Tag Archives: NHS Trusts

The secret influence of NHS Resolution that ensures so many doctor whistleblowers don’t get their jobs back

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logo for NHS Resolution

Why do 97 per cent of whistleblowers fail to win their cases in employment tribunals? Why are they sacked – not for their disclosures of patient safety which is illegal – but under the nebulous title – some other substantial reason (SOSR)? This could be allegations of bullying or saying they cannot get on with colleagues.

But how does a trust gather such information to discredit a doctor? What I have discovered is that NHS trust managers can get a free advice service or an endorsement for actions considered by managers against a Whistleblower from NHS Resolution, an arms length quango from the Department for Health and Social Care.

This ” phone a friend” service would allow the manager to set up a case file under Practitioner Performance Advice without the doctor even knowing this has happened. Effectively the evidence will be later presented at an employment tribunal by highly skilled and expensive lawyers hired by the trust to discredit the unfortunate doctor.

This process has no transparency, no verification with the doctor and there are no public records of what happens in these cases.

The only information that there is such a process is in the annual reports and accounts of NHS Resolution and even that is very sparse.

While there are reams of statistics about the organisation’s public facing work dealing with patients complaints about clinical and non clinical issues which it tries to resolve without going to expensive legal action, the role of practitioner performance advice service gets very little mention.

In the 2024-25 annual report it acknowledges “NHS Resolution’s Practitioner Performance Advice service delivers expert advice, support and interventions on the fair management of concerns about the performance of doctors, dentists and pharmacists.”

How do they judge performance having branded the therapist with a “behaviour” issue at the outset even with untrue claims or without awareness of risks to patients? Only when the formal referral actioned the therapist or doctors may get an opportunity to represent their side of the story BUT if the behaviour analyse are not even clinicians, how would they understand what culture therapist or doctor has been working in.

The PPA service also claims to be very efficient. It says 90% of advice and other case interventions delivered within target timeframe – this was achieved in 2024/25 NHS Resolution annual report and accounts 2024 to 2025 90% of all exclusions/suspensions critically reviewed (where due) – this was within tolerance at 82%, with 155 of 189 exclusions/suspensions reviewed within required timescales.

What it does reveal is that trusts searching to use its services are booming.

The report says: “The service received 1,420 new and reopened requests for advice from healthcare organisations with concerns about the practice of individual practitioners as well as services in 2024/25, representing a 24% increase compared to 2023/24.The open caseload at the end of the financial year stood at 1,149, a 15% increase when compared with the end of 2023/24 .”

It adds: “Requests for assessment and remediation services remained at a high level in 2024/25, with 50 requests for professional support and remediation action plans, 44 requests for behavioural assessments, six requests for clinical performance assessments and four requests for team reviews.”

And it says:” NHS Resolution delivered OARs ( Organised Activity Reports) to 18 secondary care trusts in England, offering follow-up consultations with a Performance Practitioner Advice adviser to each, and finalized reports for primary care trusts, mental health trusts and trusts in Wales and Northern Ireland for delivery in 2025/26″.

Helen Vernon, CEO of NHS Resolution

On what grounds has this service without transparency or regulation of its advisors been set up and run?Sally Cheshire Chair of the NHSR , and Helen Vernon,CEO, need to explain this.

The only other references are likely to lead to hollow laughs from some of the whistleblowers who lost their jobs at trusts – notably Martyn Pitman at Hampshire Hospitals NHS Trust and Usha Prasad at the now St Georges and Epsom and St Helier Hospitals Trust.

It claims that the whole process is to “develop Compassionate Conversations in relation to performance conversations to support kindness and compassion within the NHS .”

It goes on to say: the aim of the advice includes” Fostering just and learning cultures rather than punitive approaches” and” Ensuring fairness and proportionality in managing performance concerns.”

If there is a lack of transparency how can it be justified as a just culture suitable for learning?

Having covered employment tribunals now in NHS sacking cases the last thing I have seen is any compassionate conversation. Instead the trusts are keen to employ numerous highly paid lawyers to terrify and frighten professional doctors reducing in some cases people to tears – at enormous cost to the taxpayer who foots the bill for their salaries.

So if NHS Resolution is boasting about saving lawyer’s fees in patient complaint cases, it is also responsible for increasing lawyer’s fees – often running to hundreds of thousands of pounds – by advising trusts on how to ruin doctors’ careers when all they have raised is patient safety problems.

If you take this process alongside my previous blog about the role of the General Medical Council and its relationship with the responsible medical officer in the trust- it is no wonder that whistleblowers have little chance of success in the NHS. I now know of senior doctors who are NOT going to report patient safety issues because they fear it will be the end of their careers if they do.

NHSR’s PPA is yet another tool like the unregulated triage by the GMC that can be exploited to bury serious concerns using public funding.

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Are there flaws in the new guidance for General Medical Council investigations?

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Dr Andrew Hoyle

Reforms without addressing core issues may lead to persistence of key flaws  or omissions in any future changes with risks to patients

Last month I wrote about the government proposing the first major reforms for 40 years in the running of the General Medical Council. My blog was meant as a warning to ministers to scrutinise the changes very carefully because I was sceptical, after talking to a number of doctors, that there were flaws in the changes. You can read the blog here.

Now the GMC has published its new guidance by Dr Andrew Hoyle, an assistant director in the GMC’s Fitness to Practise Team He is both a doctor and a barrister.

In a high minded piece on Linked In and in a blog ( see the article here) he promises greater clarity and consistency .. and fair, flexible and compassionate fitness to practise processes. He also emphasises the GMC’s duty under the 1983 Medical Act to protect, promote and maintain the health, safety and well being of the public, promote public confidence in the profession and promote and maintain professional standards and conduct by doctors.

Now from the patient’s point of view how is this being enacted by a change to one simple process?

The first point is drawing up guidance for the decision makers on whether to proceed. There is a comprehensive list of issues to consider for the decision makers whether to start an investigation into a doctor. But the response to the concern raiser, the guidance does not specify who the decision makers are. Are they fully competent in the field or even sub-field of medicine practised by the doctor to make a sound judgment  about clinical matters? I have heard from some doctors that this is not always the case. On the question of accountability should it not be made public who made the decision and their qualifications to do so. This would reassure the public and the patients that it had been properly investigated.

The current process’s most crucial step, the  “initial triage and closure of concerns” relies on the “opinions” of the GMC postholders who in turn rely on managers. There is no mandatory requirement to immediately investigate serious harms or near miss issues that may have led to consequences to that or other patients.

This is particularly relevant as there is also the issue of the seriousness of the concern. The guidelines suggest that if there is evidence of repeated bad practice this should be relevant to striking off doctors. But there is a second flaw in this process. How does the GMC know about a bad doctor? The answer is because he or she is reported to the GMC by the responsible officer – normally the medical director or chief medical officer of the trust or far less by patients and or colleagues who are more in the know of bad practices but are fearful of consequences. See article in the Lancet.

Therefore the issue the GMC knows about may not be the first one and the GMC cannot verify it with the current approach neither can the complainant know of all issues. 

From earlier blogs I have found this process to be flawed – either because the responsible officer has targeted a doctor who has raised whistleblowing issues – whether patient safety or fraud – to discredit a perfectly good doctor – the case of Usha Prasad, a former cardiologist at St Helier and Epsom hospital is a current example – or covered up bad practice to save the reputation of the trust or private hospital.

The most egregious example of the latter is the case of Mr Ian Paterson, a breast and general surgeon, now serving a 20 year prison sentence after performing unnecessary operations on hundreds if not thousands of unsuspecting patients until a lawyer brought a civil case against him.

The public inquiry into his practice concluded “They were then let down both by an NHS trust and an independent healthcare provider who failed to supervise him appropriately and did not respond correctly to well-evidenced complaints about his practice.”

It went on: “The recall of patients did not put their safety and care first, which led many of them to consider the Heart of England NHS Foundation Trust and Spire were primarily concerned for their own reputation. Patients were further let down when they complained to regulators and believed themselves frequently treated with disdain.”

Imagine how different the outcome for hundreds of patients if this had been first reported by a responsible officer to the GMC – life changing needless operations would have been stopped rather than covered up. What the GMC should demand is that the management of NHS trusts and private hospital groups have to sign a ” duty of candour” putting them on par with doctors who raise complaints. This would require them to notify the GMC about the practices of the doctor involved and meet the legal requirement that the GMC has to protect patients and promote higher standards in the profession. Otherwise the assessment of a serious repeated bad practice is a hollow gesture in many cases.

 However if the GMC has been and appears it is continuing to rely on the Responsible Officers to provide a response can the GMC’s decisions be evidence-based  and safe for public. Even if a small minority of doctors are unsafe or dishonest,  the impact on the patient and profession must be the core of decision.

The third point is when a doctor acts inappropriately or unsafely that can be investigated by the GMC personnel but who are potentially not being regulated by any one and via a process built on reliance on an RO and in at times without transparency or evidence verification and opinion based decisions are taken that can affect lives This does not appear to be a safe approach as multiple scandals continue to occur; suggesting concerns are not really reaching the GMC due to its current system or are being ignored.

The current concern management requires a complete overhaul and not just superficial tweaks

Since I started looking at this issue I have been contacted by doctors across the country about the GMC and I intend to follow this up in a future blog.

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Guest blog: Time to regulate the all too powerful NHS Trust managers

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They act as ” judge, jury and executioner” when whistleblowers raise patient safety issues

By David Ward, a former consultant cardiologist at St George’s Hospital, Tooting, London

All staff working in the healthcare professions should be regulated for very obvious reasons. Most of them are but NHS Trust managers (non-medical) are not. Why? Given that managers have enormous and disproportionate powers to initiate investigation, (enlisting private investigators is not unknown) restrict activities, refer to disciplinary hearings and regulatory bodies such as the GMC [ General Medical Council ] and the CQC, [Care Quality Commission] suspend and dismiss healthcare staff – most notably well-meaning, hardworking doctors for raising concerns about patient safety – shouldn’t managers should be regulated just like other NHS workers?

Doctors are obliged to raise concerns if they see problems which may affect patient safety (Duty of Candour, Reg 20 HSC Act 2008 and 2014) pejoratively called “whistleblowing”. It is a matter of patient safety. We know that the reactions by Trust managements to doctors raising concerns can destroy careers and family lives. Suicides of staff under persecution are not unknown. A few courageous people may resort to the corrupt Employment Tribunal process after dismissal. Trusts spend £millions (yes, really!) to defend their untenable self-appointed positions as “judge, jury and executioner”. Where does this money come from? You and me, the taxpayer. Does the victim (whistleblower) have equal access to such resources? Of course not! In fact, they are often sent the bill (aka a cost threat, a merciless device not worthy of a civilised society and in this context used to force the claimant to concede the case) for the huge legal expenses of the Trust’s lawyers. (I’ve seen a well-known law firms’ cost sheet, it’s mind-blowing).

Who initiates the actions that can result in these disastrous consequences? Yes, the Trust managers; sorry, but it’s true. (OK, sometimes medical managers are complicit as we have seen in recent dismissals – shame on them). This process must be taken away from management and regulation could incorporate this. As many recent cases illustrate, PIDA (1998) forces a Trust to deny that “whistleblowing” had any part of a dismissal despite the prior narrative being clearly laden with raising patient safety concerns. It urgently requires updating.

No winners in this egregious process

There are no winners during these egregious processes. Trusts are deprived of money that would be better spent on care. Doctors and nurses who have families to support but may be left without employment even in times of severe need such as the recent pandemic, their careers and family lives in ruins. Mental problems are not uncommon, why wouldn’t they be? Doctors who are required to cover for suspended and dismissed colleagues have to put in more hours. Dismissed doctors often find it difficult to get work in other Trusts. I know of cases where the management at the index Trust interferes with (including preventing) the appointment of a whistleblowing doctor elsewhere.

Managers (and their acolytes) should be banned from acting as “judge, jury and executioner”*. That’s not in keeping with open and fair justice, is it? (Human Rights Act,1998, Article 6). Stop disciplinaries just initiate prompt investigation (thereby reducing risk of further harms) of the concerns, analogous to the inquisitorial French system of discovering the facts – not the damaging adversarial approach prevalent at present in these situations.

Stop trusts wasting £millions on law firms

No wasting £millions on law firms and costly (very costly) barristers, no claimants (victims) forced to sell the family house, move abroad, give up the profession, no months of waiting for court hearings (often many, recurring over years – I know of at least 2 cases of dismissed doctors whose cases in the Employment Tribunal system have dragged on for a decade or more), less mental illness.

Pastoral care for staff who raise concerns? That would be a constructive, cost effective and beneficial alternative approach, wouldn’t it?

Just one last thing: in any given Trust does anyone remember the patient safety concerns that triggered all the iniquitous nonsensical sequence of particular events, what they were about and whether steps have been taken to rectify the deficiencies which led to the concerns in the first place (which may have included avoidable deaths)? Have they been documented other than by the person who initially raised the concerns? Were they formally registered? I doubt it. They are usually buried in a fog of emails and shrouded by a cloud of managerial vengeance directed toward the whistleblower. Perhaps some of the simple and inexpensive ideas mentioned here could be explored.

Does anyone really think that NHS managers should be exempt from regulation?

There is of course one simple solution: ban the suspension and dismissal by Trusts of medical staff who raise patient safety concerns in good faith. They are doing society a favour. *The Political State of Great Britain, for October 1717, Vol.XIV:398]

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NHS Whistleblowers: Persecuted and trashed by managers to cover up patient safety issues

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Issue much more widespread than the public realise

The recent Dispatches programme and article in the Times by journalist Matthew Syed highlighted the plight of whistleblowers in the NHS citing the case of Peter Duffy, a consultant surgeon, working for the Morecambe Bay Foundation Trust. Faced with failures at the trust in the emergencies department he expressed concern for two patients who subsequently died from kidney sepsis.

One would have expected the Trust to have remedied the situation. Instead they turned on him rather than admit any failings. As he told Matthew Syed: ” I was on the receiving end of allegations of bullying, abuse and racism. And so what I hoped would be an attempt to raise standards became an investigation of myself”.

It took five years of toxic attacks and tribunal hearings before he won his case for constructive dismissal. The sad thing is that this is not some isolated instance but appears to be growing in an NHS that is more concerned with its reputation than the safety of patients in its care and is preparing to spend millions of taxpayers money on lawyers fees to undermine any cases brought by whistleblowers. Furthermore it is prepared to spend literally years to wear down anybody who puts their face above the parapet.

Dr Usha Prasad

Readers of this blog will be aware of the case of Usha Prasad, a popular and competent cardiologist ( the General Medical Council has recently revalidated her) who has been driven out of the Epsom and St Helier University Health Trust ( now merged with St George’s Health Trust),

Today she starts a 16 day employment tribunal hearing as a whistleblower. She is backed by Dr Sola Odimuyiwa, from the hospital trust and two retired eminent cardiologists, Professor Jane Somerville and Dr David Ward, who believe her case is just one example of a malign system designed to cover up failures in the NHS. This week the latter two sent a letter to the Sunday Times which was edited down for publication. This is the full text:

“We thank Matthew Syed (Comment Oct 24) for his frank exposure of some of the “mistakes and weaknesses” of the NHS of which the persecution of medical whistle-blowers, as shown by the heinous story of the consultant surgeon, Mr Peter Duffy. He is one example of many.

It is a doctor’s duty of candour to draw attention to matters which are not safe for patients. This action, in good faith, prevents accidents thereby protecting patients. Hospital Trusts may not respond favourably to such complaints and may use their unbridled powers to instigate prolonged, expensive and vengeful disciplinary processes.

Medicine has learnt some of the lessons from aviation safety but the fair and open treatment of whistle-blowers is not one of them. Hospital Trusts are able to fund these processes because they can access public funds not available to the whistle-blower which is a gross imbalance of power. Shady external “management consultants”, who operate by their own rules, and expensive legal firms are hired by Trusts at great expense with the sole aim of ensuring the dismissal of the troublesome whistle-blower. This certainly affects the recruitment and retention of doctors the NHS so badly needs.

A serious consequence of this nefarious process has been the emergence of a cover-up culture in which the initial deficiencies or ‘protected disclosures’ are inadequately investigated.  There is no oversight or regulation of the way Trusts investigate whistleblowers. What informal processes there are may have been designed deliberately to avoid or deflect scrutiny. We have been unable to find a body or organisation to whom to report a Trust’s bad treatment of a whistle-blower. Attempts by supporters of whistle-blowers to engage higher regulatory bodies such as NHS England are usually met with indifference.

For the victimised, whistle-blowing doctor the outcome can be devastating. Their careers are stolen from them. The reputational damage prevents them from securing another job. Serious physical and mental health problems are not uncommon and family lives are destroyed.

We think the investigation of NHS whistle-blowers, of which there have been many notable cases over the past decade, should open and accountable. It is a scandal unknown by the wider public and in need of an independent inquiry.”

A national problem

You can see they believe this is a national problem not an isolated case. It can be backed up by a roll call of cases ( some of which are not yet finished). You can click on the stories reported in various newspapers to get an idea of the scale of toxicity on this issue.

Whistleblowing cases

Dr Raj Mattuhttps://www.theguardian.com/uk-news/2016/feb/04/dismissed-nhs-whistleblower-who-exposed-safety-concerns-handed-122m
Dr David Drewhttps://www.theguardian.com/society/2015/feb/11/nhs-whistleblowers-the-staff-who-raised-the-alarmhttps://www.amazon.co.uk/Little-Stories-Life-Death-NHSwhistleblowr/dp/1783065230?asin=1783065230&revisionId=&format=4&depth=1
Dr Kevin Beatthttps://www.standard.co.uk/news/health/nhs-to-pay-ps870-000-to-whistleblower-doctor-who-spoke-out-on-patient-safety-a4384211.html
Dr Chris Dayhttps://www.theguardian.com/society/2018/oct/02/nhs-whistleblowing-protection-tribunal-junior-doctors
Dr Ed Jesudason https://www.drphilhammond.com/blog/2018/06/28/private-eye/private-eye-medicine-balls-1468-march-16-2018/
Mr Peter Duffyhttps://the-medical-negligence-experts.co.uk/lancaster-surgeon-peter-duffy-nhs-whistleblower-book/
Dr Claire Connollyhttps://www.rllaw.co.uk/success-at-tribunal-for-nhs-whistleblower-dr-claire-connolly/
Dr Minh Alexander, who hosts a blog site about whistleblowing having been one herselfhttps://minhalexander.com
Pandemic whistleblowers inchttps://www.independent.co.uk/news/uk/home-news/coronavirus-uk-nhs-ppe-whistleblowers-job-losses-ppe-a9515856.html
Dr Usha Prasadhttps://davidhencke.com/?s=Prasad&submit=Search
Mr David Sellu, a surgeon in the private sector, was treated badly but he was not a whistleblower just a victim of the judiciaryhttps://www.theguardian.com/global/2019/jun/16/they-look-for-a-scapegoat-a-sugeons-battle-to-clear-his-name-dr-david-sellu

But this is not the end of it by many means. Since I took up Dr Prasad’s case I have become aware through a new group. Doctors for Justice, that there are as many as 35, yes 35, other cases. Nearly all the doctors at the moment are requesting confidentiality until their case becomes public at an employment tribunal hearing. There are many, many other doctors who have quietly quit trusts to find work elsewhere because they don’t want to have to fight their employers for years on end.

Under this system it is the patient that pays the price – and in a number of cases the ultimate price – death. That is why this blog is going to keep an eye on what is going on the NHS until someone has the guts to reform the system and take on a bureaucracy that seems more interested in preserving its reputation than improving patient safety.

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Time for the NHS to come clean on its tax avoiding bosses

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An amazing piece of evidence revealing that they were up to 2,400 off pay roll people in the NHS was slipped into an inquiry by the House of Lords by the Department of Health last week.

The findings published today in a report by Exaro News reveals that as many NHS staff as Whitehall staff were avoiding paying tax and national insurance at source – bringing the total in government to nearly 5000 in 2012.

Now no doubt some people on short-term contracts can justify this but what is becoming increasingly clear from the evidence submitted by the Department of Health ( see page 91 onwards) that many do not.

The worst offenders appear to be high earners at the top of NHS Foundation Trusts – where over a third -51 out of 147 – had someone at the top avoiding paying tax and national insurance at source. Someone was even off pay roll and claiming a full pension from the taxpayer as well!

 Monitor,the regulatory authority for NHS Foundation Trusts, is currently conducting an inquiry into exactly who is benefiting – and as a result numbers are shrinking.

 But we don’t know yet whether Monitor is going to name and shame the trusts and the people taking advantage of this tax loophole. Well if the organisation  has got any teeth it should be like the National Audit Office  and publish a full and detailed report. Avoiding tax while working for the cash strapped NHS is particularly nasty and greedy and should be stamped out. Let’s see if Monitor is going to do its job.

Is your NHS boss a tax avoider? You’ll soon find out

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NHS bosses: subject to tax avoidance inquiry

NHS bosses: subject to tax avoidance inquiry

The tax avoidance scandal that shook up Whitehall is soon to spread to the NHS. As reported earlier following the exposure of Ed Lester, the former head of the Students Loan Company, for channelling his salary through a personal service company to avoid  paying national insurance and tax at source. The practice was still going on in Whitehall two years after the event and 125 civil servants who quit have been reported to Revenue and Customs.

 Now the NHS is to face the same scrutiny. Reports in Exaro News and Tribune last week highlighted the issue – with the findings now likely to be sooner rather than later.

An inquiry has been ordered by Jeremy Hunt, the health secretary, after Danny Alexander, Chief Secretary to the Treasury requested it.

Some two years ago a lesser inquiry – just into board members of NHS bodies – revealed some 28 out of 84 people were on this bandwagon. Earlier examples included   Robert Clarke, finance director at NHS Professionals, which supplies temporary workers to the health service, was paid at least £534,000 over three years through a personal-service company.

Another former chief executive of NHS Professionals, Neil Lloyd, was paid £631,000 off payroll over three years.

This time the Health Department sounds uncompromising. A spokesman said:

 “Tax avoidance will not be tolerated, and there is no excuse for it in the NHS, or any other part of the public sector.”

The Trust Development Authority, which provides guidance on governance to NHS trusts, is working with Monitor, which regulates the running of health bodies, to carry out the investigation to ensure that the use of off-payroll contracts is in line with guidance.

targeted is anybody earning over £58,200 a year or has been in post for more than six months and being paid through a personal service company.

In my view it cannot come soon enough. Tax avoidance deprives the Treasury of cash that could be used for better public services. Tax avoidance in the cash strapped NHS is actually depriving hospitals and communities of vital cash. All these people also earn a fair whack. They are not those forced to take a one per cent pay rise and see their living standards go down. On the contrary through tax avoidance they get richer on the backs of others.