen to negative signals from staff or lacked knowledge of the real issues at the frontline. Comfort-seeking tended to demonstrate preoccupation with positive news and results from staff, and could lead to concerns and critical comments being dismissed as ‘whining’ or disruptive behaviour”.

 The CQC asserted in “Complaints Matter” that it had consulted whistleblowers about its handling of concerns. However, this was based on focus group data. No information was given about methodology and numbers. Tellingly perhaps, the CQC has not responded to questions about whether it will arrange transparent, independent audit of whistleblowers’ experience of its handling of their concerns.

 The CQC’s joint investigation with Monitor into the reported dysfunctional culture at the Christie, [8] did not support the concerns of several whistleblowers. This does not bode well for the CQC’s application of FPPR in relation to whistleblower suppression.

 In my view, the altruism and commitment of whistleblowers, some who lose their careers, their livelihoods, their health and family life, does not seem matched by suitably principled behaviour by CQC.

 Watchdogs should be protectors, but history shows that they can in fact become bottlenecks.[9]

 What would Lord Sugar say to Nero? “You’re fired”?

 If Secretary of State, you aspire to “More Gandhi, less Stalin”, please note that Mahatma Gandhi once said:

“Action expresses priorities”.

 Please re-align CQC strategy urgently, and please ensure that whistleblowers and would be whistleblowers are not harmed or deterred by any hostile acts of commission or omission.

 The safety of patients depends on staff who are free and safe to speak up.

  [1]http://www.cqc.org.uk/sites/default/files/documents/cm_0114310_item_10_appendix_1_cqc_framework_agreement.pdf

 [2] http://www.theguardian.com/society/2014/nov/22/there-were-hundreds-of-us-crying-out-for-help-afterlife-of-whistleblower

 [3] https://sharmilachowdhury.com/2014/12/21/the-nhs-is-allowing-babies-to-be-maimed/

 [4] http://www.independent.co.uk/news/uk/home-news/shocking-footage-shows-elderly-residents-being-taunted-and-abused-at-essex-care-home-9303888.html

 http://www.bbc.co.uk/news/uk-27906730

 http://www.theguardian.com/uk-news/2014/dec/14/labour-pledges-yarls-wood-centre-investigation

 [5] https://www.whatdotheyknow.com/request/whistleblowing_nhs_analysis

[6] http://www.cqc.org.uk/sites/default/files/20141208_complaints_matter_report.pdf

[7] http://qualitysafety.bmj.com/content/early/2013/08/28/bmjqs-2013-001947.full.pdf

 [8]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/379803/Christie_Review.pdf

 [9] http://www.washingtonpost.com/politics/federal-diary-whistleblowers-get-a-defender/2011/10/18/gIQAtnvfvL_story.html