Daily Insight: Term starts for the juniors

After announcing the Cabinet-level positions on Friday, Keir Starmer has begun to make appointments to junior ministerial positions.

Two new ministers are joining secretary of state Wes Streeting at the Department of Health and Social Care.

Karin Smyth has held the seat of Bristol South since 2015 and was appointed shadow health minister last year, with a remit for NHS reform. Ms Smyth has previously taken aim at the NHS’s profligacy when it comes to management consultants, suggesting a crackdown could be imminent.

More of a surprise is the appointment of Stephen Kinnock as minister for care, given that he previously held the shadow immigration brief. Mr Kinnock has been an MP since 2015, representing the Welsh seat of Aberafan Maesteg.

The new ministers — who are expected to be joined by others in the coming days — have a big task on their hands. Mr Streeting, in his remarks as health and care secretary, has declared the “NHS is broken”.

Time to blow whistle on the system

Wes Streeting told interviewers a fortnight ago that managers who “silence” whistleblowers should not work again in the NHS.

He may yet come to regret the statement, as whistleblowing is often complex.

In principle, every whistleblower is simply trying to protect patient safety and is cynically ignored by bureaucrats, zealous in guarding their organisation’s reputation.

In practice it is often more complicated than that.

Almost everyone working in the NHS could point to sub-standard care somewhere in their organisation. Of course they could, resources have not kept pace with demand.

That they mostly don’t whistleblow every day is because the service has, sadly but understandably, normalised declining standards, so what’s the point of calling it out? Your bosses aren’t unaware of the problem and they can’t do much about it. Plus they have also been given an ambitious savings targets to achieve.

The Nizam Mamode case, reported by HSJ yesterday, has been taken up by other whistleblowers and campaigners as an example fitting Mr Streeting’s criteria, and one that he must act on.

It’s not clear how he would do that.

An employment tribunal has ruled the transplant surgeon was constructively dismissed by Guy’s and St Thomas’ Foundation Trust, which mishandled his disciplinary proceedings. These proceedings were brought in response to allegations that the 62-year-old had behaved badly to colleagues.

A large and sophisticated organisation like GSTT should have handled his case much better and more fairly than it did (although some of the bureaucratic delays might also have been caused by the onset of the pandemic).

But he did not raise a patient safety complaint against GSTT, he did that about Great Ormond Street Hospital, where he held an honorary role. GOSH say they investigated his safety allegations and found “no immediate safety concerns”. GOSH then made a complaint about the professor to GSTT, who started their own investigation into relationships within their own trust.

GOSH has not released the full reports of the three-month review, and at the moment the public must be assured about the safety of its renal transplant service by their statement that there were “no immediate safety concerns”.

What Mr Streeting could do, rather than intervening in every case — which might be largely about something else, interpersonal issues, say — is make the NHS more transparent.

An expectation of openness from trusts, of their publishing the results of their internal enquiries, of showing how concerns have been investigated and addressed would change everything.

An eager, young ministerial team could order every trust to send in its part II board papers (the not for public consumption bit of the trust board governance system). It would not only show a lot more of what was happening on the ground but also some big discrepancies in what trusts think should be kept secret.

As the Jasna Macanovic case showed, trusts and the Care Quality Commission are sometimes simply not up to the task of holding themselves to account.

Mr Streeting has declared the NHS “broken”, and at the moment the public don’t know the half of it.

There is a window of opportunity in the next 12 months to show them.

But the bigger prize would be a safer system that didn’t mangle whistleblowers and management teams in a combative, maddening conflict.