Not a single version - of truth or of the report
Statement from Caroline Aldridge, Anne Humphrys and Emma Corlett regarding the BBC Newsnight Investigation in to the Grant Thornton report on Norfolk and Suffolk NHS Foundation Trust’s (NSFT) Mortality Reporting and Recording
29th August 2023
When the ‘independent’ review was commissioned in summer 2022, NSFT’s Deputy CEO, Cath Byford, assured Norfolk Health Overview and Scrutiny Committee that the report would give a “single version of the truth”. She said that NSFT knew how many people had died. Grant Thornton’s report, published on 28th June 2023, made it clear that NSFT did not know how many patients had died. We were not given a single version of the truth and we now know there is not even a single version of the report. The arrogance that NSFT did not know that they did not know, or their duplicity in pretending they do, is concerning.
We do not know who provided information to Grant Thornton and who was in the ‘two different NSFT teams’ cited by the auditors that it is argued led to the material changes to the report. We do not know who placed pressure on whom to have the report changed, or who signed off the changes and the final report. We do not know whether it was internal to NSFT, or whether the wider Norfolk and Suffolk health and care systems were aware of the changes, and/or who is complicit in authorising them.
It is disappointing that NSFT leads looked us in the eye, apologised and told us they were being transparent, in the full knowledge the report had been altered or had no awareness of what was being done in their names. Neither of these scenarios is acceptable and evidences weak, poor and inadequate governance.
NSFT stated it was ‘standard practice’ to check the ‘factual accuracy’ of the draft report. If what has happened is NSFT’s standard practice it then calls into question the integrity of other reports about them or that they produce about concerns. We agree with Rob Behrens, Executive Chair Parliamentary and Health Service Ombudsman, opinion on the report changes: “I am concerned at the difference between the draft report and the published report, and because the differences in texts at key points are so huge, that this is not just a bureaucratic drafting of the issue”.
We have found, during our research for Forever Gone: Losing Count of Patient Deaths (7th August 2023) that there are NHS trusts who seem to investigate the majority of their deaths and have more open and transparent ways of reporting them. We found other mental health trusts (such as Essex) where concerns about patient safety and the inability to accurately count deaths feature. The culture at NSFT has been described as unsafe. There are other trusts that are similarly described to NSFT, such as the Countess of Chester Hospital where whistleblowers’ safety concerns about deaths were not listened to and indeed actively dismissed. Our observations are that NSFT also protects corporate reputation over patient safety, duty of candour and transparency.
We have had no response from Steven Barclay (Secretary of State for Health and Social Care) or Maria Caulfield (Minister for Mental Health) since the publication of our open letter to them as part of the Forever Gone report. We have had no formal response from any of the Norfolk and Suffolk MPs since their briefing and subsequent receipt of the same. This is part of the pit of inaction that believe has led to a point where serious concerns are repeatedly raised about NSFT without any meaningful or tangible action.
We all have difficult decisions to make in life and there are times when you either do the right thing or you are complicit by your silence or inaction. The local and national health and care systems, the regulators, the Secretary of State for Health and Social Care, the Minister for Mental Health and the majority of Norfolk and Suffolk MPs have failed in their duty to hold to account NSFT in terms of governance and regulation. This has happened in plain sight, in THEIR sight. They have valued protecting their reputations over protecting people. Their responsibility now is to do the right thing and initiate a statutory public inquiry into the deaths and cover up at NSFT, to hold the NSFT Board and Council of Governors to account and put in competent, credible and morally sound leadership.
We do not feel it is our place to put the different versions of Grant Thornton’s report into the public domain but we are convinced that the original version should be published so that people can compare the versions. Bereaved families deserve to know the truth. NSFT's governors, staff, clinicians and volunteers deserve to see the original version of the Grant Thornton report, in order to make up their own minds about the leadership, rather than rely on what they are communicated by their bosses. As ever, we are reliant on local journalists for uncovering and reporting on concerns about mental health services.
To avoid dragging out this sorry situation any further we urge all parties to immediately publish all correspondence, notes, meeting minutes and records relating to the Mortality Review that each organisation holds so that the public can see for themselves what has happened and how. We have today submitted Freedom of Information requests to that effect. It will further damage public confidence if, yet again, we have to drag the truth out of people.
There is a single truth that is lived every day by those whose loved ones have died because they were failed by NSFT and the wider system – their loved one’s are forever gone.
Forever Gone: Losing Count of Patient deaths is available as a free download from the www.learningsocialworker.com ‘shop’.