Modern
Leader
Modern Leader Limited 3 Canwick Hall Mews Canwick, Lincoln Lincolnshire, LN4 2RY Tel: 0843 289 5599 E-­‐mail: info@modernleader.co.uk Ruth May
By email: ruthmay@nhs.net
Date: 4 July 2013
Our reference: GW/RM
Dear Ruth
Subject: Investigation into ULHT Mortality Rates
Thank you for contacting me on Monday of this week and for your two emails
yesterday confirming our conference call at 5pm today. In the second of your emails
you referred to me providing a statement. As I explained on Monday I do not have
time at such short notice to provide a statement. Instead, I provide this note.
When we spoke briefly on Monday, you confirmed that the report you had compiled
into United Lincolnshire Hospitals NHS Trust (“the Trust”) was in draft form and that
you were required to submit it this Friday. You have contacted me decidedly late in
your review and several weeks after your process began. In my mind this calls into
question whether there is a genuine desire to gain relevant knowledge about the
organisation you are inspecting. As I said on Monday, I have little confidence in a
process where the NHS is inspecting itself. Given my personal experience of how Sir
David Nicholson and Dame Barbara Hakin have covered up events in Lincolnshire
and how Sir David misled a parliamentary select committee about those events I
cannot see how the process you are conducting could in any way be independent.
The following points are provided in rough chronological order and go to the heart of
issues surrounding mortality, governance, safety and honesty of the organisation
involved. In the time available I have not been able to collate the supporting
documents but as you are at the end of your review hopefully you will have already
uncovered the vast majority.
This is a highly summarised note.
1. I was the Chief Executive of the Trust from October 2006 to my last working
day in July 2009. My last day of employment was February 2010. My contract
was renewed for a period of 2 years by the Trust and SHA in mid 2008.
2. Also in mid 2008, the Trust notified the SHA and PCT of significant ‘overperformance’ on many service lines in the contract and asked for a capacity
review as the contractual triggers had been exceeded. During 2008, the SHA
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and PCT refused to undertake a capacity review while demand continued to
grow out of control on almost every line of the contract.
3. In December 2009, the Trust notified the SHA and PCT that it would most
likely miss the national targets in future if the demand wasn’t addressed by
the PCT.
4. In February 2009, I raised specific safety concerns with Dr Hakin and
explained that targets could not be met and that safety came first. I was
initially asked to leave my post – although this request was made and
withdrawn over the next few months. Dr Hakin asked to construct a story and
to make up a reason for my wishing to leave and to lie to my Board about that.
5. During 2008/09, the Trust was notified of higher than expected mortality rates
by Dr Foster. This led to much debate with the Board at that time over the
root cause of the issue. Various assurances were made by clinical
governance teams and the then Director of Nursing. Broadly, the response
was that coding was the main issue. This may have been on the advice of
CHKS. I was not content with that response since this was the same
reasoning given by Mid Staffordshire. I therefore requested a manual check
of health records for all deaths during the year. This audit was undertaken
and independently verified by Verita and the SHA at that time. An action plan
was approved by the Board.
6. Specific mortality issues for individual consultants were followed up by the
medical director. Details of this were reported to the Integrated Governance
Committee at the time.
7. In light of demand not being managed to anywhere near the contracted levels,
the Trust put plans in place to increase bed capacity by 100 beds at a cost of
£8m. The SHA delayed approval of that development until August 2009 (six
months).
8. In April, after many weeks of sustained increase in demand e.g. >30%
increase in A&E attendances and hospitals running at 99% bed occupancy
against a safe level of 83-85%, I raised further concerns about safety. Dr
Hakin explained that targets must be met regardless of demand. A
handwritten note by Dr Hakin to her Chairman confirms this. The GMC are
currently investigating Dr Hakin in relation to this and other matters including,
dishonesty, threatening a former director of ULHT with the sack if they did not
hit the A&E target, and putting patients at risk.
9. Various threats and letters were received from the SHA staff including the
SHA Chairman during this period.
10. The Board at the time supported me and as a result the SHA attempted to
remove the Chairman (David Bowles). These actions were orchestrated by Dr
Hakin.
11. I whistleblew to Sir David Nicholson in July 2009 citing patient safety
concerns, the conduct of Dr Hakin in putting patients at risk, and asking for
whistleblowing protection. Sir David carried out an investigation into bullying
and harassment but excluded any reference to the patient safety issues I
raised with him. In October 2009, the investigation stated there was evidence
of bullying and harassment by the SHA but that as it wasn’t in writing it didn’t
count. Sir David Nicholson stated publicly that there was ‘no evidence
whatsoever’ of wrongdoing. This is untrue and the full report was only
released in March 2013 (two and a half years later). Sir David Nicholson
reported to the Public Accounts Committee in March 2013 that I had not
asked for whistleblowing protection when I originally raised concerns to him.
Sir David later wrote to the committee to correct his evidence stating I had
asked for whistleblowing protection. This followed my attendance at the
Health Select Committee. Sir David also stated I did not raise patient safety
concerns. This is untrue. Sir David has not yet corrected this evidence.
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12. Crucial documents were released by the SHA after Sir David’s report was
published.
13. Dr Hakin personally identified a new Chairman, Paul Richardson. This was
not in accordance with Appointments Commission policy.
14. In July 2009, Paul Richardson refused to investigate my whistleblowing
allegations or review any concerns raised about patient safety.
15. Paul Richardson initiated disciplinary action against me in August 2009 but
for five months until December 2009 refused to tell me what the charges were
against me.
16. Paul Richardson suppressed witness evidence that exonerated me.
17. Paul Richardson removed six entries in a verbatim transcript of one
disciplinary hearing, which related to my protected disclosures (under the
Public Interest Disclosure Act). This deliberately inaccurate record was
presented to an employment tribunal in an attempt to mislead them.
18. Paul Richardson did not seek Remuneration Committee approval to take
disciplinary action towards me or to make offers to ‘buy me off’ in December
2009. There is an on-going inquiry to discover how Paul Richardson was
authorised to sign my Judicial Mediation payment in 2011.
19. After my dismissal in 2010, I was contacted by several people from the Trust
regarding matters ranging from a patient death to attempted waiting list
manipulation by an officer of the SHA (formerly the CE of Sherwood Forrest –
another of the 14 Trusts you are investigating). I reported these issues to the
Care Quality Commission. After the intervention of the Secretary of State and
several months later the CQC conducted an unannounced visit. One Clinical
Director asked to see the CQC and this was refused by the Trust.
20. The CQC found nothing in relation to the concerns I had raised because as it
subsequently transpired the CQC did not interview or talk to any of those
raising concerns.
21. The Trust has been approached by local and national media on many
occasions and asked to comment on the patient harm. For example in
December 2009 a patient was badly disfigured in what the surgeon said was
a result of the Trust pursuing targets ahead of patient safety. ULHT has
always publicly denied this patient ever existed, until this week. The
consultant in question is being contacted by the GMC. The Trust has been
entirely dishonest regarding its interaction with CQC and the media.
22. The member of the Board who refused to manipulate the waiting lists was
gagged and paid off by Paul Richardson.
23. In 2011, my MP contacted Andrew Lansley with the same details provided to
the CQC and was cautioned against raising concerns or comparing the Trust
to Mid Staffordshire. As it now transpires all of the key ingredients including
dishonesty, cover-up and a current belief by the Trust Board that high
mortality is a coding issue existed in the Trust as they did in Mid Staffordshire.
24. You will be aware of several adverse CQC reports across the Trust during the
past two years and significant overspends. Both of which are a
comprehensive governance failures.
25. In February 2013, in response to many issues of cover-up and gagging
concerning Mid Staffordshire I spoke to the BBC about the safety issues I had
raised and been gagged about by ULHT. The Department of Health was
added as a beneficiary to that gag. I was immediately threatened by the
Trust’s lawyers, by phone and in writing, that I would be sued with damages if
I went ahead with the interview. The Trust said it knew what I was going to
talk about on TV and that would be in breach of the gagging order. I only
spoke about patient safety issues not employment issues. Sir David and
Jeremy Hunt have both said on public record that the Trust were wrong to
threaten me. The current CEO of the Trust said there was ‘no intention’ to
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prevent me speaking out. Evidently this is a lie since the Trust knew I was
only speaking about patient safety and threatened me anyway. Additionally,
the current CEO misled all 8000 employees and volunteers when she asked
them to repeat her lie to local people. I use the word lie advisedly.
26. Recently the Trust has announced a major recruitment drive. This, as you will
know, was on the back of highly critical reports (of which the Trust presented
as positives) that the Trust was dangerously understaffed.
This is not an exhaustive list of relevant issues but is all I could recall of the top of my
head while away from home. I have not included names of those raising concerns on
the assumption this letter will become public. I remain unsure as to whether to share
those names with you given my and their previous experience of victimisation and
bullying that is widespread in an NHS known to have a ‘culture of fear’ with regards
to safety and management issues.
Yours sincerely
Gary Walker
Director
Modern Leader Ltd
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