Are top NHS officials Stephen Powis and Zoe Penn “fit for purpose”?

They can’t or won’t explain internal NHS procedures used to dismiss the perfectly competent cardiologist Dr Usha Prasad

The long drawn out saga over the dismissal of cardiologist Dr Usha Prasad by Epsom and St Helier University Hospital Trust reported earlier on this blog continues. I will be reporting soon on a lengthy Employment Tribunal recently finished where Dr Prasad made serious protected disclosures about patient and staff safety at the trust and senior consultants were cross questioned about the way they treated Dr Prasad.

In the meantime two retired cardiology consultants Professor Jane Somerville and Dr David Ward, who are championing Dr Prasad’s cause, have tried to get explanations from two of the most senior people in NHS England, Professor Stephen Powis, national medical director and Zoe Penn, Medical Director for the NHS London region and lead official for professional standards. Dr Zoe Penn took time out during the pandemic to sit on the internal Maintaining Higher Professional Standards panel which decided Dr Prasad’s future.

Claire McLaughlan , chair of the MHPS inquiry which found ” unfit for purpose”

At the heart of the matter is a ruling by the internal tribunal that Dr Prasad is ” not fit for purpose” to do her job. This was made by Claire McLaughlan, the never practised barrister who chaired the inquiry. with Zoe Penn. She has refused to explain what that term means which led to the two retired consultants going to the senior NHS officials for an answer.

What the panel could not rule was that Dr Prasad was ” not fit to practice” medicine even though the trust tried its best to be able to do so by sending 43 cases to the General Medical Council to show her failings.

The GMC not only threw out the Trust’s cases but decided to revalidate her to keep on working – taking away the power the trust had to stop her medical career.

Professor Powis’s response to this is: “Fitness for purpose is a phrase used to refer to behaviours which are not in keeping with the doctor’s ability to practise in a particular professional role but do not breach the threshold for GMC action, to be distinguished from those which are not in keeping with GMC
requirements on good medical practice and therefore may have an impact on a doctor’s licence or registration (“fitness to practice”).”

This is a cut and paste job from Claire Mclaughlan’s findings and takes us no further. It almost suggests the panel was upset that the GMC had ruled she was competent and made up something else to get rid of her.

Nobody can point to where in employment law this phrase comes from – let alone any case law of anybody being dismissed for being ” unfit for purpose”. Any employment lawyer who reads this blog is welcome to come forward to explain with some case law.

Disturbing Disclosures

The other disturbing disclosure from Professor Powis is the way he dealt with requests from the two consultants for an inquiry into the whole saga.

As they say : “How is it possible for Trusts to use cost threats, expensive lawyers and dubious (and unregulated) “independent management consultants” (aka hired guns) of the type used in this case, to push whistleblower claimants into submission and thereby achieve the “desired” outcome, i.e. their dismissal? It seems to us that this case is a particularly bad example.

They also say: “NHS Improvement has a duty to oversee behaviour of NHS Trusts. Will it continue to overlook the gravity of this and similar injustices? It is time for a review and improvement of NHS disciplinary and dismissal processes which should include senior NHS managers as well as medical personnel.
Professor Powis’s response was to refer the case to the regional medical director for London, Dr Vin Diwakar, a close colleague of medical director, Zoe Penn. He is a distinguished clinician and a former medical director of Great Ormond Street Hospital in London.

But was he the right person to do this review? He sits on the committee in charge of the re-appraisal and relicensing of medical directors in London with Zoe Penn. Given she was also on the same panel that found Dr Prasad was” unfit for purpose”, it is not surprising that Professor Powis in his own words was ” assured that a fair and independent process has been carried out.”

A really independent review would have called someone outside the London region to do this just as the General Medical Council did when a cardiologist from the North East reviewed her case. His solution would be like Epsom and St Hellier University Trust appointing a friendly cardiologist who would find in their favour at the GMC.

Professor Powis said: “It is not the responsibility of NHS England and NHS Improvement nor that of the
National Medical Director, or NHS England and NHS Improvement more generally, to intervene to resolve in individual employment matters,… although we will consider whether employment matters could indicate wider problems with how a trust is being run.”

Daniel Elkeles Pic credit: London ambulance NHS Trust

However perhaps the most damning issue he is silent about is the disclosure in Dr Ward and Professor Somerville’s letter about the behaviour of the former chief executive of the trust, Daniel Elkeles ( now at the London Ambulance Service) during this period.

I quote:”. It would appear that the CEO acted outside his powers by offering to bribe Dr Prasad to “drop all the actions you are taking against ESTH” and leave the Trust in exchange for which ESTH will “agree to cease the MHPS process”…..By offering these terms he was, in effect, cancelling the investigation. We think this is highly irregular. Do you agree?

What this shows is that Professor Powis is prepared to ignore unethical behaviour in one of London’s health trusts. Either this internal official process was necessary or it shouldn’t have been brought. It is not a bargaining chip to negotiate with a competent consultant. Frankly I think it is akin to blackmail – drop your complaints against the trust or we will make sure you will regret it.

What this nasty little saga shows is that unaccountable officials at the top of the NHS are either too frightened of health trusts or happy to go along with unethical behaviour in the NHS. It is also reveals that this complicated MHPS system is in need of a radical overhaul. It is like those at the top “unfit for purpose”.

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4 thoughts on “Are top NHS officials Stephen Powis and Zoe Penn “fit for purpose”?

  1. An excellent piece of forensic journalism David. As humans, we have to feel for the stress on Dr Prasad. As taxpayers we have to be concerned at the amount of money the NHS is spending on this. How may more staff could be employed for the same amount. Furthermore, I don’t believe the ‘safe space’ proposed in the Health and Care Bill will be the answer to protecting whistleblowers either. It is no wonder the good, honest and truthful people in the NHS are unhappy in their work environment and would rather leave when they see the potential outcome of exposing a lack of patient and staff safety. As the old saying goes “A fish rots from the head”. Your article makes that perfectly clear.


  2. The abuse of power by senior managers and doctors promoted for managerial positions has been a regular and recurring theme since the establishment of NHS Trusts some 25 years ago. It is time to reform the system and establish an external independent body to investigate whistleblowing and patient safety concerns to replace the internal control by bullies and abusers.


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