Daily Insight: Transparently poor

When Portsmouth Hospital Trust lost the employment tribunal case against a consultant who told them a novel technique was harming patients, they promised “transparency”.

Anyone can read the facts about what the judge called a “campaign of harassment” against Jasna Macanovic in the various public judgements.

There is a lot that is shocking:

• That two board members offered her a good reference if she dropped her concerns and resigned (how many bogus whistleblowers or other bad actors are in the system with good references, thanks to this management tactic?);
• That the unit she worked at tried to share only an excerpt of a Care Quality Commission report into the technique; and
• The fact that the CQC found no concerns having asked someone from a different specialism to look at it, following input from a Portsmouth doctor who performed the technique.

What is still disturbing is the ongoing lack of transparency.

The remedy judgment published by the tribunal said the trust’s counsel had told them the “board has since commissioned a review from leading counsel to understand the lessons learned and that the findings made in that review were being percolated throughout the trust”.

Perhaps the judge misremembered what the barrister told them, because when HSJ asked for a copy of the report, the findings of which were percolating throughout the organisation, the trust’s communications director Lisa Ward replied: “The review was for the board and is legally privileged.”

Transparency?

You might think, for patient safety reasons alone, the board might want to make sure it better supported whistleblowers raising patient safety concerns by “percolating” the findings further afield than just the board.

Not that the board have nothing to learn from this case.

In addition, to the two board directors who produced a “foregone conclusion” of a disciplinary process and dismissed Dr Macanovic when she refused to resign, the current chair of the organisation failed to support the consultant nephrologist.

Under the trust’s “dignity at work” policy, a whistleblower is supposed to be assigned a non-executive director to make sure they are not left unsupported.

An earlier finding of the employment tribunal was that “In due course, a non-executive director was appointed, but although she was copied in to some emails, she made no contact with Dr Macanovic”.

That non-executive director was later appointed chair of the trust.

In earlier hearings the trust’s argument was that Dr Macanovic was rightly dismissed because of the way she had raised her concerns.

The ET panel rejected this “firmly” at the liability stage but Portsmouth tried it again at the hearing to determine what her compensation should be and was again rejected.

The judge noted the mother-of-two’s resilience and the costs she had incurred moving county to take another job.

A “dismissive approach [was] taken by the trust towards Dr Macanovic throughout” the judge added, saying: “It appears to have been assumed by the most senior consultants in the team that she could not possibly be correct in what she was saying, and their view was adopted by more senior management without any real exploration.”

Portsmouth won’t even do the taxpayer the courtesy of saying how much was spent on this case, so again you have to wonder about the commitment to “transparency”.

Dr Macanovic received an apology from Portsmouth’s barrister in front of the judge but said no one at the trust had ever apologised to her directly.

Look before you leap

Apply if you dare, senior managers have been warned, as unions have described NHS England’s voluntary redundancy scheme as “unfit for purpose”.

Managers in Partnership has told its members to “consider their circumstances carefully” after NHSE launched the scheme last week.

The redundancy drive follows efforts to reduce the staff headcount by up to 40 per cent, shedding around 6,000 posts.

However, MiP is critical of the scheme and said it could not endorse it in its current version.

Chief among them was that the 8 February application deadline falls on the same day the new transformation directorate is being published.

The union claims this will leave staff making “crucial decisions about their future when they have no idea where they might fit,” with individuals asked to “bear a significant level of personal risk” too.

MiP also described the scheme criteria as “subjective,” with a successful outcome relying upon the decisions of an “as yet unknown group of individuals with an unknown scoring matrix or decision tree”.

The scheme is open to national and regional staff across various directorates and will likely be extended at some point.

NHSE declined to comment on the record.