Judy Terry: Proper accountability is needed for the East of England Ambulance Service

20 Jul

Judy Terry is a marketing professional and a former local councillor in Suffolk.

Whilst we are all grateful for, and rightly praise, NHS frontline and other essential workers for their selfless commitment to saving lives and helping vulnerable people cope with the Covid crisis, other key NHS-related issues are escaping public scrutiny. Not least because local authority Cabinets and Health & Wellbeing Boards aren’t convening in the usual way to share information.

For example, a report by Lord Carter, a non-executive director of NHS Improvement, examining Operational Productivity and Performance in Ambulance Trusts, highlighted ‘unwarranted variation in delivery of ambulance services and potential £500m efficiency savings which could be made in 2020/21’.

He noted that ‘too many patients are being taken to hospital Emergency Departments unnecessarily, when many could be treated at the scene, but aging fleets means this is not always possible, despite paramedics working incredibly hard as demand soars.’ As Chair of the Department of Health’s Procurement and Efficiency Board, no doubt he will develop a central procurement programme to replace outdated ambulances, which would be better value for money than leaving local Trusts to purchase individually.

Meanwhile, building on the recommendations in Lord Carter’s report, last October, the East of England Ambulance Service NHS Trust launched a consultation on its Corporate Strategy for 2020-25, led by the Chief Executive Officer (CEO), Dorothy Hosein, initially appointed as an interim in 2018 and confirmed in her role last autumn. Covering 6 counties, the Trust receives about one million emergency calls annually, and employs more than 4,000 staff, but suffered leadership challenges in recent years which it was hoped the new Strategy would address.

Concluding in November, feedback from the short consultation amongst staff, patients, and various organisations, identified some key issues, including three which were eerily prescient:

  • Provide long term leadership stability to ensure the Trust is well led;
  • Ensure staff feel valued and supported, with emphasis on wellbeing and mental health;
  • Improve training and development to help staff reach their full potential.

Shortly after its release, the Trust experienced three unexpected deaths of ambulance staff within days of each other; at the time, they were alleged to be suicide.

The CEO’s report to a public meeting of the Trust in January “addressing all issues since the previous public meeting on 13th November makes no mention of the deaths or any investigation.

But, in December, independent management consultant, Christine Carter, was commissioned to examine ‘the circumstances surrounding the deaths, to ensure that all appropriate actions were taken, and will continue to be taken, to ensure staff welfare is the highest priority and learning identified and translated into improvements by the organisation to mitigate the reoccurrence of any similar events.’

The investigation involved interviewing more than 40 witnesses, including the families of the three staff members. Given the significant amount of personal details revealed, the full report will not be published, to protect families’ privacy, but it has been shared with the Care Quality Commission (CQC) and NHS England/Improvement. Case specific reports have also been shared with relevant families and coroners.

Following discussion with the Trust Board, which accepted the report, on 13th May it did publish the full recommendations and Action Plan, “in the interests of transparency.”

Key to Ms. Carter’s twelve recommendations, is the “need to make improvements around guidance, policies and additional training and support for managers and staff.” In addition to the need to update policies and ‘cross-reference management’, the Trust is urged to:

  • Develop training for managers in supporting staff with mental health problems – in partnership with specialist mental health professionals;
  • Consider how it can contribute to and learn from the range of suicide prevention strategies and initiatives across its catchment area and incorporate suicide prevention into its strategic goals;
  • Establish a programme of change and development to address sexual harassment and change the behaviours of staff and managers that enable it to thrive;
  • Amend the Disciplinary Policy in relation to suspension of staff to include a clause reflecting the need to undertake a risk assessment at the time the decision to suspend is made;
  • Review its arrangements for first line management support in order to move to a model that provides front line staff with consistent and regular management support;
  • Senior operational managers (Deputy Chief Operating Officer and Heads of Operations) should be reminded of their responsibilities under the Duty of Candour Policy; and
  • Carefully consider the findings of all current investigations, together with this one, to assess any common themes or consistent messages that would suggest the need for remedial actions and further organisational development initiatives.

Welcoming the recommendations, CEO Ms. Hosein commented:

“Every day our staff do fantastic work at the frontline of healthcare and often in demanding circumstances.. the investigation brings home clearly that we must do more to support the mental health of staff if they suffer problems or anxiety in their private, family or work life.

“I am committed to instilling a culture which sees, respects and cares for all staff as individuals…taking rapid and robust action to address issues arising in the workplace and outside of work… with all managers listening to and supporting colleagues and spotting any early signs where help might be needed.

“We are already making progress on our action plan to address these recommendations and half our actions will be completed by the end of May, with all recommendations addressed by the end of September, providing regular updates to the Board and online.”

This is an opportunity for Health & Wellbeing boards across the six counties served by the East of England Ambulance Service NHS Trust to get together and set up a sub-group to monitor progress and hold the leadership to account, in order to restore confidence amongst all paramedics and staff that respect and wellbeing will genuinely be a priority in future.

The Norfolk & Suffolk Mental Health NHS Foundation Trust is another victim of poor leadership; following yet another CQC report describing a litany of errors, it still requires improvement and remains in Special Measures, first ‘awarded’ in July 2017 when deemed ‘inadequate’.

If there is to be any partnership with the Ambulance Service to support staff mental health, improvement needs to accelerate.

On several occasions I suggested that Norfolk and Suffolk county councils should co-operate in monitoring and holding the ever-changing leadership to account. It is heartbreaking to read of nine further deaths, and there needs to be stronger local oversight. After all, it is local residents who are suffering and not being listened to, despite various action groups desperate to be heard.

The same is true in the Ambulance Service; experienced paramedics are refusing deserved promotions because “we don’t want to be part of existing management”.

With a degree of ‘normality’ returning after the lockdown, local authorities need to recognise these shortcomings in our proud NHS, and work positively to ensure quality service is delivered to both patients – and staff.

Calling Conservatives: New public appointments announced. Biometrics and Surveillance Camera Commissioner – and more

20 Jul

Eight years ago, the TaxPayers’ Alliance reported that “in the last year, five times more Labour people were appointed to public bodies than Tories”.

It currently reports that almost half of avowedly political appointees last year owed their allegiance to Labour Party, compared to less than a third for the Conservatives.

Despite the selection of some Party members or supporters to fill important posts, over time, the Conservatives have punched beneath their weight when it comes to public appointments.  One of the reasons seems to be that Tories simply don’t apply in the same number as Labour supporters.

To help remedy this, each week we put up links to some of the main public appointments vacancies, so that qualified Conservatives can be aware of the opportunities presented.

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Scottish National Investment Bank – Non-Executive Directors

“The Scottish National Investment Bank Act (‘the Act’) received Royal Assent in February 2020, paving the way to establish the Bank as a public limited company and public body accountable to Scottish Ministers who own and set its strategic missions. The Act sets out how the Bank should operate in order to meet missions which will be set by Scottish Ministers as the sole-shareholder. In response to these missions the Bank is required to develop an Investment Strategy which will help create and shape future markets, spark innovation and tackle socio-economic challenges in Scotland. Additionally, the Bank will have a key role to play in Scotland’s emerging economy post Covid-19.”

Time: Up to 25 days per annum.

Remuneration: £21,250 per annum.

Closes: 24 July

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UK Trade Remedies Authority – Non-Executive Directors

The TRA as a statutory body would perform an independent function, investigating and recommending to Ministers when to impose trade remedies measures in response to injury caused by unfair trading practices, such as dumping, subsidies, or unforeseen surges in imports. Ministers would decide whether to agree the TRA’s recommendations. The TRA will also carry out reviews of those existing EU measures transitioned into the UK system to ensure that they are specific to the UK market, in line with WTO rules. The TRA will also be responsible for providing support and assistance to DIT on trade… The TRA Board sets the strategic direction and priorities of the organisation, monitoring its performance against its objectives and holding the Chief Executive and executive team to account.

Time: Approx. 15-20 per annum.

Remuneration: £15,000 per annum (additional £3,000 for the Chair of the Audit and Risk Committee).

Closes: 24 July

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Child Safeguarding Practice Review Panel – Chair

“The chair is responsible for leading and managing the Panel. They must lead development and implementation of a strategic vision for the Panel and ensure the reviews under their supervision identify improvements safeguarding partners or others should make to better safeguard and promote the welfare of children…Successful applicants will demonstrate the ability to: provide strong strategic leadership; chair high level meetings; effectively manage team dynamics and maintain the confidence of others, including child safeguarding professionals, Ministers and the public. The right candidate will also demonstrate a strong understanding of multi-agency child safeguarding arrangements, policy and frontline delivery.”

Time: 6-8 days per month.

Remuneration: £500 per diem.

Closes: 31 July

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College of Policing – Chair

“The Chair of the College of Policing is appointed by the Home Secretary to ensure the long-term success of the College. Together with the College Board of Directors, the Chair (who must not have a background in operational policing) will set the College’s strategic direction and aims against budgets and priorities. They will provide the College Chief Executive and team of Executive Directors with the necessary leadership, support and monitoring that will help them to meet the College and Home Secretary’s goals. The College plays a critical role in helping to increase the diversity within the police to reflect the communities they serve.”

Time: 1-2 days per week.

Remuneration: £135,000 pro rata.

Closes: 03 August

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Equality & Human Rights Commission – Chair

“The Secretary of State for International Trade and Minister for Women and Equalities is seeking a strong, strategic leader who will continue to develop the Equality and Human Rights Commission (EHRC) and set the Commission’s overall direction to reflect its crucial role as an equality body and National Human Rights Institution. This appointment fulfils the requirement of the Equality Act 2006 that the Secretary of State should appoint a Chair to the Commission. Although the Commission is an independent organisation, the Chair is accountable to the above sponsoring Minister. You will develop and maintain high-value relationships with Ministers, influential partners, governments at home and abroad, opinion formers, industry and others, demonstrating judgment, integrity and resilience in the face of challenge.”

Time: 1-2 days per week.

Remuneration: £500 per diem.

Closes: 03 August

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Department for Digital, Culture, Media and Sport – National Citizen Service Trustees

“National Citizen Service (NCS) is a youth programme that runs across England and Northern Ireland. We exist to engage, unite and empower young people, building their confidence so they can go out there and achieve their dreams, no matter where they’re from or what their background is. Our programme is managed and supported by NCS Trust, our central team who are constantly working to make sure we deliver the most impactful experience we can to as many young people as possible. National Citizen Service is seeking three Trustees with experience and skills at a senior level in the following areas: experience and demonstrable senior leadership in the parliamentary/public sector (1 Trustee); human resources specialist with commercial experience and a particular focus on people strategy, culture and coaching high performance teams (1 Trustee); [and] an education leader with strong links to schools and young people (1 Trustee).”

Time: 5-10 days per week.

Remuneration: “Reasonable expenses”.

Closes: 09 August

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Home Office – Biometrics and Surveillance Camera Commissioner

“The Biometrics and Surveillance Camera Commissioner role aims to promote police compliance with the rules on the collection and retention of DNA, fingerprints and surveillance cameras respectively. The roles were created by the Protection of Freedoms Act 2012 (POFA), which set out the regime for police use of DNA, fingerprints and the regulation of surveillance cameras. We have decided to appoint a single person to both roles because of the confluence of existing and emerging regulatory issues around police use of automated facial recognition. The post will cover the duties of the Biometrics Commissioner and the Surveillance Camera Commissioner, while the Government is considering reforms in this area.”

Time: Full-time.

Remuneration: £125,000 per annum.

Closes: 09 August

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Home Office – Her Majesty’s Inspectorate of Constabulary and of Fire & Rescue Authorities

“HM Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) is an independent body that inspects and reports to the public on the efficiency and effectiveness of police forces in England and Wales, fire and rescue authorities in England and national law enforcement agencies. It aims to ensure that the public and their elected representatives can hold inspected organisations to account by monitoring trends, challenging practice and identifying areas for improvement, and making performance information accessible. The principal role of HMICFRS is undertaking the all-force inspections of policing in England and Wales, and of all fire & rescue authorities in England; providing the public with a clear, consistent and independent view of the quality of services in their local area.”

Time: Full-time.

Remuneration: £175,000 per annum.

Closes: 17 August

Newslinks for Sunday 19th July 2020

19 Jul

Johnson interview: second lockdown is “like a nuclear deterrent”

“Yes. I mean, look, I can’t abandon that tool any more than I would abandon a nuclear deterrent. But it is like a nuclear deterrent, I certainly don’t want to use it.  And nor do I think we will be in that position again. It’s not just that we’re getting much better at spotting the disease and isolating it locally, but we understand far more which groups it affects, how it works, how it’s transmitted, so the possibility of different types of segmentation, of enhanced shielding for particular groups, is now there.” – Sunday Telegraph

Other main points from interview: the Government is –

  • “Looking at” the “odd and perverse” situation of someone being entitled to legal aid despite having their citizenship revoked.
  • Understood to be considering depriving convicted terrorists of legal aid if they leave the country to fight alongside a terror group and then attempt to return
  • Reviewing the “pricing mechanisms” of university courses, in a move that could see reductions in the cost of science and engineering degrees, with higher fees for some arts subjects
  • Examining whether the judicial review process goes “too far” after judges allowed to return to the UK to fight a legal case.

The Prime Minister also –

  • Says he wants the UK to “excel” in producing its own 5G and state-of-the-art broadband technology as Huawei, the Chinese firm, is phased out of the country’s new mobile network
  • All but rules out new sugar taxes
  • Suggests that he wants more “confidence and belief” from the civil service.
    Sunday Telegraph

– – –

  • A year of Johnson as Prime Minister: “Courtiers let it be known that if Johnson fell into a coma or died, the cabinet would have to vote on a successor. There could be no suggestion of the monarch just taking soundings and inviting Raab to Buckingham Palace.” – Sunday Times
  • Rift between Government and scientists over Prime Minister’s “back to work” call – Sun on Sunday
  • Track and trace only identifying a third of the people it needs to find claim – Sunday Telegraph
  • Hancock “set to give guidelines details to local authorities” – Observer
  • Ministers mull memorial to Coronavirus dead – Sun on Sunday
  • New guidelines confusion – Mail on Sunday
  • Universities face income fall of up to 30% if the Chinese market is closed off – Sunday Times
  • Free flu jab extension for this winter – Mail on Sunday
  • Botham refuses to comment on peerage claims – Observer
  • Bullying allegations against civil servant tipped to become first female Cabinet Secretary – Mail on Sunday
  • Shapps is first Cabinet Minister to say that he will take a holiday abroad – Observer

> Today: Rob Sutton on Comment – When a Coronavirus death isn’t a Coronavirus death

> Yesterday:

Labour tries to dodge Begum view. Conservative divides over her return

Challenged on Sir Keir’s previous remarks, Labour last night insisted: ‘We will not be welcoming the prospect of anyone returning to this country who wish us harm.’…There have been signs of a split among Tory MPs on the issue.  Former Home Secretary Sajid Javid has warned that allowing Begum back would ‘create a national security risk’.  But last night, Tobias Ellwood, chairman of the Commons Defence Select Committee, asked: ‘Are we safer with her behind bars in the UK or languishing in a rickety, militia-run, poorly guarded refugee camp with thousands of hardliners who are now escaping in numbers and running fresh radicalisation programmes?’” – Mail on Sunday

  • ConHome columnist Holden attacks Starmer over backing Begum’s return – Sun on Sunday
  • British Muslim leader facing the death penalty in Bangladesh sues Patel after she shared report on Twitter linking him to war crimes – Mail on Sunday
  • Former top Labour official could sue party over ‘false’ claims in leaked report into its handling of anti-Semitism complaints – Mail on Sunday
  • Starmer’s inner circle – Sunday Times

Russia electoral interference report to be published this week

“The Russia report by the Intelligence and Security Committee (ISC) is expected to raise concerns about Moscow’s interference in aspects of Scottish politics, including the long-running campaign for independence. The development comes just days after Dominic Raab, the foreign secretary, revealed that Russian “actors” were highly likely to have interfered in December’s general election…The report, which is being published more than a year after it was completed in March 2019, is also expected to find that Russian interference may have affected the Brexit referendum in June 2016, but the effect was “unquantifiable”.” – Sunday Times

  • Russia’s ambassador denies Covid-19 hacking claims – Observer
  • Lewis “lobbied Johnson for security committee job” – Mail on Sunday
  • TikTok shelves move to Britain after Huawei ban – Sun on Sunday
  • RAF accused of wasting money on ‘outdated’ F-35 warplanes – Sunday Telegraph
  • EU row over no deal crisis fund plan – Sunday Express

Raab Magnitsky sanctions expansion plan

“Dominic Raab, the Foreign Secretary, is drawing up plans to add a “corruption regime” to the so-called Magnitsky sanctions, which were introduced earlier this month. The disclosure follows concerns that the list of those being targeted by the new sanctions omits many individuals whose assets have been frozen under equivalent laws in place in the US and Canada.  MPs and peers have stated that the version introduced as part of the UK’s post-Brexit sanctions regime, fails to cover corrupt individuals who prop the human rights abusers that it does target.” – Sunday Telegraph

  • Harry Dunn’s mother urges Johnson to raise her son’s case at Pompeo meeting – Observer

Rob Colvile: The Conservatives are in danger of gifting Scotland to Sturgeon

“But the broader problem for those who love the UK, in all its messy glory, is that Scotland is a five or six-party system, but increasingly a one-party state. Just as Sturgeon is the dominant figure in politics, especially with Ruth Davidson having quit the field, so the SNP is dominant institutionally…Time is also on Sturgeon’s side. The Union is most popular among the old, and least among the young. If there were a rerun of the referendum, Davidson is the only realistic candidate to lead it: beyond her, and the increasingly silver-haired figures of Gordon Brown and Alistair Darling, the unionist cupboard is alarmingly bare.” – Sunday Times

  • The People’s Government will build a better Britain – Michael Gove, Sun on Sunday
  • This whack-a-mole Government – Dan Hodges, Mail on Sunday
  • New Hong Kong could fire UK’s recovery – Liam Halligan, Sunday Telegraph
  • Britain can lead the world into transforming water into fuel – Daniel Hannan, Sunday Telegraph
  • Face masks turn us into voiceless submissives – Peter Hitchens, Mail on Sunday
  • The Conservatives risk gifting Sturgeon Scotland – Rob Colvile, Sunday Times
  • Johnson will seek to destroy you if you don’t love him – Nick Cohen, Observer
  • Brutal reality buffets the PM’s ambitions for global trade – Sunday Times Editorial
  • Johnson must coax a wary public back to work – Sun on Sunday Editorial
  • PM must combine a more precise Covid fight with his reform agenda – Sunday Telegraph
  • Sturgeon has called for her fractured party to unite in advance of next year’s Holyrood election – Scotsman

John Gray: Mao’s cultural revolution returns to cancel freethinking dissidents

“This hounding of people is strikingly reminiscent of Mao’s Cultural Revolution, which convulsed communist China from 1966-1976 and wrecked much of what remained of the country’s ancient civilisation. The only way someone accused of thought-crime could escape punishment was through public confession, ‘re-education’ and abject apology in so-called ‘struggle sessions’, in which they were humiliated and tormented by their accusers. Tragically, the woke movement has reinvented this vile ritual, with teachers, journalists, professors and others seeking to hang on to their jobs by desperately begging forgiveness.” – Mail on Sunday

  • China banks on the decline and fall of the West – Matthew Syed, Sunday Times
  • The Marxist drive to cover up our past – Andrew Roberts, Sunday Telegraph
  • US cancel culture puts ours in the shade – Dominic Lawson, Sunday Times
  • Freedom of speech is under threat and we must fight back – Leo McKinstry, Sunday Express
  • The Guardian’s Steve Bell is the latest victim of the woke clampdown on free speech – Simon Heffer, Sunday Telegraph
  • ONS row over Black Lives Matter – Mail on Sunday

Johnson prepares for his new Prime Minister’s department

19 Jul

In Boris Johnson’s interview with the Sunday Telegraph this morning, he yearns for a civil service that will “work faster” – and thinks that “sometimes it’s a question of confidence and belief”.

“Maybe there are ways in which we can all learn together to do things faster, to have a real spirit of ‘can do’. I’m not saying that people don’t have that, but there’s an opportunity to learn from the crisis and to work faster.”

Two main criticisms of the civil service are levelled by Number Ten.  (The Prime Minister is careful to say: “Please don’t think that I in any way underestimate the brilliance of the UK civil service, they are absolutely fantastic.”)

The first is that it needs to “focus on results; decentralise its operations; use data more rigorously; understand mathematical reasoning; rotate staff less often; produce more experts and, startlingly, risk failure by innovating”.

That was our summary of Michael Gove’s recent speech on the subject.  A classic example of where it fails to act in this way, as identified by Dominic Cummings in his blogs, is defence procurement.

The second is that parts of the service have a worldview that isn’t impartial; that this was so over Brexit, to which there was opposition; that this is so over human rights norms, which are believed to trump our national sovereignty.

Downing Street’s objection to these isn’t to human rights themselves, which are a way of describing justice, but about the way they’re sometimes interpreted by the courts – see the Court of Appeal’s Shamima Begum decision.

At any rate, a slew of top civil servants have recently left their posts: beside Mark Sedwill, Simon McDonald at the Foreign Office and Richard Heaton at Justice have gone.  Philip Rutnam resigned from the Home Office.

A questionmark also hovers next to the name of Richard Slater at Education.  But Number Ten is thinking about much more than the future of individual officials.

As this site reported recently, the Cabinet Office, which is believed, like Public Health England, to have performed poorly over the Coronavirus, is marked for reform.

Friends of Dominic Cummings have signalled big changes coming both to it and to Number Ten – “a smaller, more focused and more elite centre is needed”, he recently told a SpAd zoom meeting.

He also said that the Coronavirus has exposed fundamental problems in the Whitehall machine and that many officials now accept the need for radical change.

Downing Street would resist a label reading “Prime Minister’s Department” being stuck to the coming changes, but they will clearly involve more control from Number Ten.

ConservativeHome is told that one option is moving Johnson out of his current office in Number Ten, in which Prime Ministers have been accommodated during recent years.

His is the room to which Theresa May famously restored a desk after David Cameron had done without one during his “chillaxing” years.

Under this plan, Johnson would shuffle over to 70 Whitehall, where the bulk of the Cabinet Office is accommodated, and would settle there with his Policy Unit, which is headed by Munira Mirza.

Number Ten would resist the claim that “a more elite centre” equals “a much bigger centre” – or that centralisation itself works.

Cummings’ briefing to the Zoom meeting was that “it’s ludicrous to suggest the solution to Whitehall’s problems is a bigger centre and more centralisation – it’s already far too big and incoherent”.

One idea that has been doing the rounds is that the Government needs Michael Gove as the Prime Minister’s formal deputy in order to get a grip on the pullulating Downing Street operation.

There is no knowing what the Prime Minister would do in a reshuffle, since he keeps his cards not so much close to his chest as stuffed down his vest.

However, a view put to this site by several sources is that a more efficient Number Ten wouldn’t need a powerful number two politician to run it.

Gove would instead “be promoted elsewhere” – perhaps to the Home Office if Patel runs into trouble in the courts, where Rutnam is bringing his case against her.