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May 14, 2010

Lots of reaction from latest Private Eye column….
Filed under: Private Eye — Tags: , , , — Dr. Phil @ 12:44 pm

Here’s a post from Andy Cowper from Health Policy Insight ( in response to Private Eye, and responses from Dr Gabriel Scally, Regional Director of Public Health For The South West in defence of Carruthers, and a further response to that from a former NHS manager and colleague of John Watkinson. Any other responses from either side welcome. Please post below.

Editor’s blog Wednesday 12 May 2010: Employment Tribunal trashes Sir Ian Carruthers’ treatment of Royal Cornwall CE
Publish Date/Time:
05/12/2010 – 12:34

The excellent Dr Phil Hammond is well-known for his nom-de-plume as Private Eye’s MD.
His latest Eye column, reproduced here on his website, looks at the Employment Tribunal’s ruling over the suspension and subsequent dismissal of Royal Cornwall Hospitals Trust chief executive John Watkinson in 2008.
The RCHT disciplinary action followed Watkinson’s protesting against the SHA’s plans involving a lack of (legally-required) consultation over changes to gastro-intestinal services in the region.
Phil has kindly hosted the written verdicton his site.

It is comprehensive in its condemnation of RCHT’s actions towards Watkinson, and pins the blame for their proceedings against him firmly on Sir Ian Carruthers and the SHA, NHS South-West.
By any legal standards, the rebuke is complete (though it also reserves some criticism for Watkinson for reading from his correspondence during the hearing).

It states:
“Our unanimous conclusion is that this appeal was a travesty of anything approaching basic fairness … the claimant’s dismissal flew in the face of any concept of fairness”.
“A fair-minded employer would have investigated the issues he (the claimant) raised and taken them into account, giving them careful consideration before reaching a decision. Patently that was not done … The speed and incompetent manner in which the claimant’s dismissal was handled sheds light in our judgment as to the respondent’s reason”.
“We have come to the unanimous conclusion that we can and do draw the inference that the reason for the claimant’s dismissal was due to pressure brought to bear on the RCHT by the SHA and the reason for that pressure was the claimant’s stance over the issue of consultation … the respondents had determined to dismiss the claimant as a result of pressure from the SHA”.

Aspects of NHS management are not for the faint-hearted. Sometimes, difficult decisions have to be taken. A good balance of judgment is required.

Employment law is, ultimately, pretty simple: you have to follow proper procedure, and be reasonable and fair.
In NHS management and in employment law, the secret of success is knowing how not to go too far.
It is unfortunate to see clear evidence that Sir Ian, whose career has been a successful one (including his tenure as acting chief executive of the NHS post-Crisp and pre-Nicholson), has acted so foolishly and unreasonably in this case.
Dark rumours have been emerging from the patch about the driving of activity to be the SHA with the country’s shortest waits costing the health economy across the region serious good-will.

Dark rumours always emerge; this news makes them seem better-founded.
I don’t know John Watkinson. I do know that when a medical director resigns in protest at their chief executive’s defenestration (as Dominic Byrne did in this case), you can reasonably assume that something seriously wrong has taken place.

As Hammond points out, this also undermines NHS South West’s ability to make the case not only for this reconfiguration (which in a bitter irony, Hammond suggests is probably clinically appropriate), but for other service reconfigurations going forwards.

If SHAs survive the policy turbulence, the lack of faith in NHS South West’s processes that this will engender is bad news.
It may now be time for Sir Ian to consider spending more time with his beloved Southampton FC and Somerset CC. At 59, he is young enough to enjoy it. This is not the sort of thing for which he should be remembered.
In football terms, this verdict is akin to relegation from the premier league. In cricketing terms, it’s an innings defeat.

Editor’s blog Right Of Reply Thursday 13 May 2010: Health Policy Insight blog on Sir Ian Carruthers “inaccurate and offensive”Publish Date/Time:
05/13/2010 – 19:46
The Health Policy Insight Editor’s Blog condemning the treatment of Royal Cornwall Hospitals’ former chief executive John Watkinson is inaccurate and offensive.
The claim for unfair dismissal was made not against Sir Ian Carruthers or the South West Strategic Health Authority but against Royal Cornwall Hospitals NHS Trust, which made its own decisions acting on independent legal advice.
Your piece makes reference to Sir Ian’s distinguished, 41-year track record in the NHS but fails to mention that John Watkinson’s suspension from Royal Cornwall Hospitals Trust followed an independent review which concluded that the Trust was headed towards ‘corporate failure’.

This review was in itself triggered by a damning report by Michael Taylor into the financial management and governance at John Watkinson’s former Trust, Bromley Hospitals, which was shown to have accumulated debts of £87 million.
As for ‘dark rumours’ about the driving of activity to achieve the shortest waits, we are proud of our ambitions which have been set out and led by clinicians themselves as part of the High Quality Care For All agenda.

It was this same pursuit of clinical excellence that led the Strategic Health Authority to support the drive to reconfigure upper gastrointestinal cancer services in one specialist centre, in line with Improving Outcomes Guidance and with the endorsement of two independent expert clinical consultants who conducted a local review.
Saving lives, not reputations
The aim here is to save lives, not reputations.

A recent Strategic Health Authority Assurance Process, undertaken by the Department of Health, highlighted a culture in NHS South West that was fair and based on strong partnerships between NHS organisations and people.
The findings, published recently, said that our ‘top team is widely respected across the healthcare system.’ It also said that we had a ‘gold standard approach’ and ‘a highly effective approach to managing individual NHS organisations characterised by well-judged and appropriate interventions.’

You claim that ‘by any legal standards, the rebuke is complete.’ You should be aware that the legal process itself is not complete as Royal Cornwall Hospitals Trust is actively considering an appeal.
Since John Watkinson’s departure the new management team at Royal Cornwall Hospitals NHS Trust has turned the organisation around – they are now meeting national standards and are no longer considered a‘failing’ Trust for the first time in years.
This is hardly an innings defeat, least of all for Sir Ian.

Dr Gabriel Scally
Regional Director of Public Health For The South West


The response from NHS South West is laughable. It asserts error but fails to demonstrate it, and it’s also worth noting that the response conveniently ignores the point that the review showing RCHT heading to ‘corporate failure’ was thoroughly discredited by the employment tribunal.

I was also greatly amused to see a couple of ‘old stand-by’ PR tactics deployed by NHS South West in the response: if you know you are going to be criticised and have no real defence, get a third party report manufactured (the ‘SHA Assurance Process’ ) that gives you something to hide behind. Secondly, the ‘we’re considering an appeal and therefore can’t comment’ manoeuvre, which enables you to kick the issue into the long grass for a while, and hope that everyone forgets. (I say with confidence that these are tactics because they’re exactly what I would have done given the desperate circumstances facing Carruthers et al!)