Can Whitehall promote innovation, efficiency and AI technology to help overcome the crisis in providing public services?

Posted on February 5, 2025 by davidhencke

Gareth Davies, head of the National Audit Office

Head of the National Audit Office raises pertinent questions about the future direction of Whitehall in annual speech

Anybody reading the latest tranche of reports from the National Audit Office and the Commons Public Accounts Committee could be forgiven for thinking the UK is living in a dystopian world. Indeed fiction writers could use their reports as a basis for a dystopian novel or a new TV series.

The problem is that it is not fiction, it is factual based evidence.

Never in my 40 years of reporting the NAO have I seen so many things run by Whitehall going wrong. Yes we have had scandals, waste of public money and even corrupt deals exposed by them. But the last tranche of reports almost beggars belief.

Simultaneously we have had the biggest backlog of building maintenance, totally £49 billion, the largest ever NHS waiting lists for operations, the Home Office admitting it has made 1000 mistakes and wasted tens of millions on acquiring sites for housing asylum seekers, half the local authorities in England on the verge of bankruptcy, outdated computer systems without proper security protection, record homelessness, and a huge backlog of people waiting for special education places or treatment in psychiatric hospitals.

Innovate or die

It is against this background that Gareth Davies, the head of the National Audit Office, addressed a well attended meeting yesterday in Parliament of MPs, peers, former permanent secretaries, academics and journalists.

While he did not use my journalistic hyperbole, his message was a simple one to Whitehall, innovate or die. And although the NAO is strictly non party political, there was an underlying message to the present government, sharpen your act or lose the next election.

As he put it: “we have a new Parliament and a new Government, but many of the same problems of rising demand and not enough money to quickly fix the gaps in key public services. We also face other challenges that risk causing widespread disruption, from global instability and climate change to public health emergencies and cyber threats.”

NHS needed fundamental reform

He was particularly critical of the department for Health and Social Care and the NHS, the biggest employer in the UK.

” Figures from NHS England in May last year showed it was still 8 per cent lower in productivity in 2023/24 than before the pandemic and much work is underway to address this.”

He went on later: ” In the last few months, our reports on supporting children with special education needs and NHS financial sustainability both identified the need for fundamental reform in the face of rising demand and costs, alongside unsatisfactory outcomes. This means tackling the causes of avoidable demand and allocating resources in a redesigned system where they can have maximum impact on outcomes.”

He is pleased that Whitehall is piloting AI but also warned that new technology is not the whole answer to greater productivity. He also emphasised that ministries need to employ the best skilled people – notably recently in the need for people with good computer skills and capable of negotiating good procurement deals.

He is also wanted Whitehall to concentrate on tackling resilience to protect the country. This included fighting cyber attacks and the risk of future pandemics. He revealed the NAO would soon publish a report looking at the international and domestic implications of protecting the UK from another pandemic like Covid 19 which came from abroad.

Civil servants must be less risk averse

Finally he wanted civil servants to be less risk averse and try out well managed schemes, dropping those that don’t work quickly.

His solution was summed up in four succinct points.

First, a clearly articulated risk appetite and a spread of investments, to maximise the chances of success in innovation
Second, harnessing new technology as I’ve already mentioned
Third, a culture of fast learning and evaluation, stopping failed experiments quickly and scaling up successes
Finally – and close to home for us – an accountability and scrutiny framework that encourages well-managed risk taking

” It’s no coincidence that innovation thrives in times of crisis, such as when lives are at stake. Organisations rapidly adjusted their risk appetites during the pandemic to meet urgent needs,” he said.

He pointed that Whitehall fears that they would hung up to dry by MPs and the press if they failed was now no longer true -instead MPs on the public accounts committee were now more critical of civil servants who failed to look at new ways of tackling problems rather than following safe bureaucratic procedures.

So what are the NAO doing themselves? “our refreshed strategy from 2025 to 2030 takes fully into account the risk appetite set for the range of innovative projects. We will continue to look for and highlight positive examples of innovation, including where unsuccessful initiatives have been stopped in favour of more promising ones. As well as featuring these in our reports on departments and organisations, we will publish what we learn across government as part of our programme of lessons learned reports.”

AI is also coming to the NAO so auditors can spend more time making professional judgements on department’s performance and less time on manual exercises.

Talking to people who attended afterwards it was clear that MPs and academics are well aware that innovation is necessary or we will not be able to deliver public services to meet growing demand. MPs seemed especially aware that the NHS was not functioning properly – whether it was their local health trust – or the bureaucracy at the top. MPs have already publicly criticised the top management of the NHS for being complacent.

Over the next five years how Whitehall balances the money needed for innovation and risk taking against the perennial problem of working in a public sector which has been neglected for too long and needs ” first aid” to keep going will be crucial. Whitehall should treat the present state of public services as a national crisis which can only be tackled by radical innovation.

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How Claire McLaughlan got promoted to review Lucy Letby in 2016 two years after the NHS was told she had to apologise for distorting whistleblower Dr Chris Day views in a major health trust investigation

Posted on November 20, 2024 by davidhencke

Her role in the Lucy Letby case comes out in a savage cross examination at the Thirlwall inquiry

Claire McLaughlan may not be nationally known but has great influence in the NHS. She has become the “go to” person when health trusts want to deal with what they see as troublesome doctors raising inconvenient issues such as patient safety and helping trusts to discredit whistleblowers who do this. Her career has included being head of fitness to practise at the Nursing and Midwifery Council and as associate director at the National Clinical Assessment Service. Her work for NHS also includes being a lay member of the Performance Advisory Group and chair of the Performance List Decision Making Panel, which assigned people to internal NHS inquiries. . For more information I have written up her profile here.

She gave evidence last week to Lady Justice’s Thirlwall Inquiry, which is investigating what went wrong at the Countess of Chester hospital that led to the murder of babies by nurse Lucy Letby. She claimed she has great expertise in examining doctors, dentists, pharmacists and nurses behaviours and attitudes when they were facing complaints.

Lucy Letby Pic credit: BBC and Cheshire Constabulary

She was called to the inquiry as a lay reviewer appointed by the Royal College of Paediatrics and Child Health. She was asked to review the maternity department at the Countess of Chester Hospital. She was part of a team led by Dr David Milligan, a retired neonatal paediatric consultant; Dr Graham Stewart, a paediatrician from Glasgow and Alex Mancini, a neo natal nurse, representing the Royal College of Nursing.

The review, invited by the Countess of Chester medical director, Ian Harvey, came before the involvement of the police but after consultants who suspected Lucy Letby had been threatened by the management after they raised concerns.

Given her evidence that at one stage she was in a position to review 300 doctors including their competence while she was at the National Clinical Assessment Service it is rather remarkable that in two cases covered by this blog – Dr Chris Day, then a junior doctor at Woolwich Hospital and Dr Usha Prasad, a cardiology consultant at Epsom and St Helier Trust(now combined with St George’s), she has a history of distorting facts to the detriment of their careers. More of that later.

At the Thirlwall inquiry, Ms McLaughlan was skewered by the experienced barrister, Nicholas de la Poer, from New Park Court chambers who previously appeared at the Manchester Arena bombing and Grenfell Tower inquiries. In many cases, she couldn’t recall or answer his persistent questions.

Nicholas de la Poer KC Pic Credit: New Park Court chambers, barrister for the Thirlwall inquiry

From the start he challenged her about her statement that she was a “non practising barrister” – and what that meant she could have practised as a barrister in the past. He pointed out Sue Eardley, the head of health policy at the Royal College of Paedriatrics, “appears to have ascribed some considerable significance … to the fact that you were a qualified barrister when being asked about your experience of legal process. In fact, is this fair: your experience as a barrister would not have involved you engaging in any legal process,” he suggested.

His questioning effectively revealed that she had given a misleading impression to the Royal college in 2014 particularly as she had to change her description to being an unregistered barrister in later years.

She could not answer why the person who engaged her for 14 reviews for the college from 2014 had that impression.

It then emerged from her and other witnesses that prior to the review coming up to the Countess of Cheshire the team were never told that consultants had raised complaints that babies there could have been murdered. It was sprung on them 12 hours after they arrived.

This is significant because a review by a Royal College cannot take place if there is suspicion of misconduct or criminal behaviour. It has to be cancelled immediately but it wasn’t.

Claire McLaughlan’s response to this was that while doctors had raised this possibility, people said that Lucy Letby was a good nurse, therefore it should not have been cancelled. She later went on to attack one of the consultants who did.

“Well it is possible to be a good nurse and murderer?” was the lawyer’s response. She also claimed she was given false assurances by the trust.

Lack of empathy for the parents of the dead babies

The questioning was also revealing about Claire McLaughlan’s views on her role of safeguarding patients and the public interest. When quizzed about that she claimed she had a wider role and unlike other witnesses never expressed regret about the babies’ deaths and the effects on the their parents. She was rather vague about her own safeguarding training.

When it came to the crunch about the doctor’s concerns about the deaths of the babies she depicted Dr Steve Brearery’s concerns as a personal rather than a professional judgement. Cross questioned by the lawyer she insisted:

“In my opinion I cannot speak for the whole team. This was the personal view, feelings, interpretation of
one person regarding Ms Letby, it was not based on fact and was uncorroborated. Even now I would not consider his view as objective or impartial as he was too involved, too close to the situation and had a conflict of interest.”

She went on to attack him for preparing a rota sheet showing who was on when a baby died.

“It’s not normally the role of somebody of that doctor’s status and experience to have any involvement,
is my understanding, in the rostering of staff. And therefore I would not have — I wouldn’t have called it
his professional role for him to take on the analysis that he apparently did of those rosters.”

Later when questioned by Lady Justice Thirlwall herself she claimed the document could have been manipulated because she had not seen the source of the material.

It was also revealed that she tried to get the report for ” balance” to say that some of the babies died because of congenital problems without any medical knowledge- but this was not included.

Frankly her evidence seems to betray a prejudice against doctors, a lack of empathy for patients, and it was obvious that her preferred solution would have been to treat it as an internal disciplinary matter run by the human resources department. This would have chimed with what the trust wanted to do as one non executive director said to ” contain it.”

She also seemed to suffer a loss of memory and recall about what documents she had seen and conversations that had taken place. There was also a rather bizarre incident about how she got hold of Lucy Letby’s telephone number. She couldn’t explain why and thought someone else might have put it there.

She has previous form with other doctor’s and consultants. One of the most egregious cases involves Dr Chris Day a whistleblower who is still fighting as ten year old battle with Lewisham and Greenwich Health Trust, after he reported two avoidable deaths in the intensive care unit at Woolwich Hospital.

She interviewed Dr Day on behalf of the trust and I’ll let his pleadings tell the story. The way she distorted the interview was sent to Department of Health, the courts and senior people at the top of the NHS who took no action.

Also evidence submitted by ,Dr Sebastian Hormaerche, a consultant anaesthetist, severely criticised Claire McLaughlan’s investigation and safeguarding in this case, not commenting on two serious incidents.

In Dr Usha Prasad’s case, a well qualified cardiologist who was popular with patients who was also whistleblower over an avoidable death at Epsom Hospital, was dismissed. Claire McLaughlan presided over an internal hearing and decided she was ” unfit for purpose.” No such ruling exists in employment law. To decide this she ignored the fact that the General Medical Council revalidated her to work anywhere in the NHS as a competent and well qualified doctor. But no doubt Ms McLaughlan thought that was just a personal rather than a professional view.

One can only wonder how many other doctors have suffered from Claire McLaughlan.

The full day’s evidence from Claire McLaughlan and others is here.

Judge reserves judgement on whether a top legal firm should pay wasted costs for hiding documents that removed 54,000 English doctors from the UK’s legal whistleblowing protection in the Public Interest Disclosure Act

Posted on October 27, 2024 by davidhencke

The latest in the long saga of employment tribunal hearings involving whistleblower doctor Chris Day and his ten year fight for justice over patient safety following the avoidable deaths of two patients in the intensive care unit at Queen Elizabeth Hospital, Woolwich ended with a judge reserving her decision.

This particular hearing concerned the role of top NHS lawyers Hill Dickinson, who were paid public money to draft commissioning contracts each worth tens of millions controlling the employment of junior doctors at every NHS trust in the country. As a result some 100 people observed the hearing on line over two days – more than could be accommodated in any of London South Employment Tribunal courts.

Directly involved in the case is the now defunct body Health Education England (HEE) which used to fund, commission and govern the employment and training of all English doctors on their path to hospital consultant or GP at NHS health trusts before it was merged with the rest of the NHS bureaucracy as part of NHS England.

Hill Dickinson was engaged by HEE to draw up a series of contracts called Learning and Development Agreements which were drafted in 2014 underpinning the £2 billion commissioning relationship between HEE and NHS Trust that was concealed from the courts in Dr Day’s case until last week’s hearing.

But the existence of these contracts — which exposed as false the denial from HEE made by Hill Dickinson that HEE had substantial influence over doctors – were kept from the courts during the long battle by Dr Chris Day over over the loss of his career and claims of deliberate concealment of patient safety issues,

Journalist’s Freedom of Information request was crucial

A freedom of information request put in by the indefatigable investigative journalist, Tommy Greene, resulted in the very LDA contract being disclosed that was in force during the time of Dr Day’s case between Lewisham and Greenwich NHS Trust and Health Education England . This came after Dr Day had agreed to no less than 3 separate settlement agreements one of which designed to protect all lawyers in the case from wasted costs arising out of misconduct.

This week’s wasted cost hearing was triggered by Tommy Greene’s discovery in July 2019. The hearing had been delayed for over 4 years by the London South Employment Tribunal since Dr Day’s original application. Since all the way back in 2015 and the all the way up to the Court of Appeal in 2017 and down again to the ET in May 2018, HEE and Hill Dickinson clung to the false factual submission that all contemporaneous documents showed Dr Day’s claim that HEE had substantial influence over the terms of engagement was fanciful.

The wording of the 2014 contract strengthened the power of the postgraduate dean employed by HEE who could end the career chances of an aspiring junior doctor who wanted to become a consultant as well as withdrawing money from a trust who was employing him. This included the power to delete a doctors National Training Number or as Dijen Basu KC, Hill Dickinson’s lawyer, admitted “a career death sentence”.

Yet HEE and Hill Dickinson powered by public money went all the way up to the Court of Appeal to argue that HEE had no substantial influence over a doctors career and that Dr Day’s claim that they did was fanciful. At the EAT level this resulted in Dr Day being threatened for costs for effectively defending whistleblowing for the nation’s doctors

Much of this week’s hearing was taken up with the semantics of whether these contracts really meant the HEE had the upper hand or whether the trust was still really the employer. The Court of Appeal had ruled that both the HEE and the trust were employers. Hill Dickinson admitted the ruling was a game changer but tried to argue it did not apply to Dr Day’s case as he had been employed under an earlier version.

Dr Day argued that if the documents had been shared by Hill Dickinson and HEE at the time of earlier hearings it would have saved taxpayers a fortune and him and his wife 10 years- hence the argument to claim back ” wasted costs” from Hill Dickinson because of all the legal fees spent.

Dijen Basu KC Pic credit: Serjeants’ Inn Chambers

Dijen Basu, barrister from Serjeants’ Inn chambers and a qualified doctor, cross questioned Dr Day about the difference between what is known as the ” gold guide” for junior doctors and the contract — implying he should have worked out for himself the existence of the hidden LDA contracts or could have used the Gold Guide himself to win the case.

Dr Day pointed out that it was Health Education and Hill Dickinson’s case from the 2015-2018 that the Gold Guide made fanciful Dr Day’s claim that HEE had substantial influence and also made the point that the ” Gold Guide” was worded as mere guidance on how doctors should be dealt with by NHS Trusts while the LDA was a proper contract that gave HEE a right to sue any NHS Trust if the LDA terms were not met.

Michael Wright, a partner with Hill Dickinson, even tried to argue in the hearing that the new contract was not a contract because of the rule in the NHS that different branches never sued its each other so it couldn’t be upheld in the courts. He was rather shot down when it was clear that HEE had the power to withdraw all the money given to trusts if they broke the detailed rules over the training of junior doctors which is just as powerful.

In his witness statement to the tribunal Mr Wright said he first had no knowledge of LDA’s as they were drawn up by the firm’s commercial department not his department. When he did have knowledge he thought they were irrelevant which is his explanation why they were not handed over to Dr Day’s solicitors. After the Court of Appeal ruling which said both HEE and the trust were employers, he still argues that they are just a further extension of the ” gold guide” which is seen as guidance. Much of what really happened was clothed in secrecy as he claimed legal privilege not to disclose discussion that had gone on between Hill Dickinson and HEE.

Mr Basu also argued that Dr Day was out of time to pursue this case, which had already failed during a previous strike out hearing on wasted costs. See the Byline Times article on this. He said that the 2014 changes to the LDA came after he left, and urged the judge to throw out the claim because a three day summary hearing was not enough to deal with such a complex issue. He also appeared to suggest to the judge, Kathryn Ramsden, that if she ruled in Dr Day’s favour, she could be overruled by a higher court citing a House of Lords case. Is he prepared to go to Supreme Court over this?

It took Andrew Allan, KC, funded by supporters on Crowdjustice, o put in real context what Dr Day had had to put up with in his ten year struggle.

In his closing submission he said: “Whistleblowers in the NHS are stamped upon – it happens in case after case – in which extra hurdles are added to the already numerous hurdles in Part IVA
of the ERA[ Employment Relations Act] 1996 – the first is that you must be rich enough fund endless
litigation; the second is that you must have sufficient stamina to survive years of litigation – the second is that you must be perfect – because any imperfection will be seized upon and never let go – the tactic is to attack the whistleblower – they are obsessive – they are litigious – can’t let an injustice go – not the sort of people who get on in the NHS
” The skeleton argument on behalf of Hill Dickinson is a case in point – most of it is taken up in a partisan account of C’s [ Chris’s] litigation which – and frequently inaccurate – such as the comment about him having got nowhere in the EAT.. and is largely irrelevant a comment that C made about LJ Simler (as she was then) in 2020 is a favourite stick to beat C with – what possible relevance it could have to this application is unknown.
And it came back again in My Learned Friend’s oral submission –
These attacks are now routine – that C has had to prepare a ‘smears / misinformation document in anticipation of the same old points being trotted out.” See the smear file on Dr Day’s whistleblowing site on the hearing here.

Dijen Basu’s new smear against Dr Chris Day

And guess what ! At this tribunal a new smear against Chris was laid before the judge and Chris Day was not even asked about during his 4 hours of cross examination by Dijen Basu so he could reply.
In his late submission to the tribunal Dijen Basu accused Dr Chris Day of failing to refund £55,000 he had received in an earlier costs ruling to his Crowd Justice Fund implying he had pocketed the money.

His submission said: “he accepts that he has raised £470,490 for the crowd funding of his legal costs through Crowd Justice Limited (www.crowdjustice.com) and he has failed to show a single penny
being refunded to Crowd Justice Limited on his behalf, e.g. when HEE paid him £55,000 in
respect of his earlier employment tribunal costs which shows £284,719.61 then received (mostly) from Crowd Justice Limited, the £55,000 from HEE and £3,700 from Dr. Day, being entirely gobbled up by legal fees and disbursements, none of which was a refund to Crowd Justice Limited).”

This allegation was refuted by Crowd Justice Ltd itself who pointed out that none of the money raised to Dr Day goes to himself and is instead paid directly to law firms recognised by the Solicitors Regulation Authority. I am told Hill Dickinson and its law firm were informed this allegation was not the case by Crowd Justice Ltd

Andrew Allan’s and Elizabeth Grace’s submission covers this and can be read in full here.

Yet Dijen Basu went ahead. Given he works as a leading barrister for Serjeants’ Inn Chambers, he should have known this himself. He also markets himself as the go to barrister for chief constables up and down the country for handling police work. I would have thought they might express a bit of a surprise that he chose to influence a judge by using what is false information in a tribunal case.

The next stage in Dr Chris Day’s long fight will be an employment appeal tribunal on July 1 and July 2 next year. He will appeal the extraordinary case where employment judge Martin ignored the destruction of 90,000 emails by a management witness during the hearing against his former employer, Lewisham and Greenwich NHS trust and took no action. She has since wisely retired. My report on the hearing that led to the appeal is here. My verdict on judge Martin’s case – the tribunal of the absurd – is here.

For a full list of legal submissions and witness statements see Chris Day’s whistleblowing site. The link is here.

The rest of my coverage of Dr Day’s case is here.