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 Bell. 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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Exclusive on Byline Times: How a highly controversial contract to collect data on thousands of English Covid-19 hospital patients was never put out to competitive tender

Image by Syaibatul Hamdi from Pixabay

An expose by The Guardian earlier this month revealed that confidential data from patients being treated for Cofid-19 in England was being collected and processed by tech companies – two of which were highly controversial companies.

Now after persistently chasing up officials NHS England have admitted that the contracts which involved the US company Palantir – run by Trump supporting right wing billionaire Peter Thiel – and British start up Faculty – which has links to Dominic Cummings, the Prime Minister’s chief adviser – were never put out to tender.

Read how they did it on Byline Times here

How the NHS wasted £16m of your money on a botched privatisation that collapsed within months


Meg Hillier MP:,chair of the Commons Public Accounts Committee, condemned the failings in the scheme


New ways of  helping the elderly and mentally ill survive in the community and not continually end up in hospital is a cornerstone of government policy.

So when a limited liability partnership offered a cash strapped  NHS commissioning group an initiative which promised better services for these people and could save them £178m over five years it sounded too good to be true.

The trouble is it was. As a devastating report from the National Audit Office reveals today the £800m scheme  ran into trouble just four weeks after it was launched and collapsed seven months later. You can read the full story on the Exaro website.

The scandal of the £800m scheme run by UnitingCare Partnership for Cambridgeshire and Peterborough clinical commissioning group may not be an isolated instance.That is why sources at the National Audit Office have highlighted it in their report – because it exposes an alarming lack of financial expertise inside the NHS and a flawed system to monitor whether projects like this are financially feasible  andcan  be properly checked.

The promised aim of the project was to establish  tapering payments to the partnership – with £152m up front and less money later, ¬ so that the financially challenged commissioning group could put money to better use.

But within four weeks of starting the contract the partnership was asking for an extra £34m, blaming a delay by the commissioning authority in starting the work. When the money was not forthcoming the scheme collapsed after eight months and the NHS was forced to provide services directly.

The NAO report reveals that despite employing reputable financial companies and lawyers, basic errors were made – including a failure to realise that sub-contractors could not recover the VAT from the partnership – a cost that had not been factored into the contract.

Auditors also report that nobody had overall oversight of the contract.

No wonder both Amyas Morse, the head of the NAO, and Meg Hillier, the Labour chair of the Commons Public Accounts Committee have been withering in their criticism.

Amyas Morse said: “This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.”

Meg Hillier said: “The result is damning: a contract terminated before the ink had even dried out, at an unnecessary cost of £16m.”

What is disturbing is that the NAO point out that Monitor, the body which checks health bodies, had no locus to check whether the scheme was viable and NHS England were too remote to act.”

The report says: ““No organisation was responsible for taking a holistic view of the risks and benefits of this approach, or considering whether the anticipated longer‐term benefits were sufficient to justify additional short‐term support.“

What is really disturbing  is that £16m was wasted -plus £8.9m  on setting up a complex tendering operation and start up costs.

Far better to have spent this extra money on patient and community care – instead of throwing our money down the drain on a scheme that anyone would have thought to be too good to be true.


The next NHS scandal: Taking cash from the deprived and handing it to the affluent

Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Next April NHS England plans to take away money from some of the most deprived parts of the country and give it to areas that are the most affluent.
An arcane formula that decides how much your local NHS clinical commissioning body has to spend on you is expected to be changed by removing a weighting that automatically gives a bit of extra cash to areas of social deprivation. It will also mean that less money will go to areas where people die younger and more to areas where people live longer.
I am indebted to research by the Royal College of Nursing who have recalculated the effect of the change and I have already written about it for Tribune Magazine.
The political implications of this change- just over a year before the next general election are enormous. While NHS England is obviously not a branch of Conservative Central Office, its decisions will be remarkably helpful to the coalition government.
Without spending an extra penny it will appear that there is more spending on the NHS in many Conservative and Liberal Democrat marginals by election day and far less spending in many Labour strongholds where there is more social deprivation.
As the table illustrates the changes at the top and bottom are going to be dramatic.
Losers and Gainers; Health spending per head

Losers and Gainers; Health spending per head

Translate this into Westminster politics this means extra help for Tory and Liberal Democrat seats in the south. Gainers include Tory strongholds in Royal Windsor, Ascot and Maidenhead – the latter the seat held by Theresa May, the home secretary; South East Hampshire, Eastbourne, Hailsham and Seaford ( Liberal Democrat seats); the West Sussex coast, Gosport and Fareham and Newbury.
Most useful is Reading North and West, which includes a Tory marginal, and has an extra £98 per person to spend; Dorset (£89) which is both a Liberal Democrat and Tory area, and South Gloucestershire, part of the Cotswolds, which gains £86.
While the losers with the exception of Carlisle ( a Labour Tory marginal with a 853 Tory majority) are all Labour.Worst affected will be Sunderland which will lose health care spending worth £146 per person. Nearly equally badly affected will be South Tyneside, Newcastle West and Gateshead.
Also if you take the latest Office of National Statistics life expectancy figures you will live much longer in Dorset than in Blackpool.
In 2009–11, male life expectancy at birth was highest in East Dorset (83.0 years); 9.2 years
higher than in Blackpool, which had the lowest figure (73.8 years).
• For females, life expectancy at birth was also highest in East Dorset at 86.4 years and lowest in
Manchester where females could expect to live for 79.3 years.
• According to 2009–11 mortality rates, approximately 91% of baby boys and 94% of girls in East
Dorset at birth will reach their 65th birthday. The comparable figures were 77% and 86% in
Blackpool and Manchester respectively.
No wonder the RCN is furious. As Glenn Turp, regional director for the RCN Northern region says: “The North East and Cumbria suffers from some of the worst health inequalities in the country. NHS England should be aiming to reduce inequalities in health outcomes, not make them worse.
“Given the size of health inequalities in this region, I believe that NHS England should actually be increasing funds to the areas with the worst outcomes. However, NHS England’s own data shows these proposals will do the opposite.”
Of course this figures are not yet in stone. But taken together with welfare cuts, big drops in the standard of living for the majority,and slashing support for the disabled – NHS England is merely helping the wealthy and rich in Windsor, Maidenhead and Hampshire villages get better NHS services all paid by the taxpayer at the expense of a Sunderland council tenant. All helping the coalition win the next general election.