Following my blog on the secret process using NHS Resolution to help hospital managers discredit whistleblowers I decided to ask the advisory body a series of questions on its operations using the Freedom of Information Act.

What emerged was extremely revealing. NHS Resolution hides in its annual report how many hospital doctors are involved by lumping them together with dentists and pharmacists. But the breakdown revealed through FOI reveals it is almost exclusively targeting doctors to advise trusts on how to handle them.

It shows that in the last financial year it advised in cases involving 1168 doctors in England, Wales and Northern Ireland. And the number of cases would be higher – as a number have multiple complaints from managers against them. This compares with 53 dentists and under 5 pharmacists. Indeed the pharmacists involved are so few – it won’t give me an exact number for fear of identifying individuals.

The PPS was last audited in 2019 and the organisation says it was then considered to be adequate and. effective. A more recent review in July this year by Dr Penny Dash looked just at the patient safety and learning role of the organisation and not wider issues.

Nor does NHS Resolution check whether it is given accurate information by managers. It said:” our role is to provide impartial and expert advice which is aimed towards supporting the local management and resolution of performance concerns. We are not a decision-making or an investigative body – in all cases, any decisions about the ongoing management, employment or contractual status of the practitioner rests solely with the healthcare organisation.”

In other words it is there solely to support health managers – who have no duty of candour – and it tries to include doctors by saying managers should tell them about their request for advice. In fact managers can and do ignore this as there is no requirement for them to say anything to the doctor they are investigating. So without hearing the doctor’s case it cannot be genuinely impartial. Also should a practitioner object to the partial advice given by a health manager they are ignored and the body continues to deal with the health manager.

NHS Resolution has not carried out any audit on the effect on doctors who are subject to complaints but it does do occasional research into problems arising on a very small scale. One example in its Insight Publication series last year was looking at whether ethnic minority doctors were badly treated in the NHS.

Involving just 11 doctors it said:”Most participants felt discriminated against based on their ethnicity and/or where they qualified. They felt this was reflected in the way their cases were handled by both their employer and Advice, and the higher rates of concerns raised against practitioners from ethnic minority backgrounds.”

Not surprisingly there was a lot of ignorance of how NHS Resolution’s advice service worked – given that health managers needn’t tell them about it. Again NHS Resolution’s solution was to give advice to managers which they need not take up. The full report is here.

Then there is the question of the phrase, performance. Is it a misnomer? NHS Resolution advice service does not look into the question of performance by doctors – relying on hospital manager for that – and it does not employ people qualified to do so. Many are solicitors, human resources staff and employment law experts and are not qualified to know when say a complex heart operation went wrong or the details of paediatric care. Indeed from doctors who have contacted me the trust often cites uncooperative behaviour and not working well with colleagues as part of its case.

Taken with earlier articles on the role of the General Medical Council a disturbing picture emerges which shows the hospital doctor is always at a disadvantage while the responsible officer – usually the medical director – holds all the cards – using NHS Resolution for advice and reporting the doctor to the GMC. Yet neither body is necessarily equipped to handle this and in NHS Resolution’s case, it is toothless to influence decisions by trusts. It can help to easily ruin a doctor’s career and even ban him or her for life for continuing their careers.

There seems to be a wholly unregulated sector covering NHS Resolution, the GMC and the trusts themselves and certainly no accountability. Patients have no idea how this is handled -yet their safety should be paramount in the NHS. And while NHS Resolution says it works under the direction of the Department for Health and Social Care my research shows it is not clear who regulates them.

If ever there was a case for reform of both systems, now is the time for something to be done.

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